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Kienbacher CL, Schreiber W, Herkner H, Holzhacker C, Chwojka CC, Tscherny K, Egger A, Fuhrmann V, Niederer M, Neymayer M, Bernert L, Gamsjäger A, Grünbeck I, Heitger MB, Saleh L, Schmidt S, Schönecker S, Wirth D, Williams KA, Roth D. Drone-Facilitated Real-Time Video-Guided Feedback Helps to Improve the Quality of Lay Bystander Basic Life Support. A Randomized Controlled Simulation Trial. PREHOSP EMERG CARE 2024:1-7. [PMID: 38776259 DOI: 10.1080/10903127.2024.2351970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/26/2024] [Indexed: 05/24/2024]
Abstract
OBJECTIVES Telephone instructions are commonly used to improve cardiopulmonary resuscitation (CPR) by lay bystanders. This usually implies an audio but no visual connection between the provider and the emergency medical telecommunicator. We aimed to investigate whether video-guided feedback via a camera drone enhances the quality of CPR. METHODS We conducted a randomized controlled simulation trial. Lay rescuers performed 8 min of CPR on an objective feedback manikin. Participants were randomized to receive telephone instructions with (intervention group) or without (control group) a drone providing a visual connection with the telecommunicator after a 2-min run-in phase. Performed work (total compression depth minus total lean depth) was the primary outcome. Secondary outcomes were the proportion of effective chest compressions, average compression depth, subjective physical strain measured every 2 min, and dexterity in the nine-hole peg test after the scenario. Outcomes were compared using the t- and Mann Whitney-U tests. A two-sided p-value of <0.05 was considered significant. RESULTS We included 27 individuals (14 (52%) female, mean age 41 ± 14 years). Performed work was greater in the intervention than in the control group (41.3 ± 7.0 vs. 33.9 ± 10.9 m; absolute difference 7.5, 95% CI 1.4 to 14.8; p = 0.046), with higher average compression depth (49 ± 7 vs. 40 ± 13 mm; p = 0.041), and higher proportions of adequate chest compressions (43 (IQR 14-60) vs. 3 (0-29) %; p = 0.041). We did not find any significant differences regarding the remaining secondary outcomes. CONCLUSION Video-guided feedback via drones might be a helpful tool to enhance the quality of telephone-assisted CPR in lay bystanders.
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Affiliation(s)
| | - Wolfgang Schreiber
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | - Katharina Tscherny
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Egger
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Verena Fuhrmann
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Maximilian Niederer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Marco Neymayer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Larissa Bernert
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexandra Gamsjäger
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Isabella Grünbeck
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Marietta B Heitger
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Line Saleh
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Sophie Schmidt
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Dilara Wirth
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Kenneth A Williams
- Department of Emergency Medicine, Division of Emergency Medical Services, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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Tamur S, Alasmari RM, Alnemari MA, Altowairgi MA, Altowairqi AH, Alshamrani NM, Aljaid M, Al-Malki S, Khayat A, Alzahrani A, Shams A. Knowledge and Attitudes around First Aid and Basic Life Support of Kindergarten and Elementary School Teachers and Parents in Taif City, Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1266. [PMID: 37508763 PMCID: PMC10378546 DOI: 10.3390/children10071266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/05/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The foremost cause of children's (1-19 year) death is inadvertent injuries. While most of these accidental harms occur at home and school, rapid and suitable parental and teacher intervention is required to increase the chances of a child's survival. Therefore, both parents and teachers of the children in kindergarten and elementary school must be knowledgeable in first aid practice and basic life support (BLS) training. OBJECTIVES In the current study, our ambition is to evaluate the orientation level, knowledge, and attitudes around first aid and BLS training of kindergarten and elementary school teachers and parents in the city of Taif, Makkah region. METHODS A cross-sectional study in Taif, Saudi Arabia, targeted kindergarten and elementary school teachers and parents of students enrolled at these levels. There were 648 participants included in this study. The researchers assessed teachers' and parents' knowledge and attitudes around first aid and BLS using a validated, self-administered online questionnaire. RESULTS The study included 648 participants, including 248 (38.3%) teachers and 400 (61.7%) parents. The socio-demographic analysis showed that 412 (63.6%) are females and 233 (36.5%) are between the ages of 36 and 45 years. Approximately 142 (21.9%) participants reported previous training in the cardiopulmonary resuscitation (CPR) program, though more than half of them (53.5%) had outdated certificates (more than 2 years). The mean total knowledge for our study was 4.6 ± 1.4, with 22.4% of the participants being educated about first aid support and expressing a fair level of CPR foundations. Only a small percentage (2.3%) of the participants exposed a good and adequate theoretical level of knowledge around CPR skills and performance, while most of the contributors unveiled a poor level of knowledge (over 75%). There were no statistically significant differences between parents and teachers (p > 0.05). Finally, numerous participants (85%) appreciated training in the CPR program, and the most common motive was a "wish to avoid unnecessary death". CONCLUSIONS We concluded that a sizable portion of the contributors expressed a lack of proficiency in the fundamental CPR training knowledge and skills, pointing to an alarming public concern. Promisingly, a sizable percentage of participants expressed motivated attitudes toward CPR training. Therefore, additional study and data are required to effectively combat injury, with an emphasis on investigating causes and risk factors, burden and socioeconomic health determinants, community awareness level and desire to contribute, and accessibility for disseminating specific intervention strategies.
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Affiliation(s)
- Shadi Tamur
- Department of Pediatrics, College of Medicine, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | | | | | | | | | | | - Maryam Aljaid
- Department of Pediatrics, College of Medicine, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Sultan Al-Malki
- Department of Pediatrics, College of Medicine, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Abdullah Khayat
- Department of Pediatrics, College of Medicine, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Ahmad Alzahrani
- Department of Pediatrics, College of Medicine, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Anwar Shams
- Department of Pharmacology, College of Medicine, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
- Centre of Biomedical Sciences Research (CBSR), Taif University, P.O. Box 11099, Taif 21974, Saudi Arabia
- High Altitude Research Center, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
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Perry O, Wacht O, Jaffe E, Sinuany-Stern Z, Bitan Y. Using a filming protocol to improve video-instructed cardiopulmonary resuscitation. Technol Health Care 2020; 28:213-220. [PMID: 31958102 PMCID: PMC7175934 DOI: 10.3233/thc-192024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND: Video communications during cardiopulmonary resuscitation (CPR) can improve the quality of information exchange between a bystander performing CPR and an emergency medical dispatcher (EMD). OBJECTIVE: To improve chest compression effectiveness, a filming protocol instructing video camera placements around a patient was developed. This study measured whether the filming protocol increased chest compressions’ effectiveness. METHODS: A simulation study was conducted comparing CPR effectiveness under three conditions: telephone-instructed, video-instructed, and video-instructed with the filming protocol. Twenty-five emergency medical technicians acted as EMDsin the three conditions. A mannequin measured five factors that determined the effectiveness of the chest compressions. RESULTS: Compared with telephone-instructed CPR, the filming protocol improved the proportion of time in which the bystander’s hands were in the correct position during chest compressions. Compared with video-instructed CPR, the filming protocol improved both the proportion of time in which the chest was fully released after each compression and the proportion of time in which the compressions were conducted with an appropriate rhythm. The depth and rate of compressions did not improve in the filming protocol condition. CONCLUSIONS: Video-instructed CPR with the filming protocol improves CPR effectiveness compared to telephone- and video-instructed CPR. Detailed implementation can improve new technology introduction.
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Affiliation(s)
- Omer Perry
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oren Wacht
- Department of Emergency Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Magen-David-Adom (Israel National Emergency Medical Service), Israel
| | - Eli Jaffe
- Department of Emergency Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Magen-David-Adom (Israel National Emergency Medical Service), Israel
| | - Zilla Sinuany-Stern
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yuval Bitan
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Shibahashi K, Ishida T, Kuwahara Y, Sugiyama K, Hamabe Y. Effects of dispatcher-initiated telephone cardiopulmonary resuscitation after out-of-hospital cardiac arrest: A nationwide, population-based, cohort study. Resuscitation 2019; 144:6-14. [PMID: 31499100 DOI: 10.1016/j.resuscitation.2019.08.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/23/2019] [Accepted: 08/17/2019] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to investigate the effects of dispatcher-initiated telephone cardiopulmonary resuscitation (TCPR) in Japan using a nationwide population-based registry. METHODS Adult Japanese patients with out-of-hospital cardiac arrest (OHCA; n = 582,483, age ≥18 years) were selected from a nationwide Utstein-style database (2010-2016) and divided into 3 groups: no bystander CPR (NCPR) before emergency medical service arrival (n = 448,606), bystander-initiated CPR (BCPR) performed without assistance (n = 46,964), and TCPR (n = 86,913). The primary outcome was a favourable neurological outcome 1 month after OHCA. RESULTS After adjusting for potential confounders, and relative to the NCPR group, significantly better 1-month neurological outcomes were observed in the BCPR group (odds ratio: 2.25, 95% confidence interval: 2.15-2.36; P < 0.001) and in the TCPR group (odds ratio: 1.30, 95% confidence interval: 1.24-1.36; P < 0.001). The collapse-to-CPR time was independently associated with the 1-month outcomes, with a rate of <1% for 1-month favourable neurological outcomes if CPR was initiated >5 min after the collapse. CONCLUSION Patients who received TCPR had significantly better outcomes than those who did not receive CPR. However, the TCPR outcomes were less favourable than those in the BCPR group. Better protocol development and enhanced education are needed to improve dispatcher instructions in Japan, which may help lessen the gap between the BCPR and TCPR outcomes and further improve the outcomes after OHCA.
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Affiliation(s)
- Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan.
| | - Takuto Ishida
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Yusuke Kuwahara
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
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Chen KY, Ko YC, Hsieh MJ, Chiang WC, Ma MHM. Interventions to improve the quality of bystander cardiopulmonary resuscitation: A systematic review. PLoS One 2019; 14:e0211792. [PMID: 30759140 PMCID: PMC6373936 DOI: 10.1371/journal.pone.0211792] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/21/2019] [Indexed: 12/28/2022] Open
Abstract
Background Performing high-quality bystander cardiopulmonary resuscitation (CPR) improves the clinical outcomes of victims with sudden cardiac arrest. Thus far, no systematic review has been performed to identify interventions associated with improved bystander CPR quality. Methods We searched Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, Ovid PsycInfo, Thomson Reuters SCI-EXPANDED, and the Cochrane Central Register of Controlled Trials to retrieve studies published from 1 January 1966 to 5 October 2018 associated with interventions that could improve the quality of bystander CPR. Data regarding participant characteristics, interventions, and design and outcomes of included studies were extracted. Results Of the initially identified 2,703 studies, 42 were included. Of these, 32 were randomized controlled trials. Participants included adults, high school students, and university students with non-medical professional majors. Interventions improving bystander CPR quality included telephone dispatcher-assisted CPR (DA-CPR) with simplified or more concrete instructions, compression-only CPR, and other on-scene interventions, such as four-hand CPR for elderly rescuers, kneel on opposite sides for two-person CPR, and CPR with heels for a tired rescuer. Devices providing real-time feedback and mobile devices containing CPR applications or software were also found to be beneficial in improving the quality of bystander CPR. However, using mobile devices for improving CPR quality or for assisting DA-CPR might cause rescuers to delay starting CPR. Conclusions To further improve the clinical outcomes of victims with cardiac arrest, these effective interventions may be included in the guidelines for bystander CPR.
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Affiliation(s)
- Kuan-Yu Chen
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ying-Chih Ko
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: , (MHM); (MH)
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Matthew Huei-Ming Ma
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
- * E-mail: , (MHM); (MH)
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Fuchs P, Obermeier J, Kamysek S, Degner M, Nierath H, Jürß H, Ewald H, Schwarz J, Becker M, Schubert JK. Safety and applicability of a pre-stage public access ventilator for trained laypersons: a proof of principle study. BMC Emerg Med 2017; 17:37. [PMID: 29202698 PMCID: PMC5716260 DOI: 10.1186/s12873-017-0150-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contemporary resuscitation guidelines for basic life support recommend an immediate onset of cardiac compressions in case of cardiac arrest followed by rescue breaths. Effective ventilation is often omitted due to fear of doing harm and fear of infectious diseases. In order to improve ventilation a pre-stage of an automatic respirator was developed for use by laypersons. METHODS Fifty-two healthy volunteers were ventilated by means of a prototype respirator via a full-face mask in a pilot study. The pre-stage public access ventilator (PAV) consisted of a low-cost self-designed turbine, with sensors for differential pressure, flow, FO2, FCO2 and 3-axis acceleration measurement. Sensor outputs were used to control the respirator and to recognize conditions relevant for efficiency of ventilation and patients' safety. Different respiratory manoeuvres were applied: a) pressure controlled ventilation (PCV), b) PCV with controlled leakage and c) PCV with simulated airway occlusion. Sensor signals were analysed to detect leakage and airway occlusion. Detection based upon sensor signals was compared with evaluation based on clinical observation and additional parameters such as exhaled CO2. RESULTS Pressure controlled ventilation could be realized in all volunteers. Leakage was recognized with 93.5% sensitivity and 93.5% specificity. Simulated airway occlusion was detected with 91.8% sensitivity and 91.7% specificity. CONCLUSION The pre-stage PAV was able to detect potential complications relevant for patients' safety such as leakage and airway occlusion in a proof of principle study. Prospectively, this device provides a respectable basis for the development of an automatic emergency respirator and may help to improve bystander resuscitation.
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Affiliation(s)
- Patricia Fuchs
- Department of Anaesthesiology and Intensive Care Medicine, Rostock University Medical Centre, Schillingallee 35, 18057, Rostock, Germany.
| | - Juliane Obermeier
- Department of Anaesthesiology and Intensive Care Medicine, Rostock University Medical Centre, Schillingallee 35, 18057, Rostock, Germany
| | - Svend Kamysek
- Department of Anaesthesiology and Intensive Care Medicine, Rostock University Medical Centre, Schillingallee 35, 18057, Rostock, Germany
| | - Martin Degner
- Institute for General Electrical Engineering, University of Rostock, 18059, Rostock, Germany
| | - Hannes Nierath
- Institute for General Electrical Engineering, University of Rostock, 18059, Rostock, Germany
| | - Henning Jürß
- Institute for General Electrical Engineering, University of Rostock, 18059, Rostock, Germany
| | - Hartmut Ewald
- Institute for General Electrical Engineering, University of Rostock, 18059, Rostock, Germany
| | | | | | - Jochen K Schubert
- Department of Anaesthesiology and Intensive Care Medicine, Rostock University Medical Centre, Schillingallee 35, 18057, Rostock, Germany
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The authors reply: Comparing dispatcher assisted CPR versus trained bystander CPR. Am J Emerg Med 2017; 35:652-653. [DOI: 10.1016/j.ajem.2017.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/20/2022] Open
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Navarro-Patón R, Freire-Tellado M, Pavón-Prieto MDP, Vázquez-López D, Neira-Pájaro M, Lorenzana-Bargueiras S. Dispatcher assisted CPR: Is it still important to continue teaching lay bystander CPR? Am J Emerg Med 2016; 35:569-573. [PMID: 28010960 DOI: 10.1016/j.ajem.2016.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/01/2016] [Accepted: 12/08/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Miguel Freire-Tellado
- Emergency Medical Services, Fundación Pública Urgencias Sanitarias (FPUS) 061, Lugo, Spain
| | | | - Daniel Vázquez-López
- Emergency Medical Services, Fundación Pública Urgencias Sanitarias (FPUS) 061, Lugo, Spain
| | - Miguel Neira-Pájaro
- Emergency Medical Services, Fundación Pública Urgencias Sanitarias (FPUS) 061, Foz, Spain
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Interactive videoconferencing versus audio telephone calls for dispatcher-assisted cardiopulmonary resuscitation using the ALERT algorithm: a randomized trial. Eur J Emerg Med 2016; 23:418-424. [DOI: 10.1097/mej.0000000000000338] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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10
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Dispatcher-assisted compression-only cardiopulmonary resuscitation provides best quality cardiopulmonary resuscitation by laypersons. Eur J Anaesthesiol 2016; 33:575-80. [DOI: 10.1097/eja.0000000000000432] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Min Ko RJ, Wu VX, Lim SH, San Tam WW, Liaw SY. Compression-only cardiopulmonary resuscitation in improving bystanders’ cardiopulmonary resuscitation performance: a literature review. Emerg Med J 2016; 33:882-888. [DOI: 10.1136/emermed-2015-204771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 11/12/2015] [Accepted: 12/28/2015] [Indexed: 11/03/2022]
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How effectively can young people perform dispatcher-instructed cardiopulmonary resuscitation without training? Resuscitation 2015; 90:138-42. [DOI: 10.1016/j.resuscitation.2015.02.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/13/2015] [Accepted: 02/27/2015] [Indexed: 11/19/2022]
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Standardisierte Telefonanweisungen zur Wiederbelebung durch Laienhelfer. Anaesthesist 2014; 63:919-31. [DOI: 10.1007/s00101-014-2391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
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Georgiou M, Papathanassoglou E, Xanthos T. Systematic review of the mechanisms driving effective blood flow during adult CPR. Resuscitation 2014; 85:1586-93. [PMID: 25238739 DOI: 10.1016/j.resuscitation.2014.08.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 07/27/2014] [Accepted: 08/24/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND High quality chest compressions is the most significant factor related to improved short-term and long-term outcome in cardiac arrest. However, considerable controversy exists over the mechanisms involved in driving blood flow. OBJECTIVES The aim of this systematic review is to elucidate major mechanisms involved in effective compression-mediated blood flow during adult cardiopulmonary resuscitation (CPR). DESIGN AND SETTING Systematic review of studies identified from the bibliographic databases of PubMed/Medline, Cochrane, and Scopus. SELECTION CRITERIA All human and animal studies including information on the responsible mechanisms of compression-related blood flow. DATA COLLECTION AND ANALYSIS Two reviewers (MG, TX) independently screened all potentially relevant titles and abstracts for eligibility, by using a standardized data-worksheet. MAIN RESULTS Forty seven studies met the inclusion criteria. Because of the heterogeneity in outcome measures, quantitative synthesis of evidence was not feasible. Evidence was critically synthesized in order to answer the review questions, taking into account study heterogeneity and validity. The number of included studies per category is as follows: blood flow during chest compression, nine studies; blood flow during chest decompression, six studies; effect of chest compression on cerebral blood flow, eight studies; active compression-decompression CPR, 14 studies; and effect of ventilation on compression-related blood flow, 13 studies. CONCLUSION The evidence so far is inconclusive regarding the major responsible mechanism in compression-related blood flow. Although both 'cardiac pump' and 'thoracic pump' have a key role, the effect of each mechanism is highly depended on other resuscitation parameters, such as positive pressure ventilation and compression depth.
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Affiliation(s)
- Marios Georgiou
- Nursing, American Medical Center, Nicosia, Cyprus; Cyprus Resuscitation Council, Nicosia, Cyprus
| | - Elizabeth Papathanassoglou
- Cyprus Resuscitation Council, Nicosia, Cyprus; School of Health Sciences, Cyprus Technological University of Technology, Nicosia, Cyprus
| | - Theodoros Xanthos
- National and Kapodistrian University of Athens, Medical School, Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
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Bohm K, Castrén M. Emergency medical dispatch. With increasing research it is important to unify the reporting. Resuscitation 2014; 85:3-4. [DOI: 10.1016/j.resuscitation.2013.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 10/13/2013] [Indexed: 11/28/2022]
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van Tulder R, Roth D, Krammel M, Laggner R, Heidinger B, Kienbacher C, Novosad H, Chwojka C, Havel C, Sterz F, Schreiber W, Herkner H. Effects of repetitive or intensified instructions in telephone assisted, bystander cardiopulmonary resuscitation: an investigator-blinded, 4-armed, randomized, factorial simulation trial. Resuscitation 2013; 85:112-8. [PMID: 24012684 DOI: 10.1016/j.resuscitation.2013.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 08/08/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Compression depth is frequently suboptimal in cardiopulmonary resuscitation (CPR). We investigated effects of intensified wording and/or repetitive target depth instructions on compression depth in telephone-assisted, protocol driven, bystander CPR on a simulation manikin. METHODS Thirty-two volunteers performed 10 min of compression only-CPR in a prospective, investigator-blinded, 4-armed, factorial setting. Participants were randomized either to standard wording ("push down firmly 5 cm"), intensified wording ("it is very important to push down 5 cm every time") or standard or intensified wording repeated every 20s. Three dispatchers were randomized to give these instructions. Primary outcome was relative compression depth (absolute compression depth minus leaning depth). Secondary outcomes were absolute distance, hands-off times as well as BORG-scale and nine-hole peg test (NHPT), pulse rate and blood pressure to reflect physical exertion. We applied a random effects linear regression model. RESULTS Relative compression depth was 35 ± 10 mm (standard) versus 31 ± 11 mm (intensified wording) versus 25 ± 8 mm (repeated standard) and 31 ± 14 mm (repeated intensified wording). Adjusted for design, body mass index and female sex, intensified wording and repetition led to decreased compression depth of 13 (95%CI -25 to -1) mm (p=0.04) and 9 (95%CI -21 to 3) mm (p=0.13), respectively. Secondary outcomes regarding intensified wording showed significant differences for absolute distance (43 ± 2 versus 20 (95%CI 3-37) mm; p=0.01) and hands-off times (60 ± 40 versus 157 (95%CI 63-251) s; p=0.04). CONCLUSION In protocol driven, telephone-assisted, bystander CPR, intensified wording and/or repetitive target depth instruction will not improve compression depth compared to the standard instruction.
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Affiliation(s)
- R van Tulder
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - D Roth
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - M Krammel
- Department of General Anaesthesiology, Intensive Care and Pain Management, Austria
| | - R Laggner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - B Heidinger
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - C Kienbacher
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - H Novosad
- NOTRUF NOE GmbH, Emergency Call and Coordination Centre, Lower Austria, Austria
| | - C Chwojka
- NOTRUF NOE GmbH, Emergency Call and Coordination Centre, Lower Austria, Austria
| | - C Havel
- Department of Emergency Medicine, Medical University of Vienna, Austria.
| | - F Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - W Schreiber
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - H Herkner
- Department of Emergency Medicine, Medical University of Vienna, Austria
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Birkenes TS, Myklebust H, Kramer-Johansen J. New pre-arrival instructions can avoid abdominal hand placement for chest compressions. Scand J Trauma Resusc Emerg Med 2013; 21:47. [PMID: 23799963 PMCID: PMC3694465 DOI: 10.1186/1757-7241-21-47] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/16/2013] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate if modified pre-arrival instructions using patient's arm and nipple line as landmarks could avoid abdominal hand placements for chest compressions. METHOD Volunteers were randomized to one of two telephone instructions: "Kneel down beside the chest. Place one hand in the centre of the victim's chest and the other on top" (control) or "Lay the patient's arm which is closest to you, straight out from the body. Kneel down by the patient and place one knee on each side of the arm. Find the midpoint between the nipples and place your hands on top of each other" (intervention). Hand placement was conducted on an adult male and documented by laser measurements. Hand placement, quantified as the centre of the compressing hands in the mid-sagittal plane, was compared to the inter-nipple line (INL) for reference and classified as above or below. Fisher's exact test was used for comparison of proportions. RESULTS Thirty-six lay people, age range 16-60, were included. None in the intervention group placed their hands in the abdominal region, compared to 5/18 in the control group (p = 0.045). Using INL as a reference, the new instructions resulted in less caudal hand placement, and the difference in mean hand position was 47 mm [95% CI 21,73], p = 0.001. CONCLUSION New pre-arrival instructions where the patient's arm and nipple line were used as landmarks resulted in less caudal hand placements and none in the abdominal region.
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Affiliation(s)
- Tonje S Birkenes
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Ulleval, PO Box 4956 Nydalen, N-0426 OSLO, Norway
- Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway
| | - Helge Myklebust
- Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway
| | - Jo Kramer-Johansen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Ulleval, PO Box 4956 Nydalen, N-0426 OSLO, Norway
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Van Vleet LM, Hubble MW. Time to first compression using Medical Priority Dispatch System compression-first dispatcher-assisted cardiopulmonary resuscitation protocols. PREHOSP EMERG CARE 2011; 16:242-50. [PMID: 22150694 DOI: 10.3109/10903127.2011.616259] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Without bystander cardiopulmonary resuscitation (CPR), cardiac arrest survival decreases 7%-10% for every minute of delay until defibrillation. Dispatcher-assisted CPR (D-CPR) has been shown to increase the rates of bystander CPR and cardiac arrest survival. Other reports suggest that the most critical component of bystander CPR is chest compressions with minimal interruption. Beginning with version 11.2 of the Medical Priority Dispatch System (MPDS) protocols, instructions for mouth-to-mouth ventilation (MTMV) and pulse check were removed and a compression-first pathway was introduced to facilitate rapid delivery of compressions. Additionally, unconscious choking and third-trimester pregnancy decision-making criteria were added in versions 11.3 and 12.0, respectively. However, the effects of these changes on time to first compression (TTFC) have not been evaluated. OBJECTIVE We sought to quantify the TTFC of MPDS versions 11.2, 11.3, and 12.0 for all calls identified as cardiac arrest on call intake that did not require MTMV instruction. METHODS Audio recordings of all D-CPR events for October 2005 through May 2010 were analyzed for TTFC. Differences in TTFC across versions were compared using the Kruskal-Wallis test. RESULTS A total of 778 cases received D-CPR. Of these, 259 were excluded because they met criteria for MTMV (pediatric patients, allergic reaction, etc.), were missing data, or were not initially identified as cardiac arrest. Of the remaining 519 calls, the mean TTFC was 240 seconds, with no significant variation across the MPDS versions (p = 0.08). CONCLUSIONS Following the removal of instructions for pulse check and MTMV, as well as other minor changes in the MPDS protocols, we found the overall TTFC to be 240 seconds with little variation across the three versions evaluated. This represents an improvement in TTFC compared with reports of an earlier version of MPDS that included pulse checks and MTMV instructions (315 seconds). However, the MPDS TTFC does not compare favorably with reports of older, non-MPDS protocols that included pulse checks and MTMV. Efforts should continue to focus on improving this key, and modifiable, determinant of cardiac arrest survival.
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In patients with out-of-hospital cardiac arrest, does the provision of dispatch cardiopulmonary resuscitation instructions as opposed to no instructions improve outcome: A systematic review of the literature. Resuscitation 2011; 82:1490-5. [DOI: 10.1016/j.resuscitation.2011.09.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 08/17/2011] [Accepted: 09/01/2011] [Indexed: 11/17/2022]
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Pokorna M, Necas E, Skripsky R, Kratochvil J, Andrlik M, Franek O. How accurately can the aetiology of cardiac arrest be established in an out-of-hospital setting? Analysis by “Concordance in Diagnosis Crosscheck Tables”. Resuscitation 2011; 82:391-7. [DOI: 10.1016/j.resuscitation.2010.11.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 11/13/2010] [Accepted: 11/26/2010] [Indexed: 11/30/2022]
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Koster RW, Sayre MR, Botha M, Cave DM, Cudnik MT, Handley AJ, Hatanaka T, Hazinski MF, Jacobs I, Monsieurs K, Morley PT, Nolan JP, Travers AH. Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2011; 81 Suppl 1:e48-70. [PMID: 20956035 DOI: 10.1016/j.resuscitation.2010.08.005] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands.
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Bobrow BJ, Vadeboncoeur TF, Spaite DW, Potts J, Denninghoff K, Chikani V, Brazil PR, Ramsey B, Abella BS. The Effectiveness of Ultrabrief and Brief Educational Videos for Training Lay Responders in Hands-Only Cardiopulmonary Resuscitation. Circ Cardiovasc Qual Outcomes 2011; 4:220-6. [DOI: 10.1161/circoutcomes.110.959353] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bentley J. Bobrow
- From the Department of Emergency Medicine (B.J.B., P.R.B.) and Resuscitation Science Center (B.J.B.), Maricopa Medical Center, Phoenix, AZ; Arizona Department of Health Services (B.J.B., V.C., P.R.B.), Bureau of EMS and Trauma System, Phoenix, AZ; Arizona Emergency Medicine Research Center (B.J.B., D.W.S., K.D.), Department of Emergency Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine (T.F.V.), Mayo Clinic, Jacksonville, FL; The American Heart Association (J.P.), Dallas,
| | - Tyler F. Vadeboncoeur
- From the Department of Emergency Medicine (B.J.B., P.R.B.) and Resuscitation Science Center (B.J.B.), Maricopa Medical Center, Phoenix, AZ; Arizona Department of Health Services (B.J.B., V.C., P.R.B.), Bureau of EMS and Trauma System, Phoenix, AZ; Arizona Emergency Medicine Research Center (B.J.B., D.W.S., K.D.), Department of Emergency Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine (T.F.V.), Mayo Clinic, Jacksonville, FL; The American Heart Association (J.P.), Dallas,
| | - Daniel W. Spaite
- From the Department of Emergency Medicine (B.J.B., P.R.B.) and Resuscitation Science Center (B.J.B.), Maricopa Medical Center, Phoenix, AZ; Arizona Department of Health Services (B.J.B., V.C., P.R.B.), Bureau of EMS and Trauma System, Phoenix, AZ; Arizona Emergency Medicine Research Center (B.J.B., D.W.S., K.D.), Department of Emergency Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine (T.F.V.), Mayo Clinic, Jacksonville, FL; The American Heart Association (J.P.), Dallas,
| | - Jerald Potts
- From the Department of Emergency Medicine (B.J.B., P.R.B.) and Resuscitation Science Center (B.J.B.), Maricopa Medical Center, Phoenix, AZ; Arizona Department of Health Services (B.J.B., V.C., P.R.B.), Bureau of EMS and Trauma System, Phoenix, AZ; Arizona Emergency Medicine Research Center (B.J.B., D.W.S., K.D.), Department of Emergency Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine (T.F.V.), Mayo Clinic, Jacksonville, FL; The American Heart Association (J.P.), Dallas,
| | - Kurt Denninghoff
- From the Department of Emergency Medicine (B.J.B., P.R.B.) and Resuscitation Science Center (B.J.B.), Maricopa Medical Center, Phoenix, AZ; Arizona Department of Health Services (B.J.B., V.C., P.R.B.), Bureau of EMS and Trauma System, Phoenix, AZ; Arizona Emergency Medicine Research Center (B.J.B., D.W.S., K.D.), Department of Emergency Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine (T.F.V.), Mayo Clinic, Jacksonville, FL; The American Heart Association (J.P.), Dallas,
| | - Vatsal Chikani
- From the Department of Emergency Medicine (B.J.B., P.R.B.) and Resuscitation Science Center (B.J.B.), Maricopa Medical Center, Phoenix, AZ; Arizona Department of Health Services (B.J.B., V.C., P.R.B.), Bureau of EMS and Trauma System, Phoenix, AZ; Arizona Emergency Medicine Research Center (B.J.B., D.W.S., K.D.), Department of Emergency Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine (T.F.V.), Mayo Clinic, Jacksonville, FL; The American Heart Association (J.P.), Dallas,
| | - Paula R. Brazil
- From the Department of Emergency Medicine (B.J.B., P.R.B.) and Resuscitation Science Center (B.J.B.), Maricopa Medical Center, Phoenix, AZ; Arizona Department of Health Services (B.J.B., V.C., P.R.B.), Bureau of EMS and Trauma System, Phoenix, AZ; Arizona Emergency Medicine Research Center (B.J.B., D.W.S., K.D.), Department of Emergency Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine (T.F.V.), Mayo Clinic, Jacksonville, FL; The American Heart Association (J.P.), Dallas,
| | - Bob Ramsey
- From the Department of Emergency Medicine (B.J.B., P.R.B.) and Resuscitation Science Center (B.J.B.), Maricopa Medical Center, Phoenix, AZ; Arizona Department of Health Services (B.J.B., V.C., P.R.B.), Bureau of EMS and Trauma System, Phoenix, AZ; Arizona Emergency Medicine Research Center (B.J.B., D.W.S., K.D.), Department of Emergency Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine (T.F.V.), Mayo Clinic, Jacksonville, FL; The American Heart Association (J.P.), Dallas,
| | - Benjamin S. Abella
- From the Department of Emergency Medicine (B.J.B., P.R.B.) and Resuscitation Science Center (B.J.B.), Maricopa Medical Center, Phoenix, AZ; Arizona Department of Health Services (B.J.B., V.C., P.R.B.), Bureau of EMS and Trauma System, Phoenix, AZ; Arizona Emergency Medicine Research Center (B.J.B., D.W.S., K.D.), Department of Emergency Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine (T.F.V.), Mayo Clinic, Jacksonville, FL; The American Heart Association (J.P.), Dallas,
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Sayre MR, Koster RW, Botha M, Cave DM, Cudnik MT, Handley AJ, Hatanaka T, Hazinski MF, Jacobs I, Monsieurs K, Morley PT, Nolan JP, Travers AH. Part 5: Adult basic life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S298-324. [PMID: 20956253 DOI: 10.1161/circulationaha.110.970996] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Dispatcher-assisted telephone cardiopulmonary resuscitation using a French-language compression-only protocol in volunteers with or without prior life support training: A randomized trial. Resuscitation 2010; 82:57-63. [PMID: 21036454 DOI: 10.1016/j.resuscitation.2010.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 09/06/2010] [Accepted: 09/19/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Due to the recent interest in hands-only protocols for dispatcher-assisted cardiopulmonary resuscitation (CPR) and the lack of any validated algorithms in French, our primary objective was to evaluate a new French-language protocol in terms of its efficacy to help previously untrained volunteers in performing basic life support efforts of appropriate quality, and secondarily to investigate its potential utility in subjects with previous training. METHODS Untrained volunteers were recruited among adults in a public movie centre and previously trained volunteers among undergraduate nursing students. Participants were randomly assigned to 'phone CPR' versus 'no phone CPR' by drawing sets of envelopes. Primary outcome measures were the results of the Cardiff evaluation test; the secondary measures were global scoring of a complete 5min period of CPR, in a manikin model of cardiac arrest. RESULTS Out of 146 volunteers assessed for eligibility, 36 previously untrained candidates declined participation. 110 participants, distributed into four groups, completed the study: the previously untrained non-guided group (group A, n=30), the previously untrained guided group (group B, n=30), the previously trained non-guided group (group C, n=25) and the previously trained guided group (group D, n=25). Results of the Cardiff test and global evaluation of CPR performance revealed a significant improvement in group B as compared with group A, approaching the level of the group C. Previously trained guided bystanders had the best CPR scores, notably because of an improvement in the quality of airway management. CONCLUSION When used by dispatchers, this new French-language algorithm offers the opportunity to help previously untrained bystanders initiate CPR. The same protocol may serve to guide volunteers with prior basic life support training to reach their best CPR performance.
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Rawlins L, Woollard M, Williams J, Hallam P. Effect of listening to Nellie the Elephant during CPR training on performance of chest compressions by lay people: randomised crossover trial. BMJ 2009; 339:b4707. [PMID: 20008376 PMCID: PMC2792674 DOI: 10.1136/bmj.b4707] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether listening to music during cardiopulmonary resuscitation (CPR) training increases the proportion of lay people delivering chest compressions of 100 per minute. DESIGN Prospective randomised crossover trial. SETTING Large UK university. PARTICIPANTS 130 volunteers (81 men) recruited on an opportunistic basis. Exclusion criteria included age under 18, trained health professionals, and cardiopulmonary resuscitation (CPR) training within the past three months. INTERVENTIONS Volunteers performed three sequences of one minute of continuous chest compressions on a skill meter resuscitation manikin accompanied by no music, repeated choruses of Nellie the Elephant (Nellie), and That's the Way (I like it) (TTW) according to a pre-randomised order. MAIN OUTCOME MEASURES Rate of chest compressions delivered (primary outcome), depth of compressions, proportion of incorrect compressions, and type of error. RESULTS Median (interquartile range) compression rates were 110 (93-119) with no music, 105 (98-107) with Nellie, and 109 (103-110) with TTW. There were significant differences within groups between Nellie v no music and Nellie v TTW (P<0.001) but not no music v TTW (P=0.055). A compression rate of between 95 and 105 was achieved with no music, Nellie, and TTW for 15/130 (12%), 42/130 (32%), and 12/130 (9%) attempts, respectively. Differences in proportions were significant for Nellie v no music and Nellie v TTW (P<0.001) but not for no music v TTW (P=0.55). Relative risk for a compression rate between 95 and 105 was 2.8 (95% confidence interval 1.66 to 4.80) for Nellie v no music, 0.8 (0.40 to 1.62) for TTW v no music, and 3.5 (1.97 to 6.33) for Nellie v TTW. The number needed to treat for listening to Nellie v no music was 5 (4 to 10)-that is, the number of cardiac arrests required during which lay responders listen to Nellie to facilitate one patient receiving compressions at the correct rate (v no music) would be between four and 10. A greater proportion of compressions were too shallow when participants listened to Nellie v no music (56% v 47%, P=0.022). CONCLUSIONS Listening to Nellie the Elephant significantly increased the proportion of lay people delivering compression rates at close to 100 per minute. Unfortunately it also increased the proportion of compressions delivered at an inadequate depth. As current resuscitation guidelines give equal emphasis to correct rate and depth, listening to Nellie the Elephant as a learning aid during CPR training should be discontinued. Further research is required to identify music that, when played during CPR training, increases the proportion of lay responders providing chest compressions at both the correct rate and depth.
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Affiliation(s)
- L Rawlins
- Birmingham University School of Medicine, Edgbaston, Birmingham B15 2TT
| | - M Woollard
- Pre-hospital, Emergency and Cardiovascular Care Applied Research Group, Coventry University, Coventry CV1 5FB
| | - J Williams
- School of Health and Emergency Professions, University of Hertfordshire, Hatfield AL10 9AB
| | - P Hallam
- West Midlands Ambulance Service NHS Trust, Waterfront Business Park, Brierley Hill, West Midlands DY5 1LX
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Ong ME, Yap S, Chan KP, Sultana P, Anantharaman V. Knowledge and attitudes towards cardiopulmonary resuscitation and defibrillation amongst Asian primary health care physicians. Open Access Emerg Med 2009; 1:11-20. [PMID: 27147830 PMCID: PMC4806819 DOI: 10.2147/oaem.s6721] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To assess the knowledge and attitudes of local primary health care physicians in relation to cardiopulmonary resuscitation (CPR) and defibrillation. Methods We conducted a survey on general practitioners in Singapore by using a self-administered questionnaire that comprised 29 questions. Results The response rate was 80%, with 60 of 75 physicians completing the questionnaire. The average age of the respondents was 52 years. Sixty percent of them reported that they knew how to operate an automated external defibrillator (AED), and 38% had attended AED training. Only 36% were willing to perform mouth-to-mouth ventilation during CPR, and 53% preferred chest compression-only resuscitation (CCR) to standard CPR. We found those aged <50 years were more likely to be trained in basic cardiac life support (BCLS) (P < 0.001) and advanced cardiac life support (P = 0.005) or to have ever attended to a patient with cardiac arrest (P = 0.007). Female physicians tended to agree that all clinics should have AEDs (P = 0.005) and support legislation to make AEDs compulsory in clinics (P < 0.001). We also found that a large proportion of physicians who were trained in BCLS (P = 0.006) were willing to perform mouth-to-mouth ventilation. Conclusion Most local primary care physicians realize the importance of defibrillation, and the majority prefer CCR to standard CPR.
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Affiliation(s)
- Marcus Eh Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Susan Yap
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Kim P Chan
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Papia Sultana
- Department of Clinical Research, Singapore General Hospital, Singapore
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Mellor R, Woollard M. Skill acquisition by health care workers in the Resuscitation Council (UK) 2005 Guidelines for Adult Basic Life Support. Int Emerg Nurs 2009; 18:61-6. [PMID: 20382366 DOI: 10.1016/j.ienj.2009.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 08/20/2009] [Accepted: 08/25/2009] [Indexed: 10/20/2022]
Abstract
This prospective study compared pre- and post-class performance in basic life support (BLS) on a recording manikin in a convenience sample of 34 health care workers undertaking a two-hour class provided by a hospital resuscitation department teaching the 2005 Resuscitation Council (UK) guidelines. On completion of training there were significant improvements in the proportion of subjects correctly performing a safe approach (14/34 vs. 25/33, 95%CI +11 to +55%, p=0.004), checking for response (17/34 vs. 24/32, 95%CI +1 to +46%, p=0.029), shouting for help (18/34 vs. 28/32, 95%CI +13 to +54%, p=0.002), opening the airway (6/34 vs. 26/32, 95%CI +42 to +79%, p<0.001), checking for breathing (9/34 vs. 27/32, 95%CI +35 to +74%, p<0.001), calling a cardiac arrest team (1/34 vs. 24/32, 95%CI +53 to +85%, p<0.001), and providing the correct compression to breath ratio (11/34 vs. 20/34, +3 to +48%, p=0.033). The median number of correct chest compressions increased from 3 to 41 (p<0.001) with improvements in adequate depth (median depth 36 vs. 40mm, p=0.006), although the compression rate was too fast before training and increased afterwards (median 123 vs. 147, p<0.001). Ventilation performance could not be measured accurately as the manikin was calibrated incorrectly by the manufacturers.
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Affiliation(s)
- Ric Mellor
- Pre-hospital Care Research Unit, The James Cook University Hospital, University of Teesside, UK
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Williams JG, Brice JH, De Maio VJ, Jalbuena T. A Simulation Trial of Traditional Dispatcher-Assisted CPR Versus Compressions—Only Dispatcher-Assisted CPR. PREHOSP EMERG CARE 2009; 10:247-53. [PMID: 16531384 DOI: 10.1080/10903120500541027] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Growing evidence indicates that it may not be essential to deliver ventilations in the first few minutes of CPR. We compared time to delivery of first compression in traditional CPR with ventilations and compressions to compression-only CPR performed by untrained laypersons assisted by a mock 911 dispatcher. METHODS This randomized-controlled simulation study included a convenience sample of English-speaking emergency department visitors during a 6-month period. Exclusion criteria were prior CPR training or physical incapacity. A cardiac arrest scenario was presented to subjects who were then provided with one of two sets of telephone CPR instructions by a mock 911 dispatcher. One group received traditional CPR instructions (TCPR) and the second group received compression only CPR instructions (COCPR). Subjects performed CPR on a Laerdal Resusci-Anne CPR manikin and recording strips were analyzed for frequency and quality measures. Pre-and post-test questionnaires assessed subject fatigue and telephone instruction understanding. The primary outcome was the time interval from 911 call to initiation of chest compressions. Analysis included Student t-test, Chi-square, and Wilcoxon Rank Sum. RESULTS Of 377 potential subjects, 54 consented to randomization. The data from 50 subjects were analyzed. Compared to group TCPR, group COCPR initiated chest compressions faster (72 vs 117 sec, p < 0.0001), completed four cycles of CPR faster (168 vs. 250 sec, p < 0.0001), and paused for a smaller percentage of the resuscitation (13% vs. 36%, p < 0.0001). Only 9% of ventilation opportunities in the TCPR group yielded ventilations of the correct volume. There were no differences between groups in perceived understanding of CPR instruction or fatigue. CONCLUSIONS We have identified the potential timesavings that may occur during compressions-only CPR. Bystander resuscitation may be more efficient when ventilations are excluded from the CPR sequence.
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Affiliation(s)
- Jefferson G Williams
- Department of Emergency Medicine, University of North Carolina, Chapel Hill 27599, USA.
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Animation-assisted CPRII program as a reminder tool in achieving effective one-person-CPR performance. Resuscitation 2009; 80:680-4. [DOI: 10.1016/j.resuscitation.2009.03.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 03/13/2009] [Accepted: 03/17/2009] [Indexed: 11/21/2022]
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Interactive video instruction improves the quality of dispatcher-assisted chest compression-only cardiopulmonary resuscitation in simulated cardiac arrests. Crit Care Med 2009; 37:490-5. [PMID: 19114904 DOI: 10.1097/ccm.0b013e31819573a5] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Bystander cardiopulmonary resuscitation (CPR) significantly improves survival of cardiac arrest victims. Dispatch assistance increases bystander CPR, but the quality of dispatcher-assisted CPR remains unsatisfactory. This study was conducted to assess the effect of adding interactive video communication to dispatch instruction on the quality of bystander chest compressions in simulated cardiac arrests. DESIGN A randomized controlled study with a scenario developed to simulate cardiac arrest in a public place. SETTING The victim was simulated by a mannequin and the cell phone for dispatch assistance was a video cell phone with both voice and video modes. Chest compression-only CPR instruction was used in the dispatch protocol. SUBJECTS Ninety-six adults without CPR training within 5 years were recruited. INTERVENTIONS The subjects were randomized to receive dispatch assistance on chest compression with either voice instruction alone (voice group, n = 53) or interactive voice and video demonstration and feedback (video group, n = 43) via a video cell phone. MEASUREMENTS AND MAIN RESULTS Performance of chest compression-only CPR throughout the scenario was videotaped. The quality of CPR was evaluated by reviewing the videos and mannequin reports. Chest compressions among the video group were faster (median rate 95.5 vs. 63.0 min-1, p < 0.01), deeper (median depth 36.0 vs. 25.0 mm, p < 0.01), and of more appropriate depth (20.0% vs. 0%, p < 0.01). The video group had more "hands-off" time (5.0 vs. 0 second, p < 0.01), longer time to first chest compression (145.0 vs. 116.0 seconds, p < 0.01) and total instruction time (150.0 vs. 121.0 seconds, p < 0.01). CONCLUSION The addition of interactive video communication to dispatcher-assisted chest compression-only CPR initially delayed the commencement of chest compressions, but subsequently improved the depth and rate of compressions. The benefit was achieved mainly through real-time feedback.
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Harve H, Jokela J, Tissari A, Saukko A, Okkolin T, Pettilä V, Silfvast T. Defibrillation and the quality of layperson cardiopulmonary resuscitation-dispatcher assistance or training? Resuscitation 2008; 80:275-7. [PMID: 19058896 DOI: 10.1016/j.resuscitation.2008.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 09/14/2008] [Accepted: 10/07/2008] [Indexed: 10/21/2022]
Abstract
AIMS OF THE STUDY To examine whether basic life support-defibrillation (BLS-D) training of laypersons enhances the speed of defibrillation and the quality of cardiopulmonary resuscitation (CPR) during a simulated ventricular fibrillation scenario compared with a situation where the care provider has no previous BLS-D training but receives dispatcher assistance with the use of an automated external defibrillator (AED) and the performance of CPR. METHODS Fifty-two military conscripts of the Finnish Defence Forces who without previous medical education had been tested in a simulated cardiac arrest scenario with dispatcher assistance and thereafter received a 4-h BLS-D training. Six months later they were randomly divided to form teams of two and again tested in a similar scenario but without dispatcher assistance. The time interval from collapse to first shock, hands-off time and the quality of CPR were compared between the two tests. RESULTS The quality of mouth-to-mouth ventilation was better after training, but there was only a minor improvement in the quality of compressions and the speed of defibrillation. CONCLUSIONS Training improved the quality of mouth-to-mouth ventilation performed by laypersons but had only a minor effect on defibrillation and the quality of compressions.
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Affiliation(s)
- Heini Harve
- The Finnish Defence Forces, Centre for Military Medicine, FIN-15701 Lahti, Finland.
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Can effective basic life support be taught to untrained individuals during a cardiac arrest? Eur J Emerg Med 2008; 15:224-5. [DOI: 10.1097/mej.0b013e3282f08d5f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harve H, Jokela J, Tissari A, Saukko A, Räsänen P, Okkolin T, Pettilä V, Silfvast T. Can Untrained Laypersons Use a Defibrillator with Dispatcher Assistance? Acad Emerg Med 2008. [DOI: 10.1111/j.1553-2712.2007.tb01848.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Johnsen E, Bolle SR. To see or not to see--better dispatcher-assisted CPR with video-calls? A qualitative study based on simulated trials. Resuscitation 2008; 78:320-6. [PMID: 18583015 DOI: 10.1016/j.resuscitation.2008.04.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 03/11/2008] [Accepted: 04/10/2008] [Indexed: 12/20/2022]
Abstract
BACKGROUND Video communication through mobile telephone is now available in many parts of the world. We ask how mobile phone video-calls compares with traditional phone calls for dispatcher-assisted cardiopulmonary resuscitation (T-CPR). METHODS Primary data was collected through individual interviews with six dispatchers after their participation in simulated cardiac arrest. They had 10 scenarios each, during which they guided rescuers on resuscitation. During half of the scenarios they used video-calls, and traditional phone calls for the rest. Concepts from modern systems theory were used to analyse the material. RESULTS Video-calls influenced the information basis and understanding of the dispatchers. The dispatchers experienced that (1) video-calls are useful for obtaining information and provides adequate functionality to support CPR assistance; (2) their CPR assistance becomes easier; (3) the CPR might be of better quality; but (4) there is a risk of "noise". DISCUSSION We emphasize visual observation as a way of constructing professional understanding when using video-calls, which may provide a new basis for dispatcher assistance. Video-calls may improve rescuer compliance. The role and content of telephone-directed protocols used by dispatchers may need adjustments when video-calls are used for medical emergencies. CONCLUSION Video communication can improve the dispatchers' understanding of the rescuer's situation, and the assistance they provide.
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Affiliation(s)
- Elin Johnsen
- Norwegian Centre for Telemedicine (NST), University Hospital North Norway (UNN), p.b. 35, N-9038 Tromsø, Norway.
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Yang CW, Wang HC, Chiang WC, Chang WT, Yen ZS, Chen SY, Ko PCI, Ma MHM, Chen SC, Chang SC, Lin FY. Impact of adding video communication to dispatch instructions on the quality of rescue breathing in simulated cardiac arrests--a randomized controlled study. Resuscitation 2008; 78:327-32. [PMID: 18583016 DOI: 10.1016/j.resuscitation.2008.03.232] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 03/06/2008] [Accepted: 03/21/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Both ventilations and compressions are important for victims of prolonged cardiopulmonary resuscitation (CPR) and asphyxial arrest. Dispatch assistance increases bystander CPR, but the quality of dispatcher-assisted CPR (DA-CPR), especially rescue breathing, remains unsatisfactory. This study was conducted to assess the impact of adding interactive video communication to dispatch instructions on the quality of rescue breathing in simulated cardiac arrests. METHODS In this simulation-based study, adults without CPR training within 5 years were recruited between April and July 2007 and randomized to receive dispatch assistance with either voice instruction alone (voice group, n=53) or interactive voice and video instruction (video group, n=43) via a video cell phone. The quality of rescue breathing was evaluated by reviewing the videos and mannequin reports. RESULTS Subjects in the video group were more likely to open the airway correctly (95.3% vs. 58.5%, P<0.01) and to lift the chin properly (95.3% vs. 62.3%, P<0.01), but had similar rates of head-tilt (95.3% vs. 84.9%, P=0.10). Volunteers in the video group had larger volume of ventilation (median volume 540 ml vs. 0 ml, P<0.01), greater possibility to sustain an open airway (88.4% vs. 60.4%, P<0.01) and a tendency towards better nose-pinch (97.7% vs. 86.8%, P=0.06). The video group spent longer time to open the airway (59 s vs. 56 s, P<0.05) and to give the first rescue breathing (139 s vs. 102 s, P<0.01). CONCLUSION Adding video communication to dispatch instructions improved the quality of bystander rescue breathing, including higher proportion of airway opened, and larger volume of ventilation delivered, in simulated cardiac arrests.
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Affiliation(s)
- Chih-Wei Yang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
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Ong MEH, Ng FSP, Anushia P, Tham LP, Leong BSH, Ong VYK, Tiah L, Lim SH, Anantharaman V. Comparison of chest compression only and standard cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Singapore. Resuscitation 2008; 78:119-26. [PMID: 18502559 DOI: 10.1016/j.resuscitation.2008.03.012] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 02/22/2008] [Accepted: 03/06/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Chest compression only cardiopulmonary resuscitation (CC-CPR) without ventilation has been proposed as an alternative to standard cardiopulmonary resuscitation (CPR) for bystanders. However, there has been controversy regarding the relative effectiveness of both of these techniques. We aim to compare the outcomes of cardiac arrest patients in the cardiac arrest and resuscitation epidemiology study who either received CC-CPR, standard CPR or no bystander CPR. METHODS This prospective cohort study involved all out-of-hospital cardiac arrest (OHCA) patients attended to by emergency medical service (EMS) providers in a large urban centre. The data analyses were conducted secondarily on these collected data. The technique of bystander CPR was reported by paramedics who arrived at the scene. RESULTS From 1 October 2001 to 14 October 2004, 2428 patients were enrolled into the study. Of these, 255 were EMS-witnessed arrests and were excluded. 1695 cases did not receive any bystander CPR, 287 had standard CPR and 154 CC-CPR. Patient characteristics were similar in both the standard and CC-CPR groups except for a higher incidence of residential arrests and previous heart disease sufferers in the CC-CPR group. Patients who received standard CPR (odds ratio (OR) 5.4, 95% confidence interval (CI) 2.1-14.0) or CC-CPR (OR 5.0, 95% CI 1.5-16.4) were more likely to survive to discharge than those who had no bystander CPR. There was no significant difference in survival to discharge between those who received CC-CPR and standard CPR (OR 0.9, 95% CI 0.3-3.1). CONCLUSION We found that patients were more likely to survive with any form of bystander CPR than without. This emphasises the importance of chest compressions for OHCA patients, whether with or without ventilation.
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Affiliation(s)
- Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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Ma MHM, Yang CW, Wang HC, Chiang WC, Hsu CW, Ko CI, Chen SC. Adding interactive video communication to dispatch instructions improves the quality of bystander cardiopulmonary resuscitation in simulated cardiac arrests. Resuscitation 2008. [DOI: 10.1016/j.resuscitation.2008.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The effectiveness of cardiopulmonary resuscitation instruction: Animation versus dispatcher through a cellular phone. Resuscitation 2008; 77:87-94. [DOI: 10.1016/j.resuscitation.2007.10.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 10/07/2007] [Accepted: 10/27/2007] [Indexed: 11/24/2022]
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Sayre MR, Berg RA, Cave DM, Page RL, Potts J, White RD. Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. Circulation 2008; 117:2162-7. [PMID: 18378619 DOI: 10.1161/circulationaha.107.189380] [Citation(s) in RCA: 273] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Jones I, Whitfield R, Colquhoun M, Chamberlain D, Vetter N, Newcombe R. At what age can schoolchildren provide effective chest compressions? An observational study from the Heartstart UK schools training programme. BMJ 2007; 334:1201. [PMID: 17468118 PMCID: PMC1889955 DOI: 10.1136/bmj.39167.459028.de] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine at what age children can perform effective chest compressions for cardiopulmonary resuscitation. DESIGN Observational study. SETTING Four schools in Cardiff. PARTICIPANTS 157 children aged 9-14 years in three school year groups (ages 9-10, 11-12, and 13-14). INTERVENTIONS Participants were taught basic life support skills in one lesson lasting 20 minutes. MAIN OUTCOME MEASURE Effectiveness of chest compression during three minutes' continuous chest compression on a manikin. RESULTS No year 5 pupil (age 9-10) was able to compress the manikin's chest to the depth recommended in guidelines (38-51 mm). 19% of pupils in year 7 (age 11-12) and 45% in year 9 (age 13-14) achieved adequate compression depth. Only the 13-14 year olds performed chest compression as well as adults in other reported studies. Compression depth showed a significant relation with children's age, weight, and height (P<0.001). Multivariate analyses showed that, if the age and weight of the children were both known, the height (which is closely related to both) was no longer significant (P=0.95). No association was found between pupils' age, sex, weight, or height and the average rate of chest compressions over the three minute period. Similarly, no relation was found between year group and ability to place the hands in the correct position. During the three minutes' compression, compression rate increased and depth decreased. CONCLUSIONS The children's ability to achieve an adequate depth of chest compression depended on their age and weight. The ability to provide the correct rate and to employ the correct hand position was similar across all the age ranges tested. Young children who are not yet physically able to compress the chest can learn the principles of chest compression as well as older children.
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Affiliation(s)
- Ian Jones
- Prehospital Emergency Research Unit, Welsh Ambulance Services NHS Trust/Cardiff University, Wales School of Medicine, Cardiff CF11 8PL
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Mäkinen M, Niemi-Murola L, Mäkelä M, Castren M. Methods of assessing cardiopulmonary resuscitation skills: a systematic review. Eur J Emerg Med 2007; 14:108-14. [PMID: 17496690 DOI: 10.1097/mej.0b013e328013dc02] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Valid and reliable instruments are needed for assessment and comparison of training outcomes after various methods of cardiopulmonary resuscitation training. Trials were retrieved by searching MEDLINE (1990-February 2005) and using the reference lists of original communications and reviews. Studies were considered relevant if they included an intervention, a study population of life support providers randomized and divided into groups and an evaluation or assessment of the performance. The studies were analyzed and scored to assess their validity. Twenty-five studies fulfilled the criteria. Nineteen of them assessed cardiopulmonary resuscitation skills, four cardiopulmonary resuscitation and defibrillation and two assessed defibrillation only. The mean number of participants was 107 (range 36-495). A wide variety of assessment methods were used in the studies with methodological shortcomings. Most studies in this review compared participants with each other, not against a standard or a defined passing level. Qualified studies with well defined study populations, standardized study settings and explicit, comparable outcomes would be needed to assess the quality of cardiopulmonary resuscitation and defibrillation performance.
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Affiliation(s)
- Marja Mäkinen
- Uusimaa Emergency Medical Service, Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, FIN-00029 HUS, Helsinki, Finland
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Cheung S, Deakin CD, Hsu R, Petley GW, Clewlow F. A prospective manikin-based observational study of telephone-directed cardiopulmonary resuscitation. Resuscitation 2007; 72:425-35. [PMID: 17224230 DOI: 10.1016/j.resuscitation.2006.07.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 07/21/2006] [Accepted: 07/27/2006] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Bystander cardiopulmonary resuscitation (CPR) significantly improves the outcome from sudden cardiac arrest (SCA) and is therefore encouraged by offering telephone instructions to the bystander. The effectiveness of this technique was examined in a manikin-based study. METHODS Subjects performed CPR on an instrumented adult manikin by following Advanced Medical Priority Dispatch System v11.1 (AMPDS) instructions given by telephone from a different room. RESULTS Fifty-one volunteers (26 males, median age 56, range 27-76 years) with no previous experience of CPR were recruited. No volunteers followed the entire instructions correctly. Forty percent were unable to open the airway, only 18% achieved a median inspiration time of 2 s or greater and only 30% delivered tidal volumes within the range 700-1000 ml. Chest compressions were performed at a median rate of 52 min-1 with only 4% of subjects achieving a rate of 100 min-1. Depth of compression was also inadequate in 88% of subjects and hand positioning was incorrect in a third of subjects. The median duty cycle was 46% and there were significant delays between the commencement of the AMPDS protocol and the delivery of the first breath (123 s) and first chest compression (163 s). DISCUSSION Few bystanders perform CPR satisfactorily and further work is necessary to improve the effectiveness of telephone CPR instructions.
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Affiliation(s)
- Spencer Cheung
- South Central Ambulance Service NHS Trust (Hampshire Division), Highcroft, Romsey Road, Winchester SO22 5DH, and Department of Medical Physics and Engineering, Southampton University Hospitals NHS Trust, UK
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Baskett P. The resuscitation greats: Douglas Chamberlain CBE DSc (Hon) FRCP FRCA FACC FESC--a man for all decades of his time. Resuscitation 2007; 72:344-9. [PMID: 17240511 DOI: 10.1016/j.resuscitation.2006.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 09/20/2006] [Accepted: 09/20/2006] [Indexed: 11/30/2022]
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Deakin CD, Cheung S, Petley GW, Clewlow F. Assessment of the quality of cardiopulmonary resuscitation following modification of a standard telephone-directed protocol. Resuscitation 2007; 72:436-43. [PMID: 17239515 DOI: 10.1016/j.resuscitation.2006.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 07/21/2006] [Accepted: 08/01/2006] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Current Advanced Medical Priority Dispatch System (AMPDS) V.11.1 telephone instructions are limited in their ability to produce correctly performed basic life support. The current telephone instructions were modified in an attempt to improve areas of poor CPR performance. METHODS Fifty subjects performed CPR on an instrumented adult manikin by following instructions modified from AMPDS V.11.1 instructions. Instructions were given by telephone from a different room. RESULTS No improvements were seen with opening the airway or delivering rescue breaths. The rate of chest compression improved from 52 to 81 min-1 (P=0.004), although the depth of chest compression fell to 2.0 cm compared with 3.2 cm documented with the original AMPDS instructions (P=0.004). Instructions to put the telephone down while performing CPR improved all aspects of CPR. DISCUSSION The effective delivery of telephone-directed CPR to untrained bystanders is a complex process. Changing verbal instructions to improve the quality of CPR is not easy. Further work is urgently needed to strengthen this important link in the chain of survival.
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Affiliation(s)
- Charles D Deakin
- South Central Ambulance Service NHS Trust (Hampshire Division), Highcroft, Romsey Road, Winchester SO22 5DH, and Department of Medical Physics and Engineering, Southampton University Hospitals NHS Trust, UK.
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Abstract
PURPOSE OF REVIEW This review will summarize the available data regarding the haemodynamic changes occurring following cardiac arrest in humans and animal models. RECENT FINDINGS Following cardiac arrest due to ventricular fibrillation without cardiopulmonary resuscitation, blood flow exponentially falls but continues for approximately 5 min until the pressure gradient between the aorta and the right heart is completely dissipated. During cardiopulmonary resuscitation forward flow occurs into the aorta during the compression phase. Coronary blood flow is retrograde during the compression phase and antegrade during the decompression phase. Carotid blood flow takes over a minute to reach plateau levels following the initiation of chest compressions, and even brief interruptions of compressions result in a dramatic reduction in carotid blood flow which takes a minute or so to recover to plateau levels when compressions are reinstituted. Coronary perfusion pressure during the release phase of cardiopulmonary resuscitation has been shown to be a powerful predictor of the likelihood of recovery of spontaneous circulation following restoration of electrical activity. SUMMARY Recent studies have provided important insights into the haemodynamics of cardiac arrest and of cardiopulmonary resuscitation which may inform more effective strategies for the management of cardiac arrest in the future.
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Affiliation(s)
- Peter Andreka
- Department of Cardiology, Gottsegen National Institute of Cardiology, Budapest, Hungary, UK
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Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate the 2005 guidelines on cardiopulmonary resuscitation. RECENT FINDINGS International guidelines are based ideally on results from robust clinical trials. They are necessarily constrained in how far they can draw conclusions from experimental data, and have to pay regard to perceived safety and educational issues. Informed opinion can be more radical in drawing from compelling recent experimental findings, particularly when supported by unreplicated or indirect clinical evidence. Those already available cover a range of issues relevant to the guidelines; the most important ones are reviewed here. SUMMARY The 2005 guidelines represent a major advance on those previously in use, but on the evidence already available they cannot be considered optimal. Deviations based on good evidence should not be discouraged provided they are approved and preferably monitored by authoritative bodies that should see this as a legitimate role in developing the science of resuscitation medicine. Guidelines for the most pressing of medical emergencies should not be set and inflexible over several years whilst the science behind them continues to advance.
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Roppolo LP, Pepe PE, Cimon N, Gay M, Patterson B, Yancey A, Clawson JJ. Modified cardiopulmonary resuscitation (CPR) instruction protocols for emergency medical dispatchers: rationale and recommendations. Resuscitation 2005; 65:203-10. [PMID: 15866402 DOI: 10.1016/j.resuscitation.2004.11.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Revised: 11/01/2004] [Accepted: 11/01/2004] [Indexed: 12/12/2022]
Abstract
BACKGROUND International consensus guidelines now support the use of "chest compressions-only" cardiopulmonary resuscitation (CPR) instructions (CCOIs) by emergency medical dispatch (EMD) personnel providing telephone assistance to untrained bystanders at a cardiac arrest scene. These guidelines are based largely on evolving experimental data and a clinical trial conducted in one venue with distinct emergency medical services (EMS) system features. Accordingly, the Council of Standards for the National Academies of Emergency Dispatch was asked to adapt a modified telephone CPR protocol, and specifically one that could be applied more broadly to the spectrum of EMS systems. METHODS A group of international EMD specialists, researchers and professional association representatives analyzed available scientific data and considered variations in EMS systems, particularly those in Europe and North America. RESULTS AND CONCLUSIONS Several recommendations were established: (1) to avoid confusion, bystanders already providing CPR should continue those previously learned methods; (2) following a sudden collapse unlikely to be of respiratory etiology, CCOIs should be provided when the bystander is not CPR-trained, declining to perform mouth-to-mouth ventilation or unsure of actions to take; (3) following 4 min of CCOIs, ventilations can be provided, but, for now, only at a compression-ventilation ratio of 100:2 until EMS arrives; (4) until more data become available, dispatchers should follow existing compression-ventilation protocols for children and adult cases involving probable respiratory/trauma etiologies; (5) EMD CPR protocols should account for EMS system features and receive quality oversight and expert medical direction.
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Affiliation(s)
- Lynn P Roppolo
- Chair, Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Mail Code 8579, Dallas, TX 75390-8579, USA
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EISENBERG MICKEYS, CULLEY LINDA, REA THOMASD. D OES THEE MPEROR OFCPR W EARC LOTHES? PREHOSP EMERG CARE 2004. [DOI: 10.1080/312704000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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