Providing the best chest compression quality: Standard CPR versus chest compressions only in a bystander resuscitation model

The Impact of Compression Rates on the Quality of Cardiopulmonary Resuscitation: A Cross Over Randomized Control Study in Manikin

Background

High-quality cardiopulmonary resuscitation (HQ-CPR) focuses on improving heart and brain blood perfusion. The evaluation of HQ-CPR included depth, frequency, rate of chest compressions, and the occurrence of chest recoil between two chest compressions. Staff performing CPR may not be performing HQ-CPR since it is influenced by individual stamina, physical strength, and lack of target marker. We aimed to study the impact of 100 times per minute rate vs. 120 times per minute CPR rate on the depth and percentage of depth-on-target done by trained staff on a manikin.

Methods

This was a cross-over randomized control study. The subjects were anesthesiology and intensive care residents in a tertiary teaching hospital in Indonesia, all certified to perform advanced life support. The subject was asked to perform both CPR of 100 and 120 times per minute after a period of one-day rest. The standardized adult manikin was used, and the depth of CPR was measured using a pad-sensor attached to the manikin, and the results were transferred to recording software. Analysis was done using the chi-square analysis, and p < 0.05 was considered statistically significant.

Results

A total of 35 subjects were included. The results showed that the average compression depth at 100 times/minute was more statistically superficial than the 120 times/minute treatment (5.210 ± 0.319 vs. 5.430 ± 0.283, p = 0.007). In contrast, the compression depth-on-target percentage was significantly higher at a speed of 100 times per minute (37.130 ± 10.233 vs. 18.730 ± 7.224, p = 0.0001).

Conclusion

One hundred times per minute CPR resulted in a statistically significant lower compression depth, although not clinically significant, with a statistically significant higher percentage of compression depth-on-target than 120 times per minute CPR.

Effects of positive dispatcher encouragement on the maintenance of bystander cardiopulmonary resuscitation quality

BACKGROUND

Implementation of dispatcher-assisted cardiopulmonary resuscitation (DACPR) has increased the likelihood of bystander CPR upon cardiac arrest. However, the quality of CPR has been found to be very low. In this study, we aimed to compare CPR quality between the current DACPR practices and the interventional instruction of adding verbal encouragement from the dispatcher.

METHODS

In this randomized controlled trial, we recruited adult (age ≥18) laypersons who were non-health care providers and had never received any previous verified CPR training. They were randomly selected to perform DACPR using metronome sounds (mDACPR) as per the standard protocol, or DACPR with metronome sounds along with human encouragement (mheDACPR). The ratio of accurate compression rate, depth, and complete release for each CPR phase was examined.

RESULTS

Sixty nine records (34, mDACPR; 35, mheDACPR) were taken. The median proportion of accurate chest compression rate was initially 29.5% with mDACPR, and significantly increased to 71% after 2 minutes of CPR administration (P = .046). However, the median ratio of accurate chest compression depth was 61.5% in the first phase, and significantly decreased to 0% in the last phase (P < .001). In contrast, for the mheDACPR group, a high accurate compression rate was maintained throughout the 2 minutes of CPR administration (91%, 100%, 100%, 100%).

CONCLUSION

To maintain the quality of CPR administered by bystanders, continuous feedback and repeated human encouragement should be provided during DACPR. Active dispatcher intervention reduces the time required to reach an appropriate CPR rate and allows for the maintenance of accurate compression rates.

Effect of a New Cardiac Massage Facilitator Device on the Fatigue of Rescue Workers in Cardiopulmonary Resuscitation

Introduction: Cardiopulmonary resuscitation is a direct intervention for the prevention or postponement of death in patients with cardiac arrest. The fatigue of rescue workers is of high significance when performing cardiopulmonary resuscitation effectively. The present study aimed to investigate the effect of a cardiac massage facilitator device on the fatigue of rescue workers in cardiopulmonary resuscitation.

Materials and Methods: This experimental study was carried out on 30 emergency medical aid non-continuous bachelor students, divided equally into two groups: one group performed cardiac massage using the device and the other without the device. Fatigue levels were assessed using a visual analog scale to evaluate fatigue severity.

Results: The mean age of participants was 23.42 ± 2.02 years, the mean height was 175 ± 4.43 cm, and the mean weight was 65.45 ± 5.02 kg. There was a statistically significant difference between the mean fatigue scores of the two groups: 0.06 with the device vs. 0.57 without the device.

Conclusion: Our results suggest that the cardiac massage facilitator device presented in this study could be effective in improving the quality of cardiac massage and be helpful in cardiopulmonary resuscitation.