Analysis of the Performance for Bystanders’ Cardiopulmonary Resuscitation in Geriatric and Out-of-Hospital Cardiac Arrested Patients

Comparison of Heart Proportions Compressed by Chest Compressions Between Geriatric and Nongeriatric Patients Using Mathematical Methods and Chest Computed Tomography: A Retrospective Study

Background

Current guidelines recommended that chest compression depths during car-diopulmonary resuscitation (CPR) should be at least one-fifth of the external chest ante-riorposterior (AP) diameter. The chest AP diameter increases because of dorsal kyphosis, senile emphysema, and poor lung compliance associated with aging. This study aimed to compare the proportion of the heart compressed by chest compression (based on the ejection fraction [EF]) in geriatric and nongeriatric patients.

Methods

We performed a retrospective analysis of the chest computed tomography findings obtained between January 2010 and August 2016 and measured the chest anatomical parameters such as the perpendicular external and internal chest AP diameters with the heart AP diameter. Based on values of these parameters, EFs with 50- and 60-mm depths were obtained. In addition, we investigated and compared the proportion of 50- and 60-mm depths and heart AP to external chest AP diameter between the 2 groups.

Results

We randomly selected and analyzed 100 of 1,921 geriatric and 100 of 22,090 nongeriatric populations from a database. The means±standard deviations of EFs with 50- and 60-mm depths for geriatric and nongeriatric people were 37.1%±12.1% vs. 43.2%±13.8% and 47.5%±12.8% vs. 54.6%±14.8%, respectively (all p<0.001). The proportion of 50- and 60-mm depths and heart AP to external chest AP diameter were significantly different between the 2 groups (all p<0.05).

Conclusion

Chest compression depths based on current guidelines are not sufficient for geriatric patients during CPR; hence, deeper chest compressions would be considered.

Estimation of the variations in mechanical impedance between the actuator and the chest, and the power delivered to the chest during cardiopulmonary resuscitation using machine-embedded sensors

Background

To reduce the risk of patient damage and complications during the cardiopulmonary resuscitation (CPR) process in emergency situations, it is necessary to monitor the status of the patient and the quality of CPR while CPR processing without additional bio-signal measurement devices. In this study, an algorithm is proposed to estimate the mechanical impedance (MI) between an actuator of the CPR machine and the chest of the patient, and to estimate the power delivered to the chest of the patient during the CPR process.

Methods

Two sensors for force and depth measurement were embedded into a custom-made CPR machine and the algorithm for MI and power estimation was implemented. The performance of the algorithm was evaluated by comparing the results from the kinetic model, the conventional discrete Fourier transform (DFT), and the proposed method.

Results

The estimations of the proposed method showed similar increasing/decreasing trends with the calculations from the kinetic model. In addition, the proposed method showed statistically equivalent performance in the MI estimation, and at the same time, showed statistically superior performance in the power estimation compared with the calculations from the conventional DFT. Furthermore, the MI and power estimation could be performed almost in real-time during the CPR process without excessive hands-off periods, and the intensity of random noise contained in the input signals did not seriously affect the MI and power estimations of the proposed method.

Conclusion

We expect that the proposed algorithm can reduce various CPR-related complications and improve patient safety.

Implementation of a Sustainable Training System for Emergency in Vietnam

Purpose

This study analyzed the project outcomes to share lessons regarding the development of an emergency medicine education system in Vietnam.

Methods

Retrospective evaluation was implemented using project outcome indicators.

Results

A total of 13 training courses were administered, with the collaboration of international experts in Korea and Vietnam. A total of 23 kinds of emergency medicine education equipment were purchased, and a basic life support (BLS) and two advanced cardiac life support labs were remodeled to provide appropriate simulation training. Throughout the 2 years of the project, nine Vietnamese BLS instructors were approved by the Korea Association of Cardiopulmonary Resuscitation under American Heart Association. Results of evaluation by Korean international development experts were based on five criteria, provided by the Development Assistance Committee of the Organization for Economic Co-operation and Development, were excellent. Success factors were identified as partnership, ownership, commitment, government support, and global networking.

Conclusion

Project indicators were all accomplished and received an excellent evaluation by external experts. For sustainable success, healthcare policy and legal regulation to promote high quality and safe service to the Vietnamese people are recommended.