Quality of continuous chest compressions performed for one or two minutes

2024 RECOVER Guidelines: Basic Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR

OBJECTIVE

To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps.

DESIGN

Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.

SETTING

Transdisciplinary, international collaboration in university, specialty, and emergency practice.

RESULTS

Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag-mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation.

CONCLUSIONS

These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area.

Temporal analysis of continuous chest compression rate and depth performed by firefighters during out of hospital cardiac arrest

BACKGROUND

Quality of chest compressions (CC) during cardiopulmonary resuscitation (CPR) often do not meet guideline recommendations for rate and depth. This may be due to the fatiguing nature of physically compressing a patient's chest, meaning that CPR quality reduces over time.

OBJECTIVE

This analysis investigates the effect of CPR duration on the performance of continuous CCs delivered by firefighters equipped with CPR feedback devices.

METHODS

Data were collected from a first responder group which used CPR feedback and automatic external defibrillator devices when attending out-of-hospital cardiac arrest events. Depth and rate of CC were analysed for 134 patients. Mean CC depth and rate were calculated every 5 s during two-minute episodes of CPR. Regression models were created to evaluate the relationship between applied CC depth and rate as a function of time.

RESULTS

Mean (SD) CC depth during the investigation was 48 (9) mm. An inverse relationship was observed between CC depth and CPR duration, where CC depth decreased by 3.39 mm, over two-minutes of CPR (p < 0.001). Mean (SD) CC rate was 112.06 (5.87) compressions per minute. No significant relationship was observed between CC rate and CPR duration (p = 0.077). Mean depth was within guideline range for 33.58% of patient events, while guideline rate was observed in 92.54% of cases.

CONCLUSIONS

A reduction in CC depth was observed during two-minutes of continuous CCs while CC rate was not affected. One third of patients received a mean CC depth within guideline range (50 to 60 mm).

Effect of rotating providers on chest compression performance during simulated neonatal cardiopulmonary resuscitation

Objective

Simulation studies in adults and pediatrics demonstrate improvement in chest compression (CCs) quality as providers rotate every two minutes. There is paucity of studies in neonates on this matter. This study hypothesized that frequent rotation while performing CCs improves provider performance and decreases fatigue.

Study design

Prospective randomized, observational crossover study where 51 providers performed 3:1 compression-ventilation CPR as a pair on a term manikin. Participants performed CCs as part of 3 simulation models, rotating every 3, 5 and 10 minutes. Data on various CC metrics were collected. Participant vitals were recorded at multiple points during the simulation and participants reported their level of fatigue at completion of simulation.

Results

No statistically significant difference was seen in any of the compression metrics. However, differences in the providers’ fatigue scores were statistically significant.

Conclusion

CC performance metrics did not differ significantly, however, providers’ vital signs and self-reported fatigue scores significantly increased with longer CC durations.

Physical activity and quality of cardiopulmonary resuscitation: A secondary analysis of the MANI-CPR trial

INTRODUCTION

The association between the level of physical activity and quality of cardio-pulmonary resuscitation (CPR) performed by laypeople is unclear. The aim of this study was to evaluate the associations between physical activity level and laypeople performance during an eight-minute scenario of CPR.

MATERIALS AND METHODS

This study was a secondary analysis of the MANI-CPR Trial. The entire cohort of participants was grouped based on the level of physical activity assessed using the International Physical Activity Questionnaire (IPAQ) into a "low-moderate" level group and a "high" level group. Descriptive statistics were used for unadjusted analysis and multivariate logistic and linear regression models were also performed.

RESULTS

A total of 492 participants who reached the score of "Advanced CPR performer" at the 1-min final test monitored by Laerdal Resusci Anne QCPR were included in this analysis; 224 with a low-moderate level and 268 with a high level of physical activity. A statistically significant difference was found for the outcome of percentage of compressions with adequate depth (low-moderate group: 87.8% [41·4%-99·3%], high group: 97% [63·2%-100%]; P = 0·003). No associations remained significant after controlling for biometric characteristics of the participants, compression protocols and sex.

CONCLUSION

Adequate quality CPR may not need high baseline level of physical activity to be performed by a lay rescuer.

Evaluation of the effect of shift cycle time on chest compression quality during cardiopulmonary resuscitation

Objective

Considering the potential role of shift cycle time on chest compression quality during cardiopulmonary resuscitation (CPR) and the available contradictory results in this regard, the present study aimed at evaluating the effect of 1-min versus 2-min shift cycle time on the quality of CPR.

Materials and Methods

In this randomized crossover study, 80 rescuers performed CPR on a manikin in two scenarios with a rotation of 1 and 2-min cycles. The quality of CPR was evaluated and compared based on the information obtained regarding the chest compression depth, recoil, and rate of chest compression. In addition, rescuer fatigue was recorded in 1-min versus 2-min shift cycles.

Results

In the 1-min group, the number of chest compressions per minute, complete recoil, and good rate with the mean of 114.89 ± 3.62, 54.34 ± 3.86, and 76.06 ± 8.00 were significantly higher than those of the 2-min group with the mean of 113.78 ± 4.94, 53.49 ± 5.27, and 73.98 ± 7.87 (P < 0.05), respectively. In addition, the quality of CPR provided by males was significantly higher than females in both groups. The score of rescuer fatigue was higher in the 2-min group as compared with the 1-min group (P < 0.001).

Conclusion

According to the results of the present study, the difference in the quality of CPR in terms of the number of chest compressions, complete recoil, and good rate was higher in the 1-min group as compared with the 2-min group. In addition, the quality of CPR in terms of chest compression depth and number in both 1-and 2-min rotation cycles was higher for male rescuers than females. Furthermore, rescuer fatigue was higher in the 2-min group as compared with the 1-min group. The mentioned finding may be a factor in reducing, albeit slightly, the quality of CPR in the group with a longer time.

CPR Compression Rotation Every One Minute Versus Two Minutes: A Randomized Cross-Over Manikin Study

Background

The current basic life support guidelines recommend two-minute shifts for providing chest compressions when two rescuers are performing cardiopulmonary resuscitation. However, various studies have found that rescuer fatigue can occur within one minute, coupled with a decay in the quality of chest compressions. Our aim was to compare chest compression quality metrics and rescuer fatigue between alternating rescuers in performing one- and two-minute chest compressions.

Methods

This prospective randomized cross-over study was conducted at Songklanagarind Hospital, Hat Yai, Songkhla, Thailand. We enrolled sixth-year medical students and residents and randomly grouped them into pairs to perform 8 minutes of chest compression, utilizing both the one-minute and two-minute scenarios on a manikin. The primary end points were chest compression depth and rate. The secondary end points included rescuers' fatigue, respiratory rate, and heart rate.

Results

One hundred four participants were recruited. Compared with participants in the two-minute group, participants in the one-minute group had significantly higher mean (standard deviation, SD) compression depth (mm) (45.8 (7.2) vs. 44.5 (7.1), P=0.01) but there was no difference in the mean (SD) rate (compressions per min) (116.1 (12.5) vs. 117.8 (12.4), P=0.08), respectively. The rescuers in the one-minute group had significantly less fatigue (P < 0.001) and change in respiratory rate (P < 0.001), but there was no difference in the change of heart rate (P=0.59) between the two groups.

Conclusion

There were a significantly higher compression depth and lower rescuer fatigue in the 1-minute chest compression group compared with the 2-minute group. This trial is registered with TCTR20170823001.

Does use of the LUCAS device improve mortality in adult patients with out-of-hospital cardiac arrest?

Out-of-hospital cardiac arrest (OHCA) is a common occurrence in the UK, with 60,000 cases reported annually. To improve outcomes among these patients it is necessary to improve links in the cardiac arrest chain of survival. Cardiopulmonary resuscitation (CPR) is one of the main elements of this chain because it reduces further ischaemic insult in the brain and heart by contributing to blood flow. However, even the best manual CPR provides only 20%-30% of the normal cardiac output. Despite the emphasis on timely CPR at the correct rate and depth, delivery of compressions is suboptimal for many patients and mechanical devices may improve outcomes. This article critically appraises two important papers on the use of mechanical CPR for OHCA. It also suggests potential uses for this treatment option and areas for future research.

Design and validation of a tool for the evaluation of the quality of Cardiopulmonary Resuscitation: SIEVCA-CPR 2.0®

INTRODUCTION

Currently, no system completely evaluates the quality of cardio pulmonary resusciation.

METHODS

A cross-sectional, prospective, longitudinal study using Delphi methodology was performed in three phases: preparatory, consultation and consensus. The validation was made by a prospective longitudinal study using the tool in the evaluation of 11 videos to determine the intra-class correlation coefficient (ICC) and the intra-subject (ICC-Initial), the latter repeated at four weeks (ICC-Final). We have determined intra-subject ICC: Initial-Final. This last result has been compared with a gold-standard value.

RESULTS

After the first phase, a 28-items list has been developed. In the second phase: ICC-Initial = 0.727 (p < .001), 95% CI (0.625, 0.801), ICC-Final = 0.860 (p < .001), 95% CI (0.807; 0.898) and ICC Initial-Final = 0.880 (p < .001), 95% CI (0.835; 0.913). Finally, an online tool has been developed (SIEVCA 2.0).

CONCLUSION

The designed tool presents good reliability in the assessment of cardio pulmonary resuscitation and it is useful in different fields and scenarios.

Resuscitation quality of rotating chest compression providers at one-minute vs. two-minute intervals: A mannequin study

OBJECTIVE

The aim of this randomized cross-over study was to compare one-minute and two-minute continuous chest compressions in terms of chest compression only CPR quality metrics on a mannequin model in the ED.

MATERIALS AND METHODS

Thirty-six emergency medicine residents participated in this study. In the 1-minute group, there was no statistically significant difference in the mean compression rate (p=0.83), mean compression depth (p=0.61), good compressions (p=0.31), the percentage of complete release (p=0.07), adequate compression depth (p=0.11) or the percentage of good rate (p=51) over the four-minute time period. Only flow time was statistically significant among the 1-minute intervals (p<0.001). In the 2-minute group, the mean compression depth (p=0.19), good compression (p=0.92), the percentage of complete release (p=0.28), adequate compression depth (p=0.96), and the percentage of good rate (p=0.09) were not statistically significant over time. In this group, the number of compressions (248±31 vs 253±33, p=0.01) and mean compression rates (123±15 vs 126±17, p=0.01) and flow time (p=0.001) were statistically significant along the two-minute intervals. There was no statistically significant difference in the mean number of chest compressions per minute, mean chest compression depth, the percentage of good compressions, complete release, adequate chest compression depth and percentage of good compression between the 1-minute and 2-minute groups.

CONCLUSION

There was no statistically significant difference in the quality metrics of chest compressions between 1- and 2-minute chest compression only groups.

Chest compression quality, exercise intensity, and energy expenditure during cardiopulmonary resuscitation using compression-to-ventilation ratios of 15:1 or 30:2 or chest compression only: a randomized, crossover manikin study

OBJECTIVE

Our aim was to compare the compression quality, exercise intensity, and energy expenditure in 5-minute single-rescuer cardiopulmonary resuscitation (CPR) using 15:1 or 30:2 compression-to-ventilation (C:V) ratios or chest compression only (CCO).

METHODS

This was a randomized, crossover manikin study. Medical students were randomized to perform either type of CPR and do the others with intervals of at least 1 day. We measured compression quality, ratings of perceived exertion (RPE) score, heart rate, maximal oxygen uptake, and energy expenditure during CPR.

RESULTS

Forty-seven students were recruited. Mean compression rates did not differ between the 3 groups. However, the mean percentage of adequate compressions in the CCO group was significantly lower than that of the 15:1 or 30:2 group (31.2±30.3% vs. 55.1±37.5% vs. 54.0±36.9%, respectively; P<0.001) and the difference occurred within the first minute. The RPE score in each minute and heart rate change in the CCO group was significantly higher than those of the C:V ratio groups. There was no significant difference in maximal oxygen uptake between the 3 groups. Energy expenditure in the CCO group was relatively lower than that of the 2 C:V ratio groups.

CONCLUSION

CPR using a 15:1 C:V ratio may provide a compression quality and exercise intensity comparable to those obtained using a 30:2 C:V ratio. An earlier decrease in compression quality and increase in RPE and heart rate could be produced by CCO CPR compared with 15:1 or 30:2 C:V ratios with relatively lower oxygen uptake and energy expenditure.