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Buléon C, Parienti JJ, Morilland-Lecoq E, Halbout L, Cesaréo E, Dubien PY, Jardel B, Boyer C, Husson K, Andriamirado F, Benet X, Morel-Marechal E, Aubrion A, Muntean C, Dupire E, Roupie E, Hubert H, Vilhelm C, Gueugniaud PY. Impacts of chest compression cycle length and real-time feedback with a CPRmeter® on chest compression quality in out-of-hospital cardiac arrest: study protocol for a multicenter randomized controlled factorial plan trial. Trials 2020; 21:627. [PMID: 32641090 PMCID: PMC7346361 DOI: 10.1186/s13063-020-04536-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/19/2020] [Indexed: 01/31/2023] Open
Abstract
Background With a survival rate of 6 to 11%, out-of-hospital cardiac arrest (OHCA) remains a healthcare challenge with room for improvement in morbidity and mortality. The guidelines emphasize the highest possible quality of cardiopulmonary resuscitation (CPR) and chest compressions (CC). It is essential to minimize CC interruptions, and therefore increase the chest compression fraction (CCF), as this is an independent factor for survival. Survival is significantly and positively correlated with the suitability of CCF targets, CC frequency, CC depth, and brief predefibrillation pause. CC guidance improves adherence to recommendations and allows closer alignment with the CC objectives. The possibility of improving CCF by lengthening the time between two CC relays and the effect of real-time feedback on the quality of the CC must be investigated. Methods Using a 2 × 2 factorial design in a multicenter randomized trial, two hypotheses will be tested simultaneously: (i) a 4-min relay rhythm improves the CCF (reducing the no-flow time) compared to the currently recommended 2-min relay rate, and (ii) a guiding tool improves the quality of CC. Primary outcomes (i) CCF and (ii) correct compression score will be recorded by a real-time feedback device. Five hundred adult nontraumatic OHCAs will be included over 2 years. Patients will be randomized in a 1:1:1:1 distribution receiving advanced CPR as follows: 2-min blind, 2 min with guidance, 4-min blind, or 4 min with guidance. Secondary outcomes are the depth, frequency, and release of CC; length (care, no-flow, and low-flow); rate of return of spontaneous circulation; characteristics of advanced CPR; survival at hospital admission; survival and neurological state on days 1 and 30 (or intensive care discharge); and dosage of neuron-specific enolase on days 1 and 3. Discussion This study will contribute to assessing the impact of real-time feedback on CC quality in practical conditions of OHCA resuscitation. It will also provide insight into the feasibility of extending the relay rhythm between two rescuers from the currently recommended 2 to 4 min. Trial registration ClinicalTrials.gov, NCT03817892. Registered on 28 January 2019
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Affiliation(s)
- Clément Buléon
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France.
| | - Jean-Jacques Parienti
- UNICAEN, CHU de Caen Normandie, Unité de Biostatistiques et de Recherche Clinique, Normandie University, 14000, Caen, France
| | - Elodie Morilland-Lecoq
- UNICAEN, CHU de Caen Normandie, Unité de Biostatistiques et de Recherche Clinique, Normandie University, 14000, Caen, France
| | - Laurent Halbout
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France
| | - Eric Cesaréo
- Department of Emergency Medicine, SAMU 69, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Pierre-Yves Dubien
- Department of Emergency Medicine, SAMU 69, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Benoit Jardel
- Department of Anaesthesiology and Intensive Care, SAMU 76, Rouen University Hospital, Rouen Cedex, France
| | | | - Kévin Husson
- Emergency Medicine Department and SAMU 59, Lille University Hospital, Lille, France
| | | | - Xavier Benet
- Emergency Department, Centre Hospitalier du Havre, Le Havre, France
| | | | - Antoine Aubrion
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France.,Emergency Department, Centre Hospitalier de Lisieux, Lisieux, France
| | - Catalin Muntean
- Emergency Department, Centre Hospitalier de Cherbourg, Cherbourg, France
| | - Erwan Dupire
- Emergency Department, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Eric Roupie
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France
| | - Hervé Hubert
- University Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000, Lille, France.,French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre Électronique des Arrêts Cardiaques, Lille, France
| | - Christian Vilhelm
- University Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000, Lille, France.,French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre Électronique des Arrêts Cardiaques, Lille, France
| | - Pierre-Yves Gueugniaud
- Department of Anaesthesiology and Intensive Care, SAMU 76, Rouen University Hospital, Rouen Cedex, France.,French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre Électronique des Arrêts Cardiaques, Lille, France
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Buléon C, Delaunay J, Parienti JJ, Halbout L, Arrot X, Gérard JL, Hanouz JL. Impact of a feedback device on chest compression quality during extended manikin CPR: a randomized crossover study. Am J Emerg Med 2016; 34:1754-60. [PMID: 27349359 DOI: 10.1016/j.ajem.2016.05.077] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/25/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSES Chest compressions require physical effort leading to increased fatigue and rapid degradation in the quality of cardiopulmonary resuscitation overtime. Despite harmful effect of interrupting chest compressions, current guidelines recommend that rescuers switch every 2 minutes. The impact on the quality of chest compressions during extended cardiopulmonary resuscitation has yet to be assessed. BASIC PROCEDURES We conducted randomized crossover study on manikin (ResusciAnne; Laerdal). After randomization, 60 professional emergency rescuers performed 2 × 10 minutes of continuous chest compressions with and without a feedback device (CPRmeter). Efficient compression rate (primary outcome) was defined as the frequency target reached along with depth and leaning at the same time (recorded continuously). MAIN FINDINGS The 10-minute mean efficient compression rate was significantly better in the feedback group: 42% vs 21% (P< .001). There was no significant difference between the first (43%) and the tenth minute (36%; P= .068) with feedback. Conversely, a significant difference was evident from the second minute without feedback (35% initially vs 27%; P< .001). The efficient compression rate difference with and without feedback was significant every minute, from the second minute onwards. CPRmeter feedback significantly improved chest compression depth from the first minute, leaning from the second minute and rate from the third minute. PRINCIPAL CONCLUSIONS A real-time feedback device delivers longer effective, steadier chest compressions over time. An extrapolation of these results from simulation may allow rescuer switches to be carried out beyond the currently recommended 2 minutes when a feedback device is used.
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Affiliation(s)
- Clément Buléon
- CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France; Medical Simulation Center, Normandie Simulation en Santé, Caen F-14000, France.
| | - Julie Delaunay
- CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France; Medical Simulation Center, Normandie Simulation en Santé, Caen F-14000, France
| | - Jean-Jacques Parienti
- CHU de Caen, Unité de Biostatistiques et de Recherche Clinique, Caen F-14000, France; Université Normandie, EA4650 and UFR de Médecine, Caen F-14000, France
| | - Laurent Halbout
- CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France; Medical Simulation Center, Normandie Simulation en Santé, Caen F-14000, France
| | - Xavier Arrot
- CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France
| | - Jean-Louis Gérard
- CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France; Université Normandie, EA4650 and UFR de Médecine, Caen F-14000, France; Medical Simulation Center, Normandie Simulation en Santé, Caen F-14000, France
| | - Jean-Luc Hanouz
- CHU de Caen, Pôle Réanimations Anesthésie SAMU, Caen F-14000, France; Université Normandie, EA4650 and UFR de Médecine, Caen F-14000, France
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Zamparini G, Buléon C, Bonnieux D, De Facq Regent H, Oriot G, Rebet O, Al Afandi B, Arrot X, Genain Soulier AS, Halbout L, Harel D, Leraitre T, Moneron M, Gérard JL, Hanouz JL. [Epidemiology of out-of-hospital sudden cardiac arrest in « Basse-Normandie » according to RéAC registry]. ACTA ACUST UNITED AC 2014; 33:648-54. [PMID: 25464908 DOI: 10.1016/j.annfar.2014.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Identify from the RéAC registry, out-of-hospital sudden cardiac arrest in Caen and it's suburbs, to study epidemiology and assess our medical practices. STUDY DESIGN Observational, prospective and monocentric study. PATIENTS AND METHODS From March 2012 to March 2013, we identified 151 patients. Demographic parameters, delays until treatment, drugs given and patient outcomes were analyzed from the RéAC data registry. Depending on the variable studied, the statistical analysis used Mann-Whitney or the Chi(2) tests. RESULTS Twenty-two patients were excluded (no resuscitation attempt and patients who were transported to hospital with chest compressions only, in the absence of spontaneous circulation). One hundred and twenty-nine sudden cardiac arrests were analyzed: 107 (83%) with medical origin and 22 (17%) with traumatic origin. Direct witnesses were present for 94 (73%) of them. Basic life support actions were begun for 59 (46%) patients and a telephone advice was issued by the medical response team for 47 (36%) of them. After an advanced life support, 74 (57%) patients died on the spot. Of the 55 patients reaching the hospital alive, 39 (71%) died in the intensive care unit and 16 (29%) were discharged alive from hospital, of whom 14 (88%) with a favorable neurological outcome. CONCLUSION RéAC national registry has allowed us to analyze epidemiological data on out-of-hospital sudden cardiac arrests in our center. This register has also allowed us to highlight areas for improvement. They should be taken into account to improve our medical practices.
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Affiliation(s)
- G Zamparini
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; EA.4650-Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique, UFR de médecine, université Caen Basse-Normandie, avenue de la Côte-de-Nacre, 14032 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France.
| | - C Buléon
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - D Bonnieux
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - H De Facq Regent
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - G Oriot
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - O Rebet
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - B Al Afandi
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - X Arrot
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - A-S Genain Soulier
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - L Halbout
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - D Harel
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - T Leraitre
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - M Moneron
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Groupe de recherche RéAC, 59120 Loos, France
| | - J-L Gérard
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; EA.4650-Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique, UFR de médecine, université Caen Basse-Normandie, avenue de la Côte-de-Nacre, 14032 Caen cedex, France
| | - J-L Hanouz
- Département de réanimations et d'anesthésie ; SAMU-SMUR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; EA.4650-Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique, UFR de médecine, université Caen Basse-Normandie, avenue de la Côte-de-Nacre, 14032 Caen cedex, France
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Buléon C, Parienti JJ, Halbout L, Arrot X, De Facq Régent H, Chelarescu D, Fellahi JL, Gérard JL, Hanouz JL. Improvement in chest compression quality using a feedback device (CPRmeter): a simulation randomized crossover study. Am J Emerg Med 2013; 31:1457-61. [DOI: 10.1016/j.ajem.2013.07.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 07/26/2013] [Accepted: 07/28/2013] [Indexed: 11/25/2022] Open
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Buleon C, Defacq H, Arrot X, Halbout L, Parienti JJ, Hanouz JL. AP017 Improvement of chest compression quality performed by first rescuers using a feedback device: Q-CPR®. Manikin prospective randomized crossover study. Resuscitation 2011. [DOI: 10.1016/s0300-9572(11)70051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gueugniaud PY, David JS, Chanzy E, Hubert H, Dubien PY, Mauriaucourt P, Bragança C, Billères X, Clotteau-Lambert MP, Fuster P, Thiercelin D, Debaty G, Ricard-Hibon A, Roux P, Espesson C, Querellou E, Ducros L, Ecollan P, Halbout L, Savary D, Guillaumée F, Maupoint R, Capelle P, Bracq C, Dreyfus P, Nouguier P, Gache A, Meurisse C, Boulanger B, Lae C, Metzger J, Raphael V, Beruben A, Wenzel V, Guinhouya C, Vilhelm C, Marret E. Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation. N Engl J Med 2008; 359:21-30. [PMID: 18596271 DOI: 10.1056/nejmoa0706873] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND During the administration of advanced cardiac life support for resuscitation from cardiac arrest, a combination of vasopressin and epinephrine may be more effective than epinephrine or vasopressin alone, but evidence is insufficient to make clinical recommendations. METHODS In a multicenter study, we randomly assigned adults with out-of-hospital cardiac arrest to receive successive injections of either 1 mg of epinephrine and 40 IU of vasopressin or 1 mg of epinephrine and saline placebo, followed by administration of the same combination of study drugs if spontaneous circulation was not restored and subsequently by additional epinephrine if needed. The primary end point was survival to hospital admission; the secondary end points were return of spontaneous circulation, survival to hospital discharge, good neurologic recovery, and 1-year survival. RESULTS A total of 1442 patients were assigned to receive a combination of epinephrine and vasopressin, and 1452 to receive epinephrine alone. The treatment groups had similar baseline characteristics except that there were more men in the group receiving combination therapy than in the group receiving epinephrine alone (P=0.03). There were no significant differences between the combination-therapy and the epinephrine-only groups in survival to hospital admission (20.7% vs. 21.3%; relative risk of death, 1.01; 95% confidence interval [CI], 0.97 to 1.05), return of spontaneous circulation (28.6% vs. 29.5%; relative risk, 1.01; 95% CI, 0.97 to 1.06), survival to hospital discharge (1.7% vs. 2.3%; relative risk, 1.01; 95% CI, 1.00 to 1.02), 1-year survival (1.3% vs. 2.1%; relative risk, 1.01; 95% CI, 1.00 to 1.02), or good neurologic recovery at hospital discharge (37.5% vs. 51.5%; relative risk, 1.29; 95% CI, 0.81 to 2.06). CONCLUSIONS As compared with epinephrine alone, the combination of vasopressin and epinephrine during advanced cardiac life support for out-of-hospital cardiac arrest does not improve outcome. (ClinicalTrials.gov number, NCT00127907.)
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Affiliation(s)
- Pierre-Yves Gueugniaud
- Service d'Aide Médicale Urgente 69, Hospices Civils de Lyon, University of Lyon 1, Lyon, France.
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