scholarly journals Hands-on defibrillation and electrocardiogram artefact filtering technology increases chest compression fraction and decreases peri-shock pause duration in a simulation model of cardiac arrest

CJEM ◽  
2015 ◽  
Vol 18 (4) ◽  
pp. 270-275 ◽  
Author(s):  
Shannon M. Fernando ◽  
Sheldon Cheskes ◽  
Daniel Howes
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Standard Of Care ◽  
Pause Duration ◽  
Shock Delivery ◽  
Hands On ◽  
Before And After ◽  
Post Shock ◽  
Rhythm Analysis ◽  
Electrocardiogram Ecg

AbstractBackgroundReducing pauses during cardiopulmonary resuscitation (CPR) compressions result in better outcomes in cardiac arrest. Artefact filtering technology (AFT) gives rescuers the opportunity to visualize the underlying electrocardiogram (ECG) rhythm during chest compressions, and reduces the pauses that occur before and after delivering a shock. We conducted a simulation study to measure the reduction of peri-shock pause and impact on chest compression fraction (CCF) through AFT.MethodsIn a simulator setting, participants were given a standardized cardiac arrest scenario and were randomly assigned to perform CPR/defibrillation using the protocol from one of three experimental arms: 1) Standard of Care (pauses for rhythm analysis and shock delivery); 2) AFT (no pauses for rhythm analysis, but a pause for defibrillation); or 3) AFT with hands-on defibrillation (no pauses for rhythm analysis or defibrillation). The primary outcomes were CCF and peri-shock pause duration, with secondary outcomes of pre- and post-shock pause duration.ResultsAFT with hands-on defibrillation was found to have the highest CCF (86.4%), as compared to AFT alone (83.8%, p<0.001), and both groups significantly improved CCF in comparison with the Standard of Care (76.7%, p<0.001). AFT with hands-on defibrillation was associated with a reduced peri-shock pause (2.6 seconds) as compared to AFT alone (5.3 seconds, p<0.001), and the Standard of Care (7.4 seconds, p<0.001).ConclusionsIn this cardiac arrest model, AFT results in a greater CCF by reducing peri-shock pause duration. There is also a small but detectable improvement in CCF with the addition of hands-on defibrillation.

scholarly journals Comparison of Chest Compression Quality Using Wing Boards versus Walking Next to a Moving Stretcher: A Randomized Crossover Simulation Study

2020 ◽  
Vol 9 (5) ◽  
pp. 1584
Author(s):  
Yukako Nakashima ◽  
Takeji Saitoh ◽  
Hideki Yasui ◽  
Masahide Ueno ◽  
Kensuke Hotta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chest Compression ◽  
Vital Signs ◽  
Borg Scale ◽  
Chest Compressions ◽  
High Quality ◽  
Compression Depth ◽  
Hands On ◽  
Before And After ◽  
Randomized Crossover Study

Background: When a rescuer walks alongside a stretcher and compresses the patient’s chest, the rescuer produces low-quality chest compressions. We hypothesized that a stretcher equipped with wing boards allows for better chest compressions than the conventional method. Methods: In this prospective, randomized, crossover study, we enrolled 45 medical workers and students. They performed hands-on chest compressions to a mannequin on a moving stretcher, while either walking (the walk method) or riding on wings attached to the stretcher (the wing method). The depths of the chest compressions were recorded. The participants’ vital signs were measured before and after the trials. Results: The average compression depth during the wing method (5.40 ± 0.50 cm) was greater than during the walk method (4.85 ± 0.80 cm; p < 0.01). The average compression rates during the two minutes were 215 ± 8 and 217 ± 5 compressions in the walk and wing methods, respectively (p = ns). Changes in blood pressure (14 ± 11 vs. 22 ± 14 mmHg), heart rate (32 ± 13 vs. 58 ± 20 bpm), and modified Borg scale (4 (interquartile range: 2–4) vs. 6 (5–7)) were significantly lower in the wing method cohort compared to the walking cohort (p < 0.01). The rescuer’s size and physique were positively correlated with the chest compression depth during the walk method; however, we found no significant correlation in the wing method. Conclusions: Chest compressions performed on the stretcher while moving using the wing method can produce high-quality chest compressions, especially for rescuers with a smaller size and physique.

Abstract 356: Skill Retention in Medical Students Trained in Cardiac Arrest Care

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Miguel A Moretti ◽  
Adriana O Camboim ◽  
Caroline A Ferrandez ◽  
Isabela C Etcheverria ◽  
Iaggo B Costa ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Medical Students ◽  
Training Program ◽  
Life Support ◽  
Categorical Variables ◽  
First Year ◽  
Chi Square ◽  
Hands On ◽  
Before And After ◽  
First Year Medical Students

Background: Morbidity and mortality reduction in cardiac arrest depends upon early and effective care. Basic life support (BLS) measures encompass a series of procedures to be started outside the hospital usually by trained lay people. Therefore, it is key that lay caregivers retain knowledge and skills late after instruction. However, studies demonstrate loss of cardiopulmonary resuscitation (CPR) skills as early as 30 days after training, pending mostly on the caregiver professional background. In this study, we evaluated medical students’ retention skills at 6 months. Methods: Prospective case-control observational study. Medical students underwent a 40-hour BLS training program. CPR skills were evaluated immediately and 6 months after the course based on individual scores before and after training as well as on categorical stratification as excellent, good or poor. Data were compared using F-test, paired t-test and chi-square for categorical variables. A 95% confidence interval was used with a level of significance of 0.05. Results: Fifty first-year medical students (54% female) aged between 18 and 24 years were enrolled in the BLS training program. Total number of CPR steps accurately performed decreased after 6 months of training (10.8 vs . 12.5; p<0.001). Sex and age were not associated with performance. Categorical evaluation was considered excellent in 78% of the students immediately after training but decreased to 40% in 6 months (p<0.01). Hands-on basic skills were mostly lost within the period. Conclusion: First-year medical students lost hands-on skills after 6 months of training decreasing the efficacy of CPR measures which might affect outcomes of patients in cardiac arrest.

Abstract 98: The Association Between Manual Mode Defibrillation, Preshock Pause Duration and Appropriate Shock Delivery When Employed by Basic Life Support Paramedics During Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sheldon Cheskes ◽  
Morgan Hillier ◽  
Cathy Zhan ◽  
Adam Byers ◽  
P R Verbeek ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Pause Duration ◽  
Absolute Difference ◽  
Secondary Outcome ◽  
Correct Identification ◽  
Shock Delivery ◽  
Inappropriate Shocks ◽  
Shockable Rhythm ◽  
Manual Mode

BACKGROUND: Pre-shock pause duration of < 20 seconds is associated with improved survival after cardiac arrest. Manual mode defibrillation has been associated with the shortest duration of pre-shock pause but is largely practiced by paramedics (EMT-P) whereas defibrillator only providers (EMT-D) routinely use the defibrillator in automatic mode. OBJECTIVE: We sought to explore the relationship between manual mode defibrillation, pre-shock pause duration and shock appropriateness when defibrillation is provided by EMT-P vs. EMT-D level of providers. METHODS: We performed a retrospective review of all treated non-traumatic adult OHCA presenting in a shockable rhythm over a one year period beginning January 1, 2012. Our primary outcome measure was the proportion of manual mode shocks delivered by EMT-D’s with pre- shock pause duration of < 20 secs when compared to EMT-P’s. Our secondary outcome measures were the duration of pre-, post- and peri-shock pause and the proportion of appropriate shocks (defined as correct identification and shock delivery to patients in a shockable rhythm) delivered by either level of provider. This study had a power of 90% to detect an absolute difference of 15% between provider levels in proportion of shocks delivered with pre-shock pause duration <20 secs. RESULTS: Among 2019 treated OHCA, 335(20%) presented in a shockable rhythm. Manual defibrillation was performed in 155 (46%) of these cases (196 shocks by EMT-P, 143 shocks by EMT-D). There were no differences in the proportion of shocks delivered with pre-shock pause duration <20 secs (EMT-P 82.8% vs EMT-D 84.8%, p =.65) nor pre-shock pause duration (sec) (median, Q1, Q3); EMT-P: 12.0 (7.0,17.0) vs. EMT-D: 11.0 (5.0,17.0), p= .13 while EMT-D had shorter peri- shock pause duration (sec) (median, Q1, Q3); EMT-P: 17.0 (12.0, 23.0) vs. EMT-D: 15.0 (9.0, 22.0), p =.03. There were no differences in the rate of inappropriate shocks (EMT-P 1.0% vs EMT-D 0.7%), p=1.0. CONCLUSIONS: Manual mode defibrillation by EMT-D’s produced similar measures of pre-shock pause when compared to EMT-P’s without increasing the rate of inappropriate shocks. More widespread use of EMT-D manual mode defibrillation may have the potential to decrease shock pause duration and improve survival.

Compressions during defibrillator charging shortens shock pause duration and improves chest compression fraction during shockable out of hospital cardiac arrest

Resuscitation ◽  
2014 ◽  
Vol 85 (8) ◽  
pp. 1007-1011 ◽  
Author(s):  
Sheldon Cheskes ◽  
Matthew R. Common ◽  
P. Adam Byers ◽  
Cathy Zhan ◽  
Laurie J. Morrison
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Pause Duration ◽  
Hospital Cardiac Arrest

Abstract 368: Does Filtered Rhythm Technology Lead to Increased Inappropriate Manual Defibrillation?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jimmy To ◽  
Jenny Yang ◽  
David E Krummen ◽  
Gabriel Wardi ◽  
Rebecca E Sell
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Heart Rhythm ◽  
Clinical Effects ◽  
Academic Hospital ◽  
Hospital System ◽  
Patient Demographics ◽  
Inappropriate Shocks ◽  
Post Shock ◽  
Resuscitation Attempt

Introduction: Defibrillation of ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) is an effective treatment for patients with cardiac arrest (CA). Identifying the rhythm during cardiopulmonary resuscitation (CPR) can be difficult with the rhythm obscured by chest compression artifact. “Rhythm” checks are usually recommended, but this interrupts the resuscitation attempt. Filtered rhythm technology such as See-Thru CPR aims to reduce these interruptions by filtering out chest compression artifact, leading to easier visualization of the underlying heart rhythm without stopping CPR. Hypothesis: While See-Thru CPR is effective at improving chest compression fraction, inappropriate shocks of non-VF/VT rhythms are still common. Methods: This is a retrospective review of an internal database of all cardiac arrests occurring within a two-hospital academic hospital system between July 2012 and September 2019. The local CPR algorithm trains responders to utilize See-Thru CPR to minimize interruptions and increase the chest compression fraction (the average chest compression fraction is > 90%). The database includes all inpatient and emergency room CA and includes patient demographics, cardiac and resuscitation data including CPR parameter data when available, and outcomes. Cardiac arrests with CPR data were reviewed and all defibrillation attempts were identified and analyzed. Pre and post-shock rhythm were identified by reviewing the preceding rhythm strip, and the rhythm following the defibrillation delivery. Results: Three hundred thirty-six patients had CA with complete CPR data containing defibrillation attempts. These 336 patients had 1199 defibrillations delivered. Between 1 - 39 shocks were delivered during each event. The majority of defibrillations were delivered correctly for VF/VT (916/1199, 76%), however 23.6% of defibrillations were inappropriate - PEA in 232 attempts (19%) and asystole in 51 (4%). Of these inappropriate shocks, 23 converted to either VF/VT or ROSC, while the rest maintained a non-VF/VT rhythm. Conclusions: Defibrillation while using See-Thru CPR for inappropriate shocks is common. Further studies will be needed to show the clinical effects of shocking non-VF/VT rhythms.

Abstract 254: High Shock Efficacy and Algorithm Performance for a 150J Biphasic Waveform AED Used by Lay and BLS Responders During Out-of-hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Stacy Gehman ◽  
Edward Kompare ◽  
Barbara Fink ◽  
Tim Johnson ◽  
Walter Hufford ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Normal Sinus Rhythm ◽  
Convenience Sample ◽  
Shock Delivery ◽  
Shockable Rhythm ◽  
Normal Sinus ◽  
High Shock ◽  
Biphasic Waveform ◽  
Post Shock ◽  
Hospital Cardiac Arrest

Introduction: Effective AED defibrillation of out of hospital cardiac arrest (OHCA) depends on the safe and effective identification of shockable rhythms, and on delivery of effective defibrillation energy. This report summarizes rhythm detection performance and shock efficacy during OHCA uses of Philips HeartStart Home and OnSite AEDs using non-escalating 150 J therapy. Methods: A convenience sample of 185 OHCA AED patient uses were reviewed by clinical experts. All analysis periods that resulted in AED rhythm advisories (Shock Advised or No Shock Advised) were annotated. Shockable rhythm categories include VF and polymorphic VT/flutter. Non-Shockable rhythm categories include normal sinus rhythm, other rhythms (e.g., atrial fibrillation/flutter, bradycardia, SVT, idioventricular, bundle branch block), and asystole. Intermediate rhythms (benefits of defibrillation are limited or uncertain) were not included. Post-shock rhythm was categorized as shockable, non-shockable, or undeterminable (rhythms corrupted by CPR artifact or pads removal within 5-s of shock delivery). Shock success was defined as conversion to a non-shockable rhythm within 5-s post-shock. Results: A total of 487 analysis periods resulted in AED rhythm advisories, with 175 annotated as Shockable and 312 Non-shockable. Sensitivity and specificity (n/N, Exact 95% CI) were 97.7% (171/175, 94.3%, 99.4%) and 100% (312/312, 98.8%, 100.0%) respectively. A total of 165 shocks were delivered to 100 patients with 5 undeterminable post-shock rhythms. The remaining 160 shocks were delivered to 156 Shockable rhythm episodes. All shock efficacy was 96.9% (155/160, 92.9%, 99.0%): 150 episodes converted to non-shockable rhythms after one shock (96.2% (150/156, 91.8%, 98.6%)); 154 after two shocks (98.7% (154/156, 95.4%, 99.8%)); and 155 after three shocks, the first two of which were undeterminable (99.4% (155/156, 96.5%, 100.0%)). The remaining episode had a failed first shock, followed by an undeterminable second shock, which was the last shock of the use. Conclusion: For these 150J fixed-energy AEDs, OHCA defibrillation is safe (100% specificity), and effective (97.7% sensitivity; 96.2% single shock effectiveness; 98.7% after two shocks; 99.4% after three shocks).

scholarly journals PELATIHAN COMPRESSION ONLY-CPR EFEKTIF MENINGKATKAN KETEPATAN KOMPRESI DADA PADA ORANG AWAM

2019 ◽  
Vol 8 (1) ◽  
pp. 9-14
Author(s):  
Muhamat Nofiyanto ◽  
Miftafu Darussalam ◽  
Arif Adi Setiawan
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Emergency Preparedness ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
P Value ◽  
Lay People ◽  
Before And After ◽  
Post Test ◽  
Cpr Training

Background: Many studies show a low rate of immediate chest compression in OHCA cases. One of the factors that inhibits is the lack of knowledge of lay people who witness cases of cardiac arrest. Objective: To determine the effect of providing compression-only CPR training on chest compression skills in lay people Methods: This research used pre-experiment with one group pre-post test design, with a total of 28 respondents, using simple random sampling technique. Respondents measured chest compression skills before training, then provided training for 120 minutes.Wilcoxon test was used to analyze data sets. Results: There were almost the same number between male and female respondents, and most have never received CPR training. Only 5 respondents had received previous training, with details of 3 years, 6 years, 8 years, 9 years and 11 years ago. There was a difference in the accumulation of the accuracy of chest compression before and after training with a p-value of 0,000. Conclusion: Compression only-CPR training can improve chest compression skills, especially aspects of accuracy of compression. Broader training and intensification of training programs are needed to realize emergency preparedness in the campus community.   Keywords: Cardiac arrest, CPR, training

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