scholarly journals Accuracy of instructor assessment of chest compression quality during simulated resuscitation

CJEM ◽  
2016 ◽  
Vol 18 (4) ◽  
pp. 276-282 ◽  
Author(s):  
Erin E. Brennan ◽  
Robert C. McGraw ◽  
Steven C. Brooks
Keyword(s):  
Nursing Students ◽  
Chest Compression ◽  
Heart Association ◽  
Subjective Assessment ◽  
Quality Data ◽  
Compression Rate ◽  
Emergency Department Staff ◽  
Resuscitation Training ◽  
Cpr Quality

AbstractObjectivesThe 2010 American Heart Association Guidelines stress the importance of high quality cardiopulmonary resuscitation (CPR) as a predictor of survival from cardiac arrest. However, resuscitation training is often facilitated and evaluated by instructors without access to objective measures of CPR quality. This study aims to determine whether instructors experienced in the area of adult resuscitation (emergency department staff and senior residents) can accurately assess the quality of chest compressions as a component of their global assessment of a simulated resuscitation scenario.MethodsThis is a prospective observational study in which objective chest compression quality data (rate, depth, and fraction) were collected from the simulation manikin and compared to subjective instructor assessment. Data were collected during weekly simulation training sessions for residents, medical students, and nursing students.ResultsWe included data from 24 simulated resuscitation scenarios assessed by 1 of 15 instructors. Subjective assessment of chest compression quality identified an adequate compression rate (100–120 compressions per minute) with a sensitivity of 0.17 (confidence interval [CI] 0.02–0.32) and specificity of 0.06 (CI −0.04–0.15), adequate depth (>50 mm) with a sensitivity of 0 and specificity of 0.38 (CI 0.18–0.57), and adequate fraction (>80%) with a sensitivity of 1 and a specificity of 0.25 (CI 0.08–0.42).ConclusionInstructor assessment of chest compression rate, depth, and fraction demonstrates poor sensitivity and specificity when compared to the data from the simulation manikin. These results support the use of objective and technologically supported measures of chest compression quality for feedback during resuscitation education using simulators.

scholarly journals Effect of the Use of Metronome Feedback on the Quality of Pediatric Cardiopulmonary Resuscitation

2021 ◽  
Vol 18 (15) ◽  
pp. 8087
Author(s):  
Dongjun Yang ◽  
Wongyu Lee ◽  
Jehyeok Oh
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Healthcare Providers ◽  
Compression Rate ◽  
Audio Feedback ◽  
Simple Method ◽  
Compression Depth ◽  
Pediatric Resuscitation ◽  
Cpr Quality

Although the use of audio feedback with devices such as metronomes during cardiopulmonary resuscitation (CPR) is a simple method for improving CPR quality, its effect on the quality of pediatric CPR has not been adequately evaluated. In this study, 64 healthcare providers performed CPR (with one- and two-handed chest compression (OHCC and THCC, respectively)) on a pediatric resuscitation manikin (Resusci Junior QCPR), with and without audio feedback using a metronome (110 beats/min). CPR was performed on the floor, with a compression-to-ventilation ratio of 30:2. For both OHCC and THCC, the rate of achievement of an adequate compression rate during CPR was significantly higher when performed with metronome feedback than that without metronome feedback (CPR with vs. without feedback: 100.0% (99.0, 100.0) vs. 94.0% (69.0, 99.0), p < 0.001, for OHCC, and 100.0% (98.5, 100.0) vs. 91.0% (34.5, 98.5), p < 0.001, for THCC). However, the rate of achievement of adequate compression depth during the CPR performed was significantly higher without metronome feedback than that with metronome feedback (CPR with vs. without feedback: 95.0% (23.5, 99.5) vs. 98.5% (77.5, 100.0), p = 0.004, for OHCC, and 99.0% (95.5, 100.0) vs. 100.0% (99.0, 100.0), p = 0.003, for THCC). Although metronome feedback during pediatric CPR could increase the rate of achievement of adequate compression rates, it could cause decreased compression depth.

scholarly journals Metronome Use Positively Affect Cardiopulmonary Resuscitation Parameters: Prospective Observational Multicenter Manikin Study

2020 ◽  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Minute Ventilation ◽  
Heart Association ◽  
High Volume ◽  
Compression Rate ◽  
Compression Depth ◽  
Manikin Study ◽  
Volume Ventilation ◽  
Cpr Quality

Objective: Clinical studies have shown that eliminating performer errors is important to ensure high quality cardiopulmonary resuscitation (CPR). Literature on the effects of metronome use on the quality of CPR is scarce. This study aimed to investigate the effect of metronome use on the quality of cardiopulmonary resuscitation. Methods: Thirty volunteer emergency physicians who were divided into 15 groups participated in this prospective, observational, multi-center, manikin study. Firstly, each participant performed conventional CPR on a manikin, and then performed metronome-guided CPR after a short break. Parameters affecting CPR quality were evaluated based on the recommendations of the 2015 American Heart Association CPR and Emergency Cardiovascular Care Guideline. In addition, the fatigue levels of participants were evaluated using the Borg Fatigue Index. Results: Metronome-guided CPR significantly improved the chest compression rate (median (Interquartile Range-IQR); 128 (22) compressions/min vs. 110 (2) compressions/min; 95%CI, p < 0.001), deep compression rate (median (IQR); 95.25 (80) compressions/min vs. 72.63 (105) compressions/min; 95%CI, p < 0.001), compression depth (median (IQR); 62.50 (11) mm vs. 60.25 (14) mm; 95%CI, p = 0.016), ventilation number (median (IQR); 11.25 (6) ventilations/min vs. 9.50 (1) ventilations/min; 95%CI, p = 0.001), high-volume ventilation count (median (IQR); 10.13 (6) ventilations/min vs. 9.50 (1) ventilations/min; 95%CI, p = 0.026), minute ventilation volume (median (IQR); 11.75 (10) L/min vs. 8.03 (3) L/min; 95%CI, p < 0.05), and fatigue levels (median (IQR); 3 (2) vs. 2 (2); in 95%CI, p < 0.05). Conclusions: Our study showed that metronome is a useful device for reaching effective CPR. Metronome guidance may change the CPR parameters positively. This study is in accordance with previous studies which have investigated the effect of metronome-guided CPR on survival.

scholarly journals Effect of Acute Exposure to Altitude on the Quality of Chest Compression‐Only Cardiopulmonary Resuscitation in Helicopter Emergency Medical Services Personnel: A Randomized, Controlled, Single‐Blind Crossover Trial

2021 ◽  
Author(s):  
Anna Vögele ◽  
Michiel Jan van Veelen ◽  
Tomas Dal Cappello ◽  
Marika Falla ◽  
Giada Nicoletto ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Chest Compression ◽  
Acute Exposure ◽  
Medical Services ◽  
Compression Depth ◽  
Helicopter Emergency Medical Services ◽  
Emergency Medical ◽  
Emergency Medical Services Personnel ◽  
Cpr Quality

Background Helicopter emergency medical services personnel operating in mountainous terrain are frequently exposed to rapid ascents and provide cardiopulmonary resuscitation (CPR) in the field. The aim of the present trial was to investigate the quality of chest compression only (CCO)‐CPR after acute exposure to altitude under repeatable and standardized conditions. Methods and Results Forty‐eight helicopter emergency medical services personnel were divided into 12 groups of 4 participants; each group was assigned to perform 5 minutes of CCO‐CPR on manikins at 2 of 3 altitudes in a randomized controlled single‐blind crossover design (200, 3000, and 5000 m) in a hypobaric chamber. Physiological parameters were continuously monitored; participants rated their performance and effort on visual analog scales. Generalized estimating equations were performed for variables of CPR quality (depth, rate, recoil, and effective chest compressions) and effects of time, altitude, carryover, altitude sequence, sex, qualification, weight, preacclimatization, and interactions were analyzed. Our trial showed a time‐dependent decrease in chest compression depth ( P =0.036) after 20 minutes at altitude; chest compression depth was below the recommended minimum of 50 mm after 60 to 90 seconds (49 [95% CI, 46–52] mm) of CCO‐CPR. Conclusions This trial showed a time‐dependent decrease in CCO‐CPR quality provided by helicopter emergency medical services personnel during acute exposure to altitude, which was not perceived by the providers. Our findings suggest a reevaluation of the CPR guidelines for providers practicing at altitudes of 3000 m and higher. Mechanical CPR devices could be of help in overcoming CCO‐CPR quality decrease in helicopter emergency medical services missions. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04138446.

Abstract 133: Electrical Insulating Gloves for Safe Hands-on Defibrillation Do Not Compromise the Quality of Chest Compressions

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jakob E Thomsen ◽  
Martin Harpsø ◽  
Graham W Petley ◽  
Svend Vittinghus ◽  
Charles D Deakin ◽  
...  
Keyword(s):  
Clinical Examination ◽  
Chest Compression ◽  
Electrical Insulation ◽  
Compression Rate ◽  
Chest Compressions ◽  
Compression Depth ◽  
Resuscitation Guidelines ◽  
Hands On ◽  
Class 1

Introduction: We have recently shown that Class 1 electrical insulating gloves are safe for hands-on defibrillation. Continuous chest compressions during defibrillation reduce the peri-shock pauses and increase the subsequent chance of successful defibrillation. In this study we have investigated the effect of these electrical insulation gloves on the quality of chest compressions, compared with normal clinical examination gloves. Methods: Emergency medical technicians trained in 2010 resuscitation guidelines delivered uninterrupted chest compressions for 6 min on a manikin, whilst wearing Class 1 electrical insulating gloves or clinical examination gloves. The order of gloves was randomized and each session of chest compressions was separated by at least 30 min to avoid fatigue. Data were collected from the manikin. Compression depth and compression rate were compared. Results: Data from 35 participants are shown in Figure 1. There was no statistically significant difference between Class 1 electrical insulating gloves in chest compression depth (median±range: 45 (28-61) vs 43 (28-61) p=0.69) and chest compression rate (113 (67-150) vs 113(72-145), p=0.87) when compared to clinical examination cloves. Conclusion: These preliminary data suggest that the use of Class 1 electrical insulation gloves does not reduce the quality of chest compressions during simulated CPR compared to clinical examination gloves.

Abstract 11901: CPR Quality During the COVID-19 Pandemic - More Evidence of Collateral Damage During Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jocasta Ball ◽  
Ziad Nehme ◽  
Melanie Villani ◽  
Karen L Smith
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Healthcare Services ◽  
Quality Data ◽  
Independent Effect ◽  
Compression Rate ◽  
Post Shock ◽  
Cpr Quality ◽  
Using Data ◽  
Hospital Cardiac Arrest

Introduction: Many regions around the world have reported declining survival rates from out-of-hospital cardiac arrest (OHCA) during the COVID-19 pandemic. This has been attributed to COVID-19 infection and overwhelmed healthcare services in some regions and imposed social restrictions in others. However, the effect of the pandemic period on CPR quality, which has the potential to impact outcomes, has not yet been described. Methods: A retrospective observational study was performed using data collected in an established OHCA registry in Victoria, Australia. During a pre-pandemic period (11 February 2019-31 January 2020) and the COVID-19 pandemic period (1 February 2020-31 January 2021), 1,111 and 1,349 cases with attempted resuscitation had complete CPR quality data, respectively. The proportion of cases where CPR targets (chest compression fraction [CCF]≥90%, compression depth 5-10cm, compression rate 100-120 per minute, pre-shock pauses <6 seconds, post-shock pauses <5 seconds) were met was compared between the pre-pandemic and pandemic periods. Logistic regression was performed to identify the independent effect of the COVID-19 pandemic on achieving CPR targets. Results: The proportion of arrests where CCF≥90% significantly decreased during the pandemic (57% vs 74% in the pre-pandemic period, p<0.001) as did the proportion with pre-shock pauses <6 seconds (54% vs 62%, p=0.019) and post-shock pauses <5 seconds (68% vs 82%, p<0.001). However, the proportion within target compression rate significantly increased during the pandemic (64% vs 56%, p<0.001). Following multivariable adjustment, the COVID-19 pandemic period was independently associated with a decrease in the odds of achieving a CCF≥90% (adjusted odds ratio [AOR] 0.47 [95% CI 0.40, 0.56]), a decrease in the odds of achieving pre-shock pauses<6 seconds (AOR 0.71 [95% CI 0.52, 0.96]), and a decrease in the odds of achieving post-shock pauses<5 seconds (AOR 0.49 [95% CI 0.34, 0.71]). Conclusion: CPR quality was impacted during the COVID-19 pandemic period which may have contributed to a decrease in OHCA survival previously identified. These findings reinforce the importance of maintaining effective resuscitation practices despite changes to clinical context.

Why Change the Compression and Ventilation Rates During CPR in Neonates?

PEDIATRICS ◽  
1994 ◽  
Vol 93 (6) ◽  
pp. 1026-1027
Author(s):  
◽  
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Cardiac Care ◽  
Compression Rate ◽  
National Conference ◽  
Ventilation Rates

The 1985 American Heart Association National Conference for Emergency Cardiac Care (ECC) recommendations for neonatal cardiopulmonary resuscitation included a chest compression rate of 120/minute accompanied by ventilation at a rate of 40 to 60/minute.1 There was no attempt to coordinate ventilation and compression. Rescuers providing chest compression and those providing ventilation were taught to perform their tasks independently, resulting in frequent simultaneous compression and ventilation. At the time, much of the available data indicated that simultaneous compression and ventilation (SVC-CPR) resulted in improved blood flow.2-6

Abstract 110: Introduction of a Mechanical Chest Compression Device for In-hospital Cardiac Arrest During the Covid-19 Pandemic

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Anish Bhatnagar ◽  
Jennifer Lee ◽  
Haitham Khraishah ◽  
Douglas Hsu ◽  
Margaret Hayes ◽  
...  
Keyword(s):  
Chest Compression ◽  
Tertiary Care ◽  
Heart Association ◽  
Care Hospital ◽  
Electronic Survey ◽  
Mechanical Chest Compression ◽  
Increased Risk ◽  
Patient Size ◽  
Rapid Deployment

Introduction: Cardiopulmonary resuscitation (CPR) for hospitalized patients during the COVID-19 pandemic presents unique challenges to resuscitation teams, including a potentially increased risk from virus aerosolization. As such, the American Heart Association has published guidance, which includes a suggested use of mechanical chest compression devices if available. We herein describe the experience at a tertiary care hospital with a high COVID-19 case load, where mechanical compression devices were rapidly deployed early in the pandemic. Methods: In April 2020, two LUCAS® chest compression systems were deployed and staff trained in their use. In June 2020, an electronic survey was developed that explored experiences of resuscitation providers who responded to in-hospital cardiac arrests (IHCA) during the pandemic. The survey was sent to the physician code leaders, anesthesiologists, and intensive care nurses who had responded to IHCAs. Results: Forty-four (58%) of 76 surveys were returned. There were 21 IHCAs during the study period. Of the respondents, 15 (34%) were nurses and 14 (31.8%) were medical trainees. Thirty-two (73%) respondents had been involved in an IHCA where the LUCAS® was deployed. Ten (31.3%) respondents agreed/strongly agreed that transferring to the LUCAS® backboard was difficult, and that it was difficult to latch the LUCAS® to the backboard. Twelve (37.5%) respondents believed that the LUCAS resulted in delays in care. Twenty-two (68.8%) respondents thought that LUCAS® resulted in a more controlled resuscitation experience, 20 (62.5%) felt the LUCAS® improved the quality of chest compressions, and 23 (71.9%) reported that the LUCAS® allowed for fewer people in the room. Those who responded to arrests where the LUCAS® was not deployed, reported patient size and difficulty attaching the device as common obstacles. Conclusions: Rapid deployment of mechanical chest compression devices during the COVID-19 pandemic is feasible. Although there are substantial technical challenges, most report a more controlled resuscitation experience, better compression quality, and fewer individuals in the room. Additional staff training may be necessary to achieve optimal results.

scholarly journals Evaluation of the quality of cardiopulmonary resuscitation according to vehicle driving pattern, using a virtual reality ambulance driving system: a prospective, cross-over, randomised study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023784 ◽  
Author(s):  
Jin Ho Beom ◽  
Min Joung Kim ◽  
Je Sung You ◽  
Hye Sun Lee ◽  
Ji Hoon Kim ◽  
...  
Keyword(s):  
Chest Compression ◽  
Fire Service ◽  
Quality Parameters ◽  
Hand Position ◽  
Sudden Stop ◽  
Compression Depth ◽  
Randomised Study ◽  
Cpr Quality ◽  
Service Academy

ObjectivesTo analyse changes in the quality of cardiopulmonary resuscitation (CPR) according to driving patterns encountered during ambulance transport, using a virtual reality simulator.DesignProspective, cross-over, randomised study.SettingThis study was conducted at the National Fire Service Academy, Cheonan-si, Korea.ParticipantsEmergency medical technicians (39 men and 9 women) attending the National Fire Service Academy for clinical training with ≥6 months field experience or having performed ≥10 CPR. Individuals who withdrew consent were excluded.Outcome measuresCPR quality parameters (eg, chest compression depth and its variability).ResultsChest compressions were performed for 8 min each in a stationary and driving state. The mean chest compression depths were 54.8 mm and 55.3 mm during these two states, respectively (p=0.41). The SD of the chest compression depth was significantly higher while in the driving (7.6 mm) than in the stationary state (6.5 mm; p=0.04). The compression depths in the speed bump and sudden stop sections were 51.5 mm and 50.6 mm, respectively, which was shallower than those in all other sections (p<0.001). The correct hand position rate was low in the speed bump, sudden stop and right-hand cornering sections (65.4%, 71.5% and 72.5%, respectively; p=0.001)ConclusionsAlthough we found no differences in chest compression quality parameters between the stationary and driving states, the variability in the chest compression depth increased in the driving state. When comparing CPR quality parameters according to driving patterns, we noted a shallower compression depth, increased variability and decreased correct hand position rate in the speed bump, sudden stop and right-hand cornering sections. The clinical significance of these changes in CPR quality during ambulance transport remains to be determined. Future studies on how to reduce changes in the quality of CPR (including research on equipment development) are needed.

scholarly journals Real-Time Chest Compression Quality Measurements by Smartphone Camera

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Øyvind Meinich-Bache ◽  
Kjersti Engan ◽  
Tonje Søraas Birkenes ◽  
Helge Myklebust
Keyword(s):  
Cardiac Arrest ◽  
Real Time ◽  
Chest Compression ◽  
Quality Measurement ◽  
Smartphone Application ◽  
Average Error ◽  
Compression Rate ◽  
Chest Compressions ◽  
Compression Time ◽  
Cpr Quality

Out-of-hospital cardiac arrest (OHCA) is recognized as a global mortality challenge, and digital strategies could contribute to increase the chance of survival. In this paper, we investigate if cardiopulmonary resuscitation (CPR) quality measurement using smartphone video analysis in real-time is feasible for a range of conditions. With the use of a web-connected smartphone application which utilizes the smartphone camera, we detect inactivity and chest compressions and measure chest compression rate with real-time feedback to both the caller who performs chest compressions and over the web to the dispatcher who coaches the caller on chest compressions. The application estimates compression rate with 0.5 s update interval, time to first stable compression rate (TFSCR), active compression time (TC), hands-off time (TWC), average compression rate (ACR), and total number of compressions (NC). Four experiments were performed to test the accuracy of the calculated chest compression rate under different conditions, and a fifth experiment was done to test the accuracy of the CPR summary parameters TFSCR, TC, TWC, ACR, and NC. Average compression rate detection error was 2.7 compressions per minute (±5.0 cpm), the calculated chest compression rate was within ±10 cpm in 98% (±5.5) of the time, and the average error of the summary CPR parameters was 4.5% (±3.6). The results show that real-time chest compression quality measurement by smartphone camera in simulated cardiac arrest is feasible under the conditions tested.

Abstract 300: End-Tidal CO 2 -Guided Chest Compression Delivery Improves Survival in a Pediatric Model of Respiratory Failure and Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Caitlin E O’Brien ◽  
Polan T Santos ◽  
Michael Reyes ◽  
Shawn Adams ◽  
C. Danielle Hopkins ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Respiratory Failure ◽  
Chest Compression ◽  
Perfusion Pressure ◽  
Heart Association ◽  
Standard Group ◽  
Compression Rate ◽  
Group Survival ◽  
End Tidal ◽  
Asphyxial Cardiac Arrest

Introduction: The American Heart Association (AHA) recommends the use of end-tidal CO 2 (ETCO 2 ) to evaluate the quality of chest compression delivery during CPR. In a pediatric model of asphyxial cardiac arrest, ETCO 2 -guided chest compression delivery improved survival over standard CPR. Since the most common cause of pediatric cardiac arrest is respiratory failure, we investigated whether this observed survival benefit persisted in a model of respiratory failure preceding cardiac arrest. Methods: Prior to a 17-min asphyxial cardiac arrest, peak inspiratory pressures were adjusted to a goal PaCO 2 of 80 torr to mimic pre-arrest respiratory failure. Male swine (3-4 kg) were randomized to receive either ETCO 2 -guided or standard CPR for 10 min of BLS followed by 10 min of ALS. In the ETCO 2 -guided group, chest compression rate and depth were adjusted to obtain a maximal ETCO 2 level. In the standard group, chest compressions were delivered per AHA guidelines. Hemodynamic parameters were recorded every 30 seconds, and resuscitation was continued for 20 min or until ROSC. Results: Twenty swine underwent asphyxial cardiac arrest. After adjustment of ventilation prior to asphyxia, pH and PaCO 2 were 7.15 and 79 torr in the ETCO 2 -guided group and 7.14 and 78 torr in the standard group. Survival was greater in the ETCO 2 -guided group than in the standard group (7/10 versus 1/10; p=0.02). During resuscitation, mean ETCO 2 and chest compression rate were higher in the ETCO 2 -guided group (38.6 ± 1.2 versus 22.9 ± 1.2, p=0.01; 154.4 ± 1.2 versus 100.5 ± 0.1, p<0.001, respectively). During resuscitation, diastolic blood pressure, myocardial perfusion pressure, systemic perfusion pressure, and cerebral perfusion pressure were higher in the ETCO 2 -guided group ( Figure 1 ) Conclusions: ETCO 2 -guided chest compression delivery improves survival and resuscitation hemodynamics over standard CPR in a pediatric model of respiratory failure and cardiac arrest.

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