scholarly journals Bystander fatigue and CPR quality by older bystanders: a randomized crossover trial comparing continuous chest compressions and 30:2 compressions to ventilations

CJEM ◽  
2016 ◽  
Vol 18 (6) ◽  
pp. 461-468 ◽  
Author(s):  
Shawn Liu ◽  
Christian Vaillancourt ◽  
Ann Kasaboski ◽  
Monica Taljaard
Keyword(s):  
Chest Compression ◽  
Crossover Trial ◽  
Tertiary Care ◽  
Rest Period ◽  
Mean Difference ◽  
Chest Compressions ◽  
Lay Persons ◽  
Randomized Crossover Trial ◽  
Cpr Quality ◽  
Cpr Training

ABSTRACTObjectivesThis study sought to measure bystander fatigue and cardiopulmonary resuscitation (CPR) quality after five minutes of CPR using the continuous chest compression (CCC) versus the 30:2 chest compression to ventilation method in older lay persons, a population most likely to perform CPR on cardiac arrest victims.MethodsThis randomized crossover trial took place at three tertiary care hospitals and a seniors’ center. Participants were aged ≥55 years without significant physical limitations (frailty score ≤3/7). They completed two 5-minute CPR sessions (using 30:2 and CCC) on manikins; sessions were separated by a rest period. We used concealed block randomization to determine CPR method order. Metronome feedback maintained a compression rate of 100/minute. We measured heart rate (HR), mean arterial pressure (MAP), and Borg Exertion Scale. CPR quality measures included total number of compressions and number of adequate compressions (depth ≥5 cm).ResultsSixty-three participants were enrolled: mean age 70.8 years, female 66.7%, past CPR training 60.3%. Bystander fatigue was similar between CPR methods: mean difference in HR -0.59 (95% CI −3.51-2.33), MAP 1.64 (95% CI −0.23-3.50), and Borg 0.46 (95% CI 0.07-0.84). Compared to 30:2, participants using CCC performed more chest compressions (480.0 v. 376.3, mean difference 107.7; p<0.0001) and more adequate chest compressions (381.5 v. 324.9, mean difference. 62.0; p=0.0001), although good compressions/minute declined significantly faster with the CCC method (p=0.0002).ConclusionsCPR quality decreased significantly faster when performing CCC compared to 30:2. However, performing CCC produced more adequate compressions overall with a similar level of fatigue compared to the 30:2 method.

scholarly journals Chest compression effectiveness with vs without feedback

2019 ◽  
Vol 2 (2) ◽  
pp. 83-84
Author(s):  
BinGe Yang ◽  
Matthew Douma ◽  
Christopher Picard
Keyword(s):  
Chest Compression ◽  
Null Hypothesis ◽  
Rest Period ◽  
T Test ◽  
Chest Compressions ◽  
Convenience Sample ◽  
Cpr Quality ◽  
Data Tracking ◽  
Giving Feedback ◽  
The Impact

The objective of this experiment is to assess clinician perceived versus actual compression quality, and to evaluate the impact of using feedback from the Laerdal CPRMeter2 on compression quality.  In our setup, we have a total of eighty four participants (43 from the Royal Alex and 41 from the Misericordia hospital). We monitored CPR quality based on the guidelines by Heart and Stroke, which breaks down chest compression effectiveness into three areas- Release, Depth and Rate. Proper Guidelines: Compress the chest at least 5cm (2inches); Compress at a rate of 100 to 120 beats per minute; Allow the chest to recoil completely after each compression. Clinical Setup: A convenience sample of participants performed two minutes of uninterrupted chest compressions on a Laerdal Resusci Anne with a CPRmeter2 on top without feedback, followed by a two minute rest period to fill out a Q.I tracking form. They later repeated the two minutes of chest compressions with the display of the CPRmeter uncovered, with the feedback visible. The chest compression metrics from the trials were compared using a data tracking form. From the data collected, enough evidence shows that the CPRmeter2 is able to improve release, rate and overall CPR quality. After filling out the survey, all of the nurses agree that the device is very useful in giving feedback and should be used in future CPR classes. Furthermore, data collected from the Q.I tracking forms indicates that nurses and other health clinicians are inadequate in predicting their own CPR abilities. Often times, nurses would either overpredict or underpredict their scores on the CPR meter. From the data gathered, the CPRmeter2 is going to be used for training in future CPR classes. Just recently, the device has been incorporated into code calls in the emergency department at the Misericordia. A T-test was done on the findings from the experiment to test if the means of two sets of data are significantly different from each other. Based on our findings, the t-test values for rate, release, and overall quality are statistically significant, meaning that the null hypothesis is rejected.  

Abstract 2019: Untrained Volunteers Perform High Quality CPR When using an Automatic External Defibrillator with a CPR Voice Prompting Algorithm

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Benjamin S Abella ◽  
Salem Kim ◽  
Alexandra Colombus ◽  
Cheryl L Shea ◽  
Lance B Becker
Keyword(s):  
Real Time ◽  
Patient Outcomes ◽  
Chest Compression ◽  
Automatic External Defibrillator ◽  
Chest Compressions ◽  
High Quality ◽  
Cpr Training ◽  
Adult Volunteers ◽  
Improve Patient ◽  
External Defibrillator

Background: Recent investigations have demonstrated that CPR performance among trained providers can be improved by audiovisual prompting and real-time feedback, and higher quality CPR before defibrillation can improve shock success and has the potential to improve patient outcomes. Objective: We hypothesized that simplified voice prompts incorporated into an automatic external defibrillator (AED) can lead to improvements in CPR performance by untrained lay rescuers. Methods: Adult volunteers with no prior CPR training were assessed in their use of an AED with chest compression voice instructions and metronome prompts on a CPR-recording manikin. Volunteers were given minimal instructions regarding use of the device and were given no instructions regarding CPR performance. The AED was designed to prompt five cycles of 30 chest compressions between defibrillatory attempts. Chest compression rates and depths were measured via review of videotape and manikin recording data, respectively. Results: A total of 60 adults were assessed in their use of the AED, with a mean age of 33.6±12.8; 36/63 (57%) were female. Mean chest compression rate was 103±12 and mean depth was 37±14 mm. Furthermore, minimal decay in chest compression rates occurred over 5 cycles of chest compressions, with mean rate of 101±19 during the first cycle and 104±10 during the 5 th cycle. No volunteers were unable to use the AED or complete 5 cycles of chest compressions. Conclusions: Our work demonstrates that with appropriate real-time prompts delivered even in the absence of training or human coaching, laypersons can perform CPR that has a quality often similar to trained providers. This finding has important implications for AED design especially in light of the renewed importance of both CPR and the interaction of quality chest compressions and defibrillatory success.

Abstract 229: Cardiopulmonary Resuscitation Compliance of Clinical Nurses Using Feedback Technology from the Zoll R Series Defibrillator

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Martha A Boudreau
Keyword(s):  
Visual Feedback ◽  
Chest Compression ◽  
Technology Use ◽  
Healthcare Providers ◽  
Rest Period ◽  
Visual Display ◽  
Chest Compressions ◽  
Compression Performance ◽  
Clinical Nurses ◽  
Use Of Technology

Use of technology driven devices aimed at providing audio-visual feedback during CPR have been developed, however research is limited to their usefulness effecting chest compression quality of clinical nurses who are often first to respond and begin chest compression on patients experiencing cardiac arrest. This study aimed to examine CPR chest compression compliance of nurses with and without feedback from the Zoll R Series® defibrillator on a manikin. Hypothesis: Audio-visual feedback technology use from the Zoll R Series defibrillator improves the percentage of appropriate chest compression depth and rate of nurses during a CPR manikin demonstration exercise. Methods: Thirty-four nurses participated using an AHA approved manikin. Each nurse performed two minutes of uninterrupted chest compressions without feedback, followed by a rest period and two minutes of uninterrupted chest compressions using feedback technology from the defibrillator. Compression data for rate and depth and total compressions in target within AHA 2015 ECC Guidelines were recorded by the defibrillator and entered into Zoll RescueNet® software. Demographics obtained for years of BLS and ACLS certification. Results: Of the 34 nurses, mean years of ACLS certification was 3.4 years and 11.7 certified years of BLS. Compressions performed with feedback showed a higher percentage of compressions in target (M = 87.37, SD= 15.95) including rate (M= 86.33, SD =15.13) and depth (M= 97.12, SD = 5.63) of compressions compared to percent compressions in target without feedback (M= 64.42, SD = 30.54) including rate (M= 65.73, SD = 32.44) and depth (M=93.34, SD = 19.99) of compressions. Twenty nine or 85% of the 34 nurses improved chest compression performance using feedback. No significant correlation found between years of BLS and ACLS certification and pre and post feedback compliance. Conclusions: Defibrillators offering verbal encouragement and a visual display allow for adjustments in rate and depth of compressions to maintain chest compressions compliance within ECC Guidelines. Further studies should investigate whether the incorporation of feedback technology use in mock code and CPR training sessions could improve CPR performance of healthcare providers including nurses.

scholarly journals Chest Compression Quality in a Newborn Manikin: A Randomized Crossover Trial (August 2016)

2018 ◽  
Vol 6 ◽  
pp. 1-5
Author(s):  
Anne Lee Solevag ◽  
Po-Yin Cheung ◽  
Elliott Li ◽  
Sarah Zhenchun Xue ◽  
Megan O'Reilly ◽  
...  
Keyword(s):  
Chest Compression ◽  
Crossover Trial ◽  
Randomized Crossover Trial

Impact of chest compression on endotracheal intubation efficacy: a randomized crossover trial

2018 ◽  
Vol 31 (1) ◽  
Author(s):  
Lukasz Szarpak ◽  
Agnieszka Madziala ◽  
Marek Dabrowski ◽  
Halla Kaminska ◽  
Wojciech Wieczorek ◽  
...  
Keyword(s):  
Endotracheal Intubation ◽  
Chest Compression ◽  
Crossover Trial ◽  
Randomized Crossover Trial

Comparison between Pediatric-Sized and Adult-Sized Bag-Valve-Mask Ventilation for Achieving Appropriate Tidal Volume in Simulated Adult Out-of-Hospital Cardiac Arrest in a Moving Ambulance

2021 ◽  
Vol 104 (9) ◽  
pp. 1404-1410
Keyword(s):  
Cardiac Arrest ◽  
Tidal Volume ◽  
Crossover Trial ◽  
Medical Training ◽  
Emergency Medical Technicians ◽  
Mask Ventilation ◽  
Chest Compressions ◽  
Randomized Crossover Trial ◽  
The Mean ◽  
Hospital Cardiac Arrest

Background: Previous studies proposed that ventilation with pediatric-sized bag-valve-mask (BVM) ventilation resulted in more appropriate tidal volume (Vt) in adult patients than adult-sized BVM ventilation. However, those studies were conducted in stationary, non-moving environment. The authors hypothesized that the result of BVM ventilation in this treatment setting may be different when the investigation was conducted in a moving ambulance. Objective: To compare pediatric-sized and adult-sized BVM ventilation for achieving appropriate Vt in simulated adult out-of-hospital cardiac arrest (OHCA) in a moving ambulance. Materials and Methods: The present study was a randomized crossover trial. Registered nurses (RNs) and basic emergency medical technicians (EMT-Bs) were recruited to perform resuscitation ventilation on a medical training manikin. All participants performed both the pediatric-sized at 500 cc, and the adult-sized at 1,600 cc, BVM ventilation during 30 to 2 chest compressions to ventilation ratio during simulated OHCA in a moving ambulance. Adult-sized mask was used for both scenarios. The manikin was ventilated for 10 minutes during each scenario. The percentage of appropriate Vt was compared between scenarios. The percentages of low Vt at less than 400 cc and high Vt at more than 600 cc between groups were also evaluated. Results: Fifty-two volunteers with 57.7% RNs and 42.3% EMT-Bs were included. Of those 52 volunteers, 44 had less than five years of pre-hospital ventilation experience. The mean Vt was 239.0 cc and 444.5 cc in the pediatric-sized and the adult-sized BVM groups, respectively (p<0.001). Low Vt was observed in 100% of pediatric-sized BVM ventilation. In the adult-sized ventilation group, 52.1±25.6% had appropriate Vt, 11.4±18.6% had high Vt, and 36.5±29.1% had low Vt (p<0.001). Conclusion: A comparison between pediatric-sized and adult-sized BVM ventilation in simulated adult OHCA in a moving ambulance demonstrated the superiority of the adult-sized BVM over the pediatric-sized BVM for achieving appropriate Vt in adult OHCA. Keywords: Bag-valve-mask ventilation; Tidal volume; Out-of-hospital cardiac arrest; Ambulance

Single Rescuer Ventilation Using a Bag Valve Mask with Removable External Handle: A Randomized Crossover Trial

2017 ◽  
Vol 32 (6) ◽  
pp. 625-630 ◽  
Author(s):  
Paul Reed ◽  
Baruch Zobrist ◽  
Monica Casmaer ◽  
Steven G. Schauer ◽  
Nurani Kester ◽  
...  
Keyword(s):  
Health Care ◽  
Tidal Volume ◽  
Health Care Providers ◽  
Crossover Trial ◽  
Rest Period ◽  
Primary Outcome Measure ◽  
Adult Health ◽  
Care Providers ◽  
Publication Type ◽  
Randomized Crossover Trial

AbstractIntroductionVentilation with a bag valve mask (BVM) is a challenging but critical skill for airway management in the prehospital setting.HypothesisTidal volumes received during single rescuer ventilation with a modified BVM with supplemental external handle will be higher than those delivered using a standard BVM among health care volunteers in a manikin model.MethodsThis study was a randomized crossover trial of adult health care providers performing ventilation on a manikin. Investigators randomized participants to perform single rescuer ventilation, first using either a BVM modified by addition of a supplemental external handle or a standard unmodified BVM (Spur II BVM device; Ambu; Ballerup, Denmark). Participants performed mask placement and delivery of 10 breaths per minute for three minutes, as guided by a metronome. After a three-minute rest period, they performed ventilation using the alternative device. The primary outcome measure was mean received tidal volume as measured by the manikin (IngMar RespiTrainer model; IngMar Medical; Pittsburgh, Pennsylvania USA). Secondary outcomes included subject device preference.ResultsOf 70 recruited participants, all completed the study. The difference in mean received tidal volume between ventilations performed using the modified BVM with external handle versus standard BVM was 20 ml (95% CI, -16 to 56 ml; P=.28). There were no significant differences in mean received tidal volume based on the order of study arm allocation. The proportion of participants preferring the modified BVM over the standard BVM was 47.1% (95% CI, 35.7 to 58.6%).ConclusionsThe modified BVM with added external handle did not result in greater mean received tidal volume compared to standard BVM during single rescuer ventilation in a manikin model.ReedP, ZobristB, CasmaerM, SchauerSG, KesterN, AprilMD. Single rescuer ventilation using a bag valve mask with removable external handle: a randomized crossover trial. Prehosp Disaster Med. 2017;32(6):625–630.

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