USING CHEST COMPRESSIONS WITH ASYNCHRONOUS VENTILATION AT VARIOUS CHEST COMPRESSION RATES (90, 100, 120/MIN) – A RANDOMIZED CONTROLLED ANIMAL TRIAL

Abstract BACKGROUND The current Pediatric Advanced Life Support guidelines recommends that newborns who require cardiopulmonary resuscitation (CPR) in settings (e.g., prehospital, Emergency department, or paediatric intensive care unit, etc.) should receive continuous chest compressions with asynchronous ventilations (CCaV) if an advanced airway is in place. However, this has never been examined in a newborn model of neonatal asphyxia. OBJECTIVES To determine if CCaV at rates of 90/min or 120/min compared to current standard of 100/min will reduce the time to return of spontaneous circulation (ROSC) in a porcine model of neonatal resuscitation. DESIGN/METHODS Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia, which was achieved by clamping the endotracheal tube until asystole. Piglets were randomized into 3 CCaV groups: chest compression (CC) at a rate of 90/min (CCaV 90,n=7), of 100/min (CCaV 100,n=7), of 120/min (CCaV 120,n=7), or sham-operated group. A two-step randomization process with sequentially numbered, sealed brown envelope was used to reduce selection bias. After surgical instrumentation and stabilization an envelope containing the allocation “sham” or “intervention” was opened (step one). The sham-operated group had the same surgical protocol, stabilization, and equivalent experimental periods without hypoxia and asphyxia. Only piglets randomized to “intervention” underwent hypoxia and asphyxia. Once the criteria for CPR were met, a second envelope containing the group allocations was opened (step two). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. RESULTS The mean (±SD) duration of asphyxia was similar between the groups with 260 (±133)sec, 336 (±217)sec, and 231 (±174)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). The mean (SD) time to ROSC was also similar between groups 342 (±345)sec, 312 (±316)sec, and 309 (±287)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). Overall, 5/7 in the CCaV 90, 5/7 in CCaV 100, and 5/7 in the CCaV 120 survived. CONCLUSION There was no significant difference in time to ROSC for either chest compression technique during cardiopulmonary resuscitation in a porcine model of neonatal asphyxia.

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Knowledge and attitude of cardiopulmonary resuscitation training and automated external defibrillators training among medical interns in a private medical college

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i11.38699 ◽

2021 ◽

Vol 12 (11) ◽

pp. 79-84

Author(s):

Archana Bhat ◽

Lulu Sherif Mahmood ◽

Akshatha Rao Aroor

Keyword(s):

Cardiopulmonary Resuscitation ◽

Health Care Professionals ◽

Life Support ◽

Training Session ◽

Automated External Defibrillators ◽

Validated Questionnaire ◽

Resuscitation Training ◽

Significant Difference ◽

Post Test ◽

The Mean

Background: Knowledge about basic life support (BLS) is mandatory for health-care professionals. Aims and Objectives: This study is done with the objective to evaluate the knowledge about cardiopulmonary resuscitation (CPR) and use of automated external defibrillators (AEDs) among medical students who have completed MBBS course and has enrolled for internship. Materials and Methods: A cross-sectional study using a validated questionnaire was given to MBBS interns before BLS training and same questionnaire was given 1 month after the training. The questionnaire included knowledge and attitudes toward use of CPR and AED and management of choking. Results: Out of the 86 students who answered the questionnaire, the mean score was 11.28 during the pre-test. In the post-test questionnaire, the mean score was 13.91. There was a statistically significant difference (P=0.000) in the post-test scores conducted after 1 month. About 39.6% of students scored average marks (5–10) in the pre-test and 60.4% of students scored good (10–15) marks in the pre-test. After the training session in the post-test, 97.7% of students scored good marks (10–15) while only 2.32% scored average marks. P<0.001, Chi-square=35.97 is highly significant. Conclusion: BLS training helps to increase knowledge of CPR and the use of an AED.

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A comparison of the effect of two methods of positioning the hands during basic and advanced cardiovascular life support on the chest compression depth in adults

Journal of Cardiovascular and Thoracic Research ◽

10.15171/jcvtr.2019.51 ◽

2019 ◽

Vol 11 (4) ◽

pp. 314-317

Author(s):

Mohammadreza Bastami ◽

Parand Soliemanifard ◽

Roholla Hemmati ◽

Golnaz Forough Ameri ◽

Mahboobeh Rasouli ◽

...

Keyword(s):

Emergency Medicine ◽

Nursing Students ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Life Support ◽

Dominant Hand ◽

Compression Depth ◽

Men And Women ◽

Significant Difference ◽

Left And Right

Introduction: There is no agreement on how the hands are positioned in cardiopulmonary resuscitation (CPR). In this study, the effects of two methods of positioning the hands during basic and advanced cardiovascular life support on the chest compression depth are compared.<br /> Methods: In this observational simulation, the samples included 62 nursing students and emergency medicine students trained in CPR. Each student performed two interventions in both basic and advanced situations on manikins and two positions of dominant hand on non-dominant hand, and vice versa, within four weeks. At each compression, the chest compression depth was numerically expressed in centimeter. Each student was assessed individually and without feedback.<br /> Results: The highest mean chest compression depth was related to Basic Cardiovascular Life Support (BCLS) and the position of the dominant hand on non-dominant hand (5.50 ± 0.6) and (P = 0.04). There was no statistically significant difference in the basic and advanced regression variables in men and women except in the case of Advanced Cardiovascular Life Support (ACLS) with dominant hand on non-dominant hand (P = 0.018). There was no significant difference in mean chest compression during basic and advanced cardiovascular life support in left- and right-handed individuals (P = 0.09). <br /> Conclusion: When the dominant hand is on the non-dominant hand, more pressure with greater depth is applied.

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Comparison of standard and over-the-head method of chest compressions during cardiopulmonary resuscitation - a simulation study

10.21203/rs.2.11675/v2 ◽

2019 ◽

Author(s):

Michał Ćwiertnia ◽

Marek Kawecki ◽

Tomasz Ilczak ◽

Monika Mikulska ◽

Mieczysław Dutka ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Artificial Ventilation ◽

Hand Position ◽

Chest Compressions ◽

Confined Spaces ◽

Medical Response ◽

Significant Difference ◽

Emergency Interventions

Abstract Background: Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial ventilation using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient’s side with compression conducted from the ‘over-the-head’ position. Methods: The subject of the study were two methods of CPR – ‘standard’ (STD) and ‘over-the-head’ (OTH). The STD method consisted of cycles of 30 chest compressions from the patient’s side, and two attempts at artificial ventilation after moving round to behind the patient’s head. In the OTH method, both compression and ventilation were conducted from behind the patient’s head. Results: Both CPR methods were conducted by 38 paramedics working in medical response teams. Statistical analysis was conducted on the data collected, giving the following results: the average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p < 0.001); the depth of compression 50–60 mm (STD 50.65%, OTH 60.22%, p < 0.001); the rate of compression 100–120/min. (STD 46.39%, OTH 53.78%, p < 0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p < 0.001); correct hand position (STD 99.32%, OTH method 99.66%, p < 0.001). A statistically significant difference was demonstrated in the results to the benefit of the OTH method in the above parameters. The remaining parameters showed no significant differences in comparison to reference values. Conclusions: The demonstrated higher quality of CPR in the simulated research using the OTH method conducted by one person justifies the use of this method in a wider range of emergency interventions than only for CPR conducted in confined spaces.

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Comparison of standard and over-the-head method of chest compressions during cardiopulmonary resuscitation - a simulation study

10.21203/rs.2.11675/v3 ◽

2019 ◽

Author(s):

Michał Ćwiertnia ◽

Marek Kawecki ◽

Tomasz Ilczak ◽

Monika Mikulska ◽

Mieczysław Dutka ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Artificial Ventilation ◽

Hand Position ◽

Chest Compressions ◽

Medical Response ◽

Single Person ◽

Significant Difference ◽

Emergency Interventions

Abstract Background: Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial ventilation using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient’s side with compression conducted from the ‘over-the-head’ position. Methods: The subject of the study were two methods of CPR – ‘standard’ (STD) and ‘over-the-head’ (OTH). The STD method consisted of cycles of 30 chest compressions from the patient’s side, and two attempts at artificial ventilation after moving round to behind the patient’s head. In the OTH method, both compressions and ventilations were conducted from behind the patient’s head. Results: Both CPR methods were conducted by 38 paramedics working in medical response teams. Statistical analysis was conducted on the data collected, giving the following results: the average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p < 0.001); the depth of compression 50–60 mm (STD 50.65%, OTH 60.22%, p < 0.001); the rate of compression 100–120/min. (STD 46.39%, OTH 53.78%, p < 0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p < 0.001); correct hand position (STD 99.32%, OTH method 99.66%, p < 0.001). A statistically significant difference was demonstrated in the results to the benefit of the OTH method in the above parameters. The remaining parameters showed no significant differences in comparison to reference values. Conclusions: The higher quality of CPR in the simulated research using the OTH method by a single person justifies the use of this method in a wider range of emergency interventions.

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Comparison of standard and over-the-head method of chest compressions during cardiopulmonary resuscitation - a simulation study

BMC Emergency Medicine ◽

10.1186/s12873-019-0292-8 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Michał Ćwiertnia ◽

Marek Kawecki ◽

Tomasz Ilczak ◽

Monika Mikulska ◽

Mieczysław Dutka ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Artificial Ventilation ◽

Hand Position ◽

Chest Compressions ◽

Medical Response ◽

Single Person ◽

Significant Difference ◽

Emergency Interventions

Abstract Background Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial ventilation using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient’s side with compression conducted from the ‘over-the-head’ position. Methods The subject of the study were two methods of CPR – ‘standard’ (STD) and ‘over-the-head’ (OTH). The STD method consisted of cycles of 30 chest compressions from the patient’s side, and two attempts at artificial ventilation after moving round to behind the patient’s head. In the OTH method, both compressions and ventilations were conducted from behind the patient’s head. Results Both CPR methods were conducted by 38 paramedics working in medical response teams. Statistical analysis was conducted on the data collected, giving the following results: the average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p < 0.001); the depth of compression 50–60 mm (STD 50.65%, OTH 60.22%, p < 0.001); the rate of compression 100–120/min. (STD 46.39%, OTH 53.78%, p < 0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p < 0.001); correct hand position (STD 99.32%, OTH method 99.66%, p < 0.001). A statistically significant difference was demonstrated in the results to the benefit of the OTH method in the above parameters. The remaining parameters showed no significant differences in comparison to reference values. Conclusions The higher quality of CPR in the simulated research using the OTH method by a single person justifies the use of this method in a wider range of emergency interventions.

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Can real-time feedback improve the simulated infant cardiopulmonary resuscitation performance of basic life support and lay rescuers?

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-316576 ◽

2019 ◽

Vol 104 (8) ◽

pp. 793-801 ◽

Cited By ~ 1

Author(s):

Jeyapal Kandasamy ◽

Peter S Theobald ◽

Ian K Maconochie ◽

Michael D Jones

Keyword(s):

Cardiopulmonary Resuscitation ◽

Real Time ◽

Chest Compression ◽

Duty Cycle ◽

Basic Life Support ◽

Life Support ◽

Cycle Performance ◽

Chest Compressions ◽

High Quality ◽

Single Measure

BackgroundPerforming high-quality chest compressions during cardiopulmonary resuscitation (CPR) requires achieving of a target depth, release force, rate and duty cycle.ObjectiveThis study evaluates whether ‘real time’ feedback could improve infant CPR performance in basic life support-trained (BLS) and lay rescuers. It also investigates whether delivering rescue breaths hinders performing high-quality chest compressions. Also, this study reports raw data from the two methods used to calculate duty cycle performance.MethodologyBLS (n=28) and lay (n=38) rescuers were randomly allocated to respective ‘feedback’ or ‘no-feedback’ groups, to perform two-thumb chest compressions on an instrumented infant manikin. Chest compression performance was then investigated across three compression algorithms (compression only; five rescue breaths then compression only; five rescue breaths then 15:2 compressions). Two different routes to calculate duty cycle were also investigated, due to conflicting instruction in the literature.ResultsNo-feedback BLS and lay groups demonstrated <3% compliance against each performance target. The feedback rescuers produced 20-fold and 10-fold increases in BLS and lay cohorts, respectively, achieving all targets concurrently in >60% and >25% of all chest compressions, across all three algorithms. Performing rescue breaths did not impede chest compression quality.ConclusionsA feedback system has great potential to improve infant CPR performance, especially in cohorts that have an underlying understanding of the technique. The addition of rescue breaths—a potential distraction—did not negatively influence chest compression quality. Duty cycle performance depended on the calculation method, meaning there is an urgent requirement to agree a single measure.

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The Effect of Operator Position on the Quality of Chest Compressions Delivered in a Simulated Ambulance

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19005193 ◽

2019 ◽

Vol 35 (1) ◽

pp. 55-60

Author(s):

Scott Mullin ◽

Sinéad Lydon ◽

Paul O’Connor

Keyword(s):

Cardiopulmonary Resuscitation ◽

Patient Care ◽

Standing Position ◽

Compression Rate ◽

Chest Compressions ◽

Safety Risks ◽

Significant Difference ◽

The Mean

AbstractBackground:Ambulances are where patient care is often initiated or maintained, but this setting poses safety risks for paramedics. Paramedics have found that in order to optimize patient care, they must compromise their own safety by standing unsecured in a moving ambulance.Hypothesis/Problem:This study sought to compare the quality of chest compressions in the two positions they can be delivered within an ambulance.Methods:A randomized, counterbalanced study was carried out with 24 paramedic students. Simulated chest compressions were performed in a stationary ambulance on a cardiopulmonary resuscitation (CPR) manikin for two minutes from either: (A) an unsecured standing position, or (B) a seated secured position. Participants’ attitudes toward the effectiveness of the two positions were evaluated.Results:The mean total number of chest compressions was not significantly different standing unsecured (220; SD = 12) as compared to seated and secured (224; SD = 21). There was no significant difference in mean compression rate standing unsecured (110 compressions per minute; SD = 6) as compared to seated and secured (113 compressions per minute; SD = 10). Chest compressions performed in the unsecured standing position yielded a significantly greater mean depth (52 mm; SD = 6) than did seated secured (26 mm; SD = 7; P < .001). Additionally, the standing unsecured position produced a significantly higher percentage (83%; SD = 21) for the number of correct compressions, as compared to the seated secured position (8%; SD = 17; P < .001). Participants also believed that chest compressions delivered when standing were more effective than those delivered when seated.Conclusions:The quality of chest compressions delivered from a seated and secured position is inferior to those delivered from an unsecured standing position. There is a need to consider how training, technologies, and ambulance design can impact the quality of chest compressions.

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Effectiveness of hands-on cardiopulmonary resuscitation practice with self-debriefing for healthcare providers: A simulation-based controlled trial

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907917735086 ◽

2017 ◽

Vol 24 (6) ◽

pp. 268-274

Author(s):

Hsuan-Jui Fan ◽

Shih-Hao You ◽

Chien-Hsiung Huang ◽

Chen-June Seak ◽

Chip-Jin Ng ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Controlled Trial ◽

Healthcare Providers ◽

Control Group ◽

Resuscitation Training ◽

Significant Difference ◽

Hands On ◽

Post Test ◽

Adequate Rate

Introduction: The psychomotor skill of cardiopulmonary resuscitation emphasized the importance of high-quality chest compression. This investigation examined the effect of self-debriefing and the different materials of debriefing during hands-on cardiopulmonary resuscitation practice for healthcare providers. Methods: This was a randomized controlled trial of a cardiopulmonary resuscitation training program involving emergency medical technicians in northern Taiwan. Participants were blinded to the study purpose and were allocated randomly using the black envelope method. All participants completed a 2-min pre-test of hands-only cardiopulmonary resuscitation using a manikin. Those who were allocated to the control group received self-debriefing with knowledge of pre-test result. Those who were allocated to the experimental group received self-debriefing with an additional biomechanical information of performance of chest compression. A post-test was performed 30 min after the pre-test. Results: A total of 88 participants were enrolled with 44 in each group. There was significant difference of cardiopulmonary resuscitation quality after self-debriefing among all participants (pre- vs post-test adequate rate, 54.7% vs 67.5%, p = 0.028; adequate depth, 41.2% vs 69.5%, p < 0.001; full recoil, 35.9% vs 54.5%, p = 0.001). The analysis of effects of self-debriefing with additional knowledge of performance revealed no significant difference in any of the measurements (improvement in adequate rate, 11.3% vs 14.2%, p = 0.767; adequate depth, 29.6% vs 27.0%, p = 0.784; full recoil, 23.0% vs 14.1%, p = 0.275). Conclusion: Self-debriefing improved hands-only cardiopulmonary resuscitation quality whether or not biomechanical information of performance of chest compression was given.

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Grade 4 Liver Laceration after Cardiopulmonary Resuscitation: A Case Report

Asploro Journal of Biomedical and Clinical Case Reports ◽

10.36502/2021/asjbccr.6236 ◽

2021 ◽

Vol 4 (2) ◽

pp. 93-98

Author(s):

Sharoon Samuel ◽

Brent Brown ◽

Nita Mason ◽

Tony Abdo

Keyword(s):

Case Report ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Life Support ◽

Advanced Cardiac Life Support ◽

Medical Procedure ◽

Chest Compressions ◽

Successful Resuscitation ◽

Liver Laceration ◽

Vital Functions

Cardiopulmonary resuscitation (CPR) is a life-saving medical procedure used in the setting of cessation of cardiac and respiratory function of a patient to maintain vital functions. CPR was developed in the 1950s as mouth to mouth resuscitation. Defibrillation, chest compression and ventilation were added to CPR in 1960. Chest compressions are thought to be the most important aspect of CPR and adequate performance of chest compression is required for successful resuscitation as emphasized in recent guidelines. However, chest compressions may be a source of injury to ribs, sternum, spleen, stomach, or liver. We present a case of a 30-year-old female with end-stage renal disease, hypertension, polysubstance abuse, and GERD who underwent CPR resulting in a grade 4 liver laceration. The new guidelines of Advanced Cardiac Life Support emphasize the need of regular forceful chest compressions during CPR which, although required for proper resuscitation of the patient may result in significant injuries to the viscera as seen in this patient. The aim of this case report is to highlight the possible complications of CPR and its long-term consequences.

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USING DIFFERENT CHEST COMPRESSIONS AND VENTILATION RATIOS (2:1, 3:1, 4:1) DURING NEONATAL ASPHYXIA IN A PORCINE MODEL OF NEONATAL RESUSCITATION – A RANDOMIZED CONTROLLED ANIMAL TRIAL

Paediatrics & Child Health ◽

10.1093/pch/pxy054.054 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e21-e22

Author(s):

Matteo Pasquin ◽

Po-Yin Cheung ◽

Michael Wagner ◽

Tze-Fun Lee ◽

Megan O’Reilly ◽

...

Keyword(s):

Porcine Model ◽

Cerebral Oxygenation ◽

Neonatal Resuscitation ◽

Alternative Methods ◽

Compression Technique ◽

Neonatal Asphyxia ◽

Respiratory Parameters ◽

Animal Trial ◽

Significant Difference ◽

Group A

Abstract BACKGROUND The rationale for a compression to ventilation ratio of 3:1 in neonates with primary hypoxic, hypercapnic cardiac arrest is to emphasize the importance of ventilation; however, there are no published studies testing this approach against alternative methods. OBJECTIVES To evaluate if using a 2:1 C:V ratio or a 4:1 C:V ratio will improve ROSC compared to using a 3:1 C:V ratio. DESIGN/METHODS Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia. Asphyxia was achieved by clamping the endotracheal tube until the piglet had asystole; at that time CPR was initiated. Piglets were then randomized into 3 groups: 2:1 C:V ratio (n=8), 3:1 ratio (n=8), 4:1 C:V ratio (n=8), or a sham operated group. A two-step randomization was used to reduce selection bias. After surgical instrumentation and stabilization, a sequentially numbered, sealed brown envelope containing the allocation “sham” or “intervention” was opened (step one). The sham-operated group had the same surgical protocol, stabilization, and equivalent experimental periods without hypoxia and asphyxia. Only piglets randomized to “intervention” underwent hypoxia and asphyxia. Once the criteria for CPR were met, a second envelope containing the allocations “2:1”,“3:1”,or “4:1”, was opened (step two). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. RESULTS The median (IQR) duration of asphyxia was similar between the groups with 318 (194–576)sec, 255 (226–334)sec, 233 (169–395)sec for 2:1, 3:1, 4:1 C:V, respectively (p=0.68; oneway ANOVA with Bonferroni). The median (IQR) time to ROSC was also similar between groups 127 (82–210)sec, 96 (88–126)sec, 119 (83–256)sec for 2:1, 3:1, 4:1 C:V, respectively (p=0.67; oneway ANOVA with Bonferroni). Overall, 8/8 in the 2:1 C:V ratio group, 7/8 in the 3:1 C:V ratio group, and 7/8 in the 4:1 C:V ratio group survived. CONCLUSION There was no significant difference in time to ROSC for either chest compression technique during cardiopulmonary resuscitation in a porcine model of neonatal asphyxia.

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