Quantification of Passive Ventilation Produced by Manual Chest Compressions Using a New Cardiopulmonary Resuscitation Feedback Device

Abstract Several studies have shown that chest compressions (CC) alone may produce in addition to blood circulation, a short-term passive ventilation. However, it is not clear whether high CC quality may produce in even greater amount of ventilation volumes. The aim of this study was to evaluate whether CC, using a new feedback device, can produce a substantial and sustainable passive volumes compared to standard CC. Thirty inexperienced volunteers performed CC for 2 min on a developed thoracic lung model and using a new feedback device. Participants were randomized into two groups that performed either CC with feedback first, followed by a trial without feedback, or vice versa. Efficient compression rate (correct CC rate and depth simultaneously) was significantly higher in feedback session (43.6% versus 25.5%; P = 0.006). As well, CC rate and depth efficiency were improved with feedback. Moreover, average tidal volumes and minute volumes that occurred during CC alone were significantly improved in feedback session (79.8 ± 5 ml versus 72.9 ± 7 ml) and (8.8 l/min versus 7.9 l/min), respectively (P < 0.001). Yet, no significant difference was found between the first and the 90th second interval (9.04 l/min versus 8.68 l/min, P = 0.163) in the feedback session. Conversely, a significant difference was evident after the first 15th seconds interval without feedback (8.77 l/min initially versus 8.38 l/min; P = 0.041). This study revealed that the new CPR feedback device improved CC quality in inexperienced volunteers. As well, the passive ventilation volumes were significantly increased and sustained when the device was used.

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

Paediatrics & Child Health ◽

10.1093/pch/pxy054.071 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e27-e28

Author(s):

Sparsh Patel ◽

Po-Yin Cheung ◽

Tze-Fun Lee ◽

Matteo Pasquin ◽

Megan O’Reilly ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Porcine Model ◽

Life Support ◽

Neonatal Resuscitation ◽

Chest Compressions ◽

Neonatal Asphyxia ◽

Significant Difference ◽

Post Test ◽

The Mean

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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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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Abstract 13027: Investigating the Airway Opening Index During Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.144.suppl_2.13027 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Shiv Bhandari ◽

Jason Coult ◽

Natalie Bulger ◽

Catherine Counts ◽

Heemun Kwok ◽

...

Keyword(s):

Cardiac Arrest ◽

Retrospective Study ◽

Cardiopulmonary Resuscitation ◽

Statistical Significance ◽

Chest Compressions ◽

Airway Patency ◽

Significant Difference ◽

Airway Opening ◽

Automated Methods ◽

Hospital Cardiac Arrest

Introduction: In 40-70% of out-of-hospital cardiac arrest (OHCA) cases, chest compressions (CCs) during CPR induce measurable oscillations in capnography (E T CO 2 ). Recent studies suggest the magnitude and frequency of oscillations are due to intrathoracic airflow dependent on airway patency. These oscillations can be quantified by the Airway Opening Index (AOI), ranging from 0-100%. We sought to develop, automate, and evaluate multiple methods of computing AOI throughout CPR. Methods: We conducted a retrospective study of all OHCA cases in Seattle, WA during 2019. E T CO 2 and impedance waveforms from LifePak 15 defibrillators were annotated for the presence of intubation and CPR, and imported into MATLAB for analysis. Four proposed methods for computing AOI were developed (Fig. 1) using peak E T CO 2 in conjunction with ΔE T CO 2 (oscillations in E T CO 2 from CCs). We examined the feasibility of automating ΔE T CO 2 and AOI calculation during CCs throughout OHCA resuscitation and evaluated differences in mean AOI using each method. Statistical significance was assessed with ANOVA (alpha = 0.05). Results: AOI was measurable in 312 of 465 cases. Mean [95% confidence interval] AOI across all cases was 34.3% [32.0-36.5%] for method 1, 27.6% [25.5-29.7%] for method 2, 22.7% [21.1-24.3%] for method 3, and 28.8% [26.6-31.0%] for method 4. Mean AOI was significantly different across the four methods (p<0.001), with the greatest difference between method 1 and 3 (11.6%, p<0.001), but no significant difference between methods 2 and 4 (p=0.44). Mean ΔE T CO 2 was 7.76 [7.08-8.44] mmHg. Conclusion: We implemented four proposed methods of automatically calculating AOI during OHCA. Each method produced a different average AOI. Consistent, automated methods to measure AOI provide the foundation to evaluate if, and how, AOI may change with treatment or predict outcomes. These four approaches require additional investigation to understand which may be best suited to improve OHCA care.

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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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Chest Compressions in the Delivery Room

10.20944/preprints201810.0027.v1 ◽

2018 ◽

Author(s):

Catalina Garcia-Hidalgo ◽

Georg M. Schmölzer

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Poor Prognosis ◽

Delivery Room ◽

Chest Compressions ◽

Short Term ◽

Optimal Depth ◽

The Poor ◽

Sustained Inflation ◽

High Incidence

Annually, an estimated 13-26 million newborns need respiratory support and 2-3 million newborns need extensive resuscitation, defined as chest compression and 100% oxygen with or without epinephrine in the delivery room. Despite such care, there is a high incidence of mortality and short-term neurologic morbidity. The poor prognosis associated with receiving chest compression alone or with medications in the delivery room raises questions as to whether improved cardiopulmonary resuscitation methods specifically tailored to the newborn could improve outcomes. This review discusses the current recommendations, mode of action, different compression to ventilation ratio, continuous chest compression with asynchronous ventilations, chest compression and sustained inflation optimal depth, and oxygen concentration during cardiopulmonary resuscitation.

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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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Two-Thumb or Two-Finger Technique in Infant Cardiopulmonary Resuscitation by a Single Rescuer? A Meta-Analysis with GOSH Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17145214 ◽

2020 ◽

Vol 17 (14) ◽

pp. 5214

Author(s):

Chun-Yu Chang ◽

Yueh-Tseng Hou ◽

Yung-Jiun Chien ◽

Yu-Long Chen ◽

Po-Chen Lin ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Cardiopulmonary Arrest ◽

Meta Analysis ◽

Compression Rate ◽

Cochrane Central Register ◽

Compression Depth ◽

Neurological Outcomes ◽

Central Register ◽

Significant Difference ◽

Off Time

Out-of-hospital infant cardiopulmonary arrest is a fatal and uncommon event. High mortality rates and poor neurological outcomes may be improved by early cardiopulmonary resuscitation (CPR). The ongoing debate over two different infant CPR techniques, the two-thumb (TT) and the two-finger (TF) technique, has remained, especially in terms of the adequate compression depth, compression rate, and hands-off time. In this article, we searched three major databases, PubMed, EMBASE (Excerpta Medica database), and CENTRAL (Cochrane Central Register of Controlled Trials), for randomized control trials which compared the outcomes of interest between the TT and TF techniques in infant CPR. The results showed that the TT technique was associated with higher proportion of adequate compression depth (Mean difference (MD): 19.99%; 95%, Confidence interval (CI): 9.77 to 30.22; p < 0.01) than the TF technique. There was no significant difference in compression rate and hands-off time. In our conclusion, the TT technique is better in terms of adequate compression depth than the TF technique, without significant differences in compression rate and hands-off time.

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Effects of ‘rescuer’ rotating time on the quality of chest compressions: 1-minute vs. 2-minute intervals

Australasian Journal of Paramedicine ◽

10.33151/ajp.16.680 ◽

2019 ◽

Vol 16 ◽

Author(s):

Farhad Gheibati ◽

Mehdi Heidarzadeh ◽

Mahmood Shamshiri ◽

Fatemeh Sadeghpour

Keyword(s):

Experimental Study ◽

Chest Compression ◽

Crossover Design ◽

Compression Rate ◽

Chest Compressions ◽

Total Rate ◽

Study Results ◽

Significant Difference ◽

Better Than

IntroductionFatigue can influence the quality of continuous chest compression cardiopulmonary resuscitation (CCC-CPR). This study was conducted to compare the effect of ‘rescuer’ rotating time on the quality of chest compressions at 1-minute and 2-minute intervals.MethodsThe present semi-experimental study was conducted on 70 non-professional ‘rescuers’ as 35 two-person teams using a crossover design. All teams performed eight 2-minute cycles of CCC-CPR with a rotation of 1 minute and 2 minutes. Quality metrics of the chest compression rate, appropriate depth of compression, and total rate of compressions at the end of eight 2-minute cycles were used to assess the quality of the chest compressions.ResultsThe study results showed that the number of chest compressions with an adequate depth performed by the non-professional rescuers in the 1- and 2-minute scenarios wererespectively 118.18 and 100.87. There was no significant difference in the number of chest compressions between the two scenarios at the end of the CCC-CPR, but the number of compressions with sufficient depth in the 1-minute scenario was better than that in the 2-minute scenario.ConclusionThe study showed that although the rate of chest compression had a downward trend in the 1-minute scenario, rescuers maintained 100 to 120 chest compressions after 16 minutes. This means that non-professional rescuers replacement after 1 minute can increase chest compression with sufficient depth.

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Abstract 481: Cardiopulmonary Resuscitation: The Effect of Fatigue on Professional Rescuers During Continuous Chest Compressions

Circulation ◽

10.1161/circ.140.suppl_2.481 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Olibhear McAlister ◽

Adam Harvey ◽

Hannah Torney ◽

Ben McCartney ◽

Laura Davis ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Sudden Cardiac Arrest ◽

Multiple Linear Regression Model ◽

Rate Data ◽

Chest Compressions ◽

Minute Period ◽

Significant Difference ◽

The Mean ◽

External Defibrillator

Introduction: It is reported that quality of chest compressions (CC) during cardiopulmonary resuscitation (CPR) for both professional and non-professional rescuers often do not meet guideline requirements. Devices which provide feedback on the quality of CCs are designed to reduce the incidence of suboptimal compressions and promote the administration of effective CCs. Objective: This analysis investigates the effect of CPR duration on the performance of continuous CCs delivered by professional rescuers. Methods: Data were collected from a first responder group based in Texas, USA. Responders were instructed to use a CPR depth feedback device (Laerdal CPRmeter) and an automatic external defibrillator (AED; HeartSine SAM 350P) when attending sudden cardiac arrest events. The AED was configured with a shock protocol separated by 2-minute episodes of CPR and rescuer CC depth and rate were guided by the CPR depth feedback device. CC depth and rate data were processed for 174 patient events. Each CPR episode was divided into 4-analysis windows, 30-seconds in duration. Mean CC depth and rate data was calculated for each window. There were 1433 observations of CC depth and rate available for analysis across 414 CPR episodes. The data was fitted by a multiple linear regression model to assess the effect of CPR duration on CC performance. Results: The mean CC depth at the beginning of an event was 49.01 +/-0.51 mm. CC depth decreased by 0.82 mm, for each passing 30-second interval (p < 0.001). The mean CC rate at the beginning of an event was 111.17 +/- 0.33 compression per minute (CPM). No significant difference was observed between CC rate and duration of continuous CCs (p = 0.896) however there was a significant increase in CC rate observed of 0.408 CPM for each elapsed 2-minute CPR episode (p = 0.011). Conclusion: A reduction in CC depth was observed within each CPR episode, which may be indicative of fatigue during continuous CCs. Although a reduction of 3.28 mm throughout a 2-minute period of CPR may be clinically insignificant, this effect was observed within a trained rescuer group with CPR feedback. Further research is required to assess the effect of fatigue in non-professional responders.

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