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

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.

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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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Implementation of automatic external defibrillator using real time ventricular fibrillation detecting algorithm based on time domain analysis

Computer Assisted Surgery ◽

10.1080/24699322.2017.1379224 ◽

2017 ◽

Vol 22 (sup1) ◽

pp. 86-92 ◽

Cited By ~ 1

Author(s):

Ki Woong Seong ◽

Sung Dae Na ◽

Young Sik Park ◽

Hee-Joon Park ◽

Myoung Nam Kim ◽

...

Keyword(s):

Ventricular Fibrillation ◽

Real Time ◽

Time Domain ◽

Time Domain Analysis ◽

Domain Analysis ◽

Automatic External Defibrillator ◽

External Defibrillator

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

Journal of Clinical Medicine ◽

10.3390/jcm9051584 ◽

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.

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A Critical Approach to Clinical Practice Guidelines

Canadian Journal of Gastroenterology ◽

10.1155/2000/302785 ◽

2000 ◽

Vol 14 (6) ◽

pp. 505-509 ◽

Cited By ~ 6

Author(s):

John K Marshall

Keyword(s):

Health Care ◽

Clinical Practice ◽

Patient Outcomes ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Care Delivery ◽

Critical Approach ◽

High Quality ◽

Number Of Publications ◽

Improve Patient

The rate of publication of clinical practice guidelines for the management of common medical illnesses continues to accelerate. The appropriate dissemination and uptake of high quality practice guidelines can synthesize evidence, improve patient outcomes and enhance the efficiency of health care delivery. However, the methodological rigour and relevance of the growing number of publications labelled ’clinical practice guidelines’ vary widely. Health care payers, providers and advocates must learn to appraise and interpret guideline recommendations critically. A simple and practical nine-question approach to evaluating the quality, relevance and effectiveness of clinical practice guidelines is presented.

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

CJEM ◽

10.1017/cem.2016.373 ◽

2016 ◽

Vol 18 (6) ◽

pp. 461-468 ◽

Cited By ~ 5

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.

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Toward Rapid Sequenced-Based Detection and Characterization of Causative Agents of Bacteremia

10.1101/162735 ◽

2017 ◽

Cited By ~ 5

Author(s):

F. Curtis Hewitt ◽

Stephanie L. Guertin ◽

Krista L. Ternus ◽

Kathleen Schulte ◽

Dana R. Kadavy

Keyword(s):

Nucleic Acid ◽

Dna Sequencing ◽

Real Time ◽

Patient Outcomes ◽

Whole Blood ◽

Library Preparation ◽

Hybrid Detection ◽

Resistant Strains ◽

Improve Patient

AbstractRapid pathogen diagnosis and characterization performed by metagenomic DNA sequencing may permit physicians to better target therapies in order to improve patient outcomes. To this end, a novel sample-to-answer workflow was assembled to enable rapid clinical detection of causative pathogens of bacteremia in whole blood utilizing metagenomic sequence data captured by the MinION. Rapid lysis, nucleic acid purification, host depletion, and genomic DNA library preparation permitted the detection of multiple bacterial and fungal agents spiked into whole blood, with sequencing commencing within 40 minutes of sample receipt. A hybrid detection strategy utilizing targeted PCR detection of specific pathogens of concern was adopted to improve overall sensitivity. As a proof of concept, primers for relatively long amplicons (~ 1800 bp) were selected to enable the specific detection ofYersinia pestis. The resulting amplicon library was spiked onto the same sequencing flow cell used to perform genomic sequencing, permitting simultaneous pathogen detection via both targeted and untargeted sequencing workflows. Sensitivities on the order of 1×10^6 cells/mL and 1x10^5 cells/mL were achieved for untargeted and targeted detection, respectively, ofY. pestisgenomes spiked into whole blood. Bacterial and fungal species present in the ZymoBIOMICS Microbial Community Standard were also detected when spiked at similar levels. Variable quality of sequence reads was observed between the transposase-based and ligation-based library preparation methods, demonstrating that the more time consuming ligation-based approach may be more appropriate for the workflow described herein. Overall, this approach provides a foundation from which future point of care platforms could be developed to permit characterization of bacteremia within hours of admittance into a clinical environment.Author SummaryCases of bacteremia in the U.S. present a significant clinical challenge, especially due to rising rates of antimicrobial resistant strains. Rapid diagnosis of the etiologic pathogen and underlying drug resistance genetic signatures between the first and second antibiotic dose should improve patient outcomes and may permit physicians to better target antibiotic therapies without turning to broad spectrum antibiotics, which may further propagate resistant strains. The methods described herein have been developed to enhance the real time nature of the MinION sequencer. DNA sequencing and real time analysis begin within 40 minutes of sample receipt (as opposed to hours or days for common clinical nucleic acid extraction or blood culture techniques). The incorporation of sensitivity enhancements, such as methylation-based pulldown of human DNA or PCR targeted for pathogens of interest, ensures that this assay can detect bacterial blood infections at clinically relevant levels. The pathogen-agnostic aspect of the assay could one day allow clinicians to identify any unknown bacterial, fungal, or viral DNA in a sample. Ultimately, this study serves as an important step toward establishing a pipeline to rapidly detect and characterize pathogens present in whole blood.

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Testing mechanical chest compression devices for pre-hospital patient transport under resuscitation

10.21203/rs.3.rs-67562/v1 ◽

2020 ◽

Author(s):

Maximilian Jörgens ◽

Jürgen Körniger ◽

Karl-Georg Kanz ◽

Torsten Birkholz ◽

Heiko Hübner ◽

...

Keyword(s):

Chest Compression ◽

User Satisfaction ◽

Chest Compressions ◽

High Quality ◽

Physical Effort ◽

Patient Transport ◽

Device Stability ◽

Mechanical Chest Compression ◽

Electrical Devices ◽

Hospital Transport

Abstract Background Mechanical chest compression (mCPR) offers advantages during transport under cardiopulmonary resuscitation. Little is known how devices perform en-route. Aim of the study was to measure performance of mCPR devices of different design during pre-hospital transport.Methods We tested animax mono (AM), autopulse (AP), corpuls cpr (CC) and LUCAS2 (L2). The route had 6 stages (transport on soft stretcher or gurney involving a stairwell, trips with turntable ladder, rescue basket and ambulance including loading/unloading). Stationary mCPR with the respective device served as control. A four-person team carried an intubated and bag-ventilated mannequin under mCPR to assess device-stability (displacement, pressure point correctness), compliance with 2015 ERC guideline criteria for high-quality chest compressions (frequency, proportion of recommended pressure depth and compression-ventilation ratio) and user satisfaction (by standardized questionnaire).Results All devices performed comparable to stationary use. Displacement rates ranged from 83% (AM) to 11% (L2). Two incorrect pressure points occurred over 15,962 compressions (0.013%). Guideline-compliant pressure depth was > 90% in all devices and compression-ventilation ratio was 40% (AM), 87% (CC, L2 respectively) and 93% (AP). Electrically powered devices showed constant frequencies while muscle-powered AM showed more variability (median 100/min, interquartile range 9). Although physical effort of AM use was comparable (median 4.0 vs. 4.5 on visual scale), participants preferred electrical devices.Conclusion All devices showed good to very good performance although device-stability, guideline compliance and user satisfaction varied by design. Our results underline the importance to check stability and connection to patient under transport.

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The immediate effect of deliberate practice and real-time feedback on high-quality CPR training in intern doctors, acute care providers, and lay rescuers

10.22514/sv.2021.119 ◽

2021 ◽

Keyword(s):

Real Time ◽

Acute Care ◽

Deliberate Practice ◽

Acquisition Training ◽

Skills Acquisition ◽

Care Providers ◽

High Quality ◽

Training Outcomes ◽

Cpr Training ◽

The Impact

The quality of cardiopulmonary resuscitation (CPR) is the main determinant of survival in cardiac arrest, so high-quality CPR (HQ-CPR) from bystanders is essential. The best instructional model for HQ-CPR performed by bystanders remains under investigation, and an instructional model’s effect on various learner types is unknown. This study examined the immediate effect of a brief, blended instructional design that combines deliberate practice (DP) with real-time feedback (RTF) on the booster training of intern doctors (IDs) and acute care providers (ACPs) as well as on the skills acquisition training of lay rescuers (LRs). This cohort crossover study was conducted in a university-affiliated hospital in January 2020. Just-in-time training on HQ-CPR that featured a popular song was provided to IDs (n = 24), ACPs (n = 29), LRs (n = 25); groups performed one-minute cardiac compressions twice, without RTF and with verbal coaching, followed by debriefing, and then with only RTF. The impact of RTF on depth, rate, compression quality (CQ), and recoil was assessed. RTF significantly improved depth, rate, CQ, and recoil (p < 0.001). Among the LRs, the depth was 0.2 millimeters below the lower cutoff. Without RTF, the previously trained IDs and ACPs tended to perform inadequately faster and deeper compressions, while the untrained LRs performed slower, shallow compressions. DP combined with RTF yielded a significant immediate effect on the HQ-CPR training outcomes of all learner types.

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Increasing the Effectiveness of Targeted Temperature Management

Critical Care Nurse ◽

10.4037/ccn2021637 ◽

2021 ◽

Vol 41 (5) ◽

pp. 59-63

Author(s):

Melissa Moreda ◽

Pamela S. Beacham ◽

Angela Reese ◽

Malissa A. Mulkey

Keyword(s):

Patient Outcomes ◽

Targeted Temperature Management ◽

Fine Tuning ◽

Temperature Management ◽

Multimodal Approach ◽

High Quality ◽

Effective Interventions ◽

Essential Components ◽

Underlying Pathophysiology ◽

Improve Patient

Topic Targeted temperature management and therapeutic hypothermia are essential components of the multimodal approach to caring for compromised patients after cardiac arrest and severe traumatic brain injury. Clinical Relevance The continuously evolving science necessitates summation of individual facets and concepts to enhance knowledge and application for optimally delivering care. Targeted temperature management is a complex therapy that requires fine-tuning the most effective interventions to maintain high-quality targeted temperature management and maximize patient outcomes. Purpose To describe the underlying pathophysiology of fever and the importance of manipulating water temperature and of preventing and treating shivering during that process. Content Covered This article discusses nursing considerations regarding the care of patients requiring targeted temperature management that are necessary to improve patient outcomes.

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