Abstract 122: Compression-Induced Ventilation Volumes Decrease with Chest Compression Depth and Prolonged CPR

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Simone Ordelman ◽  
Paul Aelen ◽  
Paul van Berkom ◽  
Gerrit J Noordergraaf
Keyword(s):  
Gas Exchange ◽  
Endotracheal Tube ◽  
Chest Compression ◽  
Minute Ventilation ◽  
Time Effect ◽  
Chest Compressions ◽  
Initial Value ◽  
Compression Depth ◽  
Minute Period ◽  
Over Time

Introduction: Compression-induced ventilation may aid gas exchange during CPR. We hypothesized that the amount of gas moving in and out of the lungs depends on chest compression depth. Methods: VF was induced in five female, anesthetized and intubated pigs of about 30 kg. After 30 seconds of non-intervention time, chest compressions were started and maintained at a rate of 100 compressions per minute. Every two minutes chest compression depth was altered, resulting in 14 minutes of CPR with a depth sequence of 4 cm, 3 cm, 4 cm, 5 cm, 5.5 cm, 5 cm and 4 cm. Ventilations were performed manually with a bag-valve device 10 times per minute during continuous chest compressions by a dedicated expert. Airway flow was measured at the end of the endotracheal tube. Compression-induced ventilation was determined from the periods between the manual ventilations. The average compression-induced minute ventilation volume was determined over the last minute of each two minute period of CPR at each specific chest compression depth. Results: The compression-induced ventilation volume in the first period of CPR at 4 cm of depth was 1.6 ± 0.9 L/min (about 4% of total ventilation volume). The figure shows how the compression-induced ventilation volume decreases with increasing chest compression depth, relative to this initial value. CPR with a chest compression depth of 4 cm was performed three times in each pig, and the corresponding compression-induced ventilation volumes decreased with time. This suggested that there might be just a time effect (e.g. atelectasis). However, the final compression depth of 4 cm resulted in larger compression-induced ventilation volumes than the preceding 5 cm and 5.5 cm compression depths, indicating that the decreased volume over time could not purely be a time effect, but must also be an effect of the depth. Conclusion: In conclusion, compression-induced ventilation volume appears to decrease with deeper chest compressions as well as with prolonged CPR.

scholarly journals Relationship between Hand Force and Chest Compression in Manikin Study

2020 ◽  
Vol 34 (5) ◽  
pp. 93-97
Author(s):  
So-Yeon Shin
Keyword(s):  
Cardiac Arrest ◽  
Grip Strength ◽  
Chest Compression ◽  
Back Muscle ◽  
Chest Compressions ◽  
Compression Technique ◽  
Compression Depth ◽  
Hand Force ◽  
Cpr Training ◽  
Over Time

A C-shaped bend is prevalent in long, thin fingers when administering the two-finger compression technique in infant cardiac arrest, making vertical chest compressions difficult. This study was a mannequin experiment, which investigated the effect of grip and back muscle strengths on the outcome of infant chest compressions. Twenty 4th year paramedicine students who had completed 15 weeks of cardiopulmonary resuscitation (CPR) training were recruited as subjects in this study. The results demonstrated greater grip strength in men than in women. Additionally, grip strength, height, and sex were found to have significant correlations with the depth of chest compressions. The chest compression depth decreased over time, using the two-finger compression technique, while the rate of incomplete release increased. Grip strength was observed to affect the ability to maintain compression depth over time, demonstrating the need for a program to improve basic fitness.

Abstract 17334: The Detrimental Effect of Chest Compression Interruptions on Coronary Perfusion Pressure Dynamics

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Norman A Paradis ◽  
Karen L Moodie ◽  
Christopher L Kaufman ◽  
Joshua W Lampe
Keyword(s):  
Blood Flow ◽  
Chest Compression ◽  
Detrimental Effect ◽  
Perfusion Pressure ◽  
Vena Cava ◽  
Coronary Perfusion Pressure ◽  
Right Atrial ◽  
Coronary Perfusion ◽  
Chest Compressions ◽  
Over Time

Introduction: Guidelines for treatment of cardiac arrest recommend minimizing interruptions in chest compressions based on research indicating that interruptions compromise coronary perfusion pressure (CPP) and blood flow and reducing the likelihood of successful defibrillation. We investigated the dynamics of CPP before, during, and after compression interruptions and how they change over time. Methods: CPR was performed on domestic swine (~30 Kg) using standard physiological monitoring. Blood flow was measured in the abdominal aorta (AAo), the inferior vena cava, the right common carotid and external jugular. Ventricular fibrillation (VF) was electrically induced. Mechanical chest compressions (CC) were started after four minutes of VF. CC were delivered at a rate of 100 compressions per minute (cpm) and at a depth of 2” for a total of 12 min. CPP was calculated as the difference between aortic and right atrial pressure at end-diastole per Utstein guidelines. CPP was determined for 5 compressions prior to the interruption, every 2 seconds during the CC interruption, and for 7 compressions after the interruption. Per protocol, 12 interruptions occurred at randomized time points. Results: Across 12 minutes of CPR, averaged CPP prior to interruption was significantly greater than the averaged CPP after the interruption (22.4±1.0 vs. 15.5±0.73 mmHg). As CPR continued throughout the 12 minutes, CPP during compressions decreased (First 6 min = 24.1±1.4 vs. Last 6 min = 20.1±1.3 mmHg, p=0.05), but the effect of interruptions remained constant resulting in a 20% drop in CPP for every 2 seconds irrespective of the prior CPP. The increase (slope) of CPP after resumption of compressions was significantly reduced over time (First 6 min = 1.47±0.18 vs. Last 6 min = 0.82±0.13 mmHg/compression). Conclusions: Chest compression interruptions have a detrimental effect on coronary perfusion and blood flow. The magnitude of this effect increases over time as a resuscitation effort continues. These data confirm the importance of providing uninterrupted CPR particularly in long duration resuscitations.

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.

scholarly journals CPR Compression Rotation Every One Minute Versus Two Minutes: A Randomized Cross-Over Manikin Study

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Nutthapong Pechaksorn ◽  
Veerapong Vattanavanit
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Chest Compression ◽  
Life Support ◽  
Chest Compressions ◽  
Compression Depth ◽  
End Points ◽  
The One ◽  
Support Guidelines

Background. The current basic life support guidelines recommend two-minute shifts for providing chest compressions when two rescuers are performing cardiopulmonary resuscitation. However, various studies have found that rescuer fatigue can occur within one minute, coupled with a decay in the quality of chest compressions. Our aim was to compare chest compression quality metrics and rescuer fatigue between alternating rescuers in performing one- and two-minute chest compressions. Methods. This prospective randomized cross-over study was conducted at Songklanagarind Hospital, Hat Yai, Songkhla, Thailand. We enrolled sixth-year medical students and residents and randomly grouped them into pairs to perform 8 minutes of chest compression, utilizing both the one-minute and two-minute scenarios on a manikin. The primary end points were chest compression depth and rate. The secondary end points included rescuers’ fatigue, respiratory rate, and heart rate. Results. One hundred four participants were recruited. Compared with participants in the two-minute group, participants in the one-minute group had significantly higher mean (standard deviation, SD) compression depth (mm) (45.8 (7.2) vs. 44.5 (7.1), P=0.01) but there was no difference in the mean (SD) rate (compressions per min) (116.1 (12.5) vs. 117.8 (12.4), P=0.08), respectively. The rescuers in the one-minute group had significantly less fatigue (P<0.001) and change in respiratory rate (P<0.001), but there was no difference in the change of heart rate (P=0.59) between the two groups. Conclusion. There were a significantly higher compression depth and lower rescuer fatigue in the 1-minute chest compression group compared with the 2-minute group. This trial is registered with TCTR20170823001.

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

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.

Manual CPR Vs Mechanical CPR: Which One Is More Effective During Ambulance Transport?

2020 ◽  
Author(s):  
İshak Şan ◽  
Burak Bekgöz ◽  
Mehmet Ergin ◽  
Eren Usul
Keyword(s):  
Chest Compression ◽  
Training Model ◽  
Chest Compressions ◽  
Compression Depth ◽  
Compression Device ◽  
Mechanical Chest Compression ◽  
Ambulance Transport ◽  
Mechanical Cpr ◽  
Off Time ◽  
Trial Setting

Abstract Objectives We aimed to evaluate and compare the qualities of chest compressions performed manually by healthcare professionals and by a mechanical chest compression device on a training model during an ambulance transfer. DesignThis is an experimental trial. Setting This study was performed by the EMS of Ankara City (Capital of Turkey). 20 (10 male and 10 female) paramedic participated the study. We used LUCAS 2 as mechanical chest compression device in the study. A total of 40 rounds were driven on the track; in that moving ambulance, the model was applied chest compression in 20 rounds by paramedics, while in 20 rounds were applied by mechanical chest compression device. The depth, rate and hands-off time of chest compression were measured by means of the model's recording system. Results The median chest compression rate was 120.1 compressions per minute (IQR 25–75%=117.9–133.5) for the paramedics, whereas it was 102.3 compressions per minute for the mechanical chest compression device (IQR 25–75%=102.1–102.7) (p<0.001). The median chest compression depth was 38.9 millimeters (IQR 25–75%=32.9–45.5) for the paramedics, whereas it was 52.7 millimeters for the mechanical chest compression device (IQR 25–75%=51.8–55.0) (p<0.001). The median hands-off time during cardiopulmonary resuscitation was 6.9% (IQR 25–75=5.0–10.1%) for the paramedics and 9% (IQR 25–75%=8.2–12.5%) (p=0.09). Conclusion Chest compressions performed by the mechanical chest compression device were found to be within the range recommended by the guidelines in terms of both speed and duration.

Abstract 324: Assessment of Optimal Chest Compression Depth to Optimize Cardiopulmonary Resuscitation: A Randomized Controlled Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Marlies Bruckner ◽  
Seung Yeun Kim ◽  
Gyu Hong Shim ◽  
Mattias Neset ◽  
Po-yin Cheung ◽  
...  
Keyword(s):  
Chest Compression ◽  
Controlled Trial ◽  
Minute Ventilation ◽  
Venous Pressure ◽  
Term Survival ◽  
Compression Depth ◽  
Neonatal Piglets ◽  
Respiratory Parameters ◽  
Anterior Posterior ◽  
Short Term Survival

Introduction: Neonatal chest compression (CC) should be performed to a 1/3 anterior-posterior (AP) chest diameter depth, however, the optimal AP depth is unknown. Hypothesis: We hypothesized that in asphyxiated neonatal piglets a 40% AP depth compared to 1/3, or 1/4 AP depth will reduce time to achieve return of spontaneously circulation and improve survival. Methods: Newborn piglets (n=8/group) were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by asphyxia and cardiac arrest. Piglets were randomly allocated to four intervention groups (“AP 12.5% depth”, “AP 1/4 depth”, “AP 1/3 depth” or “AP 40% depth“). CCs were performed using an automated CC machine with a rate of 90/min. Hemodynamic and respiratory parameters were continuously measured. Results: Median (IQR) time to return of spontaneously circulation was 70 (60-117), 85 (72-90), 90 (90-130), and 600 (600-600) sec with AP 40% depth, AP 1/3 depth, AP 1/4 depth, AP 12.5% depth, respectively. No piglet in the AP 12.5% depth group achieved ROSC while the short-term survival (1h) in the other groups was 100%. Systolic and diastolic blood pressure, central venous pressure, carotid blood flow, tidal volume, and minute ventilation increased with increasing AP depth. Conclusions: Time to return of spontaneously circulation and survival was similar between 1/4, 1/3, and 40% AP depth, while 12.5% AP depth did not result in return of spontaneously circulation. Hemodynamic and respiratory parameters improved with increasing AP depth suggesting that 40% AP depth might provide improved organ perfusion and oxygen delivery.

scholarly journals Comparison of Adult Manikin Chest Compression between Music and Metronome Practice after Video Self-Instruction

2021 ◽  
Vol 35 (1) ◽  
pp. 122-127
Author(s):  
Hee-Jeong Hwang ◽  
Tai-Hwan Uhm
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Training Group ◽  
Training Methods ◽  
Training Method ◽  
Chest Compressions ◽  
Compression Depth ◽  
Training Groups ◽  
Self Instruction ◽  
Cpr Training

The study was conducted to improve chest compression training by analyzing manikin-assessed scores on chest compression and self-assessed scores on cardiopulmonary resuscitation (CPR) based on music and metronome training after video self-instruction (VSI). The 64 participants had undertaken 50 min of VSI and practiced 25 min of compression-only (C-O) CPR. Thirty-two participants of the music (the Bee Gees’ Stayin’ Alive) training group practiced C-O CPR 103 times a min, while 32 participants of the metronome training group practiced C-O CPR at 100 times a min. Immediately after the training, participants performed 150 chest compressions on Resusci Anne SkillReporter; researchers collected 64 printouts, and 128 self-assessed scores on willingness, knowledge, performance, and attitude through pre and post-training questionnaires. There was no difference in the manikin-assessed scores between the music and metronome training groups. The two training methods were consistent with or similar to the compression guidelines. Therefore, C–O CPR training can be imparted by utilizing music as well as the existing metronome training method; however, supplementary research on how to maintain compression depth is needed, and ventilation training should be provided using other feedback devices.

scholarly journals Chest compression with 2-DOF parallel manipulator for cardiopulmonary resuscitation

2018 ◽  
Vol 7 (2.8) ◽  
pp. 211
Author(s):  
G Yedukondalu ◽  
Sajjan Patnaik ◽  
P Lakshmi Venkatesh ◽  
S Siva Jagadeesh
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Kinematic Analysis ◽  
Parallel Manipulator ◽  
Chest Compressions ◽  
Compression Process ◽  
Compression Depth ◽  
Physical Constraints ◽  
Emergency Situations

Chest compression process is used for recovering patients who met with a cardiac arrest in emergency situations. Chest compression is the only possibility of rescuing patients during cardiopulmonary resuscitation (CPR). It is hard to achieve the exact chest compression’s depth and rate even by experienced professionals as per the CPR guideline. A 2-DOF 2-RRR translational parallel manipulator was designed for delivering chest compressions. The kinematic analysis is carried out analytically.The workspace of the manipulator is examined in consideration of physical constraints imposed by joints. Finally, the manipulator operates with exact compression depth and rate during CPR.

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