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 Effect of the Use of Metronome Feedback on the Quality of Pediatric Cardiopulmonary Resuscitation

2021 ◽  
Vol 18 (15) ◽  
pp. 8087
Author(s):  
Dongjun Yang ◽  
Wongyu Lee ◽  
Jehyeok Oh
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Healthcare Providers ◽  
Compression Rate ◽  
Audio Feedback ◽  
Simple Method ◽  
Compression Depth ◽  
Pediatric Resuscitation ◽  
Cpr Quality

Although the use of audio feedback with devices such as metronomes during cardiopulmonary resuscitation (CPR) is a simple method for improving CPR quality, its effect on the quality of pediatric CPR has not been adequately evaluated. In this study, 64 healthcare providers performed CPR (with one- and two-handed chest compression (OHCC and THCC, respectively)) on a pediatric resuscitation manikin (Resusci Junior QCPR), with and without audio feedback using a metronome (110 beats/min). CPR was performed on the floor, with a compression-to-ventilation ratio of 30:2. For both OHCC and THCC, the rate of achievement of an adequate compression rate during CPR was significantly higher when performed with metronome feedback than that without metronome feedback (CPR with vs. without feedback: 100.0% (99.0, 100.0) vs. 94.0% (69.0, 99.0), p < 0.001, for OHCC, and 100.0% (98.5, 100.0) vs. 91.0% (34.5, 98.5), p < 0.001, for THCC). However, the rate of achievement of adequate compression depth during the CPR performed was significantly higher without metronome feedback than that with metronome feedback (CPR with vs. without feedback: 95.0% (23.5, 99.5) vs. 98.5% (77.5, 100.0), p = 0.004, for OHCC, and 99.0% (95.5, 100.0) vs. 100.0% (99.0, 100.0), p = 0.003, for THCC). Although metronome feedback during pediatric CPR could increase the rate of achievement of adequate compression rates, it could cause decreased compression depth.

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.

Abstract 312: "Stand Clear" Belongs to the Past: A Solution for Safe Hands-on Defibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jakob E Thomsen ◽  
Graham W Petley ◽  
Bo Løfgren ◽  
Charles D Deakin
Keyword(s):  
Leakage Current ◽  
Chest Compression ◽  
Chest Compressions ◽  
Case Scenario ◽  
Worst Case ◽  
The Past ◽  
Worst Case Scenario ◽  
Hands On ◽  
Class 1 ◽  
Additional Point

Introduction: Interruptions to chest compressions during defibrillation reduce the chances of subsequent ROSC and successful defibrillation. Safe hands-on defibrillation (HOD) will allow uninterrupted chest compression during defibrillation and may improve resuscitation success. We tested the safety of rescuer contact with the patient (at the waist) whilst additionally wearing electrical insulating gloves during clinical defibrillation; a worst case scenario. Materials and Method: Leakage current flowing from the patient to the ‘rescuer’ during defibrillation of patients undergoing elective defibrillation was measured. The ‘rescuer’ remained in contact with the patient during defibrillation, wearing Class 1 electrical insulating gloves while simulating an inadvertent contact with the patient, through an additional wired contact between rescuer’s waist and patient. The results were compared with an international safety threshold of 1 mA. Results: Data from 67 shocks of variable biphasic energy from a total of 50 patients was recorded. The median leakage current from all defibrillations was 30 μA, (range: 7 - 164). Of the 34 of the shocks delivered at 360J the median leakage current was 62 μA (range: 13 - 164), all below the safety threshold of 1 mA. Conclusion: This study demonstrates that leakage current through the rescuer is within a safe threshold to allow hands-on defibrillation when using electrically insulated gloves and in the presence of an additional point of contact with the patient

Does the quality of chest compressions deteriorate when the chest compression rate is above 120/min?

2013 ◽  
Vol 31 (8) ◽  
pp. 645-648 ◽  
Author(s):  
Soo Hoon Lee ◽  
Kyuseok Kim ◽  
Jae Hyuk Lee ◽  
Taeyun Kim ◽  
Changwoo Kang ◽  
...  
Keyword(s):  
Chest Compression ◽  
Compression Rate ◽  
Chest Compressions

PP25  Does unguided cardio-pulmonary-resuscitation in copenhagen achieve high quality recommendations?

2020 ◽  
Vol 37 (10) ◽  
pp. e12.1-e12
Author(s):  
Rasmus Meyer Lyngby ◽  
Dimitra Nikoletou ◽  
Fredrik Folke ◽  
Tom Quinn
Keyword(s):  
Heart Association ◽  
Compression Rate ◽  
High Quality ◽  
Compression Depth ◽  
Time Compression ◽  
Cardio Pulmonary Resuscitation ◽  
Hands On ◽  
Depth Compression ◽  
Hospital Cardiac Arrest

BackgroundSurvival from out-of-hospital cardiac arrest (OHCA) is associated with the quality of cardio-pulmonary-resuscitation (CPR). The European Resuscitation Council (ERC) and American Heart Association (AHA) define high quality CPR as compression depth of 5–6 centimeters, compression rate of 100–120 compressions/minute, full recoil (>400 milliseconds) after each compression and a hands-on time (compression fraction) of at least 60% (ERC) or 80% (AHA). The aim of this study was to investigate if unguided CPR performed by Copenhagen Emergency Medical Services (EMS) met these recommendations.MethodFrom October throughout December 2018, OHCA data were collected from ambulances within the Capital Region of Denmark using Zoll X-series defibrillator (without CPR feedback dashboard or metronome). Only cases where EMS performed CPR were included. Data was uploaded to a central database and extracted to EXCEL for descriptive statistics and preliminary results.ResultsEMS CPR was performed in 330 cases of which 252 were available for analysis. Mean (SD) compression depth was 5.6±1.7 centimeters, compression rate was 110±9.8 compressions/minute, release velocity was 410±125.1 milliseconds, compression quality (correct compression depth + correct compression rate) was 13.8% and compression fraction was 69.7%.ConclusionThe quality of EMS-delivered CPR, unguided by feedback or metronome, was within recommendations for compression depth, compression rate and release velocity. CPR fraction was between ERC and AHA guidelines. Compression quality, which is not included in ERC/AHA recommendations, did not reach the manufactures recommended >60%. Further work is ongoing to evaluate the effect of adding real-time feedback to guide EMS CPR.

Abstract 151: Software Annotation of Defibrillator Files: Ready for Prime Time?

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Vishal Gupta ◽  
Robert Schmicker ◽  
Pamela Owens ◽  
Elizabete Aramendi ◽  
Ahamed Idris
Keyword(s):  
Chest Compression ◽  
Intraclass Correlation ◽  
Spontaneous Circulation ◽  
Prime Time ◽  
Compression Rate ◽  
Fort Worth ◽  
Manual Annotation ◽  
Chest Compressions ◽  
The Mean

Introduction: Defibrillators record important information about the quality of chest compressions during CPR. Software made for reviewing defibrillator files automatically annotate and measure chest compression metrics. However, evidence is limited regarding the accuracy of such measurements. Objective: To compare chest compression fraction (CCF) and rate measurements made with software annotation vs. manual annotation of defibrillator files. Methods: This is a retrospective, observational study from the Dallas Fort-Worth site of the Resuscitation Outcomes Consortium. We reviewed chest compression waveforms from the bioimpedance channel of defibrillator recordings (Physio-Control Lifepak 12 and 15, Redmond, WA) of 100 prehospital patients enrolled in the DFW Cardiac Arrest Registry from 9/8/2018 to 3/9/2019. Included cases were ≥18 years, had presumed cardiac cause of arrest, and continuous chest compressions. We assessed chest compression waveforms from the time of initial CPR until the time the defibrillator was removed. A trained reviewer revised the software annotations by marking the start and end of CPR and adding or removing chest compressions. Software annotated and manual reviewer annotated measurements were compared for CCF and rate using intraclass correlation coefficient (ICC) statistical analysis. Results: Mean patient age was 63 years with 59% male. The mean (±SD) duration of CPR was 30.4 ± 10.6 min. The overall mean CCF for files annotated by software vs. manual annotation was 0.64 ± 0.19 vs. 0.86 ± 0.07, respectively, and the ICC was 0.14. For software vs. manual annotation, the overall mean rate was 109 ± 10 vs. 108 ± 10, respectively, and ICC was 0.99. The software misidentified epochs before the start of chest compressions, failed to capture epochs after resuscitation ended, and after return of spontaneous circulation, resulting in low ICC for CCF. The ICC was excellent for compression rate because the software only counted epochs where chest compressions were actually given. Conclusions: Software annotation performed poorly for chest compression fraction and very well for chest compression rate. Defibrillator files must be reviewed and annotated manually before quality of chest compression measurements are calculated.

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

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.

Abstract 261: Assessment of Area Duty Cycle in Manual Chest Compressions During Out-of-Hospital Cardiopulmonary Resuscitation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Sofía Ruiz de Gauna ◽  
Jesus M Ruiz ◽  
Digna M González-Otero ◽  
Mikel Leturiondo ◽  
Jose J Gutiérrez ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Duty Cycle ◽  
Compression Rate ◽  
Chest Compressions ◽  
Compression Depth ◽  
Resuscitation Guidelines ◽  
Compression Cycle ◽  
Patient’S Outcome ◽  
The Right ◽  
Relationship Of

Introduction: To be compliant with resuscitation guidelines, chest compressions (CCs) should be provided at a rate between 100 and 120 min -1 and a depth between 50 and 60mm during cardiopulmonary resuscitation (CPR). However, two manual CCs coincident in rate (the inverse of duration) and depth can show very different compression waveforms (left figure: the narrower CC depicted in blue suggests a higher impulse compression/decompression pattern). We hypothesized that area duty cycle (ADC) could characterize the narrowness of manual CCs. Objective: To assess the ADC of manual CCs during out-of-hospital CPR and its relationship with rate and depth. Methods: We collected electronic recordings containing compression signals from Philips HeartStart MRx monitor-defibrillators used in 30 patients during out-of-hospital CPR. ADC was defined as the ratio between the area under the compression curve (dashed area in the right figure) and the total area of the compression cycle with maximum depth (area of the red box). For each CC, we annotated the compression duration T c , the area under the depth curve A, and the maximum compression depth D. ADC was computed as 100·A/T c ·D (%). The linear relationship of ADC with compression rate and depth was assessed. Results: A total of 66,971 CCs were annotated. Medians (5 th -95 th percentiles) for compression rate, depth and ADC were 109.9 min -1 (93.8, 133), 46.5 mm (30.1, 61.7), and 41.9% (32.1, 49.5), respectively. ADC showed a very low correlation with rate and depth, favoring ADC’s independence. For every 10 min -1 increase in rate, ADC increased 0.16%. For every 10 mm increase in depth, ADC decreased 0.5%. Conclusions: ADC metric could be used for characterizing the narrowness of manual CCs, independently of depth and rate. This finding could contribute to improve understanding of manual CPR dynamics and their influence on patient’s outcome.

scholarly journals Leg-heel chest compression as an alternative for medical professionals in times of COVID-19

2021 ◽  
Author(s):  
Matthias Ott ◽  
Alexander Krohn ◽  
Laurence H. Bilfield ◽  
F. Dengler ◽  
C. Jaki ◽  
...  
Keyword(s):  
Chest Compression ◽  
Effective Alternative ◽  
Medical Professionals ◽  
Compression Rate ◽  
Compression Depth ◽  
Significant Difference ◽  
Manual Chest Compression ◽  
Special Circumstances ◽  
Previous Training

AbstractObjectiveTo evaluate leg-heel chest compression without previous training as an alternative for medical professionals and its effects on distance to potential aerosol spread during chest compression.Methods20 medical professionals performed standard manual chest compression followed by leg-heel chest compression after a brief instruction on a manikin. We compared percentage of correct chest compression position, percentage of full chest recoil, percentage of correct compression depth, average compression depth, percentage of correct compression rate and average compression rate between both methods. In a second approach, potential aerosol spread during chest compression was visualized.ResultsThere was no significant difference between manual and leg-heel compression. The distance to potential aerosol spread could have been increased by leg-heel method.ConclusionUnder special circumstances like COVID-19-pandemic, leg-heel chest compression may be an effective alternative without previous training compared to manual chest compression while markedly increasing the distance to the patient.

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