Abstract 290: Cardiopulmonary Resuscitation Duty Cycle in Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Thomas Rea ◽  
Bryce Johnson ◽  
Jason Coult ◽  
Carol Fahrenbruch ◽  
Jennifer Blackwood ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Duty Cycle ◽  
Future Research ◽  
Compression Rate ◽  
High Survival ◽  
Compression Depth ◽  
Total Period ◽  
Compression Phase ◽  
Compression Time ◽  
Rate Test

Background: CPR duty cycle is the portion of time spent in compression relative to the total time of the compression-decompression cycle. Guidelines recommend a 50% duty cycle based largely on animal investigation. Little is known about duty cycle in human resuscitation and whether duty cycle correlates with other CPR measures. Methods: We calculated the duty cycle, compression depth, and compression rate during EMS resuscitation of 164 patients with out-of-hospital ventricular fibrillation cardiac arrest. We captured force recordings from a chest accelerometer to measure ten-second CPR epochs that immediately preceded each scheduled rhythm analysis. Duty cycle was calculated using two methods. The effective compression time (ECT) is the time from beginning to end of compression divided by total period for that compression-decompression cycle. The area duty cycle (ADC) is the ratio of area under the force curve divided by total area of one compression-decompression cycle. We evaluated the compression depth and compression rate according to duty cycle quartiles. Results: There were 369 ten-second epochs among 164 patients. The median duty cycle was 38.8% (SD=5.5%) using ECT and 32.2% (SD=4.3%) using ADC. A relatively shorter compression phase (lower duty cycle) was associated with greater compression depth (test for trend < 0.05 for ECT and ADC) and slower compression rate (test for trend < 0.05 for ADC) (Table). Sixty-one patients (37%) survived to hospital discharge. Conclusions: In this system with high survival, duty cycle was well below the 50% recommended guideline, and was associated with compression depth and rate. These findings provide rationale to incorporate duty cycle into future research to evaluate how CPR influences resuscitation.

Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest

Resuscitation ◽  
2012 ◽  
Vol 83 (11) ◽  
pp. 1319-1323 ◽  
Author(s):  
Koenraad G. Monsieurs ◽  
Melissa De Regge ◽  
Kristof Vansteelandt ◽  
Jeroen De Smet ◽  
Emmanuel Annaert ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Compression Rate ◽  
Compression Depth ◽  
Prehospital Cardiac Arrest

scholarly journals Correlation of EEG-based brain resuscitation index and end-tidal carbon dioxide in porcine cardiac arrest model

2021 ◽  
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Arrest ◽  
Mixed Model ◽  
Compression Rate ◽  
Compression Depth ◽  
Mixed Model Analysis ◽  
End Tidal Carbon Dioxide ◽  
Brain Resuscitation ◽  
End Tidal ◽  
Evaluation And Monitoring

Evaluation and monitoring perfusion of vital organs is important during resuscitation from cardiac arrest. We developed a non-invasive electroencephalogram (EEG) based brain resuscitation index (EBRI) as a physiologic indicator measuring organ perfusion during cardiopulmonary resuscitation (CPR) and evaluated the correlation of EBRI and end-tidal carbon dioxide (ETCO2). A randomized crossover experimental study using a porcine cardiac arrest model was designed. After 1 minute of untreated ventricular fibrillation, 10 periods of higher-quality CPR (compression depth 5 cm and compression rate 100/min) for 50 seconds and lower-quality CPR (compression depth 3 cm and compression rate 60/min) for 50 seconds were performed in alternation. EBRI was calculated from the single EEG channel with the lowest noise. Mixed-model analysis was conducted to compare the differences of hemodynamic parameters, ETCO2, and EBRI between higher-quality CPR periods and lower-quality CPR periods. Pearson’s correlation coefficient was calculated to assess correlation between EBRI and ETCO2. The experiment was performed on 5 female swine (44.6 ± 2.8 kg). Higher-quality CPR showed significantly higher delta EBRI (median [IQR] 0.1 [0.0–0.2]) than did lower-quality CPR (median [IQR] –0.1 [–0.2–0.0], p < 0.01). EBRI had a statistically moderate positive correlation with ETCO2 (r = 0.51). In this porcine cardiac arrest model, EBRI was successfully obtained during resuscitation and had a statistically moderate correlation with ETCO2.

scholarly journals Consistency and variability in human performance during simulate infant CPR: a reliability study

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Debora Almeida ◽  
Carol Clark ◽  
Michael Jones ◽  
Phillip McConnell ◽  
Jonathan Williams
Keyword(s):  
Chest Compression ◽  
Duty Cycle ◽  
Repeated Measures ◽  
Human Performance ◽  
Life Support ◽  
Intraclass Correlation ◽  
Minimal Detectable Change ◽  
Compression Rate ◽  
Quality Indices ◽  
Compression Depth

Abstract Background Positive outcomes from infant cardiac arrest depend on the effective delivery of resuscitation techniques, including good quality infant cardiopulmonary resuscitation (iCPR) However, it has been established that iCPR skills decay within weeks or months after training. It is not known if the change in performance should be considered true change or inconsistent performance. The aim of this study was to investigate consistency and variability in human performance during iCPR. Methods An experimental, prospective, observational study conducted within a university setting with 27 healthcare students (mean (SD) age 32.6 (11.6) years, 74.1% female). On completion of paediatric basic life support (BLS) training, participants performed three trials of 2-min iCPR on a modified infant manikin on two occasions (immediately after training and after 1 week), where performance data were captured. Main outcome measures were within-day and between-day repeated measures reliability estimates, determined using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC95%) for chest compression rate, chest compression depth, residual leaning and duty cycle along with the conversion of these into quality indices according to international guidelines. Results A high degree of reliability was found for within-day and between-day for each variable with good to excellent ICCs and narrow confidence intervals. SEM values were low, demonstrating excellent consistency in repeated performance. Within-day MDC values were low for chest compression depth and chest compression rate (6 and 9%) and higher for duty cycle (15%) and residual leaning (22%). Between-day MDC values were low for chest compression depth and chest compression rate (3 and 7%) and higher for duty cycle (21%) and residual leaning (22%). Reliability reduced when metrics were transformed in quality indices. Conclusion iCPR skills are highly repeatable and consistent, demonstrating that changes in performance after training can be considered skill decay. However, when the metrics are transformed in quality indices, large changes are required to be confident of real change.

scholarly journals Real-Time Chest Compression Quality Measurements by Smartphone Camera

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Øyvind Meinich-Bache ◽  
Kjersti Engan ◽  
Tonje Søraas Birkenes ◽  
Helge Myklebust
Keyword(s):  
Cardiac Arrest ◽  
Real Time ◽  
Chest Compression ◽  
Quality Measurement ◽  
Smartphone Application ◽  
Average Error ◽  
Compression Rate ◽  
Chest Compressions ◽  
Compression Time ◽  
Cpr Quality

Out-of-hospital cardiac arrest (OHCA) is recognized as a global mortality challenge, and digital strategies could contribute to increase the chance of survival. In this paper, we investigate if cardiopulmonary resuscitation (CPR) quality measurement using smartphone video analysis in real-time is feasible for a range of conditions. With the use of a web-connected smartphone application which utilizes the smartphone camera, we detect inactivity and chest compressions and measure chest compression rate with real-time feedback to both the caller who performs chest compressions and over the web to the dispatcher who coaches the caller on chest compressions. The application estimates compression rate with 0.5 s update interval, time to first stable compression rate (TFSCR), active compression time (TC), hands-off time (TWC), average compression rate (ACR), and total number of compressions (NC). Four experiments were performed to test the accuracy of the calculated chest compression rate under different conditions, and a fifth experiment was done to test the accuracy of the CPR summary parameters TFSCR, TC, TWC, ACR, and NC. Average compression rate detection error was 2.7 compressions per minute (±5.0 cpm), the calculated chest compression rate was within ±10 cpm in 98% (±5.5) of the time, and the average error of the summary CPR parameters was 4.5% (±3.6). The results show that real-time chest compression quality measurement by smartphone camera in simulated cardiac arrest is feasible under the conditions tested.

Abstract 205: Variability of Chest Compression Duty Cycle in the Treatment of Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jessica A Cutler ◽  
David D Salcido ◽  
James J Menegazzi
Keyword(s):  
Cardiac Arrest ◽  
Duty Cycle ◽  
Maximum Depth ◽  
Research Network ◽  
Compression Depth ◽  
Dc Characteristics ◽  
Minute Period ◽  
Clinical Center ◽  
Network Compression ◽  
Hospital Cardiac Arrest

Background: The duty cycle (DC) of cardiopulmonary resuscitation (CPR), which, from the start of one compression to the start of the next compression, describes the proportion of time spent compressing the chest downward, may be useful for characterizing CPR quality. Fifty percent is considered an optimal CPR DC, but little is known about real world DC characteristics. Objective: To describe DC characteristics of CPR delivered during the treatment of out-of-hospital cardiac arrest (OHCA). Methods: Defibrillator download files for cases of OHCA treated by emergency medical services (EMS) between 2006 and 2008 were obtained from the Pittsburgh regional clinical center of the Resuscitation Outcomes Consortium (ROC), a multi-center clinical research network. Compression depth data were imported into custom software, screened for artifacts, and then parsed and analyzed to establish start, end, and maximum depth for each compression. DC was calculated as the proportion of a compression prior to maximum depth. Descriptive statistics were reported for compression depth in centimeters, rate in compressions per minute (CPM) and DC, averaged over each minute of CPR for up to 30 minutes. Generalized estimating equations (GEE) were used to model the relationship between DC and rate, depth and time. Results: The 328 cases included in this study had a mean (SD) age of 64.9 (16.7) years and were predominantly male (61.9%, SE: 2.7). A total of 393,013 analyzable compressions were detected. Figure 1 shows the average CPR DC, rate and depth over the first 30 minutes. Average DC for this period ranged from 44.0% to 46.7%. Mean (SD) DC for the entire 30 minute period was 45.6% (5.2). In a GEE model, DC was inversely related to rate (coeff: -0.0004, p<0.001) and time (coeff: -0.0006, p<0.001), but directly related to depth (coeff: 0.0038, p<0.001). Conclusions: DC in EMS-treated OHCA cases was less than the 50% standard, decreased over time, and correlated with both compression rate and depth.

Abstract 1806: End-tidal Carbon Dioxide as a Measure of Cardiopulmonary Resuscitation Efficacy during Human Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Joshua L Wallbrecht ◽  
Dana P Edelson ◽  
Barbara Litzinger ◽  
Deborah Walsh ◽  
Terry L Vanden Hoek ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Arrest ◽  
Chest Compression ◽  
Compression Rate ◽  
Medical Systems ◽  
Compression Depth ◽  
Mean Values ◽  
End Tidal Carbon Dioxide ◽  
Cpr Quality ◽  
End Tidal

Background: End-tidal carbon dioxide (EtCO 2 ) is a physiologic measure that has potential to serve as an indicator of chest compression efficacy, with higher EtCO 2 values during CPR correlating with improved hemodynamics during prior laboratory studies. EtCO 2 measurement could therefore guide resuscitation efforts and help optimize CPR performance. Objective: To test the hypothesis that EtCO 2 levels positively correlate with improved chest compression rate and depth during human cardiac arrest. Methods: A prospective, observational study was conducted using a commercially available monitor/defibrillator with CPR quality and EtCO 2 sensing capabilities (MRx-QCPR, Philips Medical Systems) during in-hospital cardiac arrests at one hospital from 4/2006 until 8/2006. Resuscitation transcripts were divided into 30-second segments and mean values of chest compression rate and depth and EtCO 2 were derived for each segment. Regression analysis, with cluster-adjustment for individual patients, was used to correlate compression rate and depth with EtCO 2 . Results: Data were collected and analyzed from 281 30-second segments with a median of 12 (interquartile range: 8–33) segments per arrest from 13 consecutive patients for whom EtCO 2 and chest compression data were simultaneously available. Mean EtCO 2 was 19±7 mmHg. After adjusting for compression rate and clustering, there was a positive correlation between compression depth and EtCO 2 (regression coefficient 0.20; 95%CI [−0.01 – 0.42]). There was no significant correlation between compression rate and EtCO 2 after adjusting for compression depth and cluster, nor between survival and EtCO 2 levels. Conclusion: We found that deeper chest compressions correlated with higher EtCO 2 levels. Based on this relationship, changes in EtCO 2 during the actual resuscitation event may be reflective of the CPR quality being delivered. This work also suggests the feasibility of continuous monitoring of physiology during CPR to ensure resuscitation quality.

Can a Software-Based Metronome Tool Enhance Compression Rate in a Realistic 911 Call Scenario Without Adversely Impacting Compression Depth for Dispatcher-Assisted CPR?

2018 ◽  
Vol 33 (4) ◽  
pp. 399-405 ◽  
Author(s):  
Greg Scott ◽  
Tracey Barron ◽  
Isabel Gardett ◽  
Meghan Broadbent ◽  
Holly Downs ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Salt Lake ◽  
Salt Lake City ◽  
Controlled Study ◽  
Control Group ◽  
Compression Rate ◽  
Compression Depth ◽  
Lake City ◽  
Automated Software ◽  
Experimental Group

AbstractIntroductionImplementation of high-quality, dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is critical to improving survival from out-of-hospital cardiac arrest (OHCA). However, despite some studies demonstrating the use of a metronome in a stand-alone setting, no research has yet demonstrated the effectiveness of a metronome tool in improving DA-CPR in the context of a realistic 911 call or using instructions that have been tested in real-world emergency calls.HypothesisUse of the metronome tool will increase the proportion of callers able to perform CPR within the target rate without affecting depth.MethodsThe prospective, randomized, controlled study involved simulated 911 cardiac arrest calls made by layperson-callers and handled by certified emergency medical dispatchers (EMDs) at four locations in Salt Lake City, Utah USA. Participants were randomized into two groups. In the experimental group, layperson-callers received CPR pre-arrival instructions with metronome assistance. In the control group, layperson-callers received only pre-arrival instructions. The primary outcome measures were correct compression rate (counts per minute [cpm]) and depth (mm).ResultsA total of 148 layperson-callers (57.4% assigned to experimental group) participated in the study. There was a statistically significant association between the number of participants who achieved the target compression rate and experimental study group (P=.003), and the experimental group had a significantly higher median compression rate than the control group (100 cpm and 89 cpm, respectively; P=.013). Overall, there was no significant correlation between compression rate and depth.Conclusion:An automated software metronome tool is effective in getting layperson-callers to achieve the target compression rate and compression depth in a realistic DA-CPR scenario.Scott G, Barron T, Gardett I, Broadbent M, Downs H, Devey L, Hinterman EJ, Clawson J, Olola C. Can a software-based metronome tool enhance compression rate in a realistic 911 call scenario without adversely impacting compression depth for dispatcher-assisted CPR? Prehosp Disaster Med. 2018;33(4):399–405

Excessive chest compression rate is associated with insufficient compression depth in out-of-hospital cardiac arrest

2011 ◽  
Vol 28 ◽  
pp. 5
Author(s):  
A. F. Kalmar ◽  
J. M. De Smet ◽  
E. L. Annaert ◽  
M. De Regge ◽  
P. A. Calle ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Compression Rate ◽  
Compression Depth ◽  
Hospital Cardiac Arrest

Abstract P192: What is the Role of Chest Compression Depth during Out-of-Hospital CPR?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ian G Stiell ◽  
Siobhan Everson-Stewart ◽  
James Christenson ◽  
Sheldon Cheskes ◽  
Judy Powell ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Positive Association ◽  
Anterior Chest Wall ◽  
Compression Rate ◽  
Inverse Association ◽  
Compression Depth ◽  
Rate Versus ◽  
Bystander Cpr

Introduction: Current CPR compression depth guidelines were empirically derived. We sought to study patterns of CPR compression depth and their associations with patient outcomes in out-of-hospital cardiac arrest (OOHCA). Methods: We studied OOHCA patients from the Resuscitation Outcomes Consortium Epistry - Cardiac Arrest for whom electronic CPR data were available from proprietary accelerometer technology attached to the prehospital defibrillators. We calculated anterior chest wall depression in millimeters and the period of active CPR (chest compression fraction [CCF]) for each minute of CPR. We controlled for covariates including compression rate and calculated adjusted odds ratios (OR) for any return of circulation (ROSC) and 24 hour survival. We calculated unadjusted OR for hospital discharge. Results: We included 615 adult patients from 6 U.S. and Canadian cities with these characteristics: mean age 68.9; male 62 %; witnessed 43%; bystander CPR 31%; initial rhythms - VF/VT 25%, PEA 17%, asystole 43%, unspecified non-shockable 15%; mean compression rate 103/min; mean compression depth <38mm 51%, 38–51mm 39%, >51mm 11%; median CCF 0.66; outcomes - ROSC 57%, 24 hour survival 18%, discharge 5%. We found an inverse association between depth and compression rate (P<0.0001; see Table ), no association between depth and CCF (P=0.30), and a positive association between CCF and rate (P<0.0001). ORs with 95% CIs for each 5mm increment in compression depth and the outcomes were: 1) ROSC - adjusted OR 1.06 (0.97–1.16), 2) 24 hour survival - adjusted OR 1.01 (0.98–1.03), 3) discharge - unadjusted OR 1.13 (0.95–1.34). Conclusions: We found half of patients received suboptimal compression depth, an inverse association between compression depth and rate, and no clear association between survival and increased compression depth. Further study is required to determine the optimum chest compression depth and its interaction with rate and CCF in order to maximize outcomes. Compression Rate versus Compression 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.

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