Abstract 17062: Can Automated Rate-only CPR Feedback be Detrimental to Chest Compression Depth? A CPR Simulation Study of 141 Untrained Operators

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hannah Torney ◽  
Peter O'Hare ◽  
Laura Davis ◽  
Bruno Delafont ◽  
Ben McCartney ◽  
...  
Keyword(s):  
Chest Compression ◽  
Mean Difference ◽  
Public Access ◽  
Shopping Mall ◽  
P Value ◽  
Compression Rate ◽  
Compression Depth ◽  
Rate Feedback ◽  
Significant Difference ◽  
Machine Interface

Introduction: A number of public access defibrillators incorporate computerised audio-visual feedback mechanisms to help responders deliver cardiopulmonary resuscitation (CPR) according to current guidelines. A 2013 American Heart Association statement suggested that chest compression fraction (CCF) and compression rate should be prioritised over compression depth, chest recoil and ventilations. This usability study assessed the effect of real-time rate-only feedback on chest compression depth. Methods: Randomly selected users were recruited in a shopping mall (n=141; 15-65+ years) to deliver CPR using a public access defibrillator in a simulated scenario. Participants were randomly assigned one of two devices - (1) with CPR rate feedback in the form of a machine-interface comprising of audio-voice prompts and light emitting diodes; (2) without CPR feedback. Participants were instructed to turn on the device and follow the prompts, with no information on how to perform CPR provided. CPR rate and depth were captured by measuring displacement of a potentiometer contained in a specially designed manikin. The device was connected to the manikin via the electrode leads. The effect of rate-only feedback on compression depth and CPR fraction were assessed. Results: ANCOVA analysis between the two devices provided a mean difference (Standard Error; SE) of 4.52mm (1.38mm) indicating a statistically significant difference (p-value=0.001) between measured CPR depth favouring the device with CPR rate feedback. There was no significant difference in CCF between the devices. ANCOVA analysis provided a mean difference (SE) of 2.9% (1.9%) for the device with CPR rate feedback compared to the device without CPR rate feedback. Conclusion: The incorporation of clear, intuitive, audio-visual machine-interface that delivers CPR feedback can assist trained and untrained users in the optimisation of chest compression rate and maintain a high CCF. In conclusion, CPR rate-only feedback was not detrimental to chest compression depth and suggests rate-only feedback may improve compression depth.

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.

scholarly journals Comparison of Long-Term Effects between Chest Compression-Only CPR Training and Conventional CPR Training on CPR Skills among Police Officers

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 34
Author(s):  
Byung-Jun Cho ◽  
Seon-Rye Kim
Keyword(s):  
Chest Compression ◽  
Police Officers ◽  
First Responders ◽  
Compression Rate ◽  
Training Method ◽  
Long Term Effects ◽  
Compression Depth ◽  
Significant Difference ◽  
Cpr Training

Despite of the changes of out-of-hospital cardiac arrest (OHCA) survival rise when bystander CPR is provided, this was only conducted in about 23% of OHCA patients in Korea in 2018. Police officers acting as first responders have a high chance of witnessing situations requiring CPR. We investigated long-term effects on CPR quality between chest compression-only CPR training and conventional CPR training in police officers to find an efficient CPR training method in a prospective, randomized, controlled trial. Police officers underwent randomization and received different CPR training. With the Brayden Pro application, we compared the accuracy of CPR skills immediately after training and the one after 3 months. Right after training, the conventional CPR group presented the accuracy of the CPR skills (compression rate: 74.6%, compression depth: 66.0%, recoil: 78.0%, compression position: 96.1%) and chest compression-only CPR group presented the accuracy of the CPR skills (compression rate: 74.5%, compression depth: 71.6%, recoil: 79.2%, compression position: 99.0%). Overall, both groups showed the good quality of CPR skills and had no meaningful difference right after the training. However, three months after training, overall accuracy of CPR skills decreased, a significant difference between two groups was observed for compression position (conventional CPR: 80.0%, chest compression only CPR: 95.0%). In multiple linear regression analysis, three months after CPR training, chest compression-only CPR training made CPR skills accuracy 28.5% higher. In conclusion, police officers showed good-quality CPR right after CPR training in both groups. But three months later, chest compression-only CPR training group had better retention of CPR skills. Therefore, chest compression-only CPR training is better to be a standard training method for police officers as first responders.

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.

TO COMPARE THE EFFECTIVENESS OF NEBULISATION WITH ADRENALINE, 3% HYPERTONIC SALINE AND NORMAL SALINE IN BRONCHIOLITIS IN CHILDREN OF 2 TO 24 MONTHS OF AGE BASED ON CLINICAL SEVERITY SCORE AND NEBULISATION FREQUENCY.

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Priyanka Jain ◽  
Rakesh Jain
Keyword(s):  
Hypertonic Saline ◽  
Normal Saline ◽  
Mean Difference ◽  
Clinical Severity ◽  
Research Centre ◽  
P Value ◽  
College Hospital ◽  
Mean Values ◽  
Significant Difference ◽  
The Mean

Background & Method: We conducted a double blinded study at Index Medical College Hospital & Research Centre, Indore. The sample size was determined to be minimum of 120 cases as based upon previous years admission due to acute bronchiolitis. Initially, 146 cases were included in the study out of which 23 cases dropped out of the study after giving consent by guardian for participation in the study as they left against medical advice from the hospital. Result: The mean difference of CSS between 0 minutes to 60 minutes of nebulisation between groups in all cases was 0.4 ± 0.6, between 60 minutes and 4 hours was 0.8 ± 0.6, between 4 to 8 hours was 0.7 ± 0.6, between 8-12 hours was 0.6 ± 0.4, between 12-24 hours was 1.6 ± 0.9 and between 24-48 hours was 1.9 ± 0.9.The mean values and resultant p-value of ANOVA of various nebulising agents used for improvement in CSS shows significant association between various nebulising agents used along with improvement in CSS at the end of assessment at 48 hours of treatment. Conclusion: This study was conducted to establish the efficacy of each nebulisation agent (i.e.  adrenaline, 3% hypertonic saline and normal saline) currently used and compare the outcomes as there is not enough evidence amongst Indian population on level of efficacy of each drug in causing improvement in symptoms and signs in various severities of bronchiolitis in early childhood. Comparison of significant improvement in mean difference in CSS at various intervals in all cases compared between groups by post hoc test revealed non-significant difference (p-value 0.700) between 3% hypertonic saline and normal saline. Keywords: nebulisation, adrenaline, bronchiolitis & clinical.

Abstract P42: Active Compression Decompression-CPR in an Infant Manikin Model Using a Novel Adhesive Glove Device

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sharda Udassi ◽  
Jai P Udassi ◽  
Melissa Lamb ◽  
Doug Theriaque ◽  
Arno L Zaritsky ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Crossover Design ◽  
P Value ◽  
Compression Pressure ◽  
Compression Depth ◽  
Significant Difference ◽  
The Mean ◽  
Chest Decompression ◽  
Acd Cpr ◽  
Paired T Test

Introduction: In animals Active Compression-Decompression(ACD)-CPR improves hemodynamics compared with standard CPR (S-CPR). We evaluated the feasibility of achieving ACD-CPR with a novel, simple and inexpensive Adhesive Glove Device (AGD) in an infant manikin model using two thumb (TT) chest compression. Hypothesis: AGD-ACD CPR provides better chest decompression compared to S-CPR in an infant manikin model without excessive rescuer fatigue. Methods: Laerdal ™ Baby ALS Trainer manikin was modified to digitally record compression pressure (CP), compression depth (CD) and decompression depth (DD). The thumb portion of two oven mitts were sewn together and a Velcro adhesive patch was stitched on the underside with an encircling adjustable strap for proper fit to create the AGD. An interlocking Velcro patch was glued to the manikin chest wall. Sixteen BLS or PALS certified healthcare providers were prospectively randomized to perform either two-thumb S-CPR or AGD-ACD-CPR for 5 minutes with a 30:2 compression:ventilation ratio using a crossover design. During AGD-ACD-CPR subjects were asked to pull up during chest decompression. Rescuer heart rate (HR), respiratory rate (RR), recovery time (RT) for HR/RR to return to baseline and actual compressions delivered per minute were recorded. Subjects were blinded to data recordings. Data (mean±SEM) was analyzed using 2 sided paired t-test; p-value ≤0.05 was considered significant. Results: Chest decompression was greater with AGD-ACD-CPR; the mean DD difference was 0.11±0.02 inches, p=<0.001. Compressions given per minute were 102±21 in S-CPR group vs. 96±16 in AGD-ACD-CPR group, p=0.04. In AGD-CPR 75% and in S-CPR only 12% of subjects achieved complete recoil to or beyond baseline. There was no significant difference in CD, CP, HR, RR and RT between the groups. Conclusions: Active decompression and improved recoil was achievable with the use of our simple, inexpensive AGD in this infant CPR model. Use of our device did not result in excessive rescuer fatigue compared to S-CPR. The clinical significance of 6 less compressions/minute in the AGD-CPR group needs to be determined.

scholarly journals Difference of Procalcitonin Levels in Gram-Positive and Gram-Negative Bacterial Sepsis Patients of Indonesia Army Central Hospital Gatot Soebroto in 2016

2022 ◽  
Vol 13 (1) ◽  
pp. 38
Author(s):  
Nindy Handayani ◽  
Soroy Lardo ◽  
Nunuk Nugrohowati
Keyword(s):  
Mean Difference ◽  
P Value ◽  
Central Hospital ◽  
Bacterial Sepsis ◽  
Gram Positive ◽  
Cross Sectional ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Significant Difference ◽  
The Mean

Introduction: Procalcitonin is known as a marker of infection and indicator for severity of infections. In sepsis, elevated procalcitonin levels in blood have a significant value that can be used as a sepsis biomarker. The aim of this study was to determine the mean difference of procalcitonin levels in Gram-positive and Gram-negative bacterial sepsis patients.Methods: This study used quantitative method with cross sectional approach. The sample of this study were bacterial sepsis patients of Indonesia Army Central Hospital Gatot Soebroto in 2016 which were divided into two groups: Gram-positive and Gram-negative bacterial sepsis patients with the number of each group was 30 samples. The data were analyzed by using independent t test.Results: This study showed that mean levels of procalcitonin in Gram-positive bacterial sepsis patients was 6.47 ng/ml and Gram-negative was 66.04 ng/ml. There was a significant difference between mean levels of procalcitonin in Gram-positive and Gram-negative bacterial sepsis patients of Indonesia Army Central Hospital Gatot Soebroto in 2016 with p value = 0.000 (p < 0.05).Conclusion: The mean difference of procalcitonin levels in Gram-negative bacterial sepsis patients were higher than Gram-positive bacterial sepsis patients, because Gram-negative bacteria have lipopolysaccharide which is a strong immunostimulator and increases TNF-α production higher than Gram-positive bacteria. 

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.

Abstract 16794: Variation in Achievable Chest Compression Depth Assessed by Cardiac MRI

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sverre Nestaas ◽  
Vigdis Rosseland ◽  
Knut Haakon Steensaeth ◽  
Jo Kramer-Johansen
Keyword(s):  
Chest Compression ◽  
Pathological Finding ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Mean Difference ◽  
Compression Depth ◽  
Left Ventricular Outflow ◽  
Mean Differences ◽  
Compression Line

Introduction: Recommended chest compression depth during cardiopulmonary resuscitation (CPR) for adults was increased to 5-6 cm in 2010. According to the cardiac pump theory each compression squeezes blood from the heart and the amount of blood per compression would be expected to be limited by the blood filled structures directly underneath the compression point. Methods: Cardiovascular MR (CMR) survey axial scans acquired from consenting patients referred for CMR were analyzed. We measured the external anterior-posterior (AP) diameter (AP) and the cumulative height of blood-filled structures in the perpendicular line in an axial plane from the compression point in the center of the inter-nipple line (INL) (Compression line). Results are means with standard deviation (SD) and mean differences with 95 % confidence intervals (CI), P-values from unpaired, two-sided t-test. Results: We included 144 patients, age 52 (17), 110 (76 %) males, 74 (60 %) having one or more pathological finding from the exam. The most prominent structure identified in the studied midline was (decreasing order): Left Atrium (41 %), Right Ventricle (31 %), Right Atrium (12 %), Left Ventricular Outflow Tract (LVOT)/Root of Aorta (8 %), Pulmonary Outflow Tract (2 %), other (6 %). Altogether, LVOT was present in 35 % and Left Ventricle in only 2 % of compression lines. Mean (SD) AP diameter for males and females was 25 (2) cm and 22 (2) cm (mean difference 2 cm (95 % CI 1, 3; P<0.001)), and the blood filled length of the compression line (APblood) were 6.5 cm (2) and 4.7 cm (2) (mean difference 1.8 cm (95 % CI 1.1, 2.5, P<0.001)), respectively. This comprised 22 % (10) and 26 % (7) of the AP diameter, for men and women, respectively. In a linear regression gender, body mass index (BMI), but not pathological findings were significant predictors of external AP diameter. Only gender was found to predict APblood. Conclusions: In the average male 5-6 cm chest compression depth at the level of the INL seems feasible, but for over half of the women compressions deeper than 5 cm would probably compress connective and muscle tissue rather than just squeeze blood from the heart, even though the blood-filled proportion of the AP diameter was larger in women than in men.

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 A comparison of the effect of two methods of positioning the hands during basic and advanced cardiovascular life support on the chest compression depth in adults

2019 ◽  
Vol 11 (4) ◽  
pp. 314-317
Author(s):  
Mohammadreza Bastami ◽  
Parand Soliemanifard ◽  
Roholla Hemmati ◽  
Golnaz Forough Ameri ◽  
Mahboobeh Rasouli ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Nursing Students ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Life Support ◽  
Dominant Hand ◽  
Compression Depth ◽  
Men And Women ◽  
Significant Difference ◽  
Left And Right

Introduction: There is no agreement on how the hands are positioned in cardiopulmonary resuscitation (CPR). In this study, the effects of two methods of positioning the hands during basic and advanced cardiovascular life support on the chest compression depth are compared.<br /> Methods: In this observational simulation, the samples included 62 nursing students and emergency medicine students trained in CPR. Each student performed two interventions in both basic and advanced situations on manikins and two positions of dominant hand on non-dominant hand, and vice versa, within four weeks. At each compression, the chest compression depth was numerically expressed in centimeter. Each student was assessed individually and without feedback.<br /> Results: The highest mean chest compression depth was related to Basic Cardiovascular Life Support (BCLS) and the position of the dominant hand on non-dominant hand (5.50 ± 0.6) and (P = 0.04). There was no statistically significant difference in the basic and advanced regression variables in men and women except in the case of Advanced Cardiovascular Life Support (ACLS) with dominant hand on non-dominant hand (P = 0.018). There was no significant difference in mean chest compression during basic and advanced cardiovascular life support in left- and right-handed individuals (P = 0.09). <br /> Conclusion: When the dominant hand is on the non-dominant hand, more pressure with greater depth is applied.

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