Abstract 131: Chest Molding in Extended Cardiopulmonary Resuscitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
James K Russell ◽  
Digna Gonzalez-Otero ◽  
Mohamud R Daya ◽  
Sofia Ruiz De Gauna ◽  
Jesus Ruiz
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Clinical Data ◽  
Chest Compressions ◽  
Initial Value ◽  
Initial Series ◽  
Change Characteristics ◽  
Applied Forces ◽  
The Subject ◽  
Acceleration Signals ◽  
Wallis Anova

Introduction: Cardiopulmonary resuscitation (CPR) is a forceful procedure that may change characteristics of the subject. Little clinical data has been published relating applied forces and depth responses, particularly in increasingly prevalent extended sessions of CPR. We analyzed synchronous force and depth records to investigate how chests mold during the course of extended CPR. Hypothesis: Chest molding, characterized as decrease in stiffness from its initial value, will increase as CPR proceeds. Methods: Force and acceleration signals were extracted from CPR monitors used in adult cases of continuous compression CPR in out-of-hospital resuscitations attended by a single EMS agency (TVFR, Tigard, Oregon) during 2013 through 2017. We computed depth and velocity from acceleration, and identified chest compressions automatically where downward velocity crossed 25mm/s and force subsequently exceeded 5 kg-f. Series were defined as sequences without pauses exceeding 2 minutes. We analyzed initial series lasting at least 10 minutes. We calculated stiffness as force/depth at peak compression velocity. We calculated molding in 5 minute blocks of CPR as 100*(1- stiffnessblock/stiffnessminute 1), using medians as stiffness was not normally distributed. Dependence of molding on CPR duration was analyzed with Kruskal-Wallis ANOVA. Results and Conclusions: Of 616 available cases, 478 had initial CPR series >= 10 minutes duration, including 997,254 compressions. Initial CPR series duration were >= 30 minutes in 152 cases, and >= 40 minutes in 48 cases. The longest initial series was 61 minutes. Chest molding increased steadily through the first 25 minutes of CPR, and plateaued thereafter (p < 0.001). Median molding at >= 25 minutes was 20%. The implications of declining stiffness warrant further investigation.

scholarly journals An alternative method of chest compression from over-the-head during cardiopulmonary resuscitation

2019 ◽  
Author(s):  
Michał Ćwiertnia ◽  
Marek Kawecki ◽  
Tomasz Ilczak ◽  
Monika Mikulska ◽  
Mieczyslaw Dutka ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Artificial Respiration ◽  
Hand Position ◽  
Chest Compressions ◽  
Confined Spaces ◽  
Medical Response ◽  
Emergency Interventions ◽  
The Subject

Abstract Background Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial respiration using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient’s side, with compression carried out from behind the patient’s head. Methods The subject of the study were two methods of CPR – ‘standard’ (STD) and ‘over-the-head’ (OTH). The STD method consisted of 30 chest compressions from the patient’s side, and two attempts at artificial respiration after moving round to behind the patient’s head. In the OTH method, both compression and respiration were conducted from behind the patient’s head. Results Both CPR methods were conducted by 38 paramedics working in medical response teams. The average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p<0.001); the depth of compression 50–60 mm (STD 50.65%, OTH 60.22%, p<0.001); the rate of compression 100–120/min. (STD 46.39%, OTH 53.78%, p<0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p<0.001); correct hand position (STD 99.32%, OTH method 99.66%, p<0.001). The remaining parameters showed no significant differences in comparison to reference values. Conclusions The demonstrated higher quality of CPR in the simulated research using the OTH method conducted by one person justifies the use of this method in a wider range of emergency interventions than only for CPR conducted in confined spaces.

A shock advisory algorithm to analyse through chest compressions for reducing interruptions during cardiopulmonary resuscitation

Resuscitation ◽  
2017 ◽  
Vol 118 ◽  
pp. e6 ◽  
Author(s):  
Chenguang Liu ◽  
Stacy Gehman ◽  
Dawn Jorgenson ◽  
Tom Lyster ◽  
Jason Coult ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compressions

Chest compression efficacy of child resuscitators

2021 ◽  
Vol 13 (11) ◽  
pp. 448-455
Author(s):  
Tiffany Wai Shan Lau ◽  
Anthony Robert Lim ◽  
Kyra Anne Len ◽  
Loren Gene Yamamoto
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Minimum Weight ◽  
Success Rates ◽  
Compression Force ◽  
Chest Compressions ◽  
Traditional Methods ◽  
Video Review ◽  
Brief Training

Background: Chest compression efficacy determines blood flow in cardiopulmonary resuscitation (CPR) and relies on body mechanics, so resuscitator weight matters. Individuals of insufficient weight are incapable of generating a sufficient downward chest compression force using traditional methods. Aims: This study investigated how a resuscitator's weight affects chest compression efficacy, determined the minimum weight required to perform chest compressions and, for children and adults below this minimum weight, examine alternate means to perform chest compressions. Methods: Volunteers aged 8 years and above were enrolled to perform video-recorded, music-facilitated, compression-only CPR on an audible click-confirming manikin for 2 minutes, following brief training. Subjects who failed this proceeded to alternate modalities: chest compressions by jumping on the lower sternum; and squat-bouncing (bouncing the buttocks on the chest). These methods were assessed via video review. Findings: There were 57 subjects. The 30 subjects above 40kg were all able to complete nearly 200 compressions in 2 minutes. Success rates declined in those who weighed less than 40kg. Below 30 kg, only one subject (29.9 kg weight) out of 14 could achieve 200 effective compressions. Nearly all of the 23 subjects who could not perform conventional chest compressions were able to achieve effective chest compressions using alternate methods. Conclusion: A weight below 40kg resulted in a declining ability to perform standard chest compressions effectively. For small resuscitators, the jumping and squat-bouncing methods resulted in sufficient compressions most of the time; however, chest recoil and injuries are concerns.

In Reply: Combinations of Antibiotics

PEDIATRICS ◽  
1960 ◽  
Vol 26 (3) ◽  
pp. 499-499
Author(s):  
Robert J. Haggerty
Keyword(s):  
Experimental Data ◽  
Clinical Data ◽  
Experimental Work ◽  
The Subject ◽  
Antimicrobial Combinations

I am delighted to have Dr. Jawetz again bring to the attention of your readers his definitive work on the subject of antimicrobial combinations. We certainly have no quarrel with the points he reiterates. Our choice of words, "It is not clear why these results are at variance with the experimental data of Jawetz or the clinical data of Lepper and Dowling," was probably unfortunate, for Dr. Jawetz points out why the results did differ from his experimental work.

Effectiveness of a Dispatcher-Assisted Cardiopulmonary Resuscitation Program Developed by the Thailand National Institute of Emergency Medicine (NIEMS)

2021 ◽  
pp. 1-6
Author(s):  
Chuenruthai Angkoontassaneeyarat ◽  
Chaiyaporn Yuksen ◽  
Chetsadakon Jenpanitpong ◽  
Pemika Rukthai ◽  
Marisa Seanpan ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Medicine ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Health Care Providers ◽  
Care Providers ◽  
Chest Compressions ◽  
Threatening Condition ◽  
Life Threatening

Abstract Background: Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS). Methods: This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1. Results: There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P <.001). However, the CPR instruction did not translate into better performance or quality of chest compressions for the overall sample or for health care or non-health care providers. Conclusion: Those in the CPR-trained group applied chest compressions (initiated CPR) more quickly than those who initiated CPR based upon dispatch-based CPR instructions.

Abstract 20: Peripheral Intravenous Analysis Detects Return of Spontaneous Circulation Without Interruption of Chest Compressions in a Rat Model of Cardiopulmonary Resuscitation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Claudius Balzer ◽  
Franz J Baudenbacher ◽  
Antonio Hernandez ◽  
Michele M Salzman ◽  
Matthias L Riess ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Venous Pressure ◽  
Fold Increase ◽  
Spontaneous Circulation ◽  
Arterial Line ◽  
Chest Compressions ◽  
Waveform Data ◽  
Return Of Spontaneous Circulation

Introduction: A higher chest compression fraction (CCF) or percentage of time providing chest compressions is associated with improved survival after cardiac arrest (CA). Pauses in chest compression duration during cardiopulmonary resuscitation (CPR) to palpate a pulse can reduce the CCF. Peripheral Intravenous Analysis (PIVA) is a novel method for determining cardiac and volume status using waveforms from a standard peripheral intravenous (IV) line. We hypothesize that PIVA will demonstrate the onset of return of spontaneous circulation (ROSC) without interruption of CPR. Methods: Eight Zucker Diabetic Fatty (ZDF) rats (4 lean, 4 diabetic) were intubated, ventilated, and cannulated with a 24g IV in the tail vein and a 22g IV in the femoral artery, each connected to a TruWave pressure transducer. Mechanical ventilation was discontinued to achieve CA. After 8 minutes, CPR began with mechanical ventilation, IV epinephrine, and chest compressions using 1.5 cm at 200 times per minute until mean arterial pressure (MAP) increased to 120 mmHg per arterial line. All waveforms were recorded and analyzed in LabChart. PIVA was measured using a Fourier transform of the peripheral venous waveform. Data are mean ± SD. Statistics: Unpaired student’s t-test (two-tailed), α = 05. Results: CA and ROSC were achieved in all 8 rats. Within 1 minute of CPR, there was a 70 ± 35 fold increase/decrease in PIVA during CPR that was temporally associated with ROSC. Within 8 ± 13 seconds of a reduction in PIVA, there was a rapid increase in end-tidal CO 2 . In all rats, ROSC occurred within 38 ± 9 seconds of the maximum PIVA value. Peripheral venous pressure decreased by 1.2 ± 0.9 mmHg during resuscitation and ROSC, which was not significant different at p=0.05. Conclusion: In this pilot study, PIVA detected ROSC without interrupting CPR. Use of PIVA may obviate the need pause CPR for pulse checks, and may result in a higher CCF and survival. Future studies will focus on PIVA and CPR efficacy.

scholarly journals Developing a kinematic understanding of chest compressions: the impact of depth and release time on blood flow during cardiopulmonary resuscitation

2015 ◽  
Vol 14 (1) ◽  
Author(s):  
Joshua W. Lampe ◽  
Yin Tai ◽  
George Bratinov ◽  
Theodore R. Weiland ◽  
Christopher L. Kaufman ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Resuscitation ◽  
Release Time ◽  
Chest Compressions ◽  
The Impact

Safety Assessment of Talc as Used in Cosmetics

2015 ◽  
Vol 34 (1_suppl) ◽  
pp. 66S-129S ◽  
Author(s):  
Monice M. Fiume ◽  
Ivan Boyer ◽  
Wilma F. Bergfeld ◽  
Donald V. Belsito ◽  
Ronald A. Hill ◽  
...  
Keyword(s):  
Clinical Data ◽  
Safety Assessment ◽  
Expert Panel ◽  
Cosmetic Products ◽  
Epidermal Barrier ◽  
The Subject ◽  
The Relationship

The Cosmetic Ingredient Review Expert Panel (Panel) assessed the safety of talc for use in cosmetics. The safety of talc has been the subject of much debate through the years, partly because the relationship between talc and asbestos is commonly misunderstood. Industry specifications state that cosmetic-grade talc must contain no detectable fibrous, asbestos minerals. Therefore, the large amount of available animal and clinical data the Panel relied on in assessing the safety of talc only included those studies on talc that did not contain asbestos. The Panel concluded that talc is safe for use in cosmetics in the present practices of use and concentration (some cosmetic products are entirely composed of talc). Talc should not be applied to the skin when the epidermal barrier is missing or significantly disrupted.

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