Abstract 12583: Low-Dose, High-Frequency Psychomotor CPR Skills Training Results in Improved and Sustained Performance of Optimal Adult/Child Ventilations in Fire-Based EMS Personnel

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
DAVID E SLATTERY ◽  
Chase Hamilton ◽  
Khanhha Tran ◽  
Aaron Singer
Keyword(s):  
High Frequency ◽  
Low Dose ◽  
Performance Metrics ◽  
Outcome Measure ◽  
Skills Training ◽  
Individual Performance ◽  
P Value ◽  
Ventilation Performance ◽  
Cpr Training ◽  
In Fire

Background: Hyper/over-ventilation (HOV) negatively effects cerebral blood and coronary artery flow during cardiac arrest. The resuscitation quality improvement (RQI) model of low-dose, high-frequency (LDHF) CPR training has been shown to improve CPR skills. Due to the deleterious impact of HOV on survival, our study seeks to determine if the RQI model improves ventilation skills for EMS personnel. We test the hypothesis that the RQI training results in improved and sustained ventilation performance. Methods: In 2014, our department transitioned from traditional BLS/ACLS training to the RQI model. Performance metrics are captured automatically for each rescuer on a quarterly basis using high-fidelity mannequins. Inclusion: All data from adult RQI attempts by EMS personnel from 2015-2019. Exclusion: attempts by non-EMS personnel. The 1 outcome measure is the overall mean (95% CI) ventilation score (composite measure, range 0-100, derived from average volume/rate and % with correct volume). The 2nd outcome measure is the proportion (95%CI) of rescuers with ventilation scores >90%. Data were extracted from RQI and analyzed with Prism statistical software. Comparisons for the 1 outcome was performed using one-way ANOVA and we report mean and 95% CI and proportions and 95% CI as appropriate. Results: During the study period, 740 personnel completed 1,490 ventilation activities in the baseline period and 5,077 in the subsequent years. The mean (95% CI) composite ventilation scores for the baseline was 84.10 (83.09,85.10) vs 2016 = 83.13 (82.17,84.09), 2017=88.79 (87.91,89.66), 2018=90.36 (89.45, 91.27), 2019= 88.59 (87.37, 89.81) for years 2016-2019; F= 41.36, R2=0.024, p value <0.0001. 10outcome: In the baseline RQI year, there were 55.3 % (95%CI= 52.8,57.8) participants with composite ventilation scores >/=90% vs. 2016= 53.5% (51.2,55.8), 2017=65.2%(62.6,68.6), 2018= 71.7%(69.1,74.3) and 2019=69.3%(66.1,72.2) in subsequent years. Limitations: Individual performance not reported, single agency. Conclusions: LDHF CPR training improves proper, and exceptional, ventilation performance in fire-based EMS personnel. Our results may be useful for other EMS agencies who are considering transitioning to LDHF training such as the RQI system.

scholarly journals Low-Dose, High-Frequency CPR Training Improves Skill Retention of In-Hospital Pediatric Providers

PEDIATRICS ◽  
2011 ◽  
Vol 128 (1) ◽  
pp. e145-e151 ◽  
Author(s):  
R. M. Sutton ◽  
D. Niles ◽  
P. A. Meaney ◽  
R. Aplenc ◽  
B. French ◽  
...  
Keyword(s):  
High Frequency ◽  
Low Dose ◽  
Skill Retention ◽  
Hospital Pediatric ◽  
Cpr Training ◽  
Pediatric Providers

Low dose- high frequency, case based psychomotor CPR training improves compression fraction for patients with in-hospital cardiac arrest

Resuscitation ◽  
2020 ◽  
Vol 146 ◽  
pp. 26-31 ◽  
Author(s):  
Ashish R. Panchal ◽  
Gregory Norton ◽  
Emily Gibbons ◽  
Jeri Buehler ◽  
Michael C. Kurz
Keyword(s):  
Cardiac Arrest ◽  
High Frequency ◽  
Low Dose ◽  
Cpr Training ◽  
Hospital Cardiac Arrest ◽  
Case Based

scholarly journals Low-dose, high-frequency CPR training with feedback for firefighters

2019 ◽  
Vol 8 (1) ◽  
pp. 64-72 ◽  
Author(s):  
Anna Abelsson ◽  
Jari Appelgren ◽  
Christer Axelsson
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
High Frequency ◽  
Design Methodology ◽  
Low Dose ◽  
Compression Depth ◽  
Content Type ◽  
Objective Feedback ◽  
Volume Compression ◽  
Cpr Training ◽  
Post Assessment

Purpose The purpose of this paper is to investigate the effects of the intervention of low-dose, high-frequency cardiopulmonary resuscitation (CPR) training with feedback for firefighters for one month. Design/methodology/approach The study had a quantitative approach. Data were collected through an intervention by means of simulation. The data collection consisted of a pre- and post-assessment of 38 firefighter’s CPR performance. Findings There was a statistically significant improvement from pre- to post-assessment regarding participants’ compression rates. Compression depth increased statistically significantly to average 2 mm too deep in the group. Recoil decreased in the group with an average of 1 mm for the better. There was a statistically significant improvement in participants’ ventilation volume from pre- to post-assessment. Originality/value Prehospital staff such as firefighters, police, and ambulance perform CPR under less than optimal circumstances. It is therefore of the utmost importance that these professionals are trained in the best possible way. The result of this study shows that low-dose, high-frequency CPR training with an average of six training sessions per month improves ventilation volume, compression depth, rate, and recoil. This study concludes that objective feedback during training enhances the firefighters’ CPR skills which in turn also could be applied to police and ambulance CPR training.

scholarly journals Enhanced self-assessment of CPR by low-dose, high-frequency training

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Anna Abelsson ◽  
Jari Appelgren ◽  
Christer Axelsson
Keyword(s):  
Visual Feedback ◽  
High Frequency ◽  
Low Dose ◽  
Compression Rate ◽  
Multiple Choice Questions ◽  
Self Assessment ◽  
Content Type ◽  
Good Ability ◽  
Cpr Quality ◽  
Cpr Training

PurposeThe purpose was to investigate what effect an intervention of low-dose, high-frequency cardiopulmonary resuscitation (CPR) training with feedback for one month would have on professionals' subjective self-assessment skill of CPR.Design/methodology/approachThis study had a quantitative approach. In total, 38 firefighters performed CPR for two minutes on a Resusci Anne QCPR. They then self-assessed their CPR through four multiple-choice questions regarding compression rate, depth, recoil and ventilation volume. After one month of low-dose, high-frequency training with visual feedback, the firefighters once more performed CPR and self-assessed their CPR.FindingsWith one month of low-dose, high-frequency training with visual feedback, the level of self-assessment was 87% (n = 33) correct self-assessment of compression rate, 95% (n = 36) correct self-assessment of compression depth, 68% (n = 26) correct self-assessment of recoil and 87% (n = 33) correct self-assessment of ventilations volume. The result shows a reduced number of firefighters who overestimate their ability to perform CPR.Originality/valueWith low-dose, high-frequency CPR training with visual feedback for a month, the firefighters develop a good ability to self-assess their CPR to be performed within the guidelines. By improving their ability to self-assess their CPR quality, firefighters can self-regulate their compression and ventilation quality.

130 Impact of Low-Dose High-Frequency in situ Simulation on Inpatient Diabetes Management: A Pilot Study

2021 ◽  
Author(s):  
Sree Kumar EJ ◽  
Makani Purva
Keyword(s):  
High Frequency ◽  
Low Dose ◽  
Diabetes Management ◽  
Working Hours ◽  
Clinical Inertia ◽  
P Value ◽  
Biomedical Knowledge ◽  
Patients With Diabetes ◽  
Control Of Diabetes ◽  
Inpatient Diabetes Management

Even in the presence of established institutional guidelines, failure of compliance by the clinical teams plays an important role in the control of diabetes. The identified gaps include contextual and biomedical knowledge, attitudes, clinical inertia, confidence and familiarity with existing hospital resources and guidelines with regards to hospital diabetes care We wanted to demonstrate the efficacy of low-dose high-frequency The exercise was a 15-minute session, delivered during working hours to individual nurses. This consisted of a 5-minute scenario, involving a standardized patient followed by a 10-minute debrief. Modified Diamond-model debrief with an advocacy-inquiry model was used by the debriefer, a trained fellow in simulation, and overseen by an expert. The scripted scenario involved a patient with Diabetic Ketoacidosis (DKA), with learning outcomes of recognizing DKA, managing the patient and adhering to the institutional guidelines including management of hypoglycaemia. The scenario was individualized based on the roles of the participants. Pre- and post-questionnaires were given to the participants. The simulation was repeated twice in the second week and once in the third week.This mixed-method study was conducted in a UK teaching hospital, in a ward designated for patients with diabetes, as a part of a quality improvement programme. In the first week, patients with diabetes, admitted for DKA, were chosen and their blood sugar recordings, dysglycaemic episodes and adherence to guidelines were noted. Every week data were collected as in the first week. GNU pspp 1.0.1 [version 3] free software was used. The confidence scores were given as mean and standard deviation with confidence interval (CI) of 98.75%. A p-value of <0.0125 was considered significant based on the number of data points.The Dysglycemic episodes and protocol adherence from medical recordsConsidering the T2 (increased recognition of diabetic emergencies and adherence to protocol) and T3 (improved patient outcomes) outcomes, the methodology was recommended as a modality of training the nursing staff involved in inpatient care of patients with diabetes. Future programmes including multi-disciplinary teams, to explore teamwork and communication, are planned.

scholarly journals The assessment of a manikin-based low-dose, high-frequency cardiac resuscitation quality improvement program in early UK adopter hospitals

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Katherine Kuyt ◽  
Montana Mullen ◽  
Catherine Fullwood ◽  
Todd P. Chang ◽  
James Fenwick ◽  
...  
Keyword(s):  
Quality Improvement ◽  
High Frequency ◽  
Low Dose ◽  
Training Session ◽  
Control Site ◽  
Improvement Program ◽  
Data Set ◽  
Significant Difference ◽  
The Uk ◽  
Cpr Training

Abstract Background Adult and paediatric basic life support (BLS) training are often conducted via group training with an accredited instructor every 24 months. Multiple studies have demonstrated a decline in the quality of cardio-pulmonary resuscitation (CPR) performed as soon as 3-month post-training. The ‘Resuscitation Quality Improvement’ (RQI) programme is a quarterly low-dose, high-frequency training, based around the use of manikins connected to a cart providing real-time and summative feedback. We aimed to evaluate the effects of the RQI Programme on CPR psychomotor skills in UK hospitals that had adopted this as a method of BLS training, and establish whether this program leads to increased compliance in CPR training. Methods The study took place across three adopter sites and one control site. Participants completed a baseline assessment without live feedback. Following this, participants at the adopter sites followed the RQI curriculum for adult CPR, or adult and infant CPR. The curriculum was split into quarterly training blocks, and live feedback was given on technique during the training session via the RQI cart. After following the curriculum for 12/24 months, participants completed a second assessment without live feedback. Results At the adopter sites, there was a significant improvement in the overall score between baseline and assessment for infant ventilations (N = 167, p < 0.001), adult ventilations (n = 129, p < 0.001), infant compressions (n = 163, p < 0.001) adult compressions (n = 205, p < 0.001), and adult CPR (n = 249, p < 0.001). There was no significant improvement in the overall score for infant CPR (n = 206, p = 0.08). Data from the control site demonstrated a statistically significant improvement in mean score for adult CPR (n = 22, p = 0.02), but not for adult compressions (N = 18, p = 0.39) or ventilations (n = 17, p = 0.08). No statistically significant difference in improvement of mean scores was found between the grouped adopter sites and the control site. The effect of the duration of the RQI curriculum on CPR performance appeared to be minimal in this data set. Compliance with the RQI curriculum varied by site, one site maintained hospital compliance at 90% over a 1 year period, however compliance reduced over time at all sites. Conclusions This data demonstrated an increased adherence with guidelines for high-quality CPR post-training with the RQI cart, for all adult and most infant measures, but not infant CPR. However, the relationship between a formalised quarterly RQI curriculum and improvements in resuscitation skills is not clear. It is also unclear whether the RQI approach is superior to the current classroom-based BLS training for CPR skill acquisition in the UK. Further research is required to establish how to optimally implement the RQI system in the UK and how to optimally improve hospital wide compliance with CPR training to improve the outcomes of in-hospital cardiac arrests.

Abstract 183: School-Centered CPR Education to Improve Survival from Out-of-Hospital Cardiac Arrest in High-Risk Neighborhoods

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Tom Califf ◽  
René Ramon ◽  
Wendy Morrison ◽  
Ariann Nassel ◽  
Comilla Sasson
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Low Income ◽  
Skills Training ◽  
Seventh Grade ◽  
Post Intervention ◽  
Train The Trainer ◽  
The People ◽  
Cpr Training ◽  
Hospital Cardiac Arrest

Background: Low-income and Latino neighborhoods are at high risk for having low provision of bystander CPR for victims of out-of-hospital cardiac arrest (OHCA). Novel community-based intervention is needed in these neighborhoods to increase awareness of CPR techniques and, ultimately, to decrease mortality from OHCA. Objective: To determine the feasibility of a train-the-trainer hands-only CPR program as a required assignment in a middle school. Methods: Design: Prospective survey-based interventional study. Setting: Public charter school in the Denver, CO metropolitan area. Population: Cohort of 118 subjects was recruited out of 134 eligible seventh grade students. Observations: Participants completed a 6-question test to assess baseline knowledge of CPR. Subjects then completed a group hands-only CPR training lasting 1 hour using the CPR Anytime kit, which included both an educational DVD and hands-on practical skills training with an inflatable mannequin. Participants were then asked to use these kits to train other community members over a 2-week period. At the end of the study, students were asked to complete the same 6-question survey to assess their retention of knowledge. Two-sample t-tests were conducted to assess for differences in hands-only CPR knowledge pre- and post-CPR training. Results: Demographics are given for the entire seventh grade class ( Table 1 ). Students were mostly white (71.6%), and 11 (8.2%) participated in the Free & Reduced Lunch program. Of 134 seventh graders attending the school, 118 (88%) completed a pre-intervention survey and 74 (55%) completed a post-intervention survey. Between the surveys, the mean number of questions answered correctly increased ( Table 2 ), as did performance on the question asking where to place AED pads on the chest (p < .001). Students performed poorest in both pre- and post-testing on identifying the appropriate situation for performing hands-only CPR. Conclusion: Implementation of a school-based train-the-trainee CPR education program is a feasible endeavor. Students demonstrated increased knowledge of CPR techniques two weeks after training compared to baseline. Future studies will need to be conducted to assess the people who are then trained by these students using the CPR Anytime Kits.

scholarly journals A double-blind randomized placebo-controlled study of low dose mirtazapine once daily in patients of major depressive disorders on escitalopram

2019 ◽  
Vol 8 (5) ◽  
pp. 1067
Author(s):  
Mallikarjuna Rao I. ◽  
Usha Kiran Prayaga ◽  
Dharma Rao Uppada ◽  
Ramachandra Rao E. ◽  
B. L. Kudagi
Keyword(s):  
Depressive Disorders ◽  
Low Dose ◽  
Rating Scale ◽  
Controlled Study ◽  
P Value ◽  
Chi Square ◽  
Double Blind ◽  
Increased Risk ◽  
Significant Difference ◽  
Chi Square Test

Background: The SSRIs being used as 1st line therapy in treatment of depression have delayed therapeutic effect which makes the patient vulnerable to an increased risk of suicide and decreased adherence to the treatment and will prematurely discontinue the therapy. The present study was conducted to evaluate if low dose mirtazapine-escitalopram combination therapy has any add on benefit over monotherapy with escitalopram.Methods: In a single-centered, comparative study involving patients with depression attending the out-patient after screening and exclusion, 60 eligible patients were randomly assigned to receive tablet mirtazapine 7.5 mg plus tablet escitalopram 10 mg intervention or tablet escitalopram 10 mg plus placebo intervention in a double-blind 6-week treatment phase. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) score from baseline. Participants were evaluated at baseline, 1st, 2nd,4th and 6th week. Results were analyzed using Chi-Square test for adverse effects and independent t-test analysis for efficacy parameter.Results: In the analysis of results at 6th week the numbers of patients achieved remission in mirtazapine group are more with a p-value of 0.018 which is significant and the numbers of responders in mirtazapine group are also more which is statistically significant on chi-square test. There is no significant difference was observed between the two groups with reference to occurrence of adverse effect.Conclusions: Adding low dose mirtazapine has an added benefit in terms of efficacy and getting remission early with more number of responders in the treatment of major depression.

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