The potential of leg-foot chest compression as an alternative to conventional hands-on compression during cardiopulmonary resuscitation

Background: Conventional hands-on chest compression, in cardiopulmonary resuscitation, is often inadequate, especially when the rescuers are weak or have a small physique. Objectives: This study aimed to investigate the potential of leg-foot chest compression, with and without a footstool, during cardiopulmonary resuscitation. Methods and Results: We prospectively enrolled 21 medical workers competent in basic life support. They performed cardiopulmonary resuscitation on a manikin for 2 min using conventional hands-on compression (HO), leg-foot compression (LF), and leg-foot compression with a footstool (LF + FS). We analyzed the compression depths, changes in the rescuers’ vital signs, and the modified Borg scale scores after the trials. The compression depth did not differ between the cases using HO and LF. In the case of LF + FS, compression depths ⩾5 cm were more frequently observed (median, inter-quartile range: 93%, 81%–100%) than in HO (9%, 0%–57%, p < 0.01) and LF (28%, 11%–47%, p < 0.01). The increase in the heart rate or modified Borg scale scores, after the trials, did not differ between the HO and LF group; however, the values were the lowest in the case of LF + FS (49 ± 18 beats/min and 5 (4–7) in HO, 46 ± 18 and 6 (5–7) in LF, and 32 ± 11 and 2 (1–3) in LF + FS, respectively, p < 0.01). However, the increase in blood pressure, SpO2, and respiratory rate were not different among each group. The increases in the heart rate and modified Borg scale scores negatively were correlated with the rescuers’ body size, in the case of HO and LF, but not LF + FS. Conclusion: LF can be used as an alternative to HO, when adequate HO is difficult. LF + FS could be used when rescuers are weak or have a small physique and when the victims are bigger than the rescuers.

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Comparison of Chest Compression Quality Using Wing Boards versus Walking Next to a Moving Stretcher: A Randomized Crossover Simulation Study

Journal of Clinical Medicine ◽

10.3390/jcm9051584 ◽

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.

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Hány éves kortól képesek a gyermekek újraéleszteni? – A hatékonyság felmérése általános iskolás gyermekek körében

Orvosi Hetilap ◽

10.1556/650.2017.30631 ◽

2017 ◽

Vol 158 (4) ◽

pp. 147-152 ◽

Cited By ~ 2

Author(s):

Bálint Bánfai ◽

Attila Pandur ◽

Emese Pék ◽

Henrietta Csonka ◽

József Betlehem

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Small Groups ◽

Basic Life Support ◽

Life Support ◽

Primary School Children ◽

Average Depth ◽

Chest Compressions ◽

Physical Capability ◽

Compression Depth

Abstract: Introduction: In cardiac arrest life can be saved by bystanders. Aim: Our aim was to determine at what age can schoolchildren perform correct cardiopulmonary resuscitation. Method: 164 schoolchildren (age 7–14) were involved in the study. A basic life support training consisted of 45 minutes education in small groups (8–10 children). They were tested during a 2-minute-long continuous cardiopulmonary resuscitation scenario using the “AMBU CPR Software”. Results: Average depth of chest compression was 44.07 ± 12.6 mm. 43.9% of participants were able to do effective chest compressions. Average ventilation volume was 0.17 ± 0.31 liter. 12.8% of participants were able to ventilate effectively the patient. It was significant correlation between the chest compression depth (p<0.001) and ventilation (p<0.001) and the children’s age, weight, height and BMI. Conclusions: Primary school children are able to learn cardiopulmonary resuscitation. The ability to do effective chest compressions and ventilation depended on the children’s physical capability. Orv. Hetil., 2017, 158(4), 147–152.

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Comparing Basic Life Support Serious Gaming Scores With Hands-on Training Platform Performance Scores: Pilot Simulation Study for Basic Life Support Training

JMIR Serious Games ◽

10.2196/24166 ◽

2020 ◽

Vol 8 (4) ◽

pp. e24166

Author(s):

Mehmet Emin Aksoy

Keyword(s):

Basic Life Support ◽

Life Support ◽

Performance Data ◽

Serious Game ◽

Sensor Data ◽

Average Score ◽

Compression Depth ◽

Serious Gaming ◽

Hands On ◽

Depth Compression

Background Serious games enrich simulation-based health care trainings and improve knowledge, skills, and self-confidence of learners while entertaining them. Objective A platform which can combine performance data from a basic life support (BLS) serious game app and hands-on data based on the same scoring system is not available in the market. The aim of this study was to create such a platform and investigate whether performance evaluation of BLS trainings would be more objective compared to conventional Objective Structured Clinical Examination (OSCE) examinations if these evaluations were carried out with the platform which combines OSCE scoring criteria with sensor data retrieved from the simulator’s sensors. Methods Participants were 25 volunteers (11 men [44.0%] and 14 [56.0] women) among Acıbadem Mehmet Ali Aydınlar University students without prior knowledge of the BLS protocol. A serious game module has been created for teaching learners the European Resuscitation Council Basic Life Support 2015 protocol. A second module called the hands-on module was designed for educators. This module includes a checklist used for BLS OSCE examinations and can retrieve sensor data such as compression depth, compression frequency, and ventilation volume from the manikin (CPR Lilly; 3B Scientific GmbH) via Bluetooth. Data retrieved from the sensors of the manikin enable educators to evaluate learners in a more objective way. Performance data retrieved from the serious gaming module have been combined with the results of the hands-on module. Data acquired from the hands-on module have also been compared with the results of conventional OSCE scores of the participants, which were obtained by watching the videos of the same trainings. Results Participants were considered successful in the game if they scored 80/100 or above. Overall, participants scored 80 or above in an average of 1.4 (SD 0.65) trials. The average BLS serious game score was 88.3/100 (SD 5.17) and hands-on average score was 70.7/100 (SD 17.3), whereas the OSCE average score was 84.4/100 (SD 12.9). There was no statistically significant correlation between success on trials (score ≥80/100), serious game, hands-on training app, and OSCE scores (Spearman rho test, P>.05). The mean BLS serious game score of the participants was 88.3/100 (SD 5.17), whereas their mean hands-on training app score was 70.7/100 (SD 17.3) and OSCE score was 84.4/100 (SD 12.9). Conclusions Although scoring criteria for OSCE and hands-on training app were identical, OSCE scores were 17% higher than hands-on training app scores. After analyzing the difference of scores between hands-on training app and OSCE, it has been revealed that these differences originate from scoring parameters such as compression depth, compression frequency, and ventilation volume. These data suggest that evaluation of BLS trainings would be more objective if these evaluations were carried out with the modality, which combines visual OSCE scoring criteria with sensor data retrieved from the simulator’s sensors. Trial Registration ClinicalTrials.gov NCT04533893; https://clinicaltrials.gov/ct2/show/NCT04533893

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CPR Compression Rotation Every One Minute Versus Two Minutes: A Randomized Cross-Over Manikin Study

Emergency Medicine International ◽

10.1155/2020/5479209 ◽

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.

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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

Journal of Cardiovascular and Thoracic Research ◽

10.15171/jcvtr.2019.51 ◽

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. 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. 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). Conclusion: When the dominant hand is on the non-dominant hand, more pressure with greater depth is applied.

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Can real-time feedback improve the simulated infant cardiopulmonary resuscitation performance of basic life support and lay rescuers?

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-316576 ◽

2019 ◽

Vol 104 (8) ◽

pp. 793-801 ◽

Cited By ~ 1

Author(s):

Jeyapal Kandasamy ◽

Peter S Theobald ◽

Ian K Maconochie ◽

Michael D Jones

Keyword(s):

Cardiopulmonary Resuscitation ◽

Real Time ◽

Chest Compression ◽

Duty Cycle ◽

Basic Life Support ◽

Life Support ◽

Cycle Performance ◽

Chest Compressions ◽

High Quality ◽

Single Measure

BackgroundPerforming high-quality chest compressions during cardiopulmonary resuscitation (CPR) requires achieving of a target depth, release force, rate and duty cycle.ObjectiveThis study evaluates whether ‘real time’ feedback could improve infant CPR performance in basic life support-trained (BLS) and lay rescuers. It also investigates whether delivering rescue breaths hinders performing high-quality chest compressions. Also, this study reports raw data from the two methods used to calculate duty cycle performance.MethodologyBLS (n=28) and lay (n=38) rescuers were randomly allocated to respective ‘feedback’ or ‘no-feedback’ groups, to perform two-thumb chest compressions on an instrumented infant manikin. Chest compression performance was then investigated across three compression algorithms (compression only; five rescue breaths then compression only; five rescue breaths then 15:2 compressions). Two different routes to calculate duty cycle were also investigated, due to conflicting instruction in the literature.ResultsNo-feedback BLS and lay groups demonstrated <3% compliance against each performance target. The feedback rescuers produced 20-fold and 10-fold increases in BLS and lay cohorts, respectively, achieving all targets concurrently in >60% and >25% of all chest compressions, across all three algorithms. Performing rescue breaths did not impede chest compression quality.ConclusionsA feedback system has great potential to improve infant CPR performance, especially in cohorts that have an underlying understanding of the technique. The addition of rescue breaths—a potential distraction—did not negatively influence chest compression quality. Duty cycle performance depended on the calculation method, meaning there is an urgent requirement to agree a single measure.

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Training frequency for educating schoolchildren in basic life support: very brief 4-month rolling-refreshers versus annual retraining—a 2-year prospective longitudinal trial

BMJ Open ◽

10.1136/bmjopen-2021-052478 ◽

2021 ◽

Vol 11 (11) ◽

pp. e052478

Author(s):

Cristian Abelairas-Gómez ◽

Santiago Martinez-Isasi ◽

Roberto Barcala-Furelos ◽

Cristina Varela-Casal ◽

Aida Carballo-Fazanes ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Basic Life Support ◽

Life Support ◽

Control Group ◽

Standard Group ◽

Global Quality ◽

Training Frequency ◽

Hands On ◽

Sequence Performance ◽

Prospective Longitudinal

ObjectiveTo compare the effectiveness of 4-month rolling-refreshers and annual retraining in basic life support (BLS) on a sample of schoolchildren.DesignProspective longitudinal trial.Setting and participantsFour hundred and seventy-two schoolchildren (8–12 years old).InterventionsSchoolchildren were instructed in BLS and then split into the following three groups: control group (CG), standard group (SG) and rolling-refresher group (RRG). Their BLS skills were assessed within 1 week (T1) and 2 years later (T2). Moreover, CG did not receive any additional training; SG received one 50 min retraining session 1 year later; RRG participated in very brief (5 min) rolling-refreshers that were carried out every 4 months.Primary and secondary outcomesHands-on skills of BLS sequence and cardiopulmonary resuscitation.ResultsBLS sequence performance was similar in all groups at T1, but SG and RRG followed the steps of the protocol in more proportion than CG at T2. When compared at T2, RRG showed higher proficiency than SG in checking safety, checking response, opening the airway and alerting emergency medical services. In addition, although the mean resuscitation quality was low in all groups, RRG participants reached a higher percentage of global quality cardiopulmonary resuscitation (CG: 16.4±24.1; SG: 25.3±28.8; RRG: 29.9%±29.4%), with a higher percentage of correct chest compressions by depth (CG: 3.9±11.8; SG: 10.8±22.7; RRG: 15.5±26.1 mm).ConclusionsIn 8-to-12-year-old schoolchildren, although annual 50 min retraining sessions help to maintain BLS performance, 4-month very brief rolling-refreshers were shown to be even more effective. Thus, we recommend implementing baseline BLS training at schools, with subsequently brief rolling-refreshers.

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Sports safety matting diminishes cardiopulmonary resuscitation quality and increases rescuer perceived exertion

PLoS ONE ◽

10.1371/journal.pone.0254800 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254800

Author(s):

Thomas Kingston ◽

Nicholas B. Tiller ◽

Elle Partington ◽

Mukhtar Ahmed ◽

Gareth Jones ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Perceived Exertion ◽

Life Support ◽

Advanced Life Support ◽

Compression Depth ◽

Support Providers ◽

High Compliance ◽

Compliant Surfaces ◽

Clinical Environments

Objectives Compliant surfaces beneath a casualty diminish the quality of cardiopulmonary resuscitation (CPR) in clinical environments. To examine this issue in a sporting environment, we assessed chest compression quality and rescuer exertion upon compliant sports safety matting. Methods Twenty-seven advanced life support providers volunteered (13 male/14 female; mass = 79.0 ± 12.5 kg; stature = 1.77 ± 0.09 m). Participants performed 5 × 2 min, randomized bouts of continuous chest compressions on a mannequin, upon five surfaces: solid floor; low-compliance matting; low-compliance matting with a backboard; high-compliance matting; high-compliance matting with a backboard. Measures included chest compression depth and rate, percentage of adequate compressions, and rescuer heart rate and perceived exertion. Results Chest compression depth and rate were significantly lower upon high-compliance matting relative to other surfaces (p<0.05). The percentage of adequate compressions (depth ≥50 mm) was lowest upon high-compliance matting (40 ± 39%) versus low-compliance matting (60 ± 36%) and low-compliance matting with a backboard (59 ± 39%). Perceived exertion was significantly greater upon high-compliance matting versus floor, low-compliance matting, and low-compliance matting with a backboard (p<0.05). Conclusion Providers of CPR should be alerted to the detrimental effects of compliant safety matting in a sporting environment and prepare to alter the targeted compression depth and rescuer rotation intervals accordingly.

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Comparing Basic Life Support Serious Gaming Scores With Hands-on Training Platform Performance Scores: Pilot Simulation Study for Basic Life Support Training (Preprint)

10.2196/preprints.24166 ◽

2020 ◽

Author(s):

Mehmet Emin Aksoy

Keyword(s):

Basic Life Support ◽

Life Support ◽

Performance Data ◽

Serious Game ◽

Sensor Data ◽

Average Score ◽

Compression Depth ◽

Serious Gaming ◽

Hands On ◽

Depth Compression

BACKGROUND Serious games enrich simulation-based health care trainings and improve knowledge, skills, and self-confidence of learners while entertaining them. OBJECTIVE A platform which can combine performance data from a basic life support (BLS) serious game app and hands-on data based on the same scoring system is not available in the market. The aim of this study was to create such a platform and investigate whether performance evaluation of BLS trainings would be more objective compared to conventional Objective Structured Clinical Examination (OSCE) examinations if these evaluations were carried out with the platform which combines OSCE scoring criteria with sensor data retrieved from the simulator’s sensors. METHODS Participants were 25 volunteers (11 men [44.0%] and 14 [56.0] women) among Acıbadem Mehmet Ali Aydınlar University students without prior knowledge of the BLS protocol. A serious game module has been created for teaching learners the European Resuscitation Council Basic Life Support 2015 protocol. A second module called the hands-on module was designed for educators. This module includes a checklist used for BLS OSCE examinations and can retrieve sensor data such as compression depth, compression frequency, and ventilation volume from the manikin (CPR Lilly; 3B Scientific GmbH) via Bluetooth. Data retrieved from the sensors of the manikin enable educators to evaluate learners in a more objective way. Performance data retrieved from the serious gaming module have been combined with the results of the hands-on module. Data acquired from the hands-on module have also been compared with the results of conventional OSCE scores of the participants, which were obtained by watching the videos of the same trainings. RESULTS Participants were considered successful in the game if they scored 80/100 or above. Overall, participants scored 80 or above in an average of 1.4 (SD 0.65) trials. The average BLS serious game score was 88.3/100 (SD 5.17) and hands-on average score was 70.7/100 (SD 17.3), whereas the OSCE average score was 84.4/100 (SD 12.9). There was no statistically significant correlation between success on trials (score ≥80/100), serious game, hands-on training app, and OSCE scores (Spearman rho test, P>.05). The mean BLS serious game score of the participants was 88.3/100 (SD 5.17), whereas their mean hands-on training app score was 70.7/100 (SD 17.3) and OSCE score was 84.4/100 (SD 12.9). CONCLUSIONS Although scoring criteria for OSCE and hands-on training app were identical, OSCE scores were 17% higher than hands-on training app scores. After analyzing the difference of scores between hands-on training app and OSCE, it has been revealed that these differences originate from scoring parameters such as compression depth, compression frequency, and ventilation volume. These data suggest that evaluation of BLS trainings would be more objective if these evaluations were carried out with the modality, which combines visual OSCE scoring criteria with sensor data retrieved from the simulator’s sensors. CLINICALTRIAL ClinicalTrials.gov NCT04533893; https://clinicaltrials.gov/ct2/show/NCT04533893

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Foundation Course Skills Development - Impact of Basic Life Support Training on Knowledge, Confidence, Skill and Perception of First Year Indian Medical Students

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/34 ◽

2021 ◽

Vol 8 (04) ◽

pp. 177-183

Author(s):

Ayan Kumar Pati ◽

Leelavati Thakur ◽

Sachin Damke

Keyword(s):

Focus Group ◽

Cardiopulmonary Resuscitation ◽

Skill Acquisition ◽

Basic Life Support ◽

Life Support ◽

Skills Development ◽

First Year ◽

Medical Council ◽

Hands On ◽

Post Test

BACKGROUND Basic life support (BLS) although a lifesaving skill, is seldom taught in the first year of traditional Indian undergraduate medical curriculum resulting in lack of competence and confidence. Medical Council of India’s new competency based undergraduate curriculum stresses on early skill acquisition. Basic life support hands-on workshop can be a simple yet effective educational intervention in achieving the goal. The aim of the study is to determine the effectiveness of introduction of BLS training workshop to first year MBBS curriculum as a part of foundation course skills development. METHODS An interventional study in the form of BLS workshop consisting of lecture, demonstration and hands on practice on mannequins was conducted on first MBBS students. Assessment was done by standardized pre- and post-test questionnaire and direct observation of procedural skills (DOPS). Student’s perception was qualitatively explored by conducting focus group discussions (FGD) followed by thematic analysis. RESULTS Analysis of median pre- and post-test scores using Wilcoxon test matched pairs signed rank test revealed highly significant gain in knowledge and confidence (P value = 0.000). Thirty three percent students could perform all the seven steps of cardiopulmonary resuscitation (CPR) correctly, meeting all six quality indicators indicating satisfactory skill acquisition. Six overarching themes emerged from the focus group responses viz. importance of clinical skill acquisition in first year, suggested methods to improve skill training, effectiveness of BLS workshop, usefulness of learning BLS skill, readiness to perform CPR in real life scenario and need for curriculum reformation. CONCLUSIONS Simulation-based hands-on workshop can serve as an effective teaching learning strategy for foundation course BLS skills development under new competencybased first MBBS curriculum by Medical Council of India (MCI). KEYWORDS Basic Life Support, Cardiopulmonary Resuscitation, MBBS, Curriculum, Competency, Qualitative Analysis, Medical Education

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