Can the British Heart Foundation PocketCPR application improve the performance of chest compressions during bystander resuscitation: A randomised crossover manikin study

This study aims to determine whether the British Heart Foundation PocketCPR training application can improve the depth and rate of chest compression and therefore be confidently recommended for bystander use. A total of 118 candidates were recruited into a randomised crossover manikin trial. Each candidate performed cardiopulmonary resuscitation for 2 min without instruction or performed chest compressions using the PocketCPR application. Candidates then performed a further 2 min of cardiopulmonary resuscitation within the opposite arm. The number of chest compressions performed improved when PocketCPR was used compared to chest compressions when it was not (44.28% vs 40.57%, p < 0.001). The number of chest compressions performed to the required depth was higher in the PocketCPR group (90.86 vs 66.26). The British Heart Foundation PocketCPR application improved the percentage of chest compressions that were performed to the required depth. Despite this, more work is required in order to develop a feedback device that can improve bystander cardiopulmonary resuscitation without creating delay.

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Quality of chest compressions, perceived fatigue and energy expenditure with compression:ventilation ratios of 15:1, 30:2 or continuous chest-compression single-rescuer cardiopulmonary resuscitation: A manikin study

Resuscitation ◽

10.1016/j.resuscitation.2008.03.151 ◽

2008 ◽

Vol 77 ◽

pp. S48-S49

Author(s):

Y.M. Kim ◽

H.J. Baek ◽

S.H. Kim ◽

H.J. Kim ◽

J.H. Park ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Energy Expenditure ◽

Chest Compression ◽

Chest Compressions ◽

Manikin Study

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Abstract 17534: The Most Appropriate Number of Personnel Needed for Chest Compressions for In-hospital Cardiac Arrest: A Randomized, Crossover Manikin Study

Circulation ◽

10.1161/circ.132.suppl_3.17534 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Shunsuke Yamanaka ◽

Kei Nishiyama ◽

Hiroyuki Hayashi ◽

Ji Young Huh

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Healthcare Providers ◽

Preliminary Evaluation ◽

Chest Compressions ◽

Rescue Team ◽

Manikin Study ◽

Hospital Cardiac Arrest

Background: Effective chest compression (CC) is vital in cardiopulmonary resuscitation (CPR), and rescuer’s fatigue negatively affects quality of CPR. However, there is no consensus on the appropriate number of personnel needed for CC to avoid rescuer’s fatigue. Objective: We determined the appropriate number of personnel needed for 30-min CPR in a rescue-team in a hospital. Methods: We conducted a preliminary randomized, crossover, manikin trial on healthcare providers. We divided them into Groups A to D according to the intervals between the 2-min CC and assigned a different interval to each group. Groups A, B, C, and D performed CCs at 2-, 4-, 6-, and 8-min intervals as in 2, 3, 4, and 5 personnel, respectively. All participants performed CCs for 30 min with different intervals depending on the assigned group; participants allocated to Groups A, B, C, and D performed 8, 5, 4, and 3 cycles, respectively. We compared the differences between first cycle and the second to the last cycle Results: We enrolled 42 participants (age: 25.2±4.2, men 47.6%) for the preliminary evaluation. We used Kruskal-Wallis for the analysis. Participants in the less interval Groups A and B performed faster (A: -24.28±15.18, B: -7.90±13.49, C: -11.27±17.01, D: -2.38±3.31, P=0.03) and shallower CCs (A: -4.42±6.92, B: -3.18±5.43, C: -0.18±5.74, D: -1.23±4.10, P=0.62). Women-rescuers performed faster (A: -27.25±12.23, B: -7.00±13.97, C: -8.16±19.26, D: 3.16±4.66, P= 0.05) and shallower CCs (A: -6.25±7.54, B: -3.00±6.89, C: -3.66±3.32, D: -0.16±4.35, P=0.58). However, CCs of men-rescuers were not faster (A: -20.33±20.65, B: -9.00±14.44, C: -15.00±15.11, D: -7.14±16.70, P= 0.60) or shallower (A: -2.00±6.55 B: -3.40±3.78, C: 4.00±5.33, D: -2.14±3.98, P=0.06). Conclusion: At least four rescuers (Group C) may be needed to reduce rescuer’s fatigue for 30-min CPR. If the team only includes women, more personnel would be needed as women experience fatigue faster.

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Chest compression efficacy of child resuscitators

Journal of Paramedic Practice ◽

10.12968/jpar.2021.13.11.448 ◽

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.

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

Circulation ◽

10.1161/circ.140.suppl_2.20 ◽

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.

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

10.21203/rs.2.11675/v1 ◽

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.

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USING CHEST COMPRESSIONS WITH ASYNCHRONOUS VENTILATION AT VARIOUS CHEST COMPRESSION RATES (90, 100, 120/MIN) – A RANDOMIZED CONTROLLED ANIMAL TRIAL

Paediatrics & Child Health ◽

10.1093/pch/pxy054.071 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e27-e28

Author(s):

Sparsh Patel ◽

Po-Yin Cheung ◽

Tze-Fun Lee ◽

Matteo Pasquin ◽

Megan O’Reilly ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Porcine Model ◽

Life Support ◽

Neonatal Resuscitation ◽

Chest Compressions ◽

Neonatal Asphyxia ◽

Significant Difference ◽

Post Test ◽

The Mean

Abstract BACKGROUND The current Pediatric Advanced Life Support guidelines recommends that newborns who require cardiopulmonary resuscitation (CPR) in settings (e.g., prehospital, Emergency department, or paediatric intensive care unit, etc.) should receive continuous chest compressions with asynchronous ventilations (CCaV) if an advanced airway is in place. However, this has never been examined in a newborn model of neonatal asphyxia. OBJECTIVES To determine if CCaV at rates of 90/min or 120/min compared to current standard of 100/min will reduce the time to return of spontaneous circulation (ROSC) in a porcine model of neonatal resuscitation. DESIGN/METHODS Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia, which was achieved by clamping the endotracheal tube until asystole. Piglets were randomized into 3 CCaV groups: chest compression (CC) at a rate of 90/min (CCaV 90,n=7), of 100/min (CCaV 100,n=7), of 120/min (CCaV 120,n=7), or sham-operated group. A two-step randomization process with sequentially numbered, sealed brown envelope was used to reduce selection bias. After surgical instrumentation and stabilization an envelope containing the allocation “sham” or “intervention” was opened (step one). The sham-operated group had the same surgical protocol, stabilization, and equivalent experimental periods without hypoxia and asphyxia. Only piglets randomized to “intervention” underwent hypoxia and asphyxia. Once the criteria for CPR were met, a second envelope containing the group allocations was opened (step two). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. RESULTS The mean (±SD) duration of asphyxia was similar between the groups with 260 (±133)sec, 336 (±217)sec, and 231 (±174)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). The mean (SD) time to ROSC was also similar between groups 342 (±345)sec, 312 (±316)sec, and 309 (±287)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). Overall, 5/7 in the CCaV 90, 5/7 in CCaV 100, and 5/7 in the CCaV 120 survived. CONCLUSION There was no significant difference in time to ROSC for either chest compression technique during cardiopulmonary resuscitation in a porcine model of neonatal asphyxia.

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The influence of past experiences on future willingness to perform bystander cardiopulmonary resuscitation

International Journal of Emergency Medicine ◽

10.1186/s12245-019-0256-5 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Keng Sheng Chew ◽

Shazrina Ahmad Razali ◽

Shirly Siew Ling Wong ◽

Aisyah Azizul ◽

Nurul Faizah Ismail ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Hospital Setting ◽

Spontaneous Circulation ◽

Cardiac Events ◽

Validated Questionnaire ◽

Bystander Cardiopulmonary Resuscitation ◽

Past Experiences ◽

Hospital Cardiac Arrest

Abstract Background The influence of past familial experiences of receiving cardiopulmonary resuscitation (CPR) and medical help in various cardiac arrest and nonfatal cardiac events toward willingness to “pay it forward” by helping the next cardiac arrest victim was explored. Methods Using a validated questionnaire, 6248 participants were asked to rate their willingness to perform bystander chest compression with mouth-to-mouth ventilation and chest compression-only CPR. Their past familial experiences of receiving cardiopulmonary resuscitation (CPR) and medical help in various cardiac arrest and nonfatal cardiac events were also recorded. Results Kruskal-Wallis test with post hoc Dunn’s pairwise comparisons showed that the following were significantly more willing to perform CPR with mouth-to-mouth ventilation: familial experience of “nonfatal cardiac events” (mean rank = 447) vs “out-of-hospital cardiac arrest with no CPR” (mean rank = 177), U = 35442.5, z = −2.055, p = 0.04; “in-hospital cardiac arrest and successful CPR” (mean rank = 2955.79) vs “none of these experiences” (mean rank = 2468.38), U = 111903, z = −2.60, p = 0.01; and “in-hospital cardiac arrest with successful CPR” (mean rank = 133.45) vs “out-of-hospital arrest with no CPR” (mean rank = 112.36), U = 4135.5, z = −2.06, p = 0.04. For compression-only CPR, Kruskal-Wallis test with multiple runs of Mann-Whitney U tests showed that “nonfatal cardiac events” group was statistically higher than the group with “none of these experiences” (mean rank = 3061.43 vs 2859.91), U = 1194658, z = −2.588, p = 0.01. The groups of “in-hospital cardiac arrest with successful CPR” and “in-hospital cardiac arrest with transient return of spontaneous circulation” were the most willing groups to perform compression-only CPR. Conclusion Prior familial experiences of receiving CPR and medical help, particularly among those with successful outcomes in a hospital setting, seem to increase the willingness to perform bystander CPR.

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Chest Compressions in the Delivery Room

Children ◽

10.3390/children6010004 ◽

2019 ◽

Vol 6 (1) ◽

pp. 4 ◽

Cited By ~ 3

Author(s):

Catalina Garcia-Hidalgo ◽

Georg M. Schmölzer

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Mode Of Action ◽

Poor Prognosis ◽

Delivery Room ◽

Chest Compressions ◽

Optimal Depth ◽

The Poor ◽

Sustained Inflation ◽

High Incidence

Annually, an estimated 13–26 million newborns need respiratory support and 2–3 million newborns need extensive resuscitation, defined as chest compression and 100% oxygen with or without epinephrine in the delivery room. Despite such care, there is a high incidence of mortality and neurologic morbidity. The poor prognosis associated with receiving chest compression alone or with medications in the delivery room raises questions as to whether improved cardiopulmonary resuscitation methods specifically tailored to the newborn could improve outcomes. This review discusses the current recommendations, mode of action, different compression to ventilation ratios, continuous chest compression with asynchronous ventilations, chest compression and sustained inflation optimal depth, and oxygen concentration during cardiopulmonary resuscitation.

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