Consistency and variability in human performance during simulate infant CPR: a reliability study

Abstract Background Positive outcomes from infant cardiac arrest depend on the effective delivery of resuscitation techniques, including good quality infant cardiopulmonary resuscitation (iCPR) However, it has been established that iCPR skills decay within weeks or months after training. It is not known if the change in performance should be considered true change or inconsistent performance. The aim of this study was to investigate consistency and variability in human performance during iCPR. Methods An experimental, prospective, observational study conducted within a university setting with 27 healthcare students (mean (SD) age 32.6 (11.6) years, 74.1% female). On completion of paediatric basic life support (BLS) training, participants performed three trials of 2-min iCPR on a modified infant manikin on two occasions (immediately after training and after 1 week), where performance data were captured. Main outcome measures were within-day and between-day repeated measures reliability estimates, determined using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC95%) for chest compression rate, chest compression depth, residual leaning and duty cycle along with the conversion of these into quality indices according to international guidelines. Results A high degree of reliability was found for within-day and between-day for each variable with good to excellent ICCs and narrow confidence intervals. SEM values were low, demonstrating excellent consistency in repeated performance. Within-day MDC values were low for chest compression depth and chest compression rate (6 and 9%) and higher for duty cycle (15%) and residual leaning (22%). Between-day MDC values were low for chest compression depth and chest compression rate (3 and 7%) and higher for duty cycle (21%) and residual leaning (22%). Reliability reduced when metrics were transformed in quality indices. Conclusion iCPR skills are highly repeatable and consistent, demonstrating that changes in performance after training can be considered skill decay. However, when the metrics are transformed in quality indices, large changes are required to be confident of real change.

Download Full-text

Effect of the Use of Metronome Feedback on the Quality of Pediatric Cardiopulmonary Resuscitation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158087 ◽

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.

Download Full-text

Leg-heel chest compression as an alternative for medical professionals in times of COVID-19

10.1101/2021.03.09.21253220 ◽

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.

Download Full-text

Abstract 133: Electrical Insulating Gloves for Safe Hands-on Defibrillation Do Not Compromise the Quality of Chest Compressions

Circulation ◽

10.1161/circ.130.suppl_2.133 ◽

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.

Download Full-text

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.

Download Full-text

Responsiveness of a Balance Assessment Using a Mobile Application

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738119888656 ◽

2020 ◽

Vol 12 (4) ◽

pp. 401-404

Author(s):

David A. Krause ◽

Sarah E. Anderson ◽

Graeme R. Campbell ◽

Samson J. Davis ◽

Samuel W. Tindall ◽

...

Keyword(s):

Repeated Measures ◽

Intraclass Correlation ◽

Algorithm Analysis ◽

Minimal Detectable Change ◽

Balance Assessment ◽

Level Of Evidence ◽

Convenience Sample ◽

Warm Up ◽

Testing Procedures ◽

A Value

Background: Balance assessment is used by clinicians as part of athlete concussion screening. The King-Devick (K-D) Balance app is designed to provide an objective balance assessment value. The purpose of this study was to investigate the responsiveness of a balance assessment using the K-D Balance app. Hypothesis: The K-D Balance app will demonstrate acceptable responsiveness for balance assessment. Study Design: Repeated-measures study. Level of Evidence: Level 5. Methods: A convenience sample of 25 participants between the ages of 20 and 25 years completed testing procedures. A battery of balance tests using the K-D Balance app on an iPhone were conducted 1 week apart. After a 5-minute warm-up, 3 stances were assessed: double leg, tandem right, and tandem left. The K-D Balance app guided the test positions and test times. A value representing movement was generated by the app algorithm. Analysis included descriptive statistics along with intraclass correlation coefficient and minimal detectable change (MDC). Results: The median score of the K-D test was 0.5 for session 1 and 0.4 for session 2. The ICC was 0.42 (95% CI, 0.04-0.70), and the MDC was 1.58. Conclusion: The MDC value of 1.58 represents the threshold of meaningful change in balance, as measured with the K-D Balance app. Clinical Relevance: Clinicians can use the results of this study to objectively assess changes in balance over time using the K-D Balance app.

Download Full-text

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

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918790068 ◽

2018 ◽

Vol 26 (2) ◽

pp. 106-110 ◽

Cited By ~ 2

Author(s):

Yoshiaki Takahashi ◽

Takeji Saitoh ◽

Misaki Okada ◽

Hiroshi Satoh ◽

Toshiya Akai ◽

...

Keyword(s):

Heart Rate ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Basic Life Support ◽

Life Support ◽

Vital Signs ◽

Borg Scale ◽

Compression Depth ◽

Hands On ◽

Scale Scores

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.

Download Full-text

Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2012.07.015 ◽

2012 ◽

Vol 83 (11) ◽

pp. 1319-1323 ◽

Cited By ~ 48

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

Download Full-text

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.<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.

Download Full-text

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

Circulation ◽

10.1161/circ.132.suppl_3.17062 ◽

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.

Download Full-text

Abstract 290: Cardiopulmonary Resuscitation Duty Cycle in Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.130.suppl_2.290 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Thomas Rea ◽

Bryce Johnson ◽

Jason Coult ◽

Carol Fahrenbruch ◽

Jennifer Blackwood ◽

...

Keyword(s):

Cardiac Arrest ◽

Duty Cycle ◽

Future Research ◽

Compression Rate ◽

High Survival ◽

Compression Depth ◽

Total Period ◽

Compression Phase ◽

Compression Time ◽

Rate Test

Background: CPR duty cycle is the portion of time spent in compression relative to the total time of the compression-decompression cycle. Guidelines recommend a 50% duty cycle based largely on animal investigation. Little is known about duty cycle in human resuscitation and whether duty cycle correlates with other CPR measures. Methods: We calculated the duty cycle, compression depth, and compression rate during EMS resuscitation of 164 patients with out-of-hospital ventricular fibrillation cardiac arrest. We captured force recordings from a chest accelerometer to measure ten-second CPR epochs that immediately preceded each scheduled rhythm analysis. Duty cycle was calculated using two methods. The effective compression time (ECT) is the time from beginning to end of compression divided by total period for that compression-decompression cycle. The area duty cycle (ADC) is the ratio of area under the force curve divided by total area of one compression-decompression cycle. We evaluated the compression depth and compression rate according to duty cycle quartiles. Results: There were 369 ten-second epochs among 164 patients. The median duty cycle was 38.8% (SD=5.5%) using ECT and 32.2% (SD=4.3%) using ADC. A relatively shorter compression phase (lower duty cycle) was associated with greater compression depth (test for trend < 0.05 for ECT and ADC) and slower compression rate (test for trend < 0.05 for ADC) (Table). Sixty-one patients (37%) survived to hospital discharge. Conclusions: In this system with high survival, duty cycle was well below the 50% recommended guideline, and was associated with compression depth and rate. These findings provide rationale to incorporate duty cycle into future research to evaluate how CPR influences resuscitation.

Download Full-text