Chest compression effectiveness with vs without feedback

The objective of this experiment is to assess clinician perceived versus actual compression quality, and to evaluate the impact of using feedback from the Laerdal CPRMeter2 on compression quality. In our setup, we have a total of eighty four participants (43 from the Royal Alex and 41 from the Misericordia hospital). We monitored CPR quality based on the guidelines by Heart and Stroke, which breaks down chest compression effectiveness into three areas- Release, Depth and Rate. Proper Guidelines: Compress the chest at least 5cm (2inches); Compress at a rate of 100 to 120 beats per minute; Allow the chest to recoil completely after each compression. Clinical Setup: A convenience sample of participants performed two minutes of uninterrupted chest compressions on a Laerdal Resusci Anne with a CPRmeter2 on top without feedback, followed by a two minute rest period to fill out a Q.I tracking form. They later repeated the two minutes of chest compressions with the display of the CPRmeter uncovered, with the feedback visible. The chest compression metrics from the trials were compared using a data tracking form. From the data collected, enough evidence shows that the CPRmeter2 is able to improve release, rate and overall CPR quality. After filling out the survey, all of the nurses agree that the device is very useful in giving feedback and should be used in future CPR classes. Furthermore, data collected from the Q.I tracking forms indicates that nurses and other health clinicians are inadequate in predicting their own CPR abilities. Often times, nurses would either overpredict or underpredict their scores on the CPR meter. From the data gathered, the CPRmeter2 is going to be used for training in future CPR classes. Just recently, the device has been incorporated into code calls in the emergency department at the Misericordia. A T-test was done on the findings from the experiment to test if the means of two sets of data are significantly different from each other. Based on our findings, the t-test values for rate, release, and overall quality are statistically significant, meaning that the null hypothesis is rejected.

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Abstract 12065: CPR Prompting Devices: Unintended Consequences Impacting High Performers

Circulation ◽

10.1161/circ.132.suppl_3.12065 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Christie L Mulvey ◽

Sally J Rudy ◽

David L Rodgers ◽

Tammi J Bortner ◽

Elizabeth H Sinz ◽

...

Keyword(s):

High Performance ◽

Unintended Consequences ◽

Entire Group ◽

Chest Compressions ◽

Convenience Sample ◽

High Performers ◽

Cpr Quality ◽

The Impact ◽

Level Group

Introduction: Prompting devices for chest compressions have been advocated as a means of improving CPR quality in previous AHA guidelines. Studies have shown overall CPR quality improves with the use of these devices. Hypothesis: This study compared the impact of prompting devices on providers with varying levels of experience and proficiency. Methods: A convenience sample of 53 subjects with varying degrees of CPR experience, ranging from zero to frequent opportunities to perform CPR, were enrolled. Using a skills recording CPR manikin, data on each subject’s chest compression performance was obtained. All subjects performed an initial one-minute cycle of continuous chest compressions with no prompting device. After a brief rest, subjects were randomized to use one of two CPR prompting devices (Philips MRX with Q-CPR or Laerdal Medical CPRmeter). An additional one minute of CPR was conducted with the first device. Subjects were then crossed over to use the other prompting device after another brief rest. Results: Across the entire group, nearly all parameters significantly improved with the prompting devices, confirming previous studies on the efficacy of CPR prompting devices. However, when subjects’ results were examined by breaking the group into three performance levels (high, medium and low) based on the Overall CPR Score generated by the manikin software, there were differences in performance. Paired t -tests were conducted on the low and high performance groups. The low-level group significantly improved across 7 of 8 variables with both devices. The high-level group had only minor changes from baseline (both positive and negative) in most variables, but had significant or near significant decrease in proficiency in one variable - percent correctly released compressions ( p = 0.011 for Philips device; p = 0.052 for the Laerdal device). Conclusions: CPR prompting devices improve the overall quality of chest compressions. Individuals with existing high performance CPR skills could be distracted by the device, reducing the quality of compressions compared to using no device. When a CPR prompting device is introduced into a health care system, all providers, especially high performers, require practice with the device in order to acclimate to its use.

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Bystander fatigue and CPR quality by older bystanders: a randomized crossover trial comparing continuous chest compressions and 30:2 compressions to ventilations

CJEM ◽

10.1017/cem.2016.373 ◽

2016 ◽

Vol 18 (6) ◽

pp. 461-468 ◽

Cited By ~ 5

Author(s):

Shawn Liu ◽

Christian Vaillancourt ◽

Ann Kasaboski ◽

Monica Taljaard

Keyword(s):

Chest Compression ◽

Crossover Trial ◽

Tertiary Care ◽

Rest Period ◽

Mean Difference ◽

Chest Compressions ◽

Lay Persons ◽

Randomized Crossover Trial ◽

Cpr Quality ◽

Cpr Training

ABSTRACTObjectivesThis study sought to measure bystander fatigue and cardiopulmonary resuscitation (CPR) quality after five minutes of CPR using the continuous chest compression (CCC) versus the 30:2 chest compression to ventilation method in older lay persons, a population most likely to perform CPR on cardiac arrest victims.MethodsThis randomized crossover trial took place at three tertiary care hospitals and a seniors’ center. Participants were aged ≥55 years without significant physical limitations (frailty score ≤3/7). They completed two 5-minute CPR sessions (using 30:2 and CCC) on manikins; sessions were separated by a rest period. We used concealed block randomization to determine CPR method order. Metronome feedback maintained a compression rate of 100/minute. We measured heart rate (HR), mean arterial pressure (MAP), and Borg Exertion Scale. CPR quality measures included total number of compressions and number of adequate compressions (depth ≥5 cm).ResultsSixty-three participants were enrolled: mean age 70.8 years, female 66.7%, past CPR training 60.3%. Bystander fatigue was similar between CPR methods: mean difference in HR -0.59 (95% CI −3.51-2.33), MAP 1.64 (95% CI −0.23-3.50), and Borg 0.46 (95% CI 0.07-0.84). Compared to 30:2, participants using CCC performed more chest compressions (480.0 v. 376.3, mean difference 107.7; p<0.0001) and more adequate chest compressions (381.5 v. 324.9, mean difference. 62.0; p=0.0001), although good compressions/minute declined significantly faster with the CCC method (p=0.0002).ConclusionsCPR quality decreased significantly faster when performing CCC compared to 30:2. However, performing CCC produced more adequate compressions overall with a similar level of fatigue compared to the 30:2 method.

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Abstract 229: Cardiopulmonary Resuscitation Compliance of Clinical Nurses Using Feedback Technology from the Zoll R Series Defibrillator

Circulation ◽

10.1161/circ.142.suppl_4.229 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Martha A Boudreau

Keyword(s):

Visual Feedback ◽

Chest Compression ◽

Technology Use ◽

Healthcare Providers ◽

Rest Period ◽

Visual Display ◽

Chest Compressions ◽

Compression Performance ◽

Clinical Nurses ◽

Use Of Technology

Use of technology driven devices aimed at providing audio-visual feedback during CPR have been developed, however research is limited to their usefulness effecting chest compression quality of clinical nurses who are often first to respond and begin chest compression on patients experiencing cardiac arrest. This study aimed to examine CPR chest compression compliance of nurses with and without feedback from the Zoll R Series® defibrillator on a manikin. Hypothesis: Audio-visual feedback technology use from the Zoll R Series defibrillator improves the percentage of appropriate chest compression depth and rate of nurses during a CPR manikin demonstration exercise. Methods: Thirty-four nurses participated using an AHA approved manikin. Each nurse performed two minutes of uninterrupted chest compressions without feedback, followed by a rest period and two minutes of uninterrupted chest compressions using feedback technology from the defibrillator. Compression data for rate and depth and total compressions in target within AHA 2015 ECC Guidelines were recorded by the defibrillator and entered into Zoll RescueNet® software. Demographics obtained for years of BLS and ACLS certification. Results: Of the 34 nurses, mean years of ACLS certification was 3.4 years and 11.7 certified years of BLS. Compressions performed with feedback showed a higher percentage of compressions in target (M = 87.37, SD= 15.95) including rate (M= 86.33, SD =15.13) and depth (M= 97.12, SD = 5.63) of compressions compared to percent compressions in target without feedback (M= 64.42, SD = 30.54) including rate (M= 65.73, SD = 32.44) and depth (M=93.34, SD = 19.99) of compressions. Twenty nine or 85% of the 34 nurses improved chest compression performance using feedback. No significant correlation found between years of BLS and ACLS certification and pre and post feedback compliance. Conclusions: Defibrillators offering verbal encouragement and a visual display allow for adjustments in rate and depth of compressions to maintain chest compressions compliance within ECC Guidelines. Further studies should investigate whether the incorporation of feedback technology use in mock code and CPR training sessions could improve CPR performance of healthcare providers including nurses.

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Analysis of chest compression depth and rate during cardiopulmonary resuscitation with and without a feedback device

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918755177 ◽

2018 ◽

Vol 25 (4) ◽

pp. 179-184

Author(s):

Magdalena Fronczek-Wojciechowska ◽

Karolina Kopacz ◽

Anna Jaźwińska ◽

Gianluca Padula ◽

Tomasz Gaszyński

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

T Test ◽

Compression Depth ◽

Group A ◽

Level Of Significance ◽

Group B ◽

The Impact ◽

Levene Test ◽

Dependent Samples

Background: Many feedback devices have been designed to improve the resuscitation outcomes. None have been implemented as a standard in patient care. Objectives: The aim of this study was to evaluate the chest compression depth and rate during cardiopulmonary resuscitation with and without a feedback device and to evaluate differences regarding the impact of a feedback device based on provider experience. Methods: The study was performed on 20 men divided into two groups: group A (n = 10)—paramedics; group B (n = 10)—non-paramedics, trained to provide resuscitation. Participants were examined during resuscitation with Ambu Megacode manikin and with or without the feedback device—CPRmeter. Depth of compressions was evaluated in the first and fourth minute of resuscitation with a BTS Smart DX7000 motion capture system. For statistical analysis, summary statistics, Shapiro–Wilk Test of normality, dependent samples t-test, Levene test, t-test for independent samples, or Welch’s t-test were used. Accepted level of significance was α = 0.05. Results: Statistically significant greater depth of chest compressions in group A was observed in the first minute of resuscitation with the device versus the first minute without the device. Significant differences in compressions rate between attempts with and without the device were observed in both groups in the first and fourth minute. Conclusion: Only the group of paramedics showed in time some benefits of the device related to the depth, whereas for the group of non-paramedics, the device seemed to have even a deleterious effect. The group of paramedics met the 2015 recommendations related to compressions rate all the time, while the non-paramedics only in the fourth minute of the procedure.

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Real-Time Chest Compression Quality Measurements by Smartphone Camera

Journal of Healthcare Engineering ◽

10.1155/2018/6241856 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12 ◽

Cited By ~ 1

Author(s):

Øyvind Meinich-Bache ◽

Kjersti Engan ◽

Tonje Søraas Birkenes ◽

Helge Myklebust

Keyword(s):

Cardiac Arrest ◽

Real Time ◽

Chest Compression ◽

Quality Measurement ◽

Smartphone Application ◽

Average Error ◽

Compression Rate ◽

Chest Compressions ◽

Compression Time ◽

Cpr Quality

Out-of-hospital cardiac arrest (OHCA) is recognized as a global mortality challenge, and digital strategies could contribute to increase the chance of survival. In this paper, we investigate if cardiopulmonary resuscitation (CPR) quality measurement using smartphone video analysis in real-time is feasible for a range of conditions. With the use of a web-connected smartphone application which utilizes the smartphone camera, we detect inactivity and chest compressions and measure chest compression rate with real-time feedback to both the caller who performs chest compressions and over the web to the dispatcher who coaches the caller on chest compressions. The application estimates compression rate with 0.5 s update interval, time to first stable compression rate (TFSCR), active compression time (TC), hands-off time (TWC), average compression rate (ACR), and total number of compressions (NC). Four experiments were performed to test the accuracy of the calculated chest compression rate under different conditions, and a fifth experiment was done to test the accuracy of the CPR summary parameters TFSCR, TC, TWC, ACR, and NC. Average compression rate detection error was 2.7 compressions per minute (±5.0 cpm), the calculated chest compression rate was within ±10 cpm in 98% (±5.5) of the time, and the average error of the summary CPR parameters was 4.5% (±3.6). The results show that real-time chest compression quality measurement by smartphone camera in simulated cardiac arrest is feasible under the conditions tested.

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What is the Impact of the European Resuscitation Council Covid-19 Guidelines on Resuscitation Quality – A Manakin Study

10.21203/rs.3.rs-77425/v1 ◽

2020 ◽

Author(s):

Gerrit Jansen ◽

Nicole Ebeling ◽

Eugen Latka ◽

Stefan Krüger ◽

Sean Scholz ◽

...

Keyword(s):

Chest Compression ◽

Oxygen Supply ◽

Life Support ◽

Flow Time ◽

Control Group ◽

European Resuscitation Council ◽

Chest Compressions ◽

Advanced Airway ◽

Rhythm Analysis ◽

The Impact

Abstract BackgroundTo evaluate the effects of European Resuscitation Council (ERC) Covid-19-guidelines on resuscitation quality.MethodsIn an observational manikin study paramedics and emergency physicians performed Advanced-Cardiac-Life-Support in three settings: ERC guidelines 2015 (Control), Covid-19-guidelines as suggested with minimum staff (Covid-19-minimal-personnel); Covid-19-guidelines with paramedics and an emergency physician (Covid-19-advanced-airway-manager). Main outcome measures were no-flow-time, quality metrics as defined by ERC and time intervals to first chest compression, oxygen supply, intubation and first rhythm analysis. Data were presented as mean (standard deviation).Results30 resuscitation scenarios were completed. No-flow-time was markly prolonged in Covid-19-minimal-personnel [113±37 sec] compared to Control [55±9 sec; p<0.001] and Covid-19-advanced-airway-manager [76±38 sec; p<0.001]. In both Covid-19-groups chest compressions started later [Control: 21±5 sec, Covid-19-minimal-personnel: 32±6 sec; Covid-19-advanced-airway-manager: 37±7 sec; each p<0.001 vs. control], but oxygen supply [Control: 77±19 sec; Covid-19-minimal-personnel: 29±5 sec; Covid-19-advanced-airway-manager: 34±7 sec; each p<0.001 vs. control] and first intubation attempt [Control: 178±44 sec; Covid-19-minimal-personnel: 111±14 sec; Covid-19-advanced-airway-manager: 131±20 sec; each p<0.001 vs. control] were earlier than in the control group. However, succesful intubation was similar [Control: 198±48 sec; Covid-19-minimal-personnel: 181±42 sec; Covid-19-advanced-airway-manager: 130±25 sec] due to a longer intubation time in Covid-19-minimal-personnel [61±35 sec] compared to Covid-19-advanced-airway-manager (p=0.002) and control [19±6 sec; p<0.001]. Time to first rhythm analysis was more than doubled in Covid-19-minimal-personnel [138±96 sec] compared to control [50±12 sec, p<0.001].ConclusionCovid-19-guidelines led to earlier attempts at intubation, delay in starting chest compressions, longer interruption in chest compression and markedly worsen the quality of resuscitation. These negative effects are attenuated by increasing the number of staff and addition of an experienced airway manager. Specific indications for Covid-19-guidelines are urgently required to carefully balance the risk of infection with SARS-CoV-2 for the staff vs. the potentially worse outcome for the patients.

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Abstract 333: End-Tidal Carbon Dioxide, CPR Quality and ROSC During Pediatric Cardiac Arrests in a Large Academic Children’s Hospital, 2013-2018

Circulation ◽

10.1161/circ.140.suppl_2.333 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Jill L Sorcher ◽

Elizabeth A Hunt ◽

Donald H Shaffner ◽

Justin Jeffers ◽

Heather Newton ◽

...

Keyword(s):

Carbon Dioxide ◽

Chest Compression ◽

Chest Compressions ◽

Significant Difference ◽

End Tidal Carbon Dioxide ◽

Study Population ◽

Cpr Quality ◽

Data Files ◽

Pediatric Populations ◽

End Tidal

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LO67: The impact of CPR quality during entire resuscitation episode on survival from cardiac arrest

CJEM ◽

10.1017/cem.2017.129 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S51

Author(s):

I. Drennan ◽

A.K. Taher ◽

S. Cheskes ◽

C. Zhan ◽

A. Byers ◽

...

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Patient Survival ◽

P Value ◽

High Quality ◽

Compression Depth ◽

Entire Duration ◽

Cpr Quality ◽

The Impact

Introduction: High-quality cardiopulmonary resuscitation (CPR) is essential for patient survival. Typically, CPR quality is only measured during the first 10 minutes of resuscitation. There is limited research examining the quality of CPR over the entire duration of resuscitation.Objective: To examine the quality of CPR over the entire duration of resuscitation and correlate the quality of CPR to patient survival. Methods: This was a retrospective observational study using data from the Toronto RescuNET Epistry-Cardiac Arrest database. We included consecutive, adult (>18) OHCA treated by EMS between January 1, 2014 and September 30, 2015. High-quality CPR was defined, in accordance with 2015 AHA Guidelines, as a chest compression rate of 100-120/min, depth of 5.0-6.0 cm and chest compression fraction (ccf) of >0.80. We further categorized high-quality resuscitation as meeting benchmarks >80% of the time, moderate-quality between 50-80% and low-quality meeting benchmarks <50% of the resuscitation. We used multivariable logistic regression to determine association between variables of interest, including CPR quality metrics, and survival to hospital discharge. Results: A total of 5,208 OHCA met our inclusion criteria with a survival rate of 8%. The median (IQR) duration of resuscitation was 23.0 min (15.0,32.7). Overall CPR quality was considered high-quality for ccf in 81% of resuscitation episodes, 41% for rate, and 7% for depth. The percentage of resuscitations meeting the quality benchmarks differed between survivors and non-survivors for both depth (15% vs 6%) and ccf (61% vs 83%) (P value <0.001). After controlling for Utstein variables maintaining a chest compression depth within recommendations for >80% showed a trend towards improved survival (OR 1.68, 95% CI 0.96, 2.92). Other variables associated with survival were public location, initial CPR by EMS providers or bystanders, witnessed cardiac arrest (EMS or bystander), and initial shockable rhythm. Increasing age and longer duration of resuscitation were associated with decreased survival. Conclusion: Overall, EMS providers were not able to maintain rate or depth within guideline recommendations for the majority of the duration of resuscitation. Maintaining chest compression depth for greater than 80% of the resuscitation showed a trend towards increased survival from OHCA.

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Effect of Chest Compression Position Depending on the Rescuer’s Hip Joint Angle During Basic CPR

Fire science and engineering ◽

10.7731/kifse.0902eaff ◽

2020 ◽

Vol 34 (2) ◽

pp. 103-109

Author(s):

Jae-Min Lee ◽

Hyeong-Wan Yun

Keyword(s):

Chest Compression ◽

Hip Joint ◽

Joint Angle ◽

Chest Compressions ◽

Compression Speed ◽

Compression Time ◽

Significant Difference ◽

Cpr Quality ◽

And Control

This study aims to investigate the improvement in basic CPR quality on the basis of the hip joint angle of the rescuer among students in the Department of Emergency Medical Technology who completed a basic CPR curriculum. In this study, we carried out a comparative analysis using SimPad SkillReporter and Resusci Anne® QCPR® to measure the quality of CPR (depth of chest compressions, full relaxation, compression speed, and more) on the basis of the rescuer’s hip joint angle in accordance with the 2015 AHA Guidelines and conducted chest compressions and CPR 5 times in a 30:2 ratio. It was found that maintenance of the rescuer’s hip joint angle at 90 degrees while compressing and relaxing the chest made a statistically significant difference in both the experimental and control groups. Moreover, this indicated that the closer the hip joint angle was to 90 degrees, the better was the quality of basic CPR. However, there was no significant difference in the hip joint angle, degree of CPR, depth of chest compressions, chest compression speed, chest compression and relaxation percentages (%), accuracy of chest compressions, hands-off time during CPR, and percentage of chest compression time (p > 0.05). Maintaining the hip joint angle at 90 degrees for basic CPR was not significantly different from not maintaining this angle. Nonetheless, good results have been obtained at moderate depth and 100% recoil. Therefore, good outcome and high-quality CPR are expected.

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