Comparison of Different Methods For Effective Manual Chest Compression In Dental Chairs, During Cardiopulmonary Resuscitation (CPR): A Manikin Study

During cardiopulmonary resuscitation (CPR), almost commercially dental chairs lack sufficient stability to perform effective manual chest compression (MCC). In our previous study, our technique that stabilizing stool can significantly reduce vertical displacement in a dental chair’s backrest. This study demonstrates that the efficacy of different methods for stabilizing 3 types of dental chair with a flat or a severely curved backrest exterior for effective MCC. Vertical displacement of the dental chair’s backrest was recorded. The data was captured with three different stool positions (no stool, under MCC, under shoulders). Reduction ratios were calculated to evaluate the effectiveness of the stool positions. In all types of dental chair, the technique significantly reduced the vertical displacements of the backrest. The reduction ratio varied nearly 40% under the area for MCC and 65% under the shoulder with a severely curved backrest exterior. With a flat shape of dental chair, these ratios were around 90% versus without a stool. The technique is a firm support and reduce the displacement of any type of dental chair’s backrest for effective MCC.

Mechanical Versus Manual Chest Compression: A Retrospective-Cohort in Out-of-Hospital Cardiac Arrest

Objective: In cardiac arrest cases, high quality cardiopulmonary resuscitation and effective chest compression are vital issues in improving survival with good neurological outcomes. In this study, we investigated the effect of mechanical chest compression devices on 30- day survival in out-of-hospital cardiac arrest. Materials and Methods: This retrospective case-control study was performed on patients who were over 18 years of age and admitted to the emergency department for cardiac arrest between January 1, 2016 and January 15, 2018. Manual chest compression was performed to the patients before January 15, 2017, and mechanical chest compression was performed after this date. Return of spontaneous circulation, hospital discharge, and 30-day survival rates were compared between the groups of patients in terms of chest compression type. In this study, the LUCAS-2 model piston-based mechanical chest compression device was used for mechanical chest compressions. Results: The rate of return of spontaneous circulation was significantly lower in the mechanical chest compression group (11.1% vs 33.1%; p < 0.001). The 30-day survival rate was higher in the manual chest compression group (6.8% vs 3.7%); however, this difference was not statistically significant (p = 0.542). Furthermore, 30-day survival was 0% in the trauma group and 0.6% in the patient group who underwent cardiopulmonary resuscitation for over 20 minutes. Conclusion: It can be seen that the effect of mechanical chest compression on survival is controversial; studies on this issue should continue and, furthermore, studies on the contribution of mechanical chest compression on labor loss should be conducted.

Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation

Purpose Mechanical chest compression has been shown to be equivalent to manual chest compression in providing survival benefits to patients experiencing cardiac arrest. There has been a growing need for a contemporary review of iatrogenic injuries caused by mechanical in comparison with manual chest compression. Our study aims to analyze the studies that document significant life-threatening iatrogenic injuries caused by mechanical and manual chest compression. Methods A systematic review of PubMed and Embase was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. All studies published after January 1st, 2000 were reviewed using inclusion/exclusion criteria and completed by May 2020. A total of 7202 patients enrolled in 15 studies were included in our meta-analysis. Results Significant life-threatening iatrogenic injuries had higher odds of occurring when mechanical chest compression was used compared to manual chest compression, especially for hemothorax and liver lacerations. Mechanical chest compression involves consistently deeper compression depths compared to manual chest compression, potentially resulting in more injuries. In the mechanical chest compression cohort, chest wall fractures had the highest incidence rate (55.7%), followed by sternal fracture (28.3%), lung injuries (3.7%), liver (1.0%), and diaphragm (.2%) lacerations. Conclusions Mechanical chest compression was associated with more iatrogenic injuries as compared to manual chest compression. Further research is needed to define the appropriate application of mechanical in comparison with manual chest compression in different scenarios. Levels of provider training, different mechanical chest compression device types, patient demographics, and compression duration/depth may all play roles in influencing outcomes.

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

ObjectiveTo 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.

CHEST COMPRESSION METHODS SIMULATED COVID-19 PATIENT RESUSCITATION: A RANDOMIZED CROSS-OVERSIMULATION TRIAL

Background: High-quality chest compression is one of the key elements of resuscitation to return of spontaneous circulation. In the COVID-19 era, medical personnel should wear personal protective equipment (PPE) against aerosol generating procedures (AGP) during resuscitation. However, the use of this personal protection equipment may reduce the effectiveness of medical procedures performed. Objective: We aimed to compare chest compression quality parameters between standard manual chest compression and chest compression with TrueCPR feedback device performed by medical students wearing full personal protractive equipment against aerosol generating procedure.Methods: The study was designed as a randomized, cross-over, single-blinded simulation study. Thirty-two medical students wearing PPE-AGP performed 2-min continuous chest compression on an adult simulator with and without TrueCPR feedback device.Results: Median chest compression depth with and without TrueCPR feedback device varied and amounted to 46 (IQR; 42-53) vs. 41 (IQR; 36-45) mm (MCC vs. TrueCPR, respectively). The manual chest compression rate was 117 (IQR; 112-125) compressions per minute (CPM) and was higher than with TrueCPR feedback device - 107 (IQR; 102-115; p = 0.017). Full chest relaxation in the manual's chest compression technique (without TrueCPR) was 33 (IQR; 26-42)% and was lower than with chest compression with TrueCPR feedback device - 58 (IQR; 40-75)% (p=0.002). Conclusions: We conclude that a TrueCPR feedback device improves chest compression quality during simulated COVID-19 resuscitation performed by medical students wearing PPE-AGP.

Abstract 12985: Efficacy and Safety of Mechanical versus Manual Compression in Cardiac Arrest and Cardiogenic Shock Patients

Introduction: Mechanical chest compression (MCC) provides consistent pressure and timing of each chest compression in line with latest evidenced-based practice. However, there has been no evidence from large randomized trials about the effectiveness of the mechanical device compared with manual chest compression. Furthermore, few studies focused on cardiogenic shock and cardiac arrest related to heart disease. Hypothesis: The aim is to assess the effectiveness and safety of mechanical chest compressions versus manual chest compressions in patients with out of hospital cardiogenic shock and cardiac arrest due to heart disease. Methods: We conducted a retrospective observational study of comparing the outcomes of mechanical and manual chest compressions. A total of 69 consecutive patients with out of hospital cardiogenic shock and cardiac arrest were enrolled between April 2014 and May 2018. 39 patients of them received only manual cardiopulmonary resuscitation (CPR) and 30 utilized a mechanical CPR device. Baseline characteristics, resuscitation details, and outcomes were compared between patients who received manual (manual group) and mechanical compressions (MCC group). Results: There was no significant difference in age, gender, the rate of bystander CPR and arterial blood gases at baseline. No differences were found for the rate of ROSC and 30-day survival between two groups. However, MCC group had significantly higher rate of bleeding events than manual group. In addition, fifty-four patients of them were treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Among patients underwent VA-ECMO, the rate of 30-day survival was significantly lower in MCC group. (Figure 1). Conclusions: This study showed that mechanical chest compression increased bleeding events than manual chest compression. Furthermore, in the patients underwent ECMO, the use of mechanical chest compression might be associated with higher mortality.

Investigation of manual chest compression in CPR on the dialysis chair

Background: Heart failure is the leading cause of death in dialysis patients. Cardiac arrest due to hypotension may also occur during dialysis therapy. If cardiac arrest is elicited, manual chest compressions (MCC) should be started as soon as possible. However, if MCC is applied during the patient is being treated on the dialysis chair, the backrest of the dialysis chair is horizontal to the floor and there is no support between the backrest and the floor, so that will shake and become unstable.Methods: we investigated whether a round chair is effective for supporting the dialysis chair for MCC. Four adult males performed MCC on three dialysis chairs using a manikin. MCC was performed with 2 sets (1 set was 100 times per minute) per person, with or without a round chair. A total of 4,800 times were performed by four executors.Results: When the chair was not used as a stabilizer, the mean value of fluctuation range were 20.8 ± 8.1 mm, 18.7 ± 5.5 mm, and 12.8 ± 1.8 mm, respectively. When the chair was used, the mean value of fluctuation range were 6.1 ± 1.1 mm, 7.5 ± 2.1 mm, and 1.0 ± 0 mm, decreasing by 70%, 59%, and 92%.Conclusion: MCC with the stool under the backrest as a stabilizer was effective for dialysis chairs.