Adequate Chest Compression Rate Research Articles

Part 4: Pediatric Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

1. High-quality cardiopulmonary resuscitation (CPR) is the foundation of resuscitation. New data reaffirm the key components of high-quality CPR: providing adequate chest compression rate and depth, minimizing interruptions in CPR, allowing full chest recoil between compressions, and avoiding excessive ventilation. 2. A respiratory rate of 20 to 30 breaths per minute is new for infants and children who are (a) receiving CPR with an advanced airway in place or (b) receiving rescue breathing and have a pulse. 3. For patients with nonshockable rhythms, the earlier epinephrine is administered after CPR initiation, the more likely the patient is to survive. 4. Using a cuffed endotracheal tube decreases the need for endotracheal tube changes. 5. The routine use of cricoid pressure does not reduce the risk ofd regurgitation during bag-mask ventilation and may impede intubation success. 6. For out-of-hospital cardiac arrest, bag-mask ventilation results in the same resuscitation outcomes as advanced airway interventions such as endotracheal intubation. 7. Resuscitation does not end with return of spontaneous circulation (ROSC). Excellent post–cardiac arrest care is critically important to achieving the best patient outcomes. For children who do not regain consciousness after ROSC, this care includes targeted temperature management and continuous electroencephalography monitoring. The prevention and/or treatment of hypotension, hyperoxia or hypoxia, and hypercapnia or hypocapnia is important. 8. After discharge from the hospital, cardiac arrest survivors can have physical, cognitive, and emotional challenges and may need ongoing therapies and interventions. 9. Naloxone can reverse respiratory arrest due to opioid overdose, but there is no evidence that it benefits patients in cardiac arrest. 10. Fluid resuscitation in sepsis is based on patient response and requires frequent reassessment. Balanced crystalloid, unbalanced crystalloid, and colloid fluids are all acceptable for sepsis resuscitation. Epinephrine or norepinephrine infusions are used for fluid-refractory septic shock. More than 20 000 infants and children have a cardiac arrest per year in the …

Impact of personal protective equipment on the effectiveness of chest compression - A systematic review and meta-analysis.

Background and objectivesTo assess the impact of personal protective equipment (PPE) on different aspects of chest compression (CC) during cardiopulmonary resuscitation, we conducted this study.MethodsThis systematic review was performed according to the PRISMA. We searched PubMed, EMBASE and Web of Science from inception to June-6, 2020, limiting to the studies that reported the comparison of the effectiveness of CC in terms of CC rate, CC depth, the proportion of adequate CC rate, the proportion of adequate CC depth or proportion of adequate recoil; in study arms with or without PPE. Risk of bias was assessed by the ROB-2 and ROBINS-I tool. Quantitative data synthesis was done using the generic inverse variance method and the fixed-effects model.ResultsFive simulation-based studies were finally included. A Significant decrease in CC rate (SMD: -0.28, 95%CI: −0.47 to −0.10) and CC depth (SMD: -0.26, 95%CI: −0.44 to −0.07) were observed in the PPE arm as compared to the no-PPE arm. The difference in CC rate was more prominently seen in adult CPR than in paediatric CPR. Without PPE, the proportion of adequate CC rate delivered was 0.74, which reduced significantly to 0.60 after use of PPE (p − 0.035). Similarly, the proportion of adequate CC depth was significantly lesser (p − 0.001) in PPE arm (0.55), as compared to that of the no-PPE arm (0.78).ConclusionThe use of PPE compromises the quality of CC during CPR significantly, and newer ways to deliver chest compression has to be investigated.This study was prospectively registered in PROSPERO (CRD42020192031).

Effect of metronome guidance on infant cardiopulmonary resuscitation.

This study was conducted to investigate the effect of metronome guidance on the performance of infant cardiopulmonary resuscitation (CPR). A total of 36 medical doctors conducted a 2-min single rescuer CPR with the two-finger technique (TFT) or two-thumb encircling hands technique (TT) on an infant manikin without metronome guidance (baseline test). After completing the baseline test, the participants were assigned to either a "guidance group" or "non-guidance group." The guidance group performed CPR with a high-pitched sound at 110 beats/min from a metronome (test 2), while the non-guidance group performed 2-min CPR without metronome guidance (test 1). Comparison between the results of tests 1 and 2 showed that the ratio of adequate chest compression rate was significantly different in both the TFT (73% [34-93] vs. 98% [95-99], P < 0.001) and the TT (53% [32-79] vs. 99% [98-100], P = 0.010). Other parameters including average depth and the ratio of adequate depth were not significantly different between tests 1 and 2 in both the TFT and TT.Conclusion: Metronome guidance improves the adequacy of chest compression rate during infant CPR without affecting chest compression depth in both the TFT and TT.Trial registration: Clinical Research Information Service, KCT0002735 What is Known: • The rate of chest compressions can be optimized by the use of metronome guidance in pediatric cardiopulmonary resuscitation (CPR). • An adverse effect of deteriorating chest compression depth was found while using a metronome guidance during adult CPR simulations. What is New: • The metronome guidance improved the adequacy of the chest compression rate during infant CPR without affecting other parameters including average depth and the ratio of adequate depth in both the two-finger chest compression technique and two-thumb encircling hand technique.

Comparison of CPR quality and rescuer fatigue between standard 30:2 CPR and chest compression-only CPR: a randomized crossover manikin trial.

ObjectiveWe aimed to compare rescuer fatigue and cardiopulmonary resuscitation (CPR) quality between standard 30:2 CPR (ST-CPR) and chest compression only CPR (CO-CPR) performed for 8 minutes on a realistic manikin by following the 2010 CPR guidelines.MethodsAll 36 volunteers (laypersons; 18 men and 18 women) were randomized to ST-CPR or CO-CPR at first, and then each CPR technique was performed for 8 minutes with a 3-hour rest interval. We measured the mean blood pressure (MBP) of the volunteers before and after performing each CPR technique, and continuously monitored the heart rate (HR) of the volunteers during each CPR technique using the MRx monitor. CPR quality measures included the depth of chest compression (CC) and the number of adequate CCs per minute.ResultsThe adequate CC rate significantly differed between the 2 groups after 2 minutes, with it being higher in the ST-CPR group than in the CO-CPR group. Additionally, the adequate CC rate significantly differed between the 2 groups during 8 minutes for male volunteers (p =0.012). The number of adequate CCs was higher in the ST-CPR group than in the CO-CPR group after 3 minutes (p =0.001). The change in MBP before and after performing CPR did not differ between the 2 groups. However, the change in HR during 8 minutes of CPR was higher in the CO-CPR group than in the ST-CPR group (p =0.007).ConclusionsThe rate and number of adequate CCs were significantly lower with the CO-CPR than with the ST-CPR after 2 and 6 minutes, respectively, and performer fatigue was higher with the CO-CPR than with the ST-CPR during 8 minutes of CPR.

The effect of inclined step stool on the quality of chest compression during in-hospital cardiopulmonary resuscitation

PurposeA step stool is an ordinary device to improve the quality of chest compression (CC) during in-hospital cardiopulmonary resuscitation (CPR). We investigated the effect of an inclined step stool on the quality of CC during CPR on a hospital bed. MethodsWe conducted a randomized crossover study of simulation using a manikin. Two different methods of CC were performed and compared: CC using a flat stool and CC using an inclined (20°) stool. Each session of CC was performed for 2 minutes using a metronome at a rate of 110 beats per minute. The primary outcome was the depth of CC. The adequate CC rate, duty cycle, rate of incomplete recoil, and the angle between the arm of the participants and the bed were also measured. ResultsThe median value of the mean depth of CC was 50.5 mm (45.0-57.0 mm) in the flat stool group and 54.5 mm (47.0-58.3 mm) in the inclined stool group (P = .014). The adequate CC rate was significantly higher in the inclined stool group (84.2% [37.6%-99.1%] vs 57.0% [15.2%-95.0%]; P = .016). The duty cycle and the rate of incomplete recoil were comparable between the 2 groups. The angles between the arm of the participants and the bed were more vertical in the inclined stool group (84.0° ± 5.2° vs 81.0° ± 4.8°; P = .014). ConclusionUsing an inclined stool resulted in an improvement in the depth of CC and the adequate CC rate without increasing the rate of incomplete chest recoil.

Improvement in chest compression quality using a feedback device (CPRmeter): a simulation randomized crossover study

PurposesCardiac arrest survival depends on celerity and efficiency of life support action. Guidelines emphasized the chest compression (CC) quality and feedback devices are encouraged. The purpose is to study the impact of the CPRmeter feedback device on resuscitation performed by untrained rescuers. Basic proceduresThis is a prospective randomized crossover study on manikins (Resusci Anne). One hundred and forty four students inexperienced in cardiopulmonary resuscitation representing untrained rescuers were included. Participants performed 2 minutes of CC without interruption with (group G) or without (group B) feedback. Four months passed between the 2 crossover phases to avoid resilience effect. Data collected by the CPRmeter device were: CC rate, depth and release. Main findingsEfficient CC rate ([simultaneous and correct CC rate, depth and release] primary outcome) (absolute difference [95% CI]) was significantly improved in group G (71%) compared to group B (26%; [45 {36-55}]; P < .0001). Adequate depth rate (>38 mm) was significantly improved in group G (85%) compared to group B (43%; [42 {33-52}]; P < .0001). Adequate CC rate (90-120/min) was significantly improved in group G (81%) compared to group B (56%; [25 {15-35}]; P < .0001). The average CC rate and depth in group G were significantly less dispersed around the mean compared to group B (test of variance P < .007; P < .015 respectively). Principal conclusionsThe use of the CPRmeter significantly improved CC quality performed by students inexperienced in cardiopulmonary resuscitation.

Nationwide survey of resuscitation education in Finland

Aims Good-quality cardiopulmonary resuscitation (CPR) is highlighted in the International Resuscitation Guidelines, but clinically the quality of CPR is often poor. Education of CPR has a major role in the primary skills imparted to students. Different methods can be used to teach CPR quality. We evaluated the current status of their usage in Finland institutes teaching students of emergency medicine at different levels. Methods The following institutes were included in an anonymous survey: medical schools (teaching future physicians), universities of applied sciences (paramedics), colleges (emergency medical technicians) and emergency services college (fire-fighters). Hours of teaching theory lessons of CPR and hours of small group training were evaluated. In particular, we focussed on the teaching methods for adequate chest compression rate and depth. Results Twenty-one of 30 institutes responded to the questionnaire. The median for hours of theory lessons of CPR was 8 h (range: 2–28 h). The median for hours of small group training was 10 (range: 3–40 h). The methods of teaching adequate chest compression rate were instructors’ visual estimation in 28.5% of the institutions, watch in 33.3%, metronome in 9.5% and manikins’ graphic in 28.5% of institutions. The methods of teaching adequate chest compression depth were instructors’ visual estimation in 33.3%, in manikins light indicators in 23.8% and manikins’ graphics in 52.3% of institutions. Conclusion The hours of theoretic lessons and small group training vary widely among different institutes. In one-third of institutions, the instructor's visual estimation was a sole method used to teach adequate chest compression rate and depth. Different technical methods were surprisingly seldom used.

Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins

Aims The adequate chest compression rate during CPR is associated with improved haemodynamics and primary survival. To explore whether the use of a metronome would affect also chest compression depth beside the rate, we evaluated CPR quality using a metronome in a simulated CPR scenario. Methods Forty-four experienced intensive care unit nurses participated in two-rescuer basic life support given to manikins in 10 min scenarios. The target chest compression to ventilation ratio was 30:2 performed with bag and mask ventilation. The rescuer performing the compressions was changed every 2 min. CPR was performed first without and then with a metronome that beeped 100 times per minute. The quality of CPR was analysed with manikin software. The effect of rescuer fatigue on CPR quality was analysed separately. Results The mean compression rate between ventilation pauses was 137 ± 18 compressions per minute (cpm) without and 98 ± 2 cpm with metronome guidance ( p < 0.001). The mean number of chest compressions actually performed was 104 ± 12 cpm without and 79 ± 3 cpm with the metronome ( p < 0.001). The mean compression depth during the scenario was 46.9 ± 7.7 mm without and 43.2 ± 6.3 mm with metronome guidance ( p = 0.09). The total number of chest compressions performed was 1022 without metronome guidance, 42% at the correct depth; and 780 with metronome guidance, 61% at the correct depth ( p = 0.09 for difference for percentage of compression with correct depth). Conclusions Metronome guidance corrected chest compression rates for each compression cycle to within guideline recommendations, but did not affect chest compression quality or rescuer fatigue.