Cardiopulmonary Resuscitation Mannequin Research Articles

Comparison between a low-cost model (CPR Pillow) and a mannequin in training hands only cardiopulmonary resuscitation (CPR): A randomised trial

IntroductionCPR is an important lifesaving skill that can improve outcomes of patients in cardiac arrest. Mass training of hands-only CPR is one of the ways to spread information and teach this skill. Need for expensive CPR mannequins are a limiting factor in conducting such mass training programmes. This study assessed the effectiveness of a low-cost CPR pillow model in training hands-only CPR. MethodologyTwo hundred and six undergraduate students underwent a two-hour CPR training session. They were randomly divided into two groups – mannequin group and CPR pillow group and practiced hands-only CPR on a standard mannequin and a low-cost CPR pillow model, respectively. Knowledge, attitude, and skill acquisition were objectively assessed and compared between the two groups. ResultsThere was no statistical difference in hand positioning, chest compression rate and fraction, depth and overall CPR score between the two groups trained via mannequin and CPR Pillow (P > 0.05). The CPR pillow group had better percentage of chest recoil as compared to the mannequin group (86% vs 73%; P < 0.001). ConclusionThe use of low-cost homemade CPR devices such as our CPR pillow model is an acceptable alternative to mannequin for training hands-only CPR to lay rescuers.

Hands-on defibrillation with safety drapes: Analysis of compressions and an alternate current pathway.

Hands-on defibrillation (HOD) could theoretically improve the efficacy of cardiopulmonary resuscitation (CPR) though a few mechanisms. Polyethylene drapes could potentially facilitate safe HOD, but questions remain about the effects of CPR on polyethylene's conductance and the magnitude of current looping through rescuers' arms in contact with patients. This study measured the leakage current through 2 mil (0.002in.) polyethylene through two different current pathways before and after 30min of continuous compressions on a CPR mannequin. The two pathways analyzed were the standardized IEC (International Electrotechnical Commission) leakage current analysis and a setup analyzing a current pathway looping through a rescuer's arms and returning to the patient. First, ten measurements involving the two pathways were obtained on a single polyethylene drape. 30min of continuous compressions were applied to the drape on a CPR mannequin after which the ten measurements were repeated. Twenty patients undergoing elective cardioversion for atrial fibrillation (18/20) or atrial flutter (2/20) at Emory University Hospital underwent analysis all receiving 200J shocks (age 38-101, 35% female). Through the IEC measurement method the peak leakage current mean was 0.70 +/- 0.02mA before compressions and 0.59 +/- 0.19mA after compressions. Only three of the ten measurements assessing current passing through a rescuer's arms had detectable current and each was of low magnitude. All measurements were well below the maximum IEC recommendations of 3.5mA RMS and 5.0mA peak. Polyethylene may facilitate safe HOD even after long durations of compressions. Current looping through a rescuer's arms is likely of insignificant magnitude.

Is a homemade cardiopulmonary resuscitation (CPR) trainer non-inferior to a commercially available CPR mannequin in teaching high-quality CPR? A non-inferiority randomized control trial

IntroductionStudies demonstrate that feedback devices help students achieve mastery of critical CPR skills and shorten the time from demonstration to competence. CPR feedback devices are costly and may not be available in low resource settings or in the context of online classes. We have developed a homemade feedback enabled CPR trainer. This trainer consists of a lid with two toilet rolls stacked on top. We have shown it is feasible to generate high quality CPR using this trainer, however the ability for this trainer to successfully be used in skill acquisition is unknown.Our main objective was to assess if learning CPR on a homemade toilet paper trainer was non-inferior to a commercially available mannequin when comparing post-training CPR scores. MethodsWe conducted a parallel non-inferiority randomized control trial using a variable block randomization to a 10-min training session on either a toilet paper or commercial mannequin trainer. Primary outcome was mean overall CPR score as determined by high fidelity mannequin software. A sample size of 62 per group was calculated based on a 90% power to assess for the lower limit of a two-sided 95% confidence interval above the non-inferiority limit of 10%. Results125 participants were randomized to the toilet paper (n = 64) or commercial mannequin trainer (n = 61). There was no difference between groups in age, sex, height, weight or previous CPR training. There was an absolute difference of 2% (CI 95% 3.3 to 7.3%) in mean overall CPR score between groups (toilet paper = 82% (SD 15.9%), commercial mannequin = 84% (SD 15%). ConclusionA homemade CPR trainer was non-inferior to a commercially available trainer. This study provides preliminary evidence supporting the use of a homemade, easily accessible trainer for basic compression-only CPR skill acquisition.

Optimal Combination of Chest Compression Depth and Rate in Virtual Reality Resuscitation Training: A Post Hoc Analysis of the Randomized Lowlands Saves Lives Trial

BackgroundDissemination of cardiopulmonary resuscitation (CPR) skills is essential for cardiac arrest survival. Virtual reality (VR)‐training methods are low cost and easily available, but to meet depth requirements adaptations are required, as confirmed in a recent randomized study on currently prevailing CPR quality criteria. Recently, the promising clinical performance of new CPR quality criteria was demonstrated, based on the optimal combination of compression depth and rate. We now study compliance with these newly proposed CPR quality criteria.Methods and ResultsPost hoc analysis of a randomized trial compared standardized 20‐minute face‐to‐face CPR training with VR training using the Lifesaver VR smartphone application. During a posttraining test, compression depth and rate were measured using CPR mannequins. We assessed compliance with the newly proposed CPR criteria, that is, compression rate within ±20% of 107/minute and depth within ±20% of 47 mm. We studied 352 participants, age 26 (22–31) years, 56% female, and 15% with CPR training ≤2 years. Among VR‐trained participants, there was a statistically significant difference between the proportions complying with newly proposed versus the currently prevailing quality criteria (52% versus 23%, P<0.001). The difference in proportions complying with rate requirements was statistically significant (96% for the new versus 50% for current criteria, P<0.001), whereas there was no significant difference with regard to the depth requirements (55% versus 51%, P=0.45).ConclusionsLifesaver VR training, although previously found to be inferior to face‐to‐face training, may lead to CPR quality compliant with recently proposed, new quality criteria. If the prognostic importance of these new criteria is confirmed in additional studies, Lifesaver VR in its current form would be an easily available vector to disseminate CPR skills.

THE USE OF A STEP STOOL DURING CHEST COMPRESSIONS: DOES IT MAKE A DIFFERENCE, AND DO CLINICIANS CHOOSE TO USE IT?

SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: High quality cardiopulmonary resuscitation (CPR) is the most important factor in surviving cardiac arrest. Using a step stool to improve chest compressions is universally recommended yet under-researched. This observational, simulation-based study sought to answer two questions: first, is CPR performance improved with the use of a step stool? Second, how often do adult healthcare providers use a step stool for chest compressions, and does the frequency increase following a brief educational session demonstrating the advantages of step stool use? METHODS: Over 3 years (2018-2020), 535 interdisciplinary providers (nurses, house staff, attendings, and pharmacists from internal medicine, intensive care, anesthesiology, and obstetrics) participated in this observational study. Participants first performed one minute of CPR on Resusci-Anne ®, a CPR mannequin, and were scored from 0-100 on their performance. A step stool was available for use next to Resusci-Anne ® if the participant desired. Thereafter, participants underwent an educational intervention on the advantages of using a step stool while performing CPR. They watched a demonstration by an instructor and were then given time to practice CPR with and without a step stool. Each participant was then asked to do another minute of CPR on the Resusci-Anne ® and again scored from 0-100 on their performance. A step stool was again in close proximity for use, if the participant desired. RESULTS: Participants were selected via convenience sampling at a large academic hospital with a pre-existing cardiac arrest simulation course. A total of 535 participants were tested pre-intervention, and 520 participants were tested post-intervention. Prior to the intervention, only 16.6% (n=89) of providers elected to use a step stool for chest compressions, compared to 97.5% (n=507) post-intervention (p=<0.001). The average CPR performance score (0-100) significantly improved from pre-intervention to post-intervention (74 vs. 95; p=<0.001). CONCLUSIONS: Our study demonstrates that the quality of CPR improves significantly with the use of a step stool. However, without education on the benefits of using a step stool and demonstration of the proper technique, few adult healthcare providers will elect to do so. A brief, hands-on intervention teaching adult healthcare providers about the benefits of CPR with a step stool significantly increased its use and the quality of chest compressions. CLINICAL IMPLICATIONS: This study demonstrates that adult healthcare providers across multiple disciplines can quickly and easily be taught to use a step stool during CPR, and that doing so significantly improves the quality of CPR they provide. Given that early and high-quality CPR is the cornerstone of advanced cardiovascular life support (ACLS), this intervention has the potential to improve the mortality of in-hospital cardiac arrest. DISCLOSURES: No relevant relationships by Timothy Clapper, source=Web Response No relevant relationships by Imaani Easthausen, source=Web Response No relevant relationships by Kelly Griffin, source=Web Response No relevant relationships by Elyse LaFond, source=Web Response No relevant relationships by Melissa Moulton, source=Web Response No relevant relationships by Kapil Rajwani, source=Web Response No relevant relationships by Nina Rusiewski, source=Web Response No relevant relationships by Samantha Smith, source=Web Response

Caregiver Characteristics Associated With Quality of Cardiac Compressions on an Adult Mannequin With Real-Time Visual Feedback: A Simulation-Based Multicenter Study.

Chest compression (CC) quality directly impacts cardiac arrest outcomes. Provider body type can influence the quality of cardiopulmonary resuscitation (CPR); however, the magnitude of this impact while using visual feedback is not well described. The aim of the study was to determine the association between provider anthropometric variables on fatigue and CC adherence to 2015 American Heart Association CPR while receiving visual feedback. This was a planned secondary analysis of healthcare professionals from multiple hospitals performing continuous CC for 2 minutes on an adult CPR mannequin with dynamic visual feedback. Main outcome measures include compression data (depth, rate, and lean) evaluated in 30-second epochs to explore performance fatigue. Multivariable models examined the relationship of provider anthropometrics to CC quality. Binomial mixed effects models were used to characterize fatigue by examining performance for 4 epochs. Three hundred seventy-seven 2-minute CC episodes were analyzed. Extreme (low and high) BMI and weight are associated with poorer CC. Larger size (height, weight, and BMI) is associated with better depth but worse lean compliance. Performance fatigued for all providers for 2 minutes, but shorter, lighter weight, female participants had the greatest decline. On multivariable analysis, rate compliance did not deteriorate regardless of provider anthropometrics. Anthropometrics impact provider CC quality. Despite visual feedback, variable effects are seen on compression depth, rate, recoil, and fatigue depending on the provider sex, weight, and BMI. The 2-minute interval for changing chest compressors should be reconsidered based on individual provider characteristics and risk of fatigue's impact on high-quality CPR.

PENGUATAN BANTUAN HIDUP DASAR PADA WARGA RW 09 PONDOK RANGGON, CIPAYUNG, JAKARTA TIMUR

Basic life support is a basic action to help someone's life in a state of cardiac arrest and respiratory arrest. Death due to cardiac arrest and respiratory arrest can be overcome if the victim gets help. Basic life support can be done by anyone and anywhere immediately when the onset of cardiac arrest or stopping breathing. The purpose of this activity is to provide education and training to the community so that they can know and demonstrate the provision of basic life support in cases of cardiac arrest and respiratory arrest, choking, burns, poisoning and drowning. The implementation of education and training was given to the people in RT 09 RW 04, Pondok Ranggon, Cipayung, East Jakarta as many as 15 people, giving material and training with discussion lecture methods accompanied by demonstrations with power point media and CPR (Cardio Pulmonary Resuscitation) mannequins for 30 minutes, in addition to the community given education and training for victims of choking, poisoning, burns and drowning. The results of the evaluation in the pre-test showed a moderate level of knowledge of 46.7% and a low of 53.3%, whereas in the post-test obtained a high level of knowledge of 20% and a moderate of 80%. The basic life support education and training program that has been carried out is very useful for increasing public knowledge so it is also expected to be able to practice first aid in cases of cardiac arrest and respiratory arrest.

P107: The development of a mentorship based, near-peer simulated resuscitation training program for medical trainees

Introduction: High quality Cardiopulmonary Resuscitation (CPR) saves lives, however skill retention after standard Basic Life support (BLS) courses has been shown to be poor. Our goal was to develop a student-run, mentorship based program to allow repetitive practice of BLS skills while minimizing resource commitment and time requirements. Methods: We developed a top down training program that relied on online teaching resources, regular simulation training and near-peer feedback. First year medical students were given the opportunity to participate in the program and baseline CPR quality was documented. They were then divided into intervention and control groups. The intervention group participated in bi-monthly 40-minute small group training sessions directed by senior medical students and monitored by a staff physician. The control group received no further training. At the end of the 8-month study period CPR quality was documented for all participants. Results: We included data from 54 medical students. Overall compression depth and rate were monitored using Laderall SimMan 3G(TM) high-fidelity CPR mannequins. Average rate and depth of compression were significantly improved in the intervention group relative to both the control group that did not receive training, as well as relative to the intervention groups own pre intervention values (both with p values below 0.05 using Mann-Whitney tests and an intention to treat analysis for loss to follow up). Conclusion: Our study demonstrated a significant improvement in CPR quality as a result of our intervention. Survey data also indicated positive feedback from participants in relation to comfort with in-hospital CPR. As such we intend to continue to run this program, identifying participants each year whom can move into training and leadership roles to help foster CPR and basic resuscitation in our medical community.

Cardiorespiratory dynamics of rescuers during cardiopulmonary resuscitation in a hypoxic environment

ObjectiveWe had previously experienced a case involving prolonged cardiopulmonary resuscitation (CPR) on Mt. Fuji (3776 m), demanding strenuous work by the rescuers. The objective of this study was to compare the effect of compression-only and conventional CPR on oxygen saturation of rescuers in a hypoxemic environment. MethodsChanges in percutaneous arterial oxygen saturation (SpO2) and heart rate during CPR action were measured in a hypobaric chamber with barometric pressure adjusted to be equivalent to 3700 m above sea level (630–640 hPa). Thirty-three volunteers performed CPR with or without breaths using a CPR mannequin. ResultsIn a 3700-m-equivalent environment, SpO2 was reduced only when CPR was performed without breaths (P < .05, one-way analysis of variance (ANOVA) post hoc Tukey test). Heart rate increased during CPR regardless of the presence or absence of breaths. Mean scores on the Borg scale, a subjective measure of fatigue, after CPR action in the 3700-m-equivalent environment were significantly higher (15 ± 2) than scores after CPR performed at sea level (11 ± 2, P < .01, paired t-test). No lethal dysrhythmia was found in subjects with a wearable electrode shirt. ConclusionsProlonged CPR at high altitude exerts a significant physical effect upon the condition of rescuers. Compression-only CPR at high altitude may deteriorate rescuer oxygenation, whereas CPR with breaths might ameliorate such deterioration.

First-aid training in school: amount, content and hindrances.

BackgroundTo increase knowledge and competence about first aid in the population, first‐aid instruction is included in primary and secondary school curricula. This study aimed to establish how much time is spent on first‐aid training, which first‐aid measures are taught, and which factors prevent teachers from providing the quantity and quality of first‐aid training that they wish to give.MethodsA questionnaire was distributed to teachers in physical education in primary and secondary schools and to teachers in vocational subjects in higher secondary schools.ResultsThe teachers taught a median of two lessons in first aid per year. Cardiopulmonary resuscitation (CPR) was taught by 64% of teachers, free airway and recovery position by 69% and stopping severe bleeding by 51%. Recognising heart attack and stroke was taught by 25% and 23%, respectively. The main factors that the teachers perceived as limiting the amount and quality of first‐aid training were insufficient learning objective specifications in the curriculum, too many other competence aims, lack of CPR mannequins and lack of training as first‐aid instructors.DiscussionNorwegian teachers provide an appreciable amount of first‐aid training to their students. However, several potential life‐saving measures are poorly covered. The curriculum needs to contain first aid but also should specify what first‐aid measures to be taught. First‐aid training of teachers should adequately prepare them to be first‐aid instructors.

Agreement in the assessment of practical skills in basic CPR between observers and a CPR mannequin with a specific software

Conducting a training activity usually involves assessing to students the knowledge and/or the skills acquired. Assessment methods must be objectives and representatives of the item being evaluated and able to ensure their independence from the evaluator. The assessment of practical skills in cardiopulmonary resuscitation (CPR) acquired by a student during a training course conforming the quality criteria for CPR on adults (2010 International Guidelines on Resuscitation 1), continues to be accomplished currently by observers. Increasingly, other objective methods of assessment (CPR manikin with specific 2 software, mechanical devices, etc.) of these skills with an excellent degree of accuracy and feedback, are being extended. The correct evaluation of these practical skills is crucial to ensure their correct acquisition, as a first step to the translation into clinical practice.

The correlation between the impedance cardiogram and end-tidal carbon dioxide during cardiopulmonary resuscitation in a porcine model of cardiac arrest

Introduction: Studies were conducted to evaluate cardiopulmonary resuscitation (CPR) in a simulated low gravitational field, such as Mars (hypoG), aimed at providing an insight into the performance of terrestrial CPR. Methods: Two studies were conducted to evaluate external chest compressions (ECC) depth and rate, as well as perceived exertion (RPE) and the physiological cost, when 4 sets of 30 ECCs were performed on a standard CPR mannequin for 1.5min during Mars simulation, using terrestrial (1Gz) as control. The first study (n=20; 2005 guidelines) also evaluated the electromyographic (EMG) activity of four muscles (triceps brachii, erector spinae, upper rectus abdominis, pectoralis major). The second study (n=30; 2010 guidelines) included range of elbow flexion, minute ventilation (VE) and peak oxygen consumption (VO2 peak) measurements. HypoG simulation was achieved using a body suspension device (BSD) and a counterweight system. Results: In both studies, subjects successfully performed ECCs at 1Gz and hypoG. In the first study, therewere increases from 1Gz values of 32% (p<0.001) for RPE and 44% (p=0.002) for HR when ECCswere performedduringMars simulation. In hypoG, the triceps brachii showed less activity when compared with the other three muscles studied (p<0.001). A higher RPE (p<0.05) was also seen in the second study, which was accompanied by an increased VE (11.4±5.9 to 37.5±10.3 Lmin−1, p<0.05) and VO2 peak (3.2±1.1 to 20.5±7.6 mLkg−1 min−1, p<0.05). The arm flexion angle during hypogravity CPR, compared to 1Gz CPR, was also increased (4.3±2.8◦ to 14.0±8.1◦, p<0.05). Conclusion: Simulated reduction of upper body weight did not decrease the ability to perform proper ECCs, however, it increased the physiological cost and altered performance of the ‘straight arm’ CPR technique. These findings could be used to improve terrestrial CPR, especially when physical disparities are encounteredwith the rescuer being smaller and lighter than the patient.

A Randomized Trial of Cardiopulmonary Resuscitation Training for Medical Students

Current European Resuscitation Guidelines 2010 recommend the use of prompt/feedback devices when training for cardiopulmonary resuscitation (CPR). We aimed to assess the quality of CPR training among second-year medical students with a voice advisory mannequin (VAM) compared to guidance provided by an instructor. Forty-three students received a theoretical reminder about CPR followed by a 2-minute pretest on CPR (compressions/ventilations cycle) with Resusci Anne SkillReporter (Laerdal Medical). They were then randomized into a control group (n = 22), trained by an instructor for 4 minutes per student, and an intervention group (n = 21) trained individually with VAM CPR mannequin for 4 minutes. After training, the students performed a 2-minute posttest, with the same method as the pretest. Participants in the intervention group (VAM) performed more correct hand position (73% vs. 37%; P = 0.014) and tended to display better compression rate (124 min vs. 135 min; P = 0.089). In a stratified analyses by sex we found that only among women trained with VAM was there a significant improvement in compression depth before and after training (36 mm vs. 46 mm, P = 0.018) and in the percentage of insufficient compressions before and after training (56% vs. 15%; P = 0.021). In comparison to the traditional training method involving an instructor, training medical students in CPR with VAM improves the quality of chest compressions in hand position and in compression rate applied to mannequins. Only among women was VAM shown to be superior in compression depth training. This technology reduces costs in 14% in our setup and might potentially release instructors' time for other activities.

Cardiopulmonary Resuscitation Prescription Program: A Pilot Randomized Comparator Trial

BackgroundThe American Heart Association wants to increase the number of citizens who know how to perform cardiopulmonary resuscitation (CPR). It is unknown whether giving patients a prescription (Rx) to learn CPR is effective. We sought to determine if patients with, or at risk for, heart disease and their families were more likely to follow prescriptive advice to buy a CPR Anytime™ kit (American Heart Association, Dallas, TX) or to take a CPR class. MethodsThis was a prospective randomized pilot study of a convenience sample of 162 patients who presented to one of three recruiting sites: a suburban community emergency department (ED), an office-based primary care (IM), or cardiology (CD) setting. After consent was obtained, CPR-naïve participants aged>44 years were randomized to one of two study arms. One group received a Rx for a CPR Anytime™ self-learning kit, consisting of a CPR mannequin and a 22-minute DVD. The comparator group was prescribed a CPR class. ResultsAt the IM office, 7/29 (24%), at the CD office 3/25 (12%), and at the ED 2/23 (9%) patients purchased the CPR kit. Across both investigational arms, 4 were lost to follow-up, yielding approximately 15% (12/77) who followed Rx advice to purchase the CPR kit and 0% (0/79) who took a CPR class. Cumulatively, a participant was significantly more likely to purchase a kit than to take a class (p=0.0004). ConclusionPatients can be motivated to purchase CPR Anytime™ kits but not to take a CPR class from prescribed advice.

Evaluation of a Novel Basic Life Support Method in Simulated Microgravity

If a cardiac arrest occurs in microgravity, current emergency protocols aim to treat patients via a medical restraint system within 2-4 min. It is vital that crewmembers have the ability to perform single-person cardiopulmonary resuscitation (CPR) during this period, allowing time for advanced life support to be deployed. The efficacy of the Evetts-Russomano (ER) method has been tested in 22 s of microgravity in a parabolic flight and has shown that external chest compressions (ECC) and mouth-to-mouth ventilation are possible. There were 21 male subjects who performed both the ER method in simulated microgravity via full body suspension and at +1 Gz. The CPR mannequin was modified to provide accurate readings for ECC depth and a metronome to set the rate at 100 bpm. Heart rate, rate of perceived exertion, and angle of arm flexion were measured with an ECG, elbow electrogoniometers, and Borg scale, respectively. The mean (+/- SD) depth of ECC in simulated microgravity was lower in each of the 3 min compared to +1 G2. The ECC depth (45.7 +/- 2.7 mm, 42.3 +/- 5.5 mm, and 41.4 +/- 5.9 mm) and rate (104.5 +/- 5.2, 105.2 +/- 4.5, and 102.4 +/- 6.6 compressions/min), however, remained within CPR guidelines during simulated microgravity over the 3-min period. Heart rate, perceived exertion, and elbow flexion of both arms increased using the ER method. The ER method can provide adequate depth and rate of ECC in simulated microgravity for 3 min to allow time to deploy a medical restraint system. There is, however, a physiological cost associated with it and a need to use the flexion of the arms to compensate for the lack of weight.

459: Cardiopulmonary Resuscitation Prescription Program: A Prospective Randomized Pilot Study

459: Cardiopulmonary Resuscitation Prescription Program: A Prospective Randomized Pilot Study

The Tide Is Turning: Organizational Structures to Embed Simulation in the Fabric of Healthcare

The Tide Is Turning: Organizational Structures to Embed Simulation in the Fabric of Healthcare

Decreasing the time to defibrillation: A crossover comparative study of Quik-Combo and padpro defibrillator electrodes

Study objectives: Time to defibrillation is the most important factor affecting survival from cardiac arrest. Mortality increases by approximately 7% to 10% for each minute that defibrillation is delayed. Therefore, any improvement in time to defibrillation could have an important impact on clinical survival. Valuable progress in shortening the inhospital "chain of survival" has been achieved with the development of cardiac monitored beds, dedicated cardiac arrest teams, and strategic location of defibrillators throughout the hospital. However, the specific impact of defibrillator electrodes on time to defibrillation has not been analyzed. The purpose of this study is to determine whether the choice of defibrillator electrodes affects the time to defibrillation. Methods: This was a randomized crossover design study. It was approved by the institutional review board. Internal medicine and emergency resident physicians supervise cardiac arrest teams at many teaching hospitals, so they were selected to test this equipment. The residents were blinded to the intent of the study. We compared the time required by the residents to apply to the patient, then connect to a defibrillator, and then deliver a shock for 2 leading defibrillator electrodes, the Quik-Combo (Medtronic Physio-Control, Redmond, WA) and the Padpro (model 2516 Padpro LLC, Ann Arbor, MI). Under scripted direction of advanced cardiac life support–trained research nurses, they used the equipment during a standardized ventricular fibrillation cardiac arrest model using cardiopulmonary resuscitation mannequins. The independent variable was the choice of defibrillator electrode. Sequence of testing for the electrodes was block randomized to control for the confounding variable of learning. The primary outcome was time to defibrillation (total time elapsed from the beginning of cardiac arrest to delivery of a defibrillatory shock). The secondary outcome was the ease of application as assessed by the resident physicians with a 10-cm visual analog scale. The minimum required sample size was calculated to be 26 trials for each defibrillator electrode study group, assuming a 20% treatment effect between models (2-sided, for α=0.05 and β=0.2). Statistical significance was analyzed using Student's t test for continuous variables. Results: Thirty residents performed a crossover assessment of both electrodes. The average time to defibrillation for the Padpro was approximately double that of the Quik-Combo (88.2 seconds versus 44.5 seconds, P P Conclusion: The Quik-Combo defibrillator electrode significantly decreased the time to defibrillation and was judged to be easier to apply in this cardiac arrest model. The average time to defibrillation difference of 44 seconds when extrapolated to the clinical setting has important implications for patient survival and morbidity. International guidelines endorse a goal time of only 2 to 4 minutes from collapse until defibrillation. We demonstrate that the choice of defibrillator electrodes can significantly influence accomplishment of that goal. Cardiopulmonary resuscitation is a complex team task under highly stressful conditions. Regularly training on standardized equipment is essential for efficient cardiac arrest team performance. Hospital and emergency medical services authorities should select the most reliable and ergonomically simple equipment to minimize any delays in defibrillation.

New Techniques in External Cardiac Compressions

Despite the 8,000 drownings that occur annually in the United States, procedures for aquatic first aid are currently limited to mouth-to-mouth resuscitation, while cardiopulmonary resuscitation (CPR) must be delayed until the victim is transported to a solid surface for conventional closed-chest cardiac compressions. We discuss techniques of positioning a victim on the rescuer's chest and initiating CPR, on site. Respiratory support was provided with a slightly modified scuba regulator, and procedures were tested on an instrumented aquatic CPR mannequin in the water and anesthetized dogs on land. Most results were within specified criteria for successful CPR.