Cardiopulmonary Resuscitation Providers Research Articles

Assessment of Cardiopulmonary Resuscitation Quality among Healthcare Providers: A Randomized Experimental Study of the Italian Resuscitation Council.

Background. The quality of cardiopulmonary resuscitation (CPR) is pivotal in improving the outcome of cardiac arrest. Nevertheless, there is evidence that even professional rescuers may deliver ineffective chest compressions (CCs). We sought to evaluate the impact of a CPR feedback device on the quality of CC performed by a supposedly highly trained and skilled population of attendees to the national annual congress of the Italian Resuscitation Council. Methods. A total of 202 congress attendees were enrolled to perform 2 min CC without feedback, followed by a 5 min rest and another 2 min interval of CC with feedback. Moreover, participants were randomly assigned to two study groups: "feedback later", in which the first 2 min CCs were delivered without the feedback, and "feedback first", in which the first 2 min CCs were aided by feedback. CPR quality has been analyzed in terms of the percentage of CC with adequate depth (CC, %), complete chest release (CR, %), and the CC rate (CC/min). Results. Approximately 60% of correct CCs were performed without feedback, which significantly increased to 79% with the use of feedback. In the "feedback later" group, the percentage of correctly performed CC and CR significantly increased during the second 2 min interval of CC with feedback (median value 51% vs. 86%, p < 0.0001 and 71% vs. 84%, p = 0.025, respectively). In the "feedback first" group, the percentage of correct CC remained stable during the two CC intervals (71% vs. 80%, p = 0.06), while CR was better without the help of the feedback (70% vs. 93%, p < 0.0001). CC/min was in the recommended range (100-120/min) in all the CC events. Conclusions. In this population of expected highly skilled CPR providers, the overall quality was inconsistent and, in many cases, did not reach guidelines recommendations. The use of a feedback device significantly improved the quality of CC. When the feedback device was used in the first CC attempt, it had a learning effect that was reflected in maintaining quality during the second CC series.

An evaluation of the NUI Compact Chest Compression Device (NCCD), a mechanical CPR device suitable for use in the saturation diving environment.

Provision of manual chest compressions in a diving bell using a conventional technique is often impossible, and alternative techniques are poorly evidenced in terms of efficacy and sustainability. The first mechanical cardiopulmonary resuscitation (CPR) device suitable for use in this environment, the NUI Compact Chest Compression Device (NCCD), has recently been designed and manufactured. This study assessed both the efficacy of the device in delivering chest compressions to both prone and seated manikins, and the ability of novice users to apply and operate it. Compression efficacy was assessed using a Resusi Anne QCPR intelligent manikin, and the primary outcome was the proportion of compressions delivered to target depth (50-60 mm). The gold standard was that achieved by expert CPR providers delivering manual CPR; the LUCAS 3 mCPR device was a further comparator. The NCCD delivered 100% of compressions to target depth compared to 98% for the gold standard (interquartile range 1.5%) and 98% for the LUCAS 3 when applied to both supine and seated manikins. The NCCD sometimes became dislodged and had to be reapplied when used with a seated manikin. The NCCD can deliver chest compressions at target rate and depth to both supine and seated manikins with efficacy equivalent to manual CPR and the LUCAS 3. It can become dislodged when applied to a seated manikin; its design has now been altered to prevent this. New users can be trained in use of the NCCD quickly, but practise is required to ensure effective use.

Out of hospital cardiac arrest: experience of a bystander CPR training program in Karachi, Pakistan

BackgroundNearly 90% of out-of-hospital cardiac arrest (OHCA) patients are witnessed, yet only 2.3% received bystander cardiopulmonary resuscitation (CPR) in Pakistan. This study aimed to determine retention of knowledge and skills of Hands-Only CPR among community participants in early recognition of OHCA and initiation of CPR in Karachi, Pakistan.MethodsPre and post-tests were conducted among CPR training participants from diverse non-health-related backgrounds from July 2018 to October 2019. Participants were tested for knowledge and skills of CPR before training (pre-test), immediately after training (post-test), and 6 months after training (re-test). All the participants received CPR training through video and scenario-based demonstration using manikins. Post-training CPR skills of the participants were assessed using a pre-defined performance checklist. The facilitator read out numerous case scenarios to the participants, such as drowning, poisoning, and road traffic injuries, etc., and then asked them to perform the critical steps of CPR identified in the scenario on manikins. The primary outcome was the mean difference in the knowledge score and skills of the participants related to the recognition of OHCA and initiation of CPR.ResultsThe pre and post-tests were completed by 652 participants, whereas the retention test after 6 months was completed by 322 participants. The mean knowledge score related to the recognition of OHCA, and initiation of CPR improved significantly (p < 0.001) from pre-test [47.8/100, Standard Deviation (SD) ±13.4] to post-test (70.2/100, SD ±12.1). Mean CPR knowledge after 6 months (retention) reduced slightly from (70.2/100, ±12.1) to (66.5/100, ±10.8). CPR skill retention for various components (check for scene safety, check for response, check for breathing and correct placement of the heel of hands) deteriorated significantly (p < 0.001) from 77.9% in the post-test to 72.8% in re-test. Participants performed slightly better on achieving an adequate rate of chest compressions from 73.1% in post-test to 76.7% in re-test (p 0.27).ConclusionCommunity members with non-health backgrounds can learn and retain CPR skills, allowing them to be effective bystander CPR providers in OHCA situations. We recommend mass population training in Pakistan for CPR to increase survival from OHCA.

Chest compression release and recoil dynamics in prolonged manual cardiopulmonary resuscitation

Aim of the studyCharacterize release and recoil dynamics in chest compressions during prolonged cardiopulmonary resuscitation (CPR) efforts, which are increasingly prevalent. MethodsForce and depth of chest compressions, and their rates of change, were calculated from records extracted from CPR monitors used during prolonged resuscitation efforts for out-of-hospital cardiac arrest and tracked over time. Metrics were normalized to the median of the first 100 compressions.Kruskal-Wallis ANOVA and Jonckheere-Terpstra trend analyses were used for differences and trends. Averages are reported as median (interquartile range). Correlations among metrics are reported as coefficients of determination. ResultsIn 471 cases of adult subjects receiving at least 1000 compressions, peak depths varied modestly over the course of extended resuscitation efforts, staying within a narrow range without a trend over the course of resuscitation efforts. Increases in recoil velocity and decreases in recoil interval also remained within limited ranges (5%, 6% variation respectively). By contrast, force waveforms changed substantially. Peak force decreased monotonically reaching a 38% decrease for compression numbers > 3500, similar to a decrease in release rate (39%) and an increase in release interval (39%). ConclusionDepth waveforms change markedly less than do force waveforms over the course of prolonged CPR. With the benefit of feedback, CPR providers effectively adjust the application of force to compensate for changes in chest stiffness, documented previously. Despite slowing release and quickening recoil, interference between release of force and recoil of depth appears limited. Spontaneous chest recoil is well preserved in prolonged duration manual CPR.

Impact of a shared decision-making mHealth tool on caregivers\u2019 team situational awareness, communication effectiveness, and performance during pediatric cardiopulmonary resuscitation: study protocol of a cluster randomized controlled trial

BackgroundEffective team communication, coordination, and situational awareness (SA) by team members are critical components to deliver optimal cardiopulmonary resuscitation (CPR). Complexity of care during CPR, involvement of numerous providers, miscommunication, and other exogenous factors can all contribute to negatively influencing patient care, thus jeopardizing survival. We aim to investigate whether an mHealth supportive tool (the Interconnected and Focused Mobile Apps on patient Care Environment [InterFACE]) developed as a collaborative platform to support CPR providers in real-time and share patient-centered information would increase SA during pediatric CPR.MethodsWe will conduct a prospective, cluster randomized controlled trial by groups of 6 participants in a tertiary pediatric emergency department (33,000 consultations/year) with pediatric physicians and nurses. We will compare the impact of the InterFACE tool with conventional communication methods on SA and effective team communication during a standardized pediatric in-hospital cardiac arrest and a polytrauma high-fidelity simulations. Forty-eight participants will be randomized (1:1) to consecutively perform two 20-min video-recorded scenarios using either the mHealth tool or conventional methods. The primary endpoint is the SA score, measured with the Situation Awareness Global Assessment Technique (SAGAT) instrument. Enrollment will start in late 2020 and data analysis in early 2021. We anticipate that the intervention will be completed by early 2021 and study results will be submitted in mid 2021 for publication.DiscussionThis clinical trial will assess the impact of a collaborative mHealth tool on increasing situational awareness and effective team communication during in-hospital pediatric resuscitation. As research in this area is scarce, the results generated by this study may become of paramount importance in improving the care of children receiving in-hospital CPR, in the era of increasing communication technology.Trial registrationClinicalTrials.gov NCT04464603. Registered on 9 July 2020.

Rapid degradation of psychomotor memory causes poor quality chest compressions in frequent cardiopulmonary resuscitation providers and feedback devices can only help to a limited degree: A crossover simulation study.

Abstract Studies report a decline in the psychomotor memory of cardiopulmonary resuscitation (CPR) providers within months of training, but they are prone to subject bias. We hypothesized that this degradation is faster and more prevalent in real world practice. The aims of our study were to Forty anaesthetists and intensivists participated in a voluntary, half-day, randomized crossover study using case-based simulation. Participants were paired and randomly assigned into 2 groups; each receiving automated feedback either in the first or second cycle of CPR. Two cycles of CC and defibrillation (ACLS protocol) were administered on a manikin. CC parameters including overall quality were measured by a feedback device. The median proportion of good quality CC was poor at baseline but improved with feedback; 38.2% (IQR 27.7, 58.7) to 57.7% (IQR 38.0, 68.7), P &lt; .05. The median proportion of good quality CC fell after feedback withdrawal; 50.5% (IQR 24.5, 67.7) to 25.6% (9, 37.6), P &lt; .05. No carryover effect was observed. Treatment effect and period effect were detected. Baseline quality of CC amongst frequent CPR providers is poor, and can be improved partly by feedback devices. As psychomotor memory of good quality CCs degrades rapidly after removal of feedback, a multimodal approach is required for CPR skill retention. Future research on the optimal frequency of CPR training, including the use of feedback devices in clinical practice should be explored.

Knowledge, Training Status and Willingness to Implement Cardiopulmonary Resuscitation of Medical University Students in Chongqing, China

Timely bystander Cardiopulmonary Resuscitation (CPR) is key to improving survival from out-of-hospital cardiac arrest. Medical university students are potential bystander CPR providers. This study aimed to identify the current level of CPR knowledge, the present status of training and factors affecting the willingness to perform CPR among medical university students in Chongqing, China. Random sampling method was used and a total of 1159 medical university students were included in this study. A self-administered structured questionnaire was used, which included: Demographic characteristics, basic CPR knowledge, CPR training experience, variables of the Theory of Planned Behavior and willingness to implement CPR. The data were analyzed using x2 test and multivariate logistic regression analysis. The respondents' mean CPR knowledge score was 3.19±1.81 (total of 6 points). Forty-eight point one percent of the respondents had received CPR training and 85.2% said they were willing to participate in CPR training. In case of cardiac arrest, 49.9% of respondents were willing to perform CPR. It was found that respondents with CPR training experience, high CPR knowledge level, high Subjective Norm (SN) scores, high Attitude towards the Behavior (AB) scores and high Perceived Behavioral Control (PBC) scores were more willing to perform CPR. It is necessary to incorporate CPR courses into medical universities' compulsory curriculum to increase the willingness to implement CPR.

A survey of cardiopulmonary resuscitation in COVID-19 patients.

Background and Aims:The novel coronavirus 2 (SARS-CoV-2) pandemic has placed severe resource constraints on hospitals. High mortality rates of the COVID-19 have overwhelmed the resuscitation services. The constant fear of virus infection during cardiopulmonary resuscitation (CPR) has placed severe restrictions on the resuscitation services. Reports of poor outcomes after CPR further dampened the spirits of CPR providers. Hence we surveyed CPR practices for COVID -19 patients across hospitals in India by health care providers.Material and Methods:An online survey using Google Forms was initiated to collect data on performance of CPR in diagnosed cases of COVID-19 after in-hospital cardiac arrest. The survey's web-link was publicized using social media, and participation sought of all personnel involved in CPR delivery in COVID-19 patients. The responses received were analyzed. The main outcome measured were determination of the percentage of COVID-19 patients discharged home who were administered CPR.Results:There were 248 responses from different parts of India. At the time of cardiac arrest, 194 victims had diffuse lung infiltrates, 22 had mild lung disease, while 32 had no documented lung lesion. Twenty-five victims had evidence of pulmonary embolism, 39 had cardiac involvement, and 3 had brain involvement. Return of spontaneous circulation (ROSC) was achieved in 59.27% of cases but ROSC sustained in only 22.59%. 7.25% of patients, who received CPR, could be discharged home.Conclusion:The survey has shown reasonable survival rates after CPR administration in COVID-19 patients suffering from IHCA. We should not ignore the need to maximize live outcomes after CPR, even in COVID-19 patients.

The Impact of a Tablet App on Adherence to American Heart Association Guidelines During Simulated Pediatric Cardiopulmonary Resuscitation: Randomized Controlled Trial.

BackgroundEvidence-based best practices are the cornerstone to guide optimal cardiopulmonary arrest resuscitation care. Adherence to the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite advances in resuscitation science and survival improvement over the last decades, only approximately 38% of children survive to hospital discharge after in-hospital cardiac arrest and only 6%-20% after out-of-hospital cardiac arrest.ObjectiveWe investigated whether a mobile app developed as a guide to support and drive CPR providers in real time through interactive pediatric advanced life support (PALS) algorithms would increase adherence to AHA guidelines and reduce the time to initiation of critical life-saving maneuvers compared to the use of PALS pocket reference cards.MethodsThis study was a randomized controlled trial conducted during a simulation-based pediatric cardiac arrest scenario caused by pulseless ventricular tachycardia (pVT). A total of 26 pediatric residents were randomized into two groups. The primary outcome was the elapsed time in seconds in each allocation group from the onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, including the time intervals between defibrillation attempts and drug doses, shock doses, and the number of shocks. All outcomes were assessed for deviation from AHA guidelines.ResultsMean time to the first defibrillation attempt (121.4 sec, 95% CI 105.3-137.5) was significantly reduced among residents using the app compared to those using PALS pocket cards (211.5 sec, 95% CI 162.5-260.6, P<.001). With the app, 11 out of 13 (85%) residents initiated chest compressions within 60 seconds from the onset of pVT and 12 out of 13 (92%) successfully defibrillated within 180 seconds. Time to all other defibrillation attempts was reduced with the app. Adherence to the 2018 AHA pVT algorithm improved by approximately 70% (P=.001) when using the app following all CPR sequences of action in a stepwise fashion until return of spontaneous circulation. The pVT rhythm was recognized correctly in 51 out of 52 (98%) opportunities among residents using the app compared to only 19 out of 52 (37%) among those using PALS cards (P<.001). Time to epinephrine injection was similar. Among a total of 78 opportunities, incorrect shock or drug doses occurred in 14% (11/78) of cases among those using the cards. These errors were reduced to 1% (1/78, P=.005) when using the app.ConclusionsUse of the mobile app was associated with a shorter time to first and subsequent defibrillation attempts, fewer medication and defibrillation dose errors, and improved adherence to AHA recommendations compared with the use of PALS pocket cards.

Risk and ROSC – Legal implications of bystander CPR

BackgroundEarly bystander cardiopulmonary resuscitation (CPR) has been associated with better patient outcomes in cardiac arrest. Despite this, not all cases of cardiac arrest receive bystander intervention. Reasons for this gap include disparities in provision of bystander CPR between race, gender and age groups. Concern of legal liability for responders has also been described. We propose that bystanders are more likely to face litigation for lack of intervention compared to providing bystander CPR due to the presence of ‘Good Samaritan’ statutes in all 50 states. This review of the legal literature seeks to quantify the number of cases brought against bystanders in the US over the past 30 years and explore the reasons behind them. MethodsThe Westlaw legal research database was searched for jury verdicts, settlements, and appellate opinions from all 50 states from 1989 to 2019 for personal injury or wrongful death lawsuits involving CPR. Of 506 cases manually reviewed by the authors, 170 were directly related to CPR. Case details including jurisdiction, location, date, plaintiff and defendant demographics, level of training of CPR provider, relationship to patient, motivation for the lawsuit, and case outcomes were recorded. ResultsOur data show a significant difference in the number of cases of cases alleging battery versus negligence regarding provision of CPR. Of 170 cases, 167 were due to inadequate or untimely bystander CPR. Three cases alleging harm due to providing CPR were identified. ConclusionsThis study represents the largest single study of legal cases involving bystander CPR in the medical literature. The likelihood of litigation is significantly higher in cases with bystander CPR absent or delayed. The authors propose the inclusion of this data and reiteration of ‘Good Samaritan’ statutes in all 50 states during CPR training to reassure and encourage public response to cardiac arrests.

The impact of bystander relation and medical training on out-of-hospital cardiac arrest outcomes

AimIn this study, we investigate the impact of bystander relation and medical training on survival to hospital discharge in out-of-hospital cardiac arrest (OHCA) patients receiving bystander cardiopulmonary resuscitation (CPR). MethodsA retrospective analysis was performed on non-traumatic OHCA patients receiving bystander CPR and Emergency Medical Service (EMS) attempted resuscitation from 2015 through 2017. Adjusted logistic regression was used to assess the association between related versus unrelated and layperson versus medically trained bystander CPR providers and survival to hospital discharge. ResultsA total of 4464 OHCA were eligible for inclusion, of which 2385 (53.4%) received CPR from a relative, 468 (10.5%) from a work colleague or friend and 1611 (36.1%) from a stranger. Layperson’s provided CPR in 3703 (83.0%) OHCA and medically trained professionals in 761 (17.0%). After adjustment for arrest characteristics, there was no difference in survival to hospital discharge between related versus unrelated CPR (adjusted odds ratio [AOR] 0.92, 95% confidence interval [CI]: 0.68–1.23, p = 0.555). However, bystander CPR by a medically trained provider rather than a layperson, was associated with an increase in the odds of survival by 47% (AOR 1.47, 95% CI: 1.09–2.00, p = 0.012) in the overall population and 73% (AOR 1.73, 95% CI: 1.21–2.49; p = 0.003) in patients with an initial shockable arrest. Adjusting for public access defibrillation significantly attenuated the effect of medically trained bystander CPR in initial shockable arrests (AOR 1.42, 95% CI: 0.97–2.07; p = 0.073). ConclusionThis study supports ongoing efforts to crowdsource a larger number of first responders with medical training to OHCA patients to assist with the provision of CPR and early defibrillation.

Accuracy of Healthcare Providers' Perception of Chest Compression Depth and Chest Recoil

Objective: The objective of this paper was to evaluate the validity and accuracy of healthcare providers’ perception of chest compression depth and chest recoil during cardiopulmonary resuscitation (CPR). Methods: A clinical simulation study was performed with healthcare providers trained in CPR including physicians, nurses, and Emergency Medical Technicians (EMT). Following 2 minutes of hands-only-CPR on a sensor-programmed manikin, providers were able to respond to subjective questions assessing their adequacy of CPR. The providers’ perception contrasted with the objective data obtained from the manikin. The validity and accuracy of CPR providers’ perception of chest compression depth and chest recoil was assessed by the calculation of sensitivity, specificity and predictive values. Results: 180 Advanced or basic life support certified healthcare providers were enrolled. The degree of correlation between self-perception and actual performance was 52.2% in the thoracic compression depth and 61.7% in the chest recoil. Caregivers’ perception of chest compression depth had a sensitivity of 29.4% and a specificity of 87.3%. Caregivers’ perception of chest recoil had a sensitivity of 30.3% and a specificity of 79.8%. Conclusions: Healthcare providers’ perception for evaluating the accuracy of thoracic compressions is not as accurate as objective feedback methods during CPR. This may impact patient outcomes during a cardiac arrest.

Ventilation Is an Important Confounding Variable When End-Tidal Carbon Dioxide Is Used to Help Guide Cardiopulmonary Resuscitation

Ventilation Is an Important Confounding Variable When End-Tidal Carbon Dioxide Is Used to Help Guide Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation performed by trained providers and shorter time to emergency medical team arrival increased patients’ survival rates in Istra County, Croatia: a retrospective study

AimTo assess the effect of the time for emergency medical services (EMS) arrival on resuscitation outcome in the transition period of the EMS system in Istra County.MethodsThis retrospective study analyzed the data from 1440 patients resuscitated between 2011 and 2017. The effect of demographic data, period of the year, time for EMS arrival, initial cardiopulmonary resuscitation (CPR) provider, initial cardiac rhythm, and airway management method on CPR outcome was assessed with multivariate logistic regression.ResultsSurvivors were younger than non-survivors (median of 66 vs 70 years, P < 0.001) and had shorter time for EMS arrival (median of 6 vs 8 min, P < 0.001). The proportion of non-survivors was significantly higher when initial basic life support (BLS) was performed by bystanders without training (83.8%) or when no CPR was performed before EMS team arrival (87.3%) than when BLS was performed by medical professionals (66.8%) (P < 0.001). Sex, airway management, and tourist season had no effect on CPR outcome.ConclusionSince the time for arrival and level of CPR provider training showed a significant effect on CPR outcome, further organizational effort should be made to reduce the time for EMS arrival and increase the number of individuals trained in BLS.Clinicaltrials.gov No. NCT03703531.

The Impact of Backboard Placement on Chest Compression Quality: A Mannequin Study.

High-quality chest compressions (CCs) are associated with high survival rates and good neurological outcomes in cardiac arrest patients. The 2015 American Heart Association (AHA; Dallas, Texas USA) Guidelines for Resuscitation defined and recommended high-quality CCs during cardiopulmonary resuscitation (CPR). However, CPR providers struggle to achieve high-quality CCs. There is a debate about the use of backboards during CPR in literature. Some studies suggest backboards improve CC quality, whereas others suggest that backboards can cause delays. This is the first study to evaluate all three components of high-quality CCs: compression depth, recoil depth, and rate, at the same time with a high number of subjects. This study evaluated the impact of backboards on CC quality during CPR. The primary outcome was the difference in successful CC rates between two groups. This was a randomized, controlled, single-blinded study using a high-fidelity mannequin. The successful CC rates, means CC depths, recoil depths, and rates achieved by 6th-grade undergraduate medical students during two minutes of CPR were compared between two randomized groups: an experimental group (backboard present) and a control group (no backboard). Fifty-one of all 101 subjects (50.5%) were female, and the mean age was 23.9 (SD = 1.01) years. The number and the proportion of successful CCs were significantly higher in the experimental group (34; 66.7%) when compared to the control group (19; 38.0%; P = .0041). The difference in mean values of CC depth, recoil depth, and CC rate was significantly higher in the experiment group. The results suggest that using a backboard during CPR improves the quality of CCs in accordance with the 2015 AHA Guidelines.Sanri E, Karacabey S. The impact of backboard placement on chest compression quality: a mannequin study. Prehosp Disaster Med. 2019;34(2):182-187.

Abstract 166: Insertion or Replacement of an Advanced Airway is Not Associated With Adverse Outcome in Neonatal Intensive Care Unit Cardiopulmonary Resuscitation

Introduction: There is a paucity of data regarding variables that impact the outcome in patients who require cardiopulmonary resuscitation (CPR) in the neonatal intensive care unit (NICU). The impact of initial need or replacement of an existing advanced airway (AA) has not been described in this population. The 2016 Neonatal Resuscitation Program (NRP) places emphasis on AA placement prior to initiating compressions in the delivery room setting. We hypothesized that providers would similarly emphasize airway placement for NICU CPR. Methods: We conducted a retrospective review of patients requiring CPR with chest compressions from 2012 to 2017 across 10 NICUs in San Antonio, Texas. We identified cases by clinician selection of a CPR code and by a review of all patients who died prior to NICU discharge. Results: We review a total of 211 NICU CPR events, 210 of which had complete data regarding the AA. An AA was present at the onset of CPR for 179 (85.2%) of CPR events and an existing airway replaced during CPR for 31 (14.7%) CPR events. All patients without an AA present at onset of CPR had an airway immediately placed. The median time to insertion of AA was 1 minute (IQR 1, 5 minutes). In comparing patients who had an AA present at CPR onset versus absent AA, there was no significant difference in rate of return of spontaneous circulation (ROSC, 63.7% vs 64.5%, p=0.92) or time to ROSC (10.2 vs 12.7 min, p=.66). The median time for replacement of an AA during CPR was 1 minute (IQR 1, 4 minutes). Those with a time to replace the AA of &gt;= 5 minutes had a similar ROSC rate compared to those who had AA replacement in &lt; 5 minutes (75% vs 73.7%, p=.96). The decision to replace an AA during CPR was associated with a non-significant increase in rate of ROSC (74.2% vs 62%, p=0.19) and no significant difference in time to ROSC (11.5 min vs. 10.4 min, p=0.65). Conclusions: The achievement of ROSC or time to ROSC are not impacted by the need to place an initial AA at the onset of CPR or the need to replace the AA during CPR in the NICU. This may be due to the rapid initial placement and replacement of the AA observed in NICU CPR events. These data indicate that NICU CPR providers emphasize rapid AA placement similar to NRP guidelines.

Abstract 109: Pediatric CPR in the Emergency Department: Initial Findings From the Videography in Pediatric Emergency Research Collaborative

Introduction: Cardiopulmonary resuscitation (CPR) is frequently performed in a manner inconsistent with American Heart Association (AHA) guidelines. Published studies on CPR quality during pediatric cardiac arrest using chest compression (CC) monitor devices have reported data in aggregate form from entire CPR events. The addition of video review allows precise measurement of CPR quality at the level of individual providers. Hypothesis: To measure individual healthcare providers’ (HCP) CPR quality during pediatric cardiac arrest events in actual patients in the emergency department (PED) and describe adherence to AHA guidelines. Methods: A report from the Videography in Pediatric Emergency Resuscitation (VIPER) Collaborative, a prospective observational database from three tertiary PEDs. All study sites videorecord and review resuscitations and use a pressure sensor/monitor device during CPR. All events where chest compressions (CC) were performed under videorecorded conditions with the monitor device in use were eligible for inclusion. Data on CPR performance was collected by a combination of video review and monitor device; CC rate and depth and ventilation rate were extracted in time periods corresponding to individual CPR providers. CPR segments were defined as ‘high-quality’ if all AHA guidelines were achieved (CC rate 100-120 cpm; CC depth &gt;= 1.5 inches for infants or &gt;= 2 inches for children; ventilation rate 8-12 bpm, no pauses &gt; 10 seconds). Results: Between August 2016 and April 2018, complete data was available for 31 events (infants: n=5; older children: n=6). 279 compression segments were analyzed. Median CC rate was 119 cpm (IQR 110 – 129); median depth was 1.0 inches in infants (IQR 0.85 – 1.2) and 2.1 inches in older children (IQR 1.4 – 2.4). Median ventilation rate was 15 bpm (IQR 10 - 30). 22/279 (8%) compression segments met all criteria for high-quality CPR. Conclusions: PED HCPs infrequently met AHA guidelines for CPR quality. Future studies using video review and CC monitor data collection should examine the impact of specific training strategies on provider-level CPR performance during pediatric cardiac arrest.

The impact of the use of a CPRMeter monitor on quality of chest compressions: a prospective randomised trial, cross-simulation.

Drowning is a common issue at many pools and beaches, and in seas all over the world. Lifeguards often act as bystanders, and therefore adequate training in high-quality cardiopulmonary resuscitation (CPR) and use of adequate equip-ment by lifeguards is essential. The aim of this study was to evaluate the impact of the recently introduced CPRMeter (Laerdal, Stavanger, Norway) on quality of CPR, if used by moderately experienced CPR providers. In particular, we tested the hypothesis that using the CPRMeter improves quality of chest compression by lifeguards compared to standard non-feedback CPR. The study was designed as prospective, randomised, cross-over manikin trial. Fifty lifeguards of the Volunteer Water Rescue Service (WOPR), a Polish nationwide association specialised in water rescue, participated in this study. Participants were randomly assigned 1:1 to one of two groups: a feedback group and a non-feedback group. Participants swim a distance of 25 m in the pool, and then they were asked to haul a manikin for the second 25 m, simulating rescuing a drowning victim. Once participants finished the second 25-m distance, participants were asked to initiate 2-min basic life support according to the randomisation. The median quality of CPR score for the 2-min CPR session without feedback was 69 (33-77) compared to 84 (55-93) in the feedback group (p < 0.001). Compression score, mean depth, rate of adequate chest compressions/min, and overall mean rate during the CPR session improved significantly in the feedback group, compared to the non-feedback group. Using the visual real-time feedback device significantly improved quality of CPR in our relatively unexperienced CPR providers. Better quality of bystander CPR is essential for clinical outcomes, and therefore feedback devices should be considered. Further clinical studies are needed to assess the effect of real-time visual devices, especially in bystander-CPR.

Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest.

Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest.

Are Chinese Students Willing to Learn and Perform Bystander Cardiopulmonary Resuscitation?

BackgroundImmediate cardiopulmonary resuscitation (CPR) can improve survival rate from cardiac arrest and students are potentially important bystander CPR providers. ObjectiveOur aim was to investigate the willingness among Chinese students to learn and perform bystander CPR. MethodsQuestionnaires were distributed to 1407 students. The survey investigated the willingness to learn and perform bystander CPR and the barriers to performing CPR on family members and strangers, assuming that students had mastered CPR. ResultsOnly 14.6% of respondents reported having ever attended CPR training classes, however, 88.3% expressed their willingness to learn. The main characteristics of the students who were willing to learn were the following: they considered the development of the local emergency system excellent (odds ratio [OR] = 3.15); cardiovascular diseases were present within their family (OR = 2.74); and they had previously heard about CPR (OR = 2.43). Almost all respondents (94.6%) reported that they would conduct bystander CPR on family members, while only 59.7% of respondents would do it for strangers. A lack of confidence was the principal barrier to doing CPR for family members (78.4%) and the leading barrier to stranger CPR was the fear of legal liability if their lifesaving attempts failed (90.8%). The complicated process of performing CPR was also a major barrier in both scenarios. ConclusionsWhen there is a great desire to learn CPR, the rate and effect of training can be significantly improved by providing students with regular CPR training, especially compression-only CPR training. Training classes should focus on enhancing the participants’ confidence. In addition, legislation by the government is needed to protect the rescuers.