Chest Compression Depth Research Articles

Proportional Versus Fixed Chest Compression Depth for Guideline-Compliant Resuscitation of Infant Asphyxial Cardiac Arrest

ABSTRACT OBJECTIVES Current guidelines for parameters of the delivery of chest compressions (CC) for infants and children are largely consensus based. Of the two recommended depth targets – 1.5 inches and 1/3 anterior-posterior chest diameter (APD) – it is unclear whether these have equal potential for injury. In previous experiments, our group showed in an animal model of pediatric asphyxial out-of-hospital cardiac arrest (OHCA; modeling ∼ 7 year-old children) that 1/3 APD resulted in significantly deeper CC and a higher likelihood of life-threatening injury. We sought to examine and compare injury characteristics of CC delivered at 1.5 inches or 1/3 APD in an infant model of asphyxial OHCA. METHODS Swine were sedated, anesthetized, paralyzed, intubated through direct laryngoscopy, and then mechanically ventilated (10ml/kg, FiO2:21%). APD was measured and confirmed by two investigators via a sliding T-square at the xiphoid. After instrumentation for vital signs monitoring, and while still anesthetized, the endotracheal tube was manually occluded to induce asphyxia, and occlusion was maintained for 9 minutes. Animals were then randomized to receive CC with a depth of 1.5 inches (Group 1) or 1/3 APD (Group 2), both with a rate of 100 per minute. Advanced life support drugs were administered at 13 minutes, and defibrillation at 14 minutes. Resuscitation continued until return of spontaneous circulation (ROSC) or 20 minutes of failed resuscitation. Survivors were sacrificed with KCl after 20 minutes of observation. Veterinary staff conducted necropsy to assay lung injury, rib fracture, hemothorax, airway bleeding, great vessel dissection, and heart/liver/spleen contusion. Injury characteristics were summarized and compared via Chi-Squared test or Mann-Whitney U-test using an alpha = 0.05. RESULTS A total of 36 animals were included for analysis (Group 1: 18; Group 2: 18). Mean (SD) APD overall was 5.58 (0.23) inches, yielding a mean 1/3 APD depth of 1.86 inches. APD did not differ between groups. ROSC rates did not differ between groups. No injury characteristics differed significantly between groups. CONCLUSIONS In an swine model of infant asphyxial OHCA and resuscitation considering 1/3 APD or 1.5 inches, neither CC depth strategy was associated with increased injury.

Effectiveness of Adult Chest Compressions during Resuscitation Performed by Children Aged 10–14 Years under Simulated Conditions

Introduction: Numerous educational programs recommend implementing the teaching principles of BLS from an early age. The aim of this study was to evaluate selected parameters of the quality of resuscitation performed by children aged 10–14 years during simulated circulatory arrest in an adult. Materials and Methods: The project involved four stages, culminating in students performing thoracic compressions on an adult simulator for 2 min. A digital analysis of the quality, depth, relaxation and rate of compressions allowed us to formulate results and conclusions. The authors’ proprietary questionnaire form allowed for the correlation of criteria such as age, gender, body mass and past experience in first aid training of the participant. Results: A total of 149 girls and 130 boys were studied. The mean age was 12 years (SD ± 1.41). A directly proportional increase in body mass with participant age was observed (p < 0.000). Children as young as 10 years old achieved only 24.13% quality, while those at the age of 14 demonstrated a more than doubled value (67.61%). The minimum depth of chest compressions recommended for an adult (5–6 cm) was not reached in any age group. Girls from all grades achieved a mean quality of 44.69% (SD ± 32.57), while boys achieved a score of 60.23% (SD ± 31.74). On the other hand, in the case of evaluating thoracic relaxation, a significantly better result was achieved by girls compared to boys (66.14% vs. 56.78%; rho-Spearman test for p = 0.011). Conclusions: Age, sex and body mass play important roles in the quality of resuscitation provided by children. None of the age groups studied achieved the minimum mean depth during adult thoracic compressions under simulated conditions. It is recommended to modify school-based BLS classes to better match the exercises to students’ predispositions.

The effect of hand and body position on chest compression quality and rescuer fatigue in prone cardiopulmonary resuscitation

AimThis study aimed to compare the quality of compressions in supine cardiopulmonary resuscitation (CPR) and prone CPR by performing chest compressions on a manikin. Evaluating the effect of prone CPR using different hand and body position on the quality of manual chest compressions and fatigue of participants. MethodsAfter completing 2 min of chest compression in the supine position (Supine Group), 25 participants randomly performed three sets of 2-minutes chest compressions on a prone position manikin. Stand + hands overlapped Group: participants stood beside the patient bed with their hands overlapped and placed on the posterior segment of the thoracic spine between the scapulae, Straddle + hands separated Group: participants straddled the patient bed with their hands placed above the scapulae on both sides at the mid-chest level, and Straddle + hands overlapped Group: participants straddled the patient bed with their hands overlapping on the posterior segment of the thoracic spine between the scapulae. Subsequently, the quality of chest compressions and participants fatigue were assessed. ResultsChest compression depth ratio and mean chest compression depth (MCCD) were worse in the three prone CPR groups (Stand + hands overlapped Group: 0.0(0.0,15.6) %, 39.8 ± 1.3 mm; Straddle + hands separated Group: 1.4(0.0,11.7) %, 42.4 ± 1.2 mm; Straddle + hands overlapped Group: 0.0(0.0,9.2) %, 40.9 ± 1.2 mm) than in the Supine group (87.1(68.1,94.0) %; p < 0.001, 52.4 ± 0.4 mm; p < 0.001). In the three prone CPR groups, Straddle + hands separated Group had the greatest MCCD, lowest changes in heart rate (p = 0.018) and lowest changes in RPE scores (p < 0.001). There were no significant differences between the four groups in terms of mean chest compression rate, accurate chest compression rate ratio, or correct recoil ratio. ConclusionThis simulation-based study showed that the quality of chest compressions was worse in the prone position than in the supine position. When prone chest compressions were performed using different hand and body position, prone CPR performed by a participant straddling a hospital bed with hands placed above the scapula on either side at the mid-chest level provided higher-quality chest compressions and lower rescuer fatigue.

Real-Time Chest Compression Depth, Rate, Posture, and Person Detections Using Binocular Vision for CPR Training

Real-Time Chest Compression Depth, Rate, Posture, and Person Detections Using Binocular Vision for CPR Training

The Effect of Step Stool Use on Chest Compression Quality During CPR in Young Children: Findings From the Videography in Pediatric Emergency Research (VIPER) Collaborative.

This study aimed to determine the effect of stepstool use on chest compression (CC) quality during cardiopulmonary resuscitation (CPR) in young children. We conducted a prospective observational study of children <8 years of age who received CC for >2 minutes in the emergency department. Data were collected through CC monitor device and video review. Data were analyzed in "CC segments" (periods of CC by individual providers). CC segments were coded "yes" or "no" for stepstool use based on video review. Univariate analyses of CC rate and depth between stepstool use and hand positions were performed through nonparametric testing, stratified by age category. Forty-two patients received 566 minutes of CC. Overall, American Heart Association (AHA)-compliant (rate and depth) CPR was achieved in 10% of CC segments for children <1 year and only 6% in children >1 year. A stepstool was used in 73% of CC segments in children <1 year and 88% in children >1 year. In children >1 year, stepstool use was associated with deeper CCs (P < 0.001) and a more compliant CC rate (P < 0.01). In children >1 year, 7% of those with a stepstool in use achieved AHA compliance, compared to those without a stepstool, where none achieved AHA compliance. In children >1 year, stepstool use resulted in greater CC depth and more AHA-compliant CC rate. No CC segments in children >1 year achieved AHA compliance without a stepstool. These data support uniform stepstool use during pediatric CPR in children >1 year of age.

Manual versus automatic chest compression devices for cardiopulmonary resuscitation under zero gravity (The MACCC - 0G STUDY)

IntroductionCardiopulmonary resuscitation (CPR) in microgravity requires specific methods to counteract weightlessness. Automatic chest compression devices (ACCDs) could improve CPR in microgravity. We aimed to compare ACCDs versus manual CPR in microgravity simulated through parabolic flights. MethodsThis prospective, open, controlled study compared 3 ACCDs (LUCAS 3©, AUTOPULSE©, EASYPULSE©) to manual CPR during the 66th CNES (Centre National d’Etudes Spatiales) parabolic flights campaign onboard the Novespace Air Zero-G A310 aircraft. Chest compression depths and rates were monitored by a Laerdal© Resusci-Ann-QCPR manikin. ResultsThe LUCAS 3© device had a median compression depth of 53.0 [53.0–54.0] mm, significantly higher than the EASYPULSE©, AUTOPULSE©, and Manual CPR (Handstand method), measured at 29.0 [26.0–32.0] mm, 29.0 [27.5–30.7] mm and 34.5 [29.6–43.3] mm, respectively (p value < 0.001). Compression rates were 101 [101–101], 100 [100–100] and 80 [80–80] compressions per minute (cpm) for the LUCAS 3©, EASYPULSE©, and AUTOPULSE©, respectively. Manual CPR provided a significantly higher compression rate with 115 [109–123] cpm (p value < 0.001). ConclusionOnly LUCAS 3© provided effective CPR according to international guidelines. ACCDs should implement microgravity CPR algorithms.

Impact of anthropometric factors on chest compression depth during CPR provided by children aged 11–14 in a community-wide study

ObjectiveTo assess the depth of chest compressions (CC) provided by schoolchildren and their relation with providers’s anthropometric characteristics. MethodsWe organized 1-hour hands-on training sessions for 11-14y.o. in volunteering schools. After training, willing subjects performed 2 min of recorded continuous CCs by means of Laerdal Resusci Anne® with CPRMeter2®, with visual feedback. Compression pace was given by metronome; instructors supervised the correct body position. Collected data included age, sex, as well as measured body weight and height. ResultsWe analyzed records from N = 702 children (mean age: 12.76 ± 1.02 years, 379 (51.63%) boys) out of 761 participating in the study. Their mean median compression depth (MCD) was 46.70 ± 7.74 mm, which was below minimal effective CC depth advised by current guidelines (50 mm). This corresponded to low mean fraction of CCs ≥ 50 mm (CCF ≥ 50 mm, 42.86 ± 33.67%), and only 42.88% of children achieving at least 50% of compressions ≥ 50 mm. Boys had significantly higher mean MCD and CCF ≥ 50 mm than girls (MCD: 49.34 ± 7.05 mm vs 45.97 ± 8.07 mm, p < 0.0001; CCF ≥ 50 mm: 50.23 ± 32.90% vs 40.40 ± 34.97%, p < 0.0001). Age differentiated children who achieved at least 50% of compressions ≥50 mm from those who did not with AUC of 0.69 (for cut-off of 12.1 years: 85% sensitivity, 41% specificity), whereas weight offered an improved prediction (AUC 0.74; for cut-off 44.8 kg: 77.4% sensitivity, 61.1% specificity). ConclusionsSex, age and anthropometric factors are significant CC quality factors. Children with higher body weight are more likely to deliver CCF50%≥50 mm. Among the studied population, children ≥12 years old provided more effective chest compressions.

Effectiveness of innovative chest compression on the emergency department stretcher by an alternative method: a randomized controlled crossover trial

Comparison of the three methods standing-on-a-stool (SS), one knee kneeling on a stretcher (KS), and kneeling at the same height as the patient’s bed on the kneeling stool (KK) to evaluate the yielded of highest CPR quality and rescuer comfortability. A prospective randomized cross-over study which compares the three different rescuer positions for their effectiveness of chest compression. Conducted at a tertiary care between 19 and 22 Aug 2022. Emergency personnel aged 18 years or older, who completed the AHA-approved BLS course. The chest compression data was obtained by the ALIVE AED manikin® and AED reporting system. The information on the CPR quality and post-test questionnaires assessing the participants’ preference, satisfaction and modified Borg’s scale score was collected. The three methods shown no statistically significant difference in adequate chest compression depth (percentage). KK was not superior than SS at chest compression rate (P = 0.05). The adequate full chest recoil achieved with KK and KS were significantly higher than that of SS. However, there were no statistical difference between the three methods in the modified Borg’s scale score. Based on the satisfying score, the rescuers preferred KK to either SS (p 0.007) or KS (p 0.012). The three methods shown no statistically significant difference in adequate chest compression depth (percentage). Still, both KK and KS provided more adequate chest recoil, so we would recommend using these two methods in the ED.Clinical trial registry: This study was retrospective registration in thaiclinicaltrials.org (TCTR20230119002, 19/1/2023).

대학생의 개인성향 및 심리적 변인이 심폐소생술 시 가슴압박깊이에 미치는 영향

대학생의 개인성향 및 심리적 변인이 심폐소생술 시 가슴압박깊이에 미치는 영향

Assessing the quality of chest compressions with a DIY low-cost manikin (LoCoMan) versus a standard manikin: a quasi-experimental study in primary education

Extending the access to cardiopulmonary resuscitation (CPR) training to a wider public is an important step in increasing survivability of out-of-hospital cardiac arrest. However, often price and maintenance of CPR manikins are barriers that prevent training at schools. This study aims to evaluate the learning of hands-only (HO) CPR by practicing with a low-cost manikin (LoCoMan) with visual qualitative feedback and to compare the results with the skills acquired by practice on a conventional manikin. A quasi-experimental study with 193 schoolchildren (10 to 12 years old) who were allocated to two groups: the LoCoMan group was taught via an integrative approach (science combined with physical education (PE)) and practiced on a handmade manikin, and a control group practiced in a traditional setting with a commercial manikin (Resusci Junior, Laerdal, Norway). All participants practiced for 1 hands-on skill session before performing a post-test on an instrumented CPR manikin. The outcomes including HO-CPR performance variables were compared between groups. The LoCoMan and control groups both achieved acceptable percentage of HO-CPR quality (57% and 71%, p = 0.004). Among 6th-graders, there were no significant differences in HO-CPR quality between LoCoMan 68% and control 71%, p = 0.66. The control group achieved better chest compression depth while the LoCoMan group showed more compressions with adequate chest recoil. Conclusion: Schoolchildren are able to build and use a low-cost manikin with visual feedback. The integrative learning approach used in this study may be a feasible alternative methodology for training and learning HO-CPR in schools when commercial manikins are not available.What is Known:• Access to CPR training should be universal and independent of age, location, financial means, or access to qualified instructors.• Scientific societies promote the implementation of CPR in schools, so that teachers and schoolchildren can play a multiplier role in their environment, but the gap in CPR learning is related to cultural, economic factors or access to resources and materials.What is New:• LoCoMan may be a useful device for teaching and learning CPR in schoolchildren from the age of 10 and upwards.• LOCOMAN shows that it is feasible and possible to build a low-cost manikin (about €5 in the European Region) and to integrate it into an integrative educational project, and outlines how this could be done. this approach can be an incentive for teachers to attempt teaching CPR, but also for education outside the formal environment.

Chest Compression Depth Targets in Critically Ill Infants and Children Measured With a Laser Distance Meter: Single-Center Retrospective Study From Japan, 2019-2022.

Current resuscitation guidelines recommend target chest compression depth (CCd) of approximately 4cm for infants and 5cm for children. Previous reports based on chest CT suggest these recommended CCd targets might be too deep for younger children. Our aim was to examine measurements of anterior-posterior chest diameter (APd) with a laser distance meter and calculate CCd targets in critically ill infants and children. A retrospective descriptive study. Single-center PICU, using data from May 2019 to May 2022. All critically ill children admitted to PICU and under 8 years old were eligible to be included in the retrospective cohort. None. The chest APd measurements using a laser distance meter are part of our usual practice on the PICU. Target CCd and the over-compression threshold CCd for each age group was calculated as 1/3 and 1/2 of APd, respectively. In 555 patients, the median (interquartile range) of the calculated target CCd for each age group was: 2.7 cm (2.5-2.9 cm), 2.9 cm (2.7-3.2 cm), 3.2 cm (3-3.5 cm), 3.4 cm (3.2-3.6 cm), 3.4 cm (3.2-3.6 cm), 3.6 cm (3.4-3.8 cm), 3.6 cm (3.4-4 cm), and 4 cm (3.5-4.2 cm), for 0, 2, 3-5, 6-8, 9-11, 12-17, 18-23, 24 to less than 60, and 60 to less than 96 months, respectively. Using guideline-recommended absolute CCd targets, 4 cm for infants and 5 cm for children, 49% of infants between 0 and 2 months, and 45.5% of children between 12 and 17 months would be over-compressed during cardiopulmonary resuscitation. In our cohort, the 1/3 CCd targets calculated from APd measured by laser meter were shallower than the guideline-recommended CCd. Further studies including evaluating hemodynamics during cardiopulmonary resuscitation with these shallower CCd targets are needed.

A Realistic, Low-Cost Simulated Automated Chest Compression Device.

This simulated automated chest compression device was designed for use in simulation cardiac arrest cases involving emergency medicine residents, but it would be applicable to other learners such as nurses, pharmacists, and medical students. Automated chest compression devices (ACCD) are commonly utilized in cardiac arrest in the emergency department and by emergency medical services (EMS) as patients arrive in the ED.1 Prolonged simulated cardiac arrest can be challenging to maintain proper chest compression depth and technique.2 Resident learning may be enhanced during cardiac arrest in the simulation environment by implementing the use of a simulated ACCD. By the end of this educational session using a resuscitation trainer or high-fidelity manikin, learners should be able to:Recognize appropriate application of simulated ACCD to an ongoing resuscitation caseDemonstrate proper positioning of simulated ACCD in manikin modelIntegrate simulated ACCD to provide compressions appropriately throughout cardiac arrest scenario. We developed a cost-effective simulated ACCD for use in resuscitation simulation cases. An initial pilot session identified components of fidelity that were used to model the simulated ACCD after those utilized in clinical situations. Three simulated devices were created and then tested for efficacy during high-fidelity simulation with 25 emergency medicine residents. Visual analog scales were used to explore how the simulated ACCD affected perceived realism and stress level during the cardiac arrest simulation. Qualitative data were collected through open-ended learner feedback comments. The institutional review board at our institution reviewed this project and determined that it was exempt. With inclusion of the simulated ACCD device, learners rated the simulation "more realistic" with an average rating of 74/100 and "less stressful" with an average rating of 69/100 on the visual analog scales. Learner comments noted that the use of the ACCD in simulation resulted in better resource availability and accurate environmental noise. The simulated ACCD presented here was found to be effective, realistic, and practical for use by learners in a resuscitation curriculum. Our results suggest that implementating a cost-effective simulated ACCD ($98 for supplies) in high-fidelity simulation cardiac arrest cases enhances the perceived realism of the environment and offers physician learners a low-stress opportunity to practice the clinical application of ACCD in cardiac arrest resuscitation. Additionally, the use of the simulated ACCD, specifically in a prolonged resuscitation, eliminated the need for physically demanding manual chest compressions. Anecdotally, in simulated environments we have observed poor-quality manual chest compressions due to an understanding that the manikin is "not real," leading to decreased psychological fidelity from the shared acceptance of the poor-quality compressions. Thus, the presence of a simulated clinical device providing chest compressions could have increased the feel of realism through improved psychological fidelity. Additionally, we note that the physical and psychological fidelity of this simulated device was sufficient for physicians to perceive clinical implementation, but may be suboptimal for assistive staff, who are focused on the specific functionality and may benefit from training on the physical device in clinical use. Finally, our simulated ACCD resembles the clinical device our department uses; we advise modifications as appropriate to allow a simulated ACCD created for other learners to also resemble their clinically used ACCD. Automated chest compression device, ACLS, improvised equipment, high fidelity simulation.

Metrics of impulsiveness of manual chest compressions for out-of-hospital cardiopulmonary resuscitation

AimPropose new metrics of impulsiveness of manual chest compressions (CCs) that account for shape and duration, separate the characteristics of the compressive part of the CC cycle from those of the recoil part, and are uncorrelated to CC depth and rate. MethodsWe conducted a retrospective analysis of adult out-of-hospital cardiac arrest monitor-defibrillator recordings having CPR data. Specifically, episodes of adult patients with ≥ 1000 compressions free of leaning were examined. CCs were obtained from the depth signal of the valid episodes, and we calculated the novel metrics: compression area index (CAI), recoil area index (RAI), compression impulsiveness index (CII) and recoil impulsiveness index (RII). Generalized linear mixed-effects models and Jonckheere-Terpstra trend analyses were employed to measure differences between populations and trends, and the absolute value of Pearson's correlation coefficient |r| was used to report dependence between variables. Statistics are reported as median and interquartile range. ResultsWe analyzed 982,340 CCs corresponding to 453 episodes, for which we calculated their CAI, RAI and duty cycle (DC). We analyzed the metrics for various populations: age, sex, any ROSC achieved and disposition, and found that CAI was significantly different according to patient disposition and RAI relative to age and sex (p<0.05). None of the metrics was correlated strongly to depth or rate (|r| values of 0.22 or smaller), and all of them varied for CC series corresponding to the same rescuer over the course of resuscitation (ptrend<0.05). However, we observed that the metrics are not balanced, in that for any value of DC, CAI and RAI span almost their entire ranges. ConclusionThe proposed metrics correctly and completely describe manual CC waveforms, improve upon the DC, since they depend on the signal waveform, and provide additional information to current indicators of quality CPR, depth and rate. Furthermore, they allow to differentiate the compressive and recoil parts of the CC cycle, reflecting influence of the rescuer (via CAI or CII) and of the biomechanics of the patient's chest (via RAI or RII). Thus, they have the potential to contribute to better understanding CPR dynamics and, eventually, to enhanced quality of CPR practice as additional indicators of proper manual CC technique.

Appropriateness of recommended chest compression depths for cardiopulmonary resuscitation based on chest computed tomography parameters among Thai population: A multicenter retrospective study

AimWe evaluated the appropriateness of various chest compression (CC) depths among Thai population by comparing the calculated heart compression fraction (HCF) using mathematical methods based on chest computed tomography (CT) measurements. MethodsThis multicenter retrospective cross-sectional study was conducted from September 2014 to December 2020. Chest parameters included external anteroposterior diameter (EAPD), internal anteroposterior diameter (IAPD), heart anteroposterior diameter (HAPD), and non-cardiac soft tissue measured at the level of maximum left ventricular diameter (LVmax). We compared the HCFs as calculated from CT parameters using different CC depths at 5 cm, 6 cm, 1/4 of EAPD, and 1/3 of EAPD, with further subgroup analysis stratified by sex and BMI. ResultsA total of 2927 eligible adult patients with contrast-enhanced chest CT were included. The study group had mean age of 60.1 ± 14.7 years, mean BMI of 22 ± 4.4 kg/m2, and were 57% males. The mean HCFs were 41.5%, 53.5%, 42.4%, and 62.6%, for CC depths of 50 mm, 60 mm, 1/4 of EAPD, and 1/3 of EAPD respectively. HCF was significantly lower in male patients for all CC depths. Advanced age and higher BMI showed significant correlation with lower HCF for CC depths of 50 mm and 60 mm. ConclusionThe CC depth measure of 50–60 mm demonstrated efficacy in maintaining HCF and coronary perfusion in the general population except for geriatric and obese individuals. Adjusting CC depth to 1/4–1/3 of the EAPD yielded better outcomes. Future research should prioritize determining individualized CC depths based on EAPD proportion.

Impact of a COVID-19 code blue protocol on resuscitation care and CPR quality during in-hospital cardiac arrest

ObjectiveWe sought to evaluate the impact of a COVID-19 Code Blue policy on in-hospital cardiac arrest (IHCA) processes of care, cardiopulmonary resuscitation (CPR) quality metrics, and survival to hospital discharge. MethodsWe completed a health record review of consecutive IHCA for which resuscitation was attempted. We report Utstein outcomes and CPR quality metrics 33 months before (July,2017-March,2020) and after (April,2020-December,2022) the implementation of a COVID-19 Code Blue policy requiring all team members to don personal protective equipment including gown, gloves, mask, and eye protection for all IHCA. ResultsThere were 800 IHCA with the following characteristics (Before n = 396; After n = 404): mean age 66, 62.9% male, 81.3% witnessed, 31.3% in the emergency department, 25.6% cardiac cause, and initial shockable rhythm in 16.7%. Among all 404 patients screened for COVID-19, 25 of 288 available test results before IHCA occurred were positive. Comparing the before and after periods: there were relevant time delays (min:sec) in start of chest compressions (0:17vs.0:37;p = 0.005), team arrival (0:43vs.1:21;p = 0.002), 1st rhythm analysis (1:15vs.3:16;p < 0.0001), 1st epinephrine (3:44vs.4:34;p = 0.02), and airway insertion (8:38vs. 10:18;p = 0.02). Resuscitation duration was similar (18:28vs.19:35;p = 0.34). Exception of peri-shock pause which appeared longer (0:06vs.0:14;p = 0.07), chest compression fraction, rate and depth were identical and good. Factors independently associated with survival were age (adjOR 0.98;p < 0.001), male sex (adjOR 1.51;p = 0.048), witnessed (adjOR 2.35;p = 0.02), shockable rhythm (adjOR 3.31;p < 0.0001), hospital location (p = 0.0002), and COVID-19 period (adjOR 0.68;p = 0.052). ConclusionsThe COVID-19 Code Blue policy was associated with delayed processes of care but similarly good CPR quality. The COVID-19 period appeared associated with decreased survival.

Hands-Only Cardiopulmonary Resuscitation Education for Elementary School Students in Korea: Tracking by School Grade, Physical Characteristics, and Physical Strength.

Objectives: This study aimed to assess variations in chest compression depth among Korean elementary school students based on grade, physical characteristics, and strength. Methods: The study involved 140 children in the third to sixth grades from elementary schools. Before providing cardiopulmonary resuscitation (CPR) education, we assessed height, weight, BMI, grip strength, and back strength. Subsequently, CPR education was administered, followed by individual measurements of compression depth. The factors related to compression depths was analyzed using t-test, ANOVA and multivariable regression. Results: The mean compression depth was consistently lower than the guideline standard across all grades, indicating grade-dependent differences (p = 0.000). Moreover, height, weight, BMI, grip strength and back strength increased, exhibited significant increases with grade (p = 0.000). In multivariable regression analysis, it was observed that as grade increased, chest compression depth increased by 0.701cm (p = 0.000). Conclusion: School grade significantly influenced achieving the proper chest compressions depth, no notable correlation found for physical factors. Thus, a strategy emphasizing the importance of sufficient chest compressions during CPR education, particularly targeting elementary school students, seems necessary to encourage greater effort.

Effectiveness of Feedback with Mobile Devices for Quality Measure of CPR Training: A Systematic Review

Cardiopulmonary resuscitation (CPR) is a life-saving skill that can significantly increase survival rates in an emergency. Medical professionals, health students, and trained lay people must all perform high-quality CPR. As an outcome, effective CPR training using instruments that support the achievement of high-quality CPR is essential. Objective: This systematic review aimed to evaluate the effectiveness of feedback provided via mobile devices in measuring the quality of CPR training. Method: Design used systematic review with reference to the PRISMA Statement Guidelines 2020. Search results through database of ScienceDirect (778 articles), Wiley Online Library (765 articles), PubMed (55 articles), and ResearchGate (73 articles). The research designs of articles analyzed was randomized controlled trial which published from 2013 to 2023 with the keywords cardiopulmonary resuscitation, CPR training, mobile devices. The sample in this study was taken from five articles that match the inclusion criteria. JBI's critical assessment tool for assessing bias risk in randomly controlled 2023 checklist tests is used to critically evaluate the instruments used for the selected article. Results: The primary results that five publications were based on CPR quality metrics such as chest compression depth and speed, as well as the proportion of acceptable chest compression depth. Conclusions: This review discovered evidence that mobile devices have an effect on the effectiveness of real-time feedback on CPR quality in CPR training. CPR trainees received effective instant guidance from a variety of mobile devices, including smartphones and smart watches equipped with sensors.

A novel CPR-assist device vs. established chest compression techniques in infant CPR: A manikin study

IntroductionGuidelines for infant CPR recommend the two-thumb encircling hands technique (TTT) and the two-finger technique (TFT) for chest compression. Some devices have been designed to assist with infant CPR, but are often not readily available. Syringe plungers may serve as an alternative infant CPR assist device given their availability in most hospitals. In this study, we aimed to determine whether CPR using a syringe plunger could improve CPR quality measurements on the Resusci-Baby manikin compared with traditional methods of infant CPR. MethodsCompression area with a diameter of 1 to 2 cm is recommended in previous infant CPR device researches. In this is a randomized crossover manikin study, we examined the efficacy of the Syringe Plunger Technique (SPT) which uses the plunger of the 20 ml syringe with a 2 cm diameter flat piston, commonly available in hospital, for infant External Chest Compressions (ECC). Participants performed TTT, TFT and SPT ECC on Resusci® Baby QCPR® according to 2020 BLS guidelines. ResultsSixty healthcare providers participated in this project. The median (IQR) ECC depths in the TTT, TFT and SPT in the first minute were 41 mm (40–42), 40 mm (38–41) and 40 mm (39–41), respectively, with p < 0.001. The median (IQR) ECC recoil in the TTT, TFT and SPT groups in the first minute was 15% (1–93), 64% (18–96) and 53% (8–95), respectively, with p = 0.003. The result in the second minute had similar findings. The SPT had the best QCPR score and less fatigue. ConclusionThe performance of chest compression depth and re-rebound ratio was statistically different among the three groups. TTT has good ECC depth and depth accuracy but poor recoil. TFT is the complete opposite. SPT can achieve a depth close to TTT and has a good recoil performance as TFT. Regarding comprehensive performance, SPT obtains the highest QCPR score, and SPT is also less fatigued. SPT may be an effective alternative technique for infant CPR.

Chest compression quality comparing 1-min vs 2-min rotation of rescuers wearing N95 masks

BackgroundDuring the COVID-19 pandemic, cardiopulmonary resuscitation (CPR) performed by rescuers wearing well-sealed respirators such as N95 masks, was associated with significant reduction in the chest compression rate and depth. This was attributed to fatigue during the standard 2-min rescuer rotations. We hypothesized that in such situations, rotating rescuers every one minute, instead of the standard two minutes would improve CPR quality. AimTo compare the quality of chest compressions when rescuers wearing N95 masks are rotated every one minute, instead of the standard practice of two-minute rotations. MethodsA randomized, controlled, crossover trial was conducted, with the approval of the institutional Ethics Committee. Medical students who volunteered as rescuers were trained to perform high-quality chest compressions on a manikin, and then randomly allocated into pairs. Each pair was randomized to one of two trial groups viz. one-minute rotations crossed-over to two-minute rotations; and vice versa. Thus, each pair performed CPR with one-minute rotations, as well as two-minute rotations Each CPR session included chest compressions for a duration of 12 min. The outcome parameters included CPR quality, compression depth, compression rate, and chest compression fraction. Rescuer fatigue was measured before and after each study session using the modified Borg scale. ResultsFifty-six participants completed the study. The overall CPR quality was statistically similar in the study arms (median 88% vs. 81%, p = 0.09). However, the minute-to-minute inter-arm comparison revealed significantly lower CPR quality in the 2-min rotation arm, at the end of minutes 4, 6, 8, 10 and 12 (respective p-values 0.03, 0.001, 0.008, 0.02, 0.002). A similar trend was observed in compression depth also. Rescuer fatigue score was significantly less with 1-min rotations compared to 2-min rotations (p < 0.001). Rescuer vital signs and cardiorespiratory parameters were not different with the two types of rotations. ConclusionDuring CPR performed by rescuers wearing N95 masks, the quality of CPR appears to be superior with rescuers rotating at 1-min instead of 2-min intervals. More frequent rotation was also associated with less rescuer fatigue.

Is dispatcher-assisted cardiopulmonary resuscitation affected by a bystander’s emotional stress state in out-of-hospital cardiac arrest?

AimThe study aimed to investigate whether a bystander’s emotional stress state affects dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) in out-of-hospital cardiac arrest (OHCA). The primary outcome was initiation of chest compressions (Yes/No). Secondarily we analysed time until chest compressions were initiated and assessed how dispatchers instructed CPR.MethodThe study was a retrospective, observational study of OHCA emergency calls from the Capital Region of Denmark. Recorded calls were evaluated by five observers using a pre-defined code catalogue regarding the variables wished investigated.ResultsIncluded were 655 OHCA emergency calls, of which 211 callers were defined as emotionally stressed. When cardiac arrest was recognized, chest compressions were initiated in, respectively, 76.8% of cases with an emotionally stressed caller and 73.9% in cases with a not emotionally stressed caller (2.18 (0.80–7.64)). Cases with an emotionally stressed caller had a longer time until chest compressions were initiated compared to cases with a not emotionally stressed caller, however non-significant (164 s. vs. 146 s.; P = 0.145). The dispatchers were significantly more likely to be encouraging and motivating, and to instruct on speed and depth of chest compressions in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller (1.64 (1.07–2.56); 1.78 (1.13–2.88)). Barriers to CPR were significantly more often reported in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller (1.83 (1.32–2.56)).ConclusionThere was no significant difference in initiation of chest compressions or in time until initiation of chest compressions in the two groups. However, the dispatchers were overall more encouraging and motivating, and likely to instruct on speed and depth of chest compressions when the caller was emotionally stressed. Furthermore, barriers to CPR were more often reported in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller.Trial registrationWe applied for ethical approval from The Danish National Committee on Health Research Ethics, but formal approval was waived. We received permission for storage of data and to use these for research of OHCAs in the Capital Region of Denmark by Danish Data Protection Agency (P-2021-670) and Danish Health Authorities (R-2,005,114). The study is registered at ClinicalTrials (NTC05113706).