Chest Compression Rate Research Articles

Randomized Comparison of Two New Methods for Chest Compressions during CPR in Microgravity-A Manikin Study.

Background: Although there have been no reported cardiac arrests in space to date, the risk of severe medical events occurring during long-duration spaceflights is a major concern. These critical events can endanger both the crew as well as the mission and include cardiac arrest, which would require cardiopulmonary resuscitation (CPR). Thus far, five methods to perform CPR in microgravity have been proposed. However, each method seems insufficient to some extent and not applicable at all locations in a spacecraft. The aim of the present study is to describe and gather data for two new CPR methods in microgravity. Materials and Methods: A randomized, controlled trial (RCT) compared two new methods for CPR in a free-floating underwater setting. Paramedics performed chest compressions on a manikin (Ambu Man, Ambu, Germany) using two new methods for a free-floating position in a parallel-group design. The first method (Schmitz–Hinkelbein method) is similar to conventional CPR on earth, with the patient in a supine position lying on the operator’s knees for stabilization. The second method (Cologne method) is similar to the first, but chest compressions are conducted with one elbow while the other hand stabilizes the head. The main outcome parameters included the total number of chest compressions (n) during 1 min of CPR (compression rate), the rate of correct chest compressions (%), and no-flow time (s). The study was registered on clinicaltrials.gov (NCT04354883). Results: Fifteen volunteers (age 31.0 ± 8.8 years, height 180.3 ± 7.5 cm, and weight 84.1 ± 13.2 kg) participated in this study. Compared to the Cologne method, the Schmitz–Hinkelbein method showed superiority in compression rates (100.5 ± 14.4 compressions/min), correct compression depth (65 ± 23%), and overall high rates of correct thoracic release after compression (66% high, 20% moderate, and 13% low). The Cologne method showed correct depth rates (28 ± 27%) but was associated with a lower mean compression rate (73.9 ± 25.5/min) and with lower rates of correct thoracic release (20% high, 7% moderate, and 73% low). Conclusions: Both methods are feasible without any equipment and could enable immediate CPR during cardiac arrest in microgravity, even in a single-helper scenario. The Schmitz–Hinkelbein method appears superior and could allow the delivery of high-quality CPR immediately after cardiac arrest with sufficient quality.

Analysis of the adequacy of infant cardiopulmonary resuscitation according to chest compression technique based on the 2020 AHA guidelines

The quantitative and qualitative differences between the two-finger (TF) and two-thumb-encircling hands (TT) techniques were not sufficiently investigated to determine which is more effective for single-rescuer infant cardiopulmonary resuscitation (CPR). As the type of chest compression (CC) technique can impact survival rates and prognoses of patients, this study aimed to compare the adequacy of single-rescuer infant CPR CC techniques and explore participants’ CPR experiences using an exploratory sequential mixed methods design. To assess the adequacy of CC and ventilation according to technique, 70 students who completed basic life support provider certification among students from emergency medical services and nursing departments of a single college performed CC using the TF and TT techniques (4 sets of 5 cycles with a ratio of 30:2) in simulation. Meanwhile, a numeric rating scale was used to measure fatigue. SPSS (v. 25.0, IBM Corp, Armonk, NY, USA) was used to analyze the collected data by frequency analysis, descriptive statistics, paired t-test, and repeated measures analysis of variance (ANOVA). We conducted focus group interviews and analyzed CPR experiences. There were statistically significant differences between the TF and TT techniques in fatigue score (6.09 vs. 4.23 points, p < 0.001), average hands-off time (6.77 vs. 7.43 s, p =0.001), mean ventilation volume (41.40 vs. 35.51 ml, p = 0.002), CC accuracy rate (65.89% vs. 77.11%, p = 0.011), mean CC rate (104.37 vs. 107.11 beats/min, p = 0.020), overall CPR score (78.26 vs. 84.37 points, p = 0.005), and overall compression score (82.60 vs. 92.54 points, p < 0.001). Furthermore, we found significant differences over time in mean CC count (p = 0.030), mean ventilation volume (p = 0.042), and mean hands-off time (p = 0.029). Two categories (ambivalent attitudes and perception of pain) and five sub-categories were derived based on the results. In conclusion, as stated in the 2020 American Heart Association (AHA) guidelines, both TF and TT techniques are useful for single-rescuer infant CPR. Overall, TT technique provides higher quality of compressions at the cost of fewer ventilations. We recommend future studies of more diverse groups and techniques.

Effectiveness of "Resuscitation Cover All" in Minimizing COVID-19 Transmission to Health-Care Workers during Cardiopulmonary Resuscitation.

Introduction:Coronavirus disease 2019 (COVID-19) is a highly contagious disease transmitted by contact, droplets, and aerosols. Front line health-care workers (HCWs), particularly emergency physicians and acute care providers, are vulnerable to being exposed while treating their sick patients. Despite appropriate personal protective equipment use, HCW gets infected, suggesting the need for multiple layers of protection such as barrier devices.Methods:We aimed to determine the effectiveness of our novel “Resuscitation Cover All”(RCA) in reducing the exposure of HCW to simulated respiratory particles and its feasibility during cardio pulmonary resuscitation (CPR). This was a pilot simulation-based study. Five CPR simulation sessions were performed in Standard and RCA protocols, individually. Exposures through contact, droplets, and aerosols were simulated using a standardized volume of liquid detergent. Under Wood's lamp illumination, exposures of participants were compared between the protocols. Rate and depth of chest compressions, time taken to intubate, interruptions in CPR, and first-pass success were analyzed.Results:Overall mean exposure in standard protocol was 4950.4 ± 1461.6 (95%confidence interval [CI]:3135.7–6765.2) sq.pixels and RCA protocol was 2203.6 ± 1499.0 (95%CI: 342.4–4064.9) sq.pixels (P = 0.019). In standard, chest compressor had the highest exposure of 3066.6 ± 1419.2 (95%CI: 2051.3–4081.9) sq.pixels followed by defibrillator assistant 1166.4 ± 767.4 (95%CI: 617.4–1715.4) sq.pixels. Chest compressor of RCA had reduced exposure compared to that of standard (P < 0.001). Hands were the most frequently exposed body part. Airway manager of RCA had no exposure over head and neck in any session. No significant difference in CPR performance metrics was observed.Conclusion:This pilot simulation-based study shows that the novel RCA device could minimize the exposure of HCW to simulated respiratory particles during CPR. Also, it might not alter the high-quality CPR performance metrics. We need more real-life evidence.

Quality of Cardiopulmonary Resuscitation and 5-Year Survival Following in-Hospital Cardiac Arrest.

PurposeTo improve cardiac arrest survival, international resuscitation guidelines emphasize measuring the quality of cardiopulmonary resuscitation (CPR). We aimed to investigate CPR quality during in-hospital cardiac arrest (IHCA) and study long-term survival outcomes.Patients and MethodsThis was a cohort study of IHCA from December 2011 until November 2014. Data were collected from the hospital switch board, patient records, and from defibrillators. Impedance data from defibrillators were analyzed manually at the level of single compressions. Long-term survival at 1-, 3-, and 5 years is reported.ResultsThe study included 189 IHCAs; median (interquartile range (IQR)) time to first rhythm analysis was 116 (70–201) seconds and median (IQR) time to first defibrillation was 133 (82–264) seconds. Median (IQR) chest compression rate was 126 (119–131) per minute and chest compression fraction (CCF) was 78% (69–86). Thirty-day survival was 25%, while 1-year-, 3-year-, and 5-year survival were 21%, 14%, and 13%, respectively. There was no significant association between any survival outcomes and CCF, whereas chest compression rate was associated with survival to 30 days and 3 years. Overall, 5-year survival was associated with younger age (median 68 vs 74 years, p=0.003), less comorbidity (Charlson comorbidity index median 3 vs 5, p<0.001), and witnessed cardiac arrest (96% vs 77%, p=0.03).ConclusionWe established a systematic collection of IHCA CPR quality data to measure and improve CPR quality and long-term survival outcomes. Median time to first rhythm check/defibrillation was <3 minutes, but median chest compression rate was too fast and median CCF slightly below 80%. More than half of 30-day survivors were still alive at 5 years.

The high impulse, palm lift technique for chest compression: Prospective, experimental, pilot study.

The classic technique of high quality chest compression (HQCC) during cardiopulmonary resuscitation (CPR) is based on the International Liaison Committee on Resuscitation (ILCOR) guidelines which specify that the rescuer's hands should maintain constant contact with the chest surface but should not lean upon it, in order to provide full chest recoil. Since end-tidal CO2 (EtCO2) values have been shown to be a reliable indicator of CPR quality, we examined a method where classic HQCC was modified by a high impulse and palm lifting (HIPL) technique which merged rapid forceful compression with disconnection of the rescuer's palm from the patient's sternum during the recoil phase. The object of the study was to detect any differences in HIPL EtCO2 values in comparison with those from classic HQCC. We report a prospective pilot study in which we compared EtCO2 readings achieved during 2min of classic HQCC technique with readings after implementing 2min of the HIPL technique during out-of-hospital CPR, provided by medical emergency response teams for cases of cardiac arrest. EtCO2 values obtained from16 cases who received HQCC followed by HIPL compressions showed a significant difference (p=0.037) between the two techniques. Mean±SD EtCO2 values after 2min of each technique were: HQCC: 18±9mmHg; HIPL: 27±11mmHg; followed by a further 2min of HQCC: 19±11mmHg. Linear regression showed that the differences in EtCO2 were associated with non - significant changes in ventilation rate (p=0.493) and chest compression rate (p=0.889). The results obtained suggest that modifying HQCC with the HIPL technique led to a significant increase in EtCO2 values in comparison with classic HQCC, indicating an improvement in circulation during CPR. We think that these encouraging early results warrant a larger multi - centre study of HIPL.

Abstract 12921: One Hand Open Palm Technique for Infant Cardiopulmonary Resuscitation: A Randomized Crossover Study

Introduction: The American Heart Association (AHA) CPR guidelines states that effective chest compression depth, rate and recoil are essential factors for establishment of return of spontaneous circulation. A recent survey from an international pediatric resuscitation collaborative showed that healthcare providers failed to meet the metrics of the AHA guidelines, with the greatest difficulty in achieving targeted chest compression depth in infants. The recommended techniques for infant compression include two finger (TFT) or two-thumb technique (TTT). We hypothesized using the heel of one palm (open palm technique, OPT) in infants will result in improved chest compression depth with decreased provider fatigue. Methods: Each participant performed three techniques including TFT, TTT, and novel open-palm technique (OPT) with randomization for sequence of techniques for each participant. Each technique was performed for 2 minutes followed by a 5-minute rest period on an infant manikin. Data were collected through Zoll R series defibrillators on chest compression depth, rate, and fraction. At the end of the study, each participant filled out a survey for difficulty level, finger fatigue, and rescuer fatigue. Results: Thirty pediatric critical care providers participated in the study consisting of 16 nurses, 9 respiratory therapists, 3 fellows, 2 nurse practitioners. The mean chest compression depth for OPT was significantly deeper (2.61 ± 0.63 cm) in comparison to TFT (2.25 ± 0.54 cm, p= 0.0004) but not significantly deeper in comparison to TTT (2.43 ± 0.46 cm, p= 0.0820). There were no significant differences between the three techniques in chest compression rate or chest compression fraction. The finger fatigue and rescuer fatigue surveys were graded from 0-10 with 10 being the most fatigue. OPT showed significantly less finger and rescuer fatigue in comparison to TTT and TFT (p&lt;0.05). Conclusion: This study demonstrated that OPT generated improved chest compression depth with considerably less rescuer and finger fatigue. However, chest compression depth with all three techniques failed to meet the AHA infant goal of 4 cm. Further research is needed to optimize CPR performance to achieve the targeted chest compression depth in infants.

Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine

AimTo evaluate an algorithm that uses an end-tidal carbon dioxide (ETCO2) target of ≥ 30 torr to guide specific changes in chest compression rate and epinephrine administration during cardiopulmonary resuscitation (CPR) in paediatric swine. MethodsSwine underwent asphyxial cardiac arrest followed by resuscitation with either standard or ETCO2-guided algorithm CPR. The standard group received chest compressions at a rate of 100/min and epinephrine every 4 min during advanced life support consistent with the American Heart Association paediatric resuscitation guidelines. In the ETCO2-guided algorithm group, chest compression rate was increased by 10 compressions/min for every minute that the ETCO2 was < 30 torr, and the epinephrine administration interval was decreased to every 2 min if the ETCO2 remained < 30 torr. Short-term survival and physiologic data during active resuscitation were compared. ResultsShort-term survival was significantly greater in the ETCO2-guided algorithm CPR group than in the standard CPR group (16/28 [57.1%] versus 4/28 [14.3%]; p = 0.002). Additionally, the algorithm group had higher predicted mean ETCO2, chest compression rate, diastolic and mean arterial pressure, and myocardial perfusion pressure throughout resuscitation. Swine in the algorithm group also exhibited significantly greater improvement in diastolic and mean arterial pressure and cerebral perfusion pressure after the first dose of epinephrine than did those in the standard group. Incidence of resuscitation-related injuries was similar in the two groups. ConclusionsUse of a resuscitation algorithm with stepwise guidance for changes in the chest compression rate and epinephrine administration interval based on a goal ETCO2 level improved survival and intra-arrest hemodynamics in this porcine cardiac arrest model.

Identification of an optimal CPR chest compression protocol.

In this study, we used a high-fidelity integrated computational model of the respiratory and cardiovascular systems to investigate cardiopulmonary resuscitation (CPR) after cardiac arrest in a virtual healthy subject. For the purpose of this work, a newly developed thoracic model has been integrated to the current model, to study the influence of external chest compressions upon the arrested circulation during CPR. We evaluated the chest compression (CC) parameters, namely, end compression force, compression rate, and duty cycle to optimize the coronary perfusion pressure and the systolic blood pressure, using a genetic algorithm. While the sternal displacement associated with the CC force agreed with the ERC guidelines, the CC rate and duty cycle were respectively higher and lower than the ones recommended by the ERC guidelines. The effect of these CC parameters on cardiac output (CO) were also assessed. The end compression force was the parameter with the largest impact on CO, while the compression rate and duty cycle scarcely influence it.Relevance- Our results may aid in understanding the underlying pathophysiology of cardiac arrest and help guide research into the refinement of CPR strategies, without sacrificing animals or conducting clinical trials, which are difficult to undertake in crisis scenarios.

64 Association of 24-hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Medical team composition at the delivery of high-risk neonates may contribute to better outcomes. The presence of 24-hour (h) in-house staff neonatologist (NN) may improve delivery room (DR) care practices and outcomes. Objectives To assess if 24-h in-house NN coverage is associated with better care practices and outcomes among inborn infants born &amp;lt; 29 weeks GA. Design/Methods Cross-sectional cohort study of 2476 inborn infants born at 23-28 weeks gestation, admitted in 2014-2015 to Canadian Neonatal Network level 3 NICUs with a maternity unit that participated in a 2015 survey on NICU coverage. Exposures were classified using survey responses based on the most senior provider offering 24-h in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders with generalized estimating equations to account for clustering within each site. Results Among the 28 participating NICUs, most senior providers ensuring 24-h in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). Infants’ characteristics are shown in Table 1. No NN/fellow coverage and 24-h fellow coverage were associated with higher odds of infants receiving DR chest compressions or epinephrine compared to 24-h NN coverage (adjusted odds ratio [AOR] 4.72, 95% CI 2.12-10.6 and AOR 3.33, 95% CI 1.44-7.70, respectively) (Table 2). 24-h fellow coverage was associated with higher odds of normothermia (36.5°C-37.2°C) on admission (AOR 2.26, 95% CI 1.51-3.37) compared to 24-h NN coverage (Table 2). Rates of mortality or major morbidity did not differ significantly among the three groups: NN, 63% (249/395); fellow, 64% (1092/1700); no NN/fellow, 70% (266/381). Compared to 24-h NN coverage, 24-h fellow coverage was associated with lower odds of mortality (AOR 0.62, 95% CI, 0.43-0.88) (Table 2). Conclusion 24-h in-house NN coverage was associated with lower rates of DR chest compressions or epinephrine use; however, it was not associated with death and/or major morbidity. These results are from a survey linked cohort, and data on the actual presence of individuals in NICU/resuscitation is unknown. Future prospective research on care providers present in the NICU, and its impact on outcomes, is needed.

Association of end-tidal carbon dioxide levels during cardiopulmonary resuscitation with survival in a large paediatric cohort

AimTo examine the associations between ETCO2, ROSC, and chest compression quality markers in paediatric patients during active resuscitation. MethodsThis was a single-centre cohort study of data collected as part of an institutional prospective quality initiative improvement program that included all paediatric patients who received chest compressions of any duration from January 1, 2013, through July 10, 2018, in the Johns Hopkins Children’s Center. Data was collected from Zoll R Series® defibrillators. Events were included if Zoll data files contained both chest compression and ETCO2 data. 2,746 minutes corresponding to 143 events were included in the analyses. ResultsThe median event ETCO2 for all 143 events was 16.8 [9.3–26.3] mmHg. There was a significant difference in median event ETCO2 between events that achieved ROSC and those that did not (ROSC: 19.3 [14.4–26.6] vs. NO ROSC: 13.9 [6.6–25.5] mmHg; p < 0.05). When the events were based on patient age, this relationship held in adolescents (ROSC: 18.8 [15.5–22.3] vs. NO ROSC: 9.6 [4.4–15.9] mmHg; p < 0.05), but not in children or infants. Median event ETCO2 was significantly associated with chest compression rate less than 140 (p < 0.0001) and chest compression fraction 90–100 (p < 0.0001). ConclusionsThis represents the largest collection of ETCO2 and chest compression data in paediatric patients to date and unadjusted analyses suggests an association between ETCO2 and ROSC in some paediatric patients.

Efficacy of a Simplified Feedback Trainer for High-Quality Chest Compression Training: A Randomized Controlled Simulation Study.

Background: The most recent international guidelines recommended support training of chest compression (CC) using feedback devices. This study aimed to compare the training efficacy of a simplified feedback trainer with the traditional cardiopulmonary resuscitation (CPR) simulator in CPR training.Methods: A total of 60 soldiers were randomly allocated into three groups equally, trained with a simplified external cardiac massage (ECM) trainer named Soul SheathTM (SS) (SS group), a Resusci Anne manikin (RA group), or traditional simulation training with instructor feedback, respectively. After 7 days of training, the CPR skills were tested blindly in a 2-min assessment session. The primary outcome was the proportion of effective CC, and the secondary outcome included CC rate, depth, compression position, and extent of the release.Results: The percentage of effective CC achieved in the SS group was comparable with the RA group (77.0 ± 15.52 vs. 77.5 ± 10.73%, p = 0.922), and significantly higher than that in the control group (77.0 ± 15.52 vs. 66.8 ± 16.87%, p = 0.037). Both the SS and RA groups showed better CC performance than the control group in terms of CC rate (SS group vs. control group, P = 0.032 and RA group vs. control group, P = 0.026), the proportion of shallow CC (SS group vs. control group, P = 0.011 and RA group vs. control group, P = 0.017). No difference between the SS group and RA group was found in all the CC parameters.Conclusions: The simplified ECM trainer (SS) provides a similar efficacy to the traditional manikin simulator with feedback in CC training to improve the quality of CPR skills.

Does patient age and BMI affect temporal changes in depth-force relationship during CPR?

Abstract Introduction A strong non-linear relationship exists between chest compression (CC) force and depth during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest events. A decrease in the depth-force (DF) relationship over time and cumulative number of CC has been described for both human and animal subjects. The effect of patient demographics such as age and body mass index (BMI) in the DF relationship during CPR is not as widely explored. Purpose The aim of the present study was to analyse the temporal effect of patient demographics (i.e. age and BMI) in the DF relationship during the performance of CPR. Methods Data were collected from a first responder group based in Texas, USA. Responders were instructed to use a CPR depth feedback device (Laerdal CPRmeter) and an automated external defibrillator (AED; HeartSine SAM 350P) when attending sudden cardiac arrest events. The AED was configured with a shock protocol separated by 2-minute episodes of CPR and rescuer CC depth and rate were guided by the CPR depth feedback device. Patient demographic data was captured at the cardiac arrest scene. CC depth and force data were extracted from Laerdal CPRmeter and processed for 171 patient events. The depth-force ratio (DFR) was calculated as mean depth local maxima divided by mean force local maxima (mm/kgf). Data processing and statistical analyses were performed with R version 3.7.3. Patient age was available for 169 events (median (IQR) = 63 (53–76) years). Age was categorised in two groups: 18–64 (n=87) and 65+ years (n=82). Patient BMI was estimated for 149 patients (median (IQR) = 25.84 (22.58–31.05) kg/m2). BMI was categorised as: Underweight (gUW, BMI &amp;lt;18.5, n=13), Normal (gN, 18.5 ≤ BMI &amp;lt;25, n=54), Overweight (gOW, 25 ≤ BMI &amp;lt;30, n=37) and Obese (gOB, BMI ≥30, n=45). Results No statistically significant differences in mean event duration were found in the age groups (t-test, p=0.368) or the BMI groups (ANOVA, p=0.309). A multiple linear regression model was applied to the data to assess the effect of time and age or BMI on the DFR. At the beginning of the events, no statistically significant differences were found in DFR between age groups (p=0.092). Time had no effect on the change in DFR for 18–64 age group (p=0.110) but the rate of change between the 18–64 and 65+ age groups was significantly different (p&amp;lt;0.010). For BMI and using gN as reference, there were significant differences in DFR between all BMI groups except gUW at the beginning of the events. Time had a significant effect in DFR during events for gUW, gN and gOB (p&amp;lt;0.050), but no common trend in temporal change was identified. Conclusions Temporal changes in DFR appear to be significantly affected by patient age. Tailoring CC force or depth to patient demographics during CPR events may be required for some patients. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): HeartSine Technologies Ltd, Belfast, UK

Training prevalence, knowledge and attitudes towards cardiopulmonary resuscitation: a survey amongst 5,921 preschool and school teachers

Abstract Purpose Preschool and school teachers could play an important role both in training children in cardiopulmonary resuscitation (CPR) and in providing necessary help in case of witnessing an emergency. This study aimed to investigate prevalence of CPR training, CPR knowledge, attitudes and willingness to perform CPR among preschool and school teachers in the territory of the Republic of Crimea, in the northern Black Sea region. Methods An anonymous online questionnaire survey was conducted in February–March 2021 utilizing Google Forms. In particular, the participants were asked to rate their knowledge of CPR and willingness to perform CPR (on a stranger, a pupil or a loved one) on a 5-point scale, and to indicate recommended chest compression rate and hand position for compressions. Results Out of 5,921 surveyed teachers, 3,765 (64%) reported previous CPR training. Among the trained, 55% attended training more than one year ago, 44% completed a CPR training course once. Reasons for not being trained were most commonly reported as “never thought about the need to go for training” (42%), “nobody demanded me to get trained” (38%) or “did not know where to attend the training” (21%). Self-perceived knowledge of CPR was rated as follows: very good – 0.4%, good – 7.8%, moderate – 37.8%, poor – 44.6%, absent – 9.4%. Hand position for giving chest compressions was indicated correctly by 66% participants, compression rate – by 16% respondents. Correct answering to the questions and higher self-perceived knowledge were associated with previous CPR training (p&amp;lt;0.001). 54% reported they wish to get trained in CPR. 28% confirmed readiness to teach CPR as part of their extracurricular work (provided that they will get preliminary training, and upon availability of proper training supplies and instructional program). Proportion of respondents who expressed high willingness to attempt CPR (4–5 points) on a stranger, a pupil or a loved one amounted to 35%, 41% and 64%, respectively, mean level or readiness to perform CPR – 3.0, 3.1 and 3.8 points, respectively. Willingness to perform CPR was positively associated with previous CPR training and level of CPR knowledge (p&amp;lt;0.001). Fear to cause harm to a victim and lack of CPR knowledge and skills were most commonly reported as the strongest barriers to attempt CPR (reported by 49–51% and 31–36% respondents, respectively, depending on the type of supposed victim). Conclusions Coverage of the preschool and school teachers with recent CPR training is limited, levels of knowledge and self-confidence in CPR are generally low. Lack of competence impede readiness of the teachers to attempt CPR. There is a demand in enhancing involvement of teachers in CPR training and retraining in the Republic of Crimea. Most teachers want to get trained in CPR, and almost one third agree to teach CPR themselves, suggesting a reasonable way to improve availability of CPR training for both teachers and pupils. Funding Acknowledgement Type of funding sources: None.

Effect of physical fatigue and smoking cigarettes on the CPR effectiveness performed by soldiers

INTRODUCTION: The witness of the event plays an important role in the diagnosis of cardiac arrest in the victim. Taking quick actions to restore basic life functions is the essence of pre-hospital assistance, and this applies not only to civilian conditions but also to combat operations. During extraordinary occurrences and civil-military cooperation, the soldier’s physical fitness and the ability to perform cardiopulmonary resus­citation effectively give a better chance to save the cardiac arrest victim’s life. The study aimed to assess the quality of cardiopulmonary resuscitation (CPR) performed by soldiers before and after physical activity, taking account of smoking by the examined persons. MATERIAL AND METHODS: Fifty-four soldiers took part in the study. The assessment included a 2-minute CPR performance by the soldier before and after physical activity in the Tactical Field Care zone. The Little Anne phantom was used to record CPR quality. Among the examined soldiers, 20% were active smokers. RESULTS: The research showed that the average CPR effectiveness before exercise was significantly higher than after combat operations (75% vs. 73%). The research also demonstrated that, physical fatigue signifi­cantly reduced the rate of chest compressions and the percentage of full chest recoil during CPR. Smoking had no significant effect on the quality of CPR performance. The quality of performance of the CPR compo­nents correlated with Body Mass Index (BMI), age, and time since the last training completion. CONCLUSIONS: The quality of CPR performance after combat exercise is lower than before the physical fa­tigue. While smoking does not affect CPR performance quality, other factors such as BMI, age, and time since the last training completion are relevant in this context.

Methodology and framework for the analysis of cardiopulmonary resuscitation quality in large and heterogeneous cardiac arrest datasets

BackgroundOut-of-hospital cardiac arrest (OHCA) data debriefing and clinical research often require the retrospective analysis of large datasets containing defibrillator files from different vendors and clinical annotations by the emergency medical services. AimTo introduce and evaluate a methodology to automatically extract cardiopulmonary resuscitation (CPR) quality data in a uniform and systematic way from OHCA datasets from multiple heterogeneous sources. MethodsA dataset of 2236 OHCA cases from multiple defibrillator models and manufacturers was analyzed. Chest compressions were automatically identified using the thoracic impedance and compression depth signals. Device event time-stamps and clinical annotations were used to set the start and end of the analysis interval, and to identify periods with spontaneous circulation. A manual audit of the automatic annotations was conducted and used as gold standard. Chest compression fraction (CCF), rate (CCR) and interruption ratio were computed as CPR quality variables. The unsigned error between the automated procedure and the gold standard was calculated. ResultsFull-episode median errors below 2% in CCF, 1 min−1 in CCR, and 1.5% in interruption ratio, were measured for all signals and devices. The proportion of cases with large errors (>10% in CCF and interruption ratio, and >10 min−1 in CCR) was below 10%. Errors were lower for shorter sub-intervals of interest, like the airway insertion interval. ConclusionsAn automated methodology was validated to accurately compute CPR metrics in large and heterogeneous OHCA datasets. Automated processing of defibrillator files and the associated clinical annotations enables the aggregation and analysis of CPR data from multiple sources.

Sports safety matting diminishes cardiopulmonary resuscitation quality and increases rescuer perceived exertion.

Compliant surfaces beneath a casualty diminish the quality of cardiopulmonary resuscitation (CPR) in clinical environments. To examine this issue in a sporting environment, we assessed chest compression quality and rescuer exertion upon compliant sports safety matting. Twenty-seven advanced life support providers volunteered (13 male/14 female; mass = 79.0 ± 12.5 kg; stature = 1.77 ± 0.09 m). Participants performed 5 × 2 min, randomized bouts of continuous chest compressions on a mannequin, upon five surfaces: solid floor; low-compliance matting; low-compliance matting with a backboard; high-compliance matting; high-compliance matting with a backboard. Measures included chest compression depth and rate, percentage of adequate compressions, and rescuer heart rate and perceived exertion. Chest compression depth and rate were significantly lower upon high-compliance matting relative to other surfaces (p<0.05). The percentage of adequate compressions (depth ≥50 mm) was lowest upon high-compliance matting (40 ± 39%) versus low-compliance matting (60 ± 36%) and low-compliance matting with a backboard (59 ± 39%). Perceived exertion was significantly greater upon high-compliance matting versus floor, low-compliance matting, and low-compliance matting with a backboard (p<0.05). Providers of CPR should be alerted to the detrimental effects of compliant safety matting in a sporting environment and prepare to alter the targeted compression depth and rescuer rotation intervals accordingly.

The clinical effects of CPR meter on chest compression quality: a QI project

The clinical effects of CPR meter on chest compression quality: a QI project.&#x0D; Christopher Picard, Richard Drew, Domhnall O’Dochartaigh, Matthew J Douma, Candice Keddie, Colleen Norris.&#x0D; Background: High-quality chest compressions are the cornerstone of resuscitation. Training guidelines require CPR feedback, and pre-clinical data shows that feedback devices improve chest compression quality; but devices are not being used in many emergency departments, and their impact on clinical care is less well understood. Some services use defibrillator generated reports for quality improvement, but these measurements may be limited in scope and have not been rigorously compared to other tools.&#x0D; Methods: Laerdal CPRMeter 2 chest compression feedback devices were purchased using funds made available by a zone QI initiative. Initial training for implementation consisted of staff performing one minute of blinded chest compression using the feedback device, followed by one minute of chest compression unblinded. Staff were shown the raw percentage of chest compressions meeting target depth, release, and rate under both conditions as well as overall improvement. Following initial orientation, devices were incorporated into clinical care and all subsequent staff simulation and training. Clinically, use of the feedback device and completion or QI tracking forms was not mandated but was encouraged by drawing code participant names from completed forms for a free ACLS or PALS course. Data from all codes were automatically collected by the LifePak 20, data from any resuscitation using the Laerdal CPRmeter 2 were also automatically recorded when the device was used: these data were downloaded weekly. Completed questionnaire forms were submitted to the Clinical Educators and extracted as received.&#x0D; Evaluation Methods: Chest compression quality data was collected in two ways: first, using a Laerdal CPRMeter2, second, by downloading and analyzing cardiac arrest data from a LifePak20 defibrillator using CodeStatTM software. Device data were matched and synthesized by an emergency department CNE using Microsoft excel and IBM SPSS 26. Descriptive statistics (mean and standard deviations) are used to describe the data. Differences in chest compression quality and duration of resuscitations between resuscitation that did or did not use a feedback device or a backboard were compared using independent t-testing. Differences in chest compressions at the target depth, release, and rate between the numbers of staff involved were assessed using ANOVA. Agreement between devices (CPRMeter2 and LifePak) used during the resuscitations were evaluated using paired t-testing, Pearson correlations, and Bland-Altman plots. All tests were two-tailed with predetermined significance levels set at a=0.05.&#x0D; Results: Data collection occurred between August 2019 and December 2020. There were a total of 50 cardiac arrests included, 36 had questionnaire data returned, 36 had data collected from the CPR meter 2, 24 had data collected from the LifePak, and 10 had data collected using all three methods. The average duration of resuscitation (number of chest compressions) was 1079.56 (SD=858.25); there was no difference in the duration of resuscitation (number of chest compressions) between resuscitations using versus not using CPR feedback devices (p=0.673). Resuscitations utilizing chest compression feedback had a higher percentage of chest compressions at the target rate compared to resuscitations not using feedback (74.08% vs 42.18%, p=0.007). Resuscitations that utilized a backboard had a higher percentage of chest compressions at target depth (72.92% vs 48.73%, p=0.048). There were no differences noted in the duration of resuscitation attempt (p=0.167) or percentages of chest compressions at the target depth (p=0.181), release (p=0.538), or rate (p=0.656) between resuscitations with different sized teams (4-5, 6-7, 8-9, &gt;10 staff involved). There was a strong positive correlation (r=0.771, p=0.005, n=11) between the two measurement methods and chest compression rates, and no statistically significant difference in measured scores (p=0.999), with 100% of values falling within the Bland-Altman confidence intervals of 36.72 and -36.72, n=11. Interpretation of the levels of agreement between these two device measures methods should be done cautiously however, given the small sample size and wide confidence intervals.&#x0D; Implications&#x0D; 1) Incorporation of visual chest compression feedback and use of a backboard are fast andaffordable and significantly improved the percentage of chest compression at the target rateand depth.&#x0D; 2) There was no correlation between the size of the resuscitation team and the percentage ofchest compressions at the target depth, release or rate; nor was the feedback device useassociated with the duration of the resuscitation attempt.&#x0D; 3) The implications of improvement with the CPR meter suggests that areas or service not usingfeedback should consider implementing its use to achieve the target compression rate.&#x0D; 4) Compared to LifePak feedback alone the CPRMeter2 will also allow services to target depthand release targets as well as rate.

Comparing audio- and video-delivered instructions in dispatcher-assisted cardiopulmonary resuscitation with drone-delivered automatic external defibrillator: a mixed methods simulation study.

This study compared first responders’ cardiopulmonary resuscitation (CPR) performance when a dispatcher provides audio instructions only and when both audio and video instructions are given. In the simulation, an automatic external defibrillator (AED) was delivered via drone in response to a cardiac arrest occurring outside a hospital setting. Participants’ qualitative experiences were also explored.An exploratory sequential mixed methods design was used. AEDs were delivered to college students via drone with one group receiving both audio and video instructions and the other receiving audio-only instruction, and differences in CPR performance and accuracy were compared. After completion, focus group interview data were collected and analyzed. Video-based instruction was found to be more effective in the number of chest compressions (p < 0.01), chest compression rate (p < 0.01), and chest compression interruptions (p < 0.01). The accuracy of the video group for the chest compression region was high (p = 0.05). Participants’ experiences were divided into three categories: “unfamiliar but beneficial experience,” “met helper during a desperate and embarrassing situation,” and “diverse views on drone use.” Our results lay the groundwork for a development plan for providing emergency medical services using drones, as well as the preparation of guidelines for dispatchers on the provision of video instructions.

Human Reliability Analysis for Cardiopulmonary Resuscitation Process in Emergency Medicine Using a Modified Hybrid Method Based on the Markov Model and Fault Tree Analysis

Introduction:In emergency departments (ED), human reliability assessment is essential for improving the quality of treatment and preventing medical accidents. A medical accident is expressed as an injury to a patient caused by the negligence of a doctor or nurse who is providing medical care. This study aimed to assess the human reliability in the cardiopulmonary resuscitation (CPR) process and recommend some comments to minimize human errors and improve patient safety.Materials and Methods: The main factors in the CPR process (such as rate and depth of chest compression and rate of ventilation) are identified based on the American heart association (AHA) roles. Data were recorded during three months in the evening shifts in the ED and CPR room of Imam Reza Hospital in Mashhad, Iran. In total, 42 samples were collected, and a modified hybrid approach according to the fault tree analysis and Markov method was proposed for the analysis of CPR team (including emergency medicine, medical interns, and nurses) reliability in the resuscitation process. Finally, the important basic events (errors) were selected using the Boruta algorithm by R software.Results: An FTA-Markov-based hybrid method is considered to compute the human reliability in the CPR process. The obtained results from human reliability analysis using the sensitivity analysis via Boruta algorithm and the proposed hybrid method show that an interrupt between chest compression process for rhythm control, the cycle of CPR, the depth of chest compression, and the discussion about reversible causes are the most effective factors in the human reliability of CPR process.Conclusion:The human reliability of the CPR process in the ED has been assessed using a hybrid method based on the FTA and Markov method for the first time. To improve the quality of treatment and prevent medical accidents during the CPR process, the main factors in the process are identified, and then, the proposed hybrid method is used to calculate human reliability.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.