Complete Chest Recoil Research Articles

Basic Cardiac Life Support: 2016 Singapore Guidelines.

Basic Cardiac Life Support (BCLS) or cardiopulmonary resuscitation (CPR) refers to the skills required (without use of equipment) in the resuscitation of cardiac arrest individuals. On recognising cardiac arrest, chest compressions should be initiated. Good quality compressions are with arms extended, elbows locked, shoulders directly over the casualty's chest and heel of the palm on the lower half of the sternum. The rescuer pushes hard and fast, compressing 4-6 cm deep for adults at 100-120 compressions per minute with complete chest recoil. Two quick mouth-to-mouth ventilations (each 400-600 mL tidal volume) should be delivered after every 30 chest compressions. Chest compression-only CPR is recommended for lay rescuers, dispatcher-assisted CPR and those unable or unwilling to give ventilations. CPR should be stopped when the casualty wakes up, an emergency team takes over casualty care or if an automated external defibrillator prompts for analysis of heart rhythm or delivery of shock.

Effectiveness of finger-marker for maintaining the correct compression point during paediatric resuscitation: A simulation study

ObjectiveHigh-quality cardiopulmonary resuscitation is a significant factor for increasing the survival rate of paediatric patients. This study is to investigate the effectiveness of finger-marker stickers for maintaining the correct compression point during simulated infant cardiopulmonary resuscitation (CPR). MethodsThis crossover simulation study was conducted with 40 emergency physicians and paramedics at emergency departments of 2 tertiary hospitals. We used a remodeled infant CPR manikin developed to measure CPR quality indicators. After random coupling of participants (20 pairs), the pre-group (10 pairs) performed conventional 2-rescuer infant manikin CPR, then performed sticker-applied CPR after 1month. The post-group (10 pairs) performed the process in the opposite order. The participants placed finger-marker stickers to indicate the appropriate compression point before starting CPR. We compared accurate finger placement rates and other CPR quality indicators (compression depth, rate, complete chest recoil, and hands-off time) with and without the finger-marker sticker. ResultsAll finger-marker stickers were correctly attached within 5s (4.88±1.28s) of approaching the model. There were significant differences in the rate of correct finger compression position between conventional and sticker-applied CPR (25.4% [IQRs 7.6–69.8] vs. 88.2% [IQRs 69.6–95.5], P<0.001). Results did not differ according to sex, career, and job of the participants. There were no significant differences in mean compression rate, depth, hands-off times, and rate of fully recoiled compression between the 2 groups. ConclusionFinger-marker stickers can be used to maintain correct finger positioning during 2-rescuer infant manikin CPR.

THE APPLICATION OF THE NEW 2015 AHA GUIDELINES ON UPDATE FOR CARDIOPULMONARY RESUSCITATION AND EMERGENCY CARDIOVASCULAR CARE: ON OCCASION OF A SUCCESSFUL CASE AT HANOI MEDICAL UNIVERSITY HOSPITAL

Cardiac arrest is associated with high mortality if without early diagnosis and cardiopulmonary resuscitation. Each minute without emergency cardiopulmonary resuscitation (CPR), the patient’s chance of survival is reduced by ten percent, even if properly resuscitated but not recirculated, the chance of survival is reduced by four percent. Therefore, CPR should be ferformed as soon as patient is diagnosed with cardiac arrest with the signs of unconsciousness, apnea, loss of carotid pulse and inguinal pulse. Chest compression plays an important role in the success of CPR. There is emphasis on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation. Emergency coronary angiography is recommended for all patients with ST elevation and for hemodynamically or electrically unstable patients without ST elevation for whom a cardiovascular lesion is suspected. All adult patients with return of spontaneous circulation after cardiac arrest should have targeted temperature management (TTM) to prevent poor neurologic outcome. Key words: Cardiac arrest, targeted temperature management, the 2015 AHA Guideline on CPR and ECC

Complete chest recoil during laypersons' CPR: Is it a matter of weight?

IntroductionChest compressions depth and complete chest recoil are both important for high-quality Cardio-Pulmonary Resuscitation (CPR). It has been demonstrated that anthropometric variables affect chest compression depth, but there are no data about they could influence chest recoil. The aim of this study was to verify whether physical attributes influences chest recoil in lay rescuers. MethodsWe evaluated 1 minute of compression-only CPR performed by 333 laypersons immediately after a Basic Life Support and Automated External Defibrillation (BLS/AED) course. The primary endpoint was to verify whether anthropometric variables influence the achievement a complete chest recoil. Secondary endpoint was to verify the influence of anthropometric variables on chest compression depth. ResultsWe found a statistically significant association between weight and percentage of compressions with correct release (p≤0.001) and this association was found also for height, BMI and sex. People who are heavier, who are taller, who have a greater BMI and who are male are less likely to achieve a complete chest recoil. Regarding chest compressions depth, we confirm that the more a person weighs, the more likely the correct depth of chest compressions will be reached. ConclusionsAnthropometric variables affect not only chest compression depth, but also complete chest recoil. CPR instructors should tailor their attention during training on different aspect of chest compression depending on the physical characteristics of the attendee.

Real-time visual feedback during training improves laypersons' CPR quality: a randomized controlled manikin study.

The chances of surviving an out-of-hospital cardiac arrest depend on early and high-quality cardiopulmonary resuscitation (CPR). Our aim is to verify whether the use of feedback devices during laypersons' CPR training improves chest compression quality. Laypersons totalling 450 participating in Basic Life Support and Automated External Defibrillation (BLS/AED) courses were randomly divided into three groups: group No Feedback (NF) attended a course without any feedback, group Short Feedback (SF) a course with 1-minute training with real-time visual feedback, and group Long Feedback (LF) a course with 10-minute training with real-time visual feedback. At the end of each course, we recorded 1 minute of compression-only CPR. The primary end point was the difference in the percentage of compressions performed with correct depth. There was a significant improvement in the percentage of compressions with correct depth in the groups receiving feedback compared to the other (NF v. LF, p=0.022; NF v. SF, p=0.005). This improvement was also present in the percentage of compressions with a complete chest recoil (71.7% in NF, 86.6% in SF, and 88.8% in LF; p<0.001), compressions with the correct hand position (93.2% in NF, 98.2% in SF, and 99.3% in LF; p<0.001), and in the Total CPR Score (79.4% in NF, 90.2% in SF, and 92.5% in LF; p<0.001). There were no significant differences for all of the parameters between group SF and group LF. Real-time visual feedback improves laypersons' CPR quality, and we suggest its use in every BLS/AED course for laypersons because it can help achieve the goals emphasized by the International Liaison Committee on Resuscitation recommendations.

A comparative study of dispatcher-assisted telephone-cardiopulmonary resuscitation and smart phone APPs for conducting cardiopulmonary resuscitation

Objective The purpose of our study was to assess the onset effect of bystander CPR assisted by a smart phone APP or by a dispatcher. Methods 74 volunteers, without any experience in basic life support measures, was randomly divided into three groups: no-assisted group(n=13), dispatcher-assisted group(n=34)and smart phone APP-assisted group(n=27). Under the condition of a simulative SCA, a QCPR mannequin was used to record the hands-off time, hand placement, rate, depth and complete chest recoil after each compression of the three different groups to make analysis. The noassisted group didn't receive any CPR instruction; the dispatcher-assisted group was instructed to do CPR through the voice from the telephone; the smartphone APP-assisted group was instructed by a preset Android smart phone CPR APP which guided the volunteers to do CPR step by step by words, voice and animations. Rank sum test analysis of each group using SPSS19.0 software. Results In aspects of hands-off time(1.0 second vs. 1.5 seconds vs. 5.0 seconds), mean rate of compression(121.0 per minute vs. 127.5 per minute vs. 58.0 per minute), percentage of correct compression rate(99.0% vs. 98.0% vs. 0.0%)and mean depth of compression(33.0 cm vs. 26.5 cm vs. 16.0 cm), smart phone APP-assisted group performed as well as dispatcher-assisted group(P>0.05)and was superior to noassisted group(P<0.05). Conclusion In terms of increasing the quality of CPR, the smart phone APP can play the same role as dispatcher’s telephone guidance, so as to enhance the effect of cardiopul-monary resuscitation. Key words: Cardiopulmonary resuscitation(CPR); First witness; Dispatcher-assisted telephone-cardiopulmonary resuscitation(T-CPR); Smartphone APP-assisted; Contrastive analysis

Effect of bed width on the quality of compressions in simulated resuscitation: a randomized crossover manikin study

ObjectivesTo investigate the effects of bed width on the quality of chest compressions during simulated in-hospital resuscitation. MethodsEach candidate performed two 2-minute cycles of compression-only cardiopulmonary resuscitation on an adult manikin placed on either an emergency stretcher (narrow bed) or a standard hospital bed (wide bed) in random order at 1 day intervals. We conducted subjective assessments of cardiopulmonary resuscitation quality and rescuer fatigue at the end of each session, using surveys. ResultsThere were no significant differences between narrow and wide bed sessions in either mean depth or the percentage of compressions with adequate depth (P=.56 and .58, respectively). The mean rate of compressions and the percentage of compressions with adequate rate were also similar between sessions (P=.24 and .27, respectively). However, the percentage of correct hand position and complete chest recoil was significantly higher in the narrow bed session than in the wide bed session (P=.02 and .02, respectively). In addition, survey results showed that rescuers felt more comfortable and less exhausted in the narrow bed session compared with the wide bed session (P<.001 and < .001). ConclusionsWhen rescuers performed chest compressions on an emergency stretcher, chest compression quality increased, and the fatigue of rescuers decreased compared with a standard hospital bed. Therefore, we propose a narrow bed for critically ill inpatients with high risk of cardiac arrest.

Abstract 14180: Real-time Visual Feedback During Training Improves Lay People’s CPR Quality: A Randomized Controlled Manikin Study

Introduction: It has been demonstrated that feedback devices could have a role in improving CPR quality, but the results regarding lay people are controversial. Hypothesis: Our aim is to verify whether the use of CPR feedback devices improves lay people’s CPR quality after a training course and if the final quality reached is influenced by the amount of time spent training with them. Methods: 450 lay participants to BLS-D courses were randomly divided into three groups with an allocation ratio 1:1:1; group 0 attended a course without any feedback, group 1 a course with 1 minute training with real-time visual feedback and group 10 a course with 10 minutes training with real-time visual feedback. There were no statistically significant differences among the three groups for the anthropometric variables. At the end of each course we recorded 1-min of compression-only CPR. Results: There was a statistically significant overall difference among the three groups. In particular, comparing group 0 vs group 1 and group 0 vs group 10 there was a significant improvement in the percentage of compressions with correct depth (66.6% (95%CI, 60.1-73.1) in gr.0 vs 77.8% (95%CI, 72.8-82.8) in gr.1, p=0.005 and 66.6% (95%CI, 60.1-73.1) in gr.0 vs 75.7% (95%CI, 70.7-80.8) in gr.10, p=0.022), in the percentage of compressions with complete chest recoil (71.7% (95%CI, 66.2-77.2) in gr. 0 vs 86.6% (95%CI, 82.4-90.8) in gr. 1, p&lt;0.001 and 71.7% (95%CI, 66.2-77.2) in gr. 0 vs 88.8% (95%CI, 85.6-92.2) in gr. 10, p&lt;0.001), in the percentage of compressions with correct hand position (93.2% (95%CI, 89.7-96.6) in gr.0 vs 98.2% (95%CI, 96.7-99.8) in gr.10, p&lt;0.001 and 93.2% (95%CI, 89.7-96.6) in gr.0 vs 99.3% (95%CI, 98.6-100) in gr.10, p=0.002) and in Total CPR score (79.4% (95%CI, 75.5-83.2) in gr.0 vs 90.2% (95%CI, 87.8-92.5) in gr.1, p&lt;0.001 and 79.4% (95%CI, 75.5-83.2) in gr.0 vs 92.5% (95%CI, 91-94) in gr.10, p&lt;0.001) in the groups in which the feedback was used. Furthermore, there were no statistically significant differences for all the parameters between group 1 and group 10. Conclusions: Real-time visual feedback improves lay people CPR quality, thus could improve OHCA survival. 1-minute of feedback is sufficient to reach a better CPR quality and we suggest its use in every BLS-D course.

0355. Optimal chest compression technique for pediatric arrest victims

In pediatric cardiopulmonary resuscitation (CPR), high-quality chest compressions (CCs) are essential to successful resuscitation, although most pediatric arrests are caused by respiratory arrest. Therefore, current guidelines emphasize deeper and faster CCs, with complete chest recoil between contractions.1, 2 These guidelines further indicate that rescuers may use a one-hand or two-hand technique for pediatric compressions, thereby allowing rescuers to adapt the technique to the victim's size and rescuer's strength. However, no previous studies have examined the quality of CCs, including the use of deeper and faster CCs with complete chest recoil emphasized in the guidelines. Additionally, no study has assessed compression quality of the one-hand technique comparing the right and left hands.

"DIRECT CPR"- Mnemonic to remember 2010 AHA BLS CPR guidelines.

The 2010 American Heart Association Guidelines (AHA) for cardiopulmonary resuscitation (CPR) and emergency cardiac care, published on the 50th anniversary of modern CPR, recommend a change in the Basic Life Support (BLS) sequence of steps from A-B-C to C-A-B.[1] This requires all of us to relearn CPR according to the new recommendations. Memory-aids are known to improve our technical abilities and confidence in providing CPR.[2] We suggest a mnemonic “DIRECT CPR” to remember the sequence of assessments and actions to be taken by BLS provider in accordance with the Adult Chain of Survival of the 2010 AHA guidelines for CPR. The mnemonic is expanded as follows: D - Detection (Collapsed person, all is not well). I - Interrogation (Are you OK? Can you hear me?). R - Respiration (Assess for 5-10 seconds). E - Emergency call (Get AED and Equipment for resuscitation). C - Check Carotid pulsations (5-10 seconds) → If absent, start Chest Compressions. (rate of at least 100/minute, depth of at least 5 cm, and allow complete chest recoil). T - Two Breaths (Each breath over one second). C- Continue Compression and Ventilation in a ratio of 30:2 for five cycles. P - Pulse check after five cycles (two minutes). R - Rotate compressors after five cycles (two minutes). Deliver shock if indicated, as soon as AED is ready. Resume CPR starting with chest compressions. Rhythm analysis after five cycles (two minutes).

Cardiopulmonary Resuscitation: New Concept

Cardiopulmonary resuscitation (CPR) is a series of life-saving actions that improve the chances of survival, following cardiac arrest. Successful resuscitation, following cardiac arrest, requires an integrated set of coordinated actions represented by the links in the Chain of Survival. The links include the following: immediate recognition of cardiac arrest and activation of the emergency response system, early CPR with an emphasis on chest compressions, rapid defibrillation, effective advanced life support, and integrated post-cardiac arrest care. The newest development in the CPR guideline is a change in the basic life support sequence of steps from "A-B-C" (Airway, Breathing, Chest compressions) to "C-A-B" (Chest compressions, Airway, Breathing) for adults. Also, "Hands-Only (compression only) CPR" is emphasized for the untrained lay rescuer. On the basis of the strength of the available evidence, there was unanimous support for continuous emphasis on high-quality CPR with compressions of adequate rate and depth, which allows for complete chest recoil, minimizing interruptions in chest compressions and avoiding excessive ventilation. High-quality CPR is the cornerstone of a system of care that can optimize outcomes beyond return of spontaneous circulation (ROSC). There is an increased emphasis on physiologic monitoring to optimize CPR quality, and to detect ROSC. A comprehensive, structured, integrated, multidisciplinary system of care should be implemented in a consistent manner for the treatment of post-cardiac arrest care patients. The return to a prior quality and functional state of health is the ultimate goal of a resuscitation system of care.

An audiovisual feedback device for compression depth, rate and complete chest recoil can improve the CPR performance of lay persons during self-training on a manikin

This study aims to contribute to the scarce data available about the abilities of untrained lay persons to perform hands-only cardio-pulmonary resuscitation (CPR) on a manikin and the improvement of their skills during training with an autonomous CPR feedback device. The study focuses on the following questions: (i) Is there a need for such a CPR training device? (ii) How adequate are the embedded visual feedback and audio guidance for training of lay persons who learn and correct themselves in real time without instructor guidance? (iii) What is the achieved effect of only 3 min of training? This is a prospective study in which 63 lay persons (volunteers) received a debriefing to basic life support and then performed two consecutive 3 min trials of hands-only CPR on a manikin. The pre-training skills of the lay persons were tested in trial 1. The training process with audio guidance and visual feedback from a cardio compression control device (CC-Device) was recorded in trial 2. After initial debriefing for correct chest compressions (CC) with rate 85–115 min−1, depth 3.8–5.4 cm and complete recoil, in trial 1 the lay persons were able to perform CC without feedback at mean rate 95.9 ± 18.9 min−1, mean depth 4.13 ± 1.5 cm, with low proportions of ‘correct depth’, ‘correct rate’ and ‘correct recoil’ at 33%, 43%, 87%, resulting in the scarce proportion of 14% for compressions, which simultaneously fulfill the three quality criteria (‘correct all’). In trial 2, the training process by the CC-Device was established by the significant improvement of the CC skills until the 60th second of training, when ‘correct depth’, ‘correct rate’ and ‘correct recoil’ attained the plateau of the highest quality at 82%, 90%, 96%, respectively, resulting in 73% ‘correct all’ compressions within 3 min of training. The training was associated with reduced variance of the mean rate 102.4 ± 4.7 min−1 and mean depth 4.3 ± 0.4 cm, indicating a steady CC performance achieved among all trained participants. Multivariable linear regression showed that the compression depth, rate and complete chest recoil did not strongly depend on lay person age, gender, height, weight in pre-training and training stage (correlation coefficient below 0.54). The study confirmed the need for developing CPR abilities in untrained lay persons via training by real-time feedback from the instructor or CC-Device. The CC-Device embedded feedback was shown to be comprehensible and easy to be followed and interpreted. The high quality of the CC-Device-assisted training process of lay persons was confirmed. Thus learning or refresher courses in basic life support could be organized for more people trained at the same time with fewer instructors needed only for the initial debriefing and presentation of the CC-Device.

Complete chest recoil evaluation result after AHA BLS provider course

Complete Chest recoil evaluation result after AHA BLS provider course Complete chest wall decompression during the CPR is recommended in the American Heart Association (AHA) and ERC. CPR traing programs have stressed the need of chest compression, chest wall recoil and hand off time. Instructors have teached hands should be resting on the chest during its recoil, but applying no pressure. In Korea, AHA BLS provider course have opened from 2004. From 2006, 1. Purpose of the study: we have open BLS provider course for medical person and student.

Part 5: Adult Basic Life Support

The critical lifesaving steps of BLS are ● Immediate Recognition and Activation of the emergency response system ● Early CPR and ● Rapid Defibrillation for VF. When an adult suddenly collapses, whoever is nearby should activate the emergency system and begin chest compressions (regardless of training). Trained lay rescuers who are able and healthcare providers should provide compressions and ventilations. Contrary to the belief of too many in this situation, CPR is not harmful. Inaction is harmful and CPR can be lifesaving. However, the quality of CPR is critical. Chest compressions should be delivered by pushing hard and fast in the center of the chest (ie, chest compressions should be of adequate rate and depth). Rescuers should allow complete chest recoil after each compression and minimize interruptions in chest compressions. They should also avoid excessive ventilation. If and when available, an AED should be applied and used without delaying chest compressions. With prompt and effective provision of these actions, lives are saved every day.

Part 5: Adult Basic Life Support

Part 8 : Advanced life support : 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

A manikin-based observational study on cardiopulmonary resuscitation skills at the Osaka Senri medical rally

To examine the current status and problems of resuscitation management in Japan as demonstrated at the 2006 and 2007 Osaka Senri medical rallies. Using manikins, the quality of resuscitation was evaluated in 33 teams that participated in the medical rallies. The challenge was to deliver defibrillation shocks for ventricular fibrillation; data were recorded using the Laerdal PC Skill Reporting System (Norway). The teams were first subjectively (visually) evaluated by a panel of judges and these evaluations were later reaffirmed using video records. An approximately 30s delay was observed between the time of contact and initiation of chest compression in the teams that adopted the American Heart Association (AHA) method compared with those that adopted the European Resuscitation Council (ERC) method. Although the overall quality of chest compressions was very good, in several instances, the hand positions were inappropriate and complete chest recoil was not achieved. The left paddle was incorrectly positioned by all teams. Only 15.8% of the teams were able to deliver shocks with less than 10s of interruption between the chest compressions. Regarding interruption of chest compressions at confirmation of correct tracheal tube placement, among the eight teams that adopted the AHA method, pauses of more than 10s were confirmed in five (62.5%). Significant differences in performance between the AHA and ERC methods were observed. The ERC guidelines were more rational and suitable in terms of actual application than the AHA guidelines.

Major Changes in the 2005 AHA Guidelines for CPR and ECC

The emergency cardiovascular care (ECC) scientists involved in the 2005 evidence evaluation process and the revision of the 2005 AHA Guidelines for CPR and ECC began and ended the process aware of the limitations of the resuscitation scientific evidence, optimistic about emerging data that documents the benefits of high-quality cardiopulmonary resuscitation (CPR), and determined to make recommendations that would increase survival from cardiac arrest and life-threatening emergencies. This editorial summarizes the factors that contributed to the tipping point, the point at which information and discussion either triggered support for major changes in the guidelines or reaffirmed existing recommendations. The scientists critically reviewed the sequence and priorities of the steps of CPR to identify those factors with the greatest potential impact on survival. They then developed recommendations to support those interventions that should be performed frequently and well. There was unanimous support for increased emphasis on ensuring that rescuers deliver high-quality CPR: rescuers need to provide an adequate number and depth of compressions, allow complete chest recoil after each compression, and minimize interruptions in chest compressions. The 2005 AHA Guidelines for CPR and ECC are based on the most comprehensive review of resuscitation literature ever published.1 The evidence evaluation process incorporated the input of 281 international resuscitation experts who evaluated research, topics, and hypotheses over a 36-month period before the 2005 Consensus Conference. The process included structured evidence evaluation, analysis, and documentation of the literature.2 It also included rigorous disclosure and management of potential conflicts of interest, a process summarized in two editorials.3,4 Cardiopulmonary resuscitation and emergency cardiovascular care is a relatively new field. The epidemiologic data is incomplete, and high-level evidence is insufficient to support many recommendations. Although sudden cardiac arrest (SCA) is responsible for an estimated 250 000 deaths out of the hospital in the United …