Compression Cardiopulmonary Resuscitation Research Articles

Quantification of ventilation volumes produced by compressions during emergency department cardiopulmonary resuscitation

BackgroundClinical investigations have shown improved outcomes with primary compression cardiopulmonary resuscitation strategies. It is unclear whether this is a result of passive ventilation via chest compressions, a low requirement for any ventilation during the early aspect of resuscitation or avoidance of inadvertent over-ventilation. ObjectivesTo quantify whether chest compressions with guideline-compliant depth (>2 in) produce measurable and substantial ventilation volumes during emergency department resuscitation of out-of-hospital cardiac arrest. MethodsThis was a prospective, convenience sampling of adult non-traumatic out-of-hospital cardiac arrest patients receiving on-going cardiopulmonary resuscitation in an academic emergency department from June 1, 2011 to July 30, 2013. Cardiopulmonary resuscitation quality files were analyzed using R-Series defibrillator/monitors (ZOLL Medical) and ventilation data were measured using a Non-Invasive Cardiac Output monitor (Philips/Respironics, Wallingford, CT). Resultscardiopulmonary resuscitation quality data were analyzed from 21 patients (17 males, median age 59). The median compression depth was 2.2 in (IQR = 1.9, 2.5) and the median chest compression fraction was 88.4% (IQR = 82.2, 94.1). We were able to discern 580 ventilations that occurred during compressions. The median passive tidal volume recorded during compressions was 7.5 ml (IQR 3.5, 12.6). While the highest volume recorded was 45.8 ml, 81% of the measured tidal volumes were <20 ml. ConclusionVentilation volume measurements during emergency department cardiopulmonary resuscitation after out-of-hospital cardiac arrest suggest that chest compressions alone, even those meeting current guideline recommendations for depth, do not provide physiologically significant tidal volumes.

What biomechanical factors are more important in compression depth for children lifesavers? A randomized crossover study

ObjectiveTo evaluate the biomechanical aspects involved in Cardiopulmonary Resuscitation's compression depth by children. MethodsA randomized crossover study with 196 children between 9 and 14 years-old was conducted. The children performed four CPR hands-only tests of 1 min in four different heights (floor, 5 cm, 10 cm, and 15 cm). Anthropometric, angulation and quality of CPR variables were registered during the tests. ResultsCPR quality was sub-optimal in all tests. Tests with the simulated victim placed on the floor had the best compression quality. Children that made deeper compressions had significantly higher values in all anthropometric variables. Analysis gives more discriminatory power to the anthropometric variables than angulation variables on compression depth. ConclusionChest compression depth obtained by children depends more on their anthropometric characteristics than on their body position. The approximate age to perform compressions with an acceptable quality is 12 years-old. The use of steps increased arm angle, getting it closer to 90° but did not increase quality CPR when compared with performance on the floor.

A Study of Influential Factors on Chest Compression in Cardiopulmonary Resuscitation from the Perspective of Personnel of Pre-Hospital Emergency of Central Hub in Iran in the First Half Year, 2016

Abstract Introduction: According to the latest guidelines of cardio pulmonary resuscitation (CPR), the American Heart Association, advises 6 centimeters for maximum chest compression in CPR; but unfortunately, so far has not mentioned any explanatory guidelines to factors affecting the amount of chest compression. Therefore, this study was aimed at assessing factors affecting the chest compression cardiopulmonary resuscitation from the perspective of personnel of pre-hospital emergency of central hub in Iran. Methodology: The present study is descriptive analytical conducted randomly among 306 individuals of emergency service personnel in central hub of Iran. Data were collected by self-made questionnaire and analyzed by SPSS, with descriptive statistics (frequency, mean, standard deviation). Results: 306 individuals participated in the study and mean age was calculated as 34.75 +/- 3.45. According to personnel of the emergency service, chest compression in CPR depends on rib curve, skeletal abnormality of chest, injured weight, elasticity of chest and stability of chest and the most influential factor on chest compression was (0.99.34) rib curve. Conclusion: Results of this study show that chest compression is not the same among all individuals and not consistent with instructions of American Heart Association. It is possible that chest compression in CPR is more than 6 centimeters or less than 5 centimeters.

A 3D-printable instrument to improve force vector measurement in CPR training

In this article, we extend our previous instrument [1], which helps trainees improve the precision of their compressions during Cardio-Pulmonary Resuscitation (CPR), by adding to it a 3D-printed component (http://acima.lncc. br/i&m) that further improves the precision of force angle measurements. Our instrument measures the force vector and frequency of CPR compressions performed by the trainee. CPR is a technique that allows a certified person to try to keep alive someone whose heartbeat and/or breathing has stopped. Through compressions applied to the thorax of the individual in need of help, one can maintain the blood flow and air intake until further help (and equipment) arrives. During CPR training, our 3D-prototype methodically attaches a standard CPR manikin to a Nintendo WiiTM Balance Board, enabling adequate balance of the instrument, and thus, obtaining more precise data out of the compressions performed. Results of our empirical evaluations show that with the 3D prototype, the measured parameters of force value, force direction and frequency have a standard uncertainty of 0.91 KgF, 0.25 Rad (14.35 degrees), and 0.15 Hz, respectively, while without our 3D prototype they have a standard uncertainty of 0.72 KgF, 0.44 Rad (25.25 degrees) and 0.12 Hz, respectively. Results prove that our 3D prototype contributes to increasing the precision of force angle measurement, since it holds the manikin firmly in place, while having negligible effect in force amount and frequency measurements.

Effects of active abdominal compression-decompression CPR on oxygen metabolism and prognosis in patients with cardiac arrest

To analyze the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and standard cardiopulmonary resuscitation (STD-CPR) on oxygen metabolism and prognosis of patient with cardiac arrest (CA), and to evaluate the treatment effect of AACD-CPR. Patients with CA, CA time less than 30 minutes, and without STD-CPR and AACD-CPR contraindications admitted to the Zhengzhou People's Hospital from October 1st 2015 to May 31st 2017 were enrolled. The patients were divided into STD-CPR group and AACD-CPR group according to random number table. All patients were given the same rescue measures, if required to give defibrillation; STD-CPR group was operated according to the 2015 American Heart Association (AHA) CPR guidelines; AACD-CPR group was recovered using abdominal lifting and compression cardiopulmonary resuscitation instrument. The oxygen metabolism, hemodynamic, arterial blood gas and prognostic indicators were recorded in the two groups during the resuscitation. A total of 69 cases, with STD-CPR group of 34 cases and AACD-CPR group of 35 cases were enrolled finally. (1) The oxygen metabolism: during the recovery, compared with STD-CPR group, arterial blood oxygen content (CaO2), arterial-venous oxygen content difference (avDO2), the oxygen carrying capacity (DO2), oxygen consumption (VO2) in AACD-CPR group were significantly increased [CaO2 (mL/L): 156±15 vs. 142±19, avDO2 (mL/L): 83±14 vs. 73±13, DO2 (mL/min): 248±51 vs. 208±54, VO2 (mL/min): 134±29 vs. 118±32, all P < 0.05], but there were no significant differences in cardiac output (CO) and mixed venous oxygen content (CvO2). (2) Hemodynamic and arterial blood gas: there were no significant differences in the base values of the heart rate (HR), mean arterial pressure (MAP), pH value, pulse oxygen saturation (SpO2), arterial oxygen pressure (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and blood lactate (Lac) between two groups. In the recovery process, MAP, pH value, SpO2, PaO2 of two groups were increased, while PaCO2 and Lac were decreased. Except MAP of STD-CPR group was slightly higher than AACD-CPR group, the change tendency of AACD-CPR group was more obvious in each index obviously [pH value difference: 0.10±0.15 vs. 0.02±0.13, SpO2 difference: 0.311±0.255 vs. 0.159±0.232, PaO2 difference (mmHg, 1 mmHg = 0.133 kPa): 12.96±21.84 vs. 3.01±13.56, PaCO2 difference (mmHg): -9.91±11.17 vs. -3.52±13.87, Lac value difference (mmol/L): -0.64±0.61 vs. -0.31±0.58, all P < 0.05]. (3) Prognosis: compared with STD-CPR group, the restoration of spontaneous circulation (ROSC) rate in AACD-CPR group was slightly increased (22.9% vs. 8.8%, P > 0.05), but the ROSC time in AACD-CPR group was significantly shortened (minutes: 9.59±2.67 vs. 11.83±3.05, P < 0.01), nerve function defect score (NDS) was significantly decreased at 1, 2 weeks (26.45±6.42 vs. 30.73±7.38, 19.25±6.27 vs. 22.64±5.63, both P < 0.05), and the 2-week survival was slightly increased (17.1% vs. 5.9%, P > 0.05). AACD-CPR is similar to STD-CPR in improving hemodynamics of CA patients, but has advantage in the blood oxygen supply for tissues and organs, and the neurological function prognosis is better.

Utility of a musical mnemonic to teach CPR compression rate based on musical skills.

The aim of this study was to explore whether healthcare providers’ perceptual musical skill affects the rate at which they give chest compressions while using a popular medical mnemonic. In the authors’ experiences, medical personnel are commonly taught to administer chest compressions to the beat of the classic disco song ‘Stayin’ Alive’ by the Bee Gees, which has a rhythm of 103 beats per minute. In this observational cohort study, physicians and nurses sang ‘Stayin’ Alive’ and then performed chest compressions on a manikin. The subjects were divided into two groups depending on their performance on the rhythm and tempo subtests of the Profile of Music Perception Skills test. Those scored in the top 50th percentile and those who scored in the bottom 50th percentile spent 27% and 52% of the time, respectively, in the prescribed 100–120 compressions per minute range, with a mean difference of 25% (95% CI −4% to 53%). Each year, approximately 535 200 individuals experience a sudden cardiac arrest in the USA. 209 000 of these events occur in the hospital setting, where survival to hospital discharge is only 25.4%.1 Quality cardiopulmonary resuscitation (CPR), specifically deep compressions at a proper rate of at least 100 compressions per minute …

Efficacy of Acute Care Health Care Providers in Cardiopulmonary Resuscitation Compressions in Normal and Obese Adult Simulation Manikins

Annually, over 350,000 persons require cardiopulmonary resuscitation (CPR), either in or outside of the hospital. With obesity a rising health issue in the United States, concerns exist regarding the efficacy of quality compressions for CPR in obese patients. The aims of this study were to determine if the compressions for three adult simulation manikins (normal, obese, and morbidly obese) met quality guidelines; to examine any differences in quality of chest compressions performed by health care providers between the three manikins; and to examine the effect of participant characteristics on the quality of chest compressions in obese and morbidly obese manikins. A randomized controlled design was used. Sixty-one health care providers performed chest compressions on the three simulation manikins. Results showed that performance on the normal-sized manikin was significantly better than that on both obese and morbidly obese manikins. Participant characteristics were significantly associated with quality of chest compressions. The effectiveness of compressions in obese and morbidly obese CPR recipients has yet to be determined.

Use of automated chest compression devices after out-of-hospital cardiac arrest in Sweden

ObjectiveTo evaluate the implementation of automated chest compression cardiopulmonary resuscitation (ACC-CPR) after out-of-hospital cardiac arrest (OHCA) in Sweden during the years 2011 through 2015. The association between ACC-CPR and 30-day survival was studied as a secondary objective. MethodsThe Swedish cardiopulmonary resuscitation registry is a prospectively recorded nationwide registry of modified Utstein parameters including all patients with attempted resuscitation after OHCA. Propensity score matching (PSM) was used to adjust for known confounders in the secondary analysis. ResultsOf the 24,316 patients included in the study population, 32.4% received ACC-CPR, with substantial regional variation ranging from 0.8% to 78.8%. Male gender and an initial shockable rhythm were associated with ACC-CPR, whereas crew witnessed status was associated with manual CPR. Potential markers of prolonged resuscitation attempts (drug administration and endotracheal intubation) were more prevalent in the ACC-CPR group. The unadjusted 30-day survival rate was 6.3% for ACC-CPR patients. The adjusted odds ratio for 30-day survival regarding use of an ACC device was 0.72 (95% CI 0.62–0.84, p<0.001, n=13922). ConclusionThe use of ACC devices varied significantly between Swedish regions and overall survival to 30days was low among patients receiving ACC-CPR. Although measured and unmeasured confounding might explain our finding of lower survival rates for patients exposed to ACC-CPR, specific guidelines recommending when and how ACC-CPR should be used are warranted as there might be circumstances where these devices do more harm than good.

Clinical application of abdominal lifting and compression cardiopulmonary resuscitation method for treatment of patients with cardiac arrest

To investigate the clinical application of rhythmic abdominal lifting and compression cardiopulmonary resuscitation (ALC-CPR) in cardiac arrest (CA) patients with conventional cardiopulmonary resuscitation (CPR) contraindication (chest rib fracture, chest trauma, etc.). The clinical data of patients with CA in emergency department of Hefei Second People's Hospital from June 2015 to December 2016 were analyzed retrospectively, and the patients with weights 40-150 kg and CA≤20 minutes, and resuscitated with ALC-CPR were selected. The vital signs and blood gas analysis indexes of patients before resuscitation and 30 minutes after return of spontaneous circulation (ROSC, after successful resuscitation) were recorded. A total of 19 patients with CA were treated with CPR-LW1000 type ALC-CPR apparatus for resuscitation, and with 12 males, 7 females; the age ranged from 43 to 87 years, and the average age was (70.32±13.49) years; there were 4 cases of heart disease, and 15 cases of non-heart disease. Compared with before resuscitation, the heart rate [HR (bpm): 115.05±21.70 vs. 0], mean arterial pressure [MAP (mmHg, 1 mmHg = 0.133 kPa): 66.05±11.69 vs. 0], pulse oxygen saturation (SpO2: 0.928±0.057 vs. 0.417±0.118), pH value (7.05±0.23 vs. 6.80±0.28), arterial oxygen partial pressure [PaO2 (mmHg): 65.42±19.11 vs. 42.42±10.78], HCO3- (mmol/L: 19.22±2.77 vs. 17.18±3.76) were significantly improved after successful resuscitation (all P < 0.05), and arterial blood carbon dioxide partial pressure (PaCO2) was decreased after successful resuscitation (mmHg: 53.72±13.23 vs. 57.66±14.86, P > 0.05). Rhythmic ALC-CPR has obvious clinical value for CA patients with conventional CPR contraindication.

Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest

BackgroundChest compression is a standard recommendation during cardiopulmonary resuscitation (CPR). However, chest compression cannot be effectively applied under certain situations, such as chest wall deformity, rib fracture, or hemopneumothorax. An alternative method, abdominal compression, was reported to achieve better resuscitation outcomes in these patients. Materials and methodsA prospective study was performed in adult patients with cardiac arrest and anticipated ineffective chest compression (thoracic trauma, chest deformity, rib fracture, and hemopneumothorax). Active abdominal lifting and compression cardiopulmonary resuscitation was used. Primary outcome was success rate of restoration of spontaneous circulation (ROSC). Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), pulse oximetry saturation (SpO2), arterial blood pH value, arterial oxygen pressure (PaO2), and arterial carbon dioxide tension (PaCO2), which were measured during the periods of pre-CPR, CPR, and 30min post-ROSC. ResultsA total of 35 patients were enrolled into the study. Five of them had ROSC (14.3%), which was statistically significantly higher than that (0%) reported in the 2015 Advanced Cardiovascular Life Support manual. HR, MAP, and SpO2 during CPR were also statistically significantly higher during CPR when compared to the period of pre-CPR period (HR 58 versus 0 beats/min, P<0.01; MAP 25 versus 0mm Hg, P<0.01; SpO2 0.68 versus 0.48%, P<0.01). In post-ROSC period, HR was statistically significantly higher than that during pre-CPR period (121 versus 0 best/min, P<0.01). ConclusionsActive abdominal lifting and compression cardiopulmonary resuscitation could reach better resuscitation outcomes in certain cardiac arrest patients.

The past, present, and future of ventilation during cardiopulmonary resuscitation.

To evaluate the past and present literature on ventilation during out of hospital cardiac arrest, highlighting research that has informed current guidelines. Previous studies have studied what are optimal compression-to-ventilation ratios, ventilation rates, and methods of ventilation. Continuous chest compression cardiopulmonary resuscitation (CPR) has not shown to provide a significant survival benefit over the traditional 30 : 2 CPR. The optimal ventilation rate is recommended at 8 to 10 breaths per minute. Methods such as capnography and thoracic impedance are being used to evaluate ventilation in research studies. Future out of hospital cardiac arrest studies are still exploring how to optimize the delivery of ventilation during the initial stages of resuscitation. More prospective studies focusing on ventilation are needed to inform guidelines.

The efficiency of ventilation in out-of-hospital cardiopulmonary resuscitation: ananimal study

Objective To study the efficiency of ventilationin in out-of-hospital cardiopulmonary resuscitation(CPR) by performing compression-only CPR or conventional CPR in rats of different causes of cardiac arrest(CA). Methods Forty five SD rats were randomly divided into 5 groups: asphyxia-conventional group(group A, n=10), asphyxia-compression-only group(group B, n=10), ventricular fibrillation-conventional group(group C, n=10), ventricular fibrillation-compression-only group(group D, n=10), group sham(n=5). The model of asphyxial CA was made by clamping endotracheal tube at expiration in group A and group B. The model of ventricular fibrillation CA was made by transoesophageal cardiac pacing in group C and group D. Bystander CPR was initiated 4 min later. Conventional CPR(compression∶ventilation=30∶2) was performed in group A and group C, compression-only CPR was performed in group B and group D. For animals that did not attain return of spontaneous circulation(ROSC) during the 8 min bystander CPR period, advanced life support(ALS) was provided. The animals which did not attain ROSC after 10 min ALS should be given up. The pathological specimens of brain, ventricular wall and right lower lobe of the lung were collected after 24 h, and the samples were collected in the death of 24 h. Post-resuscitation treatment had been performed in all successfully resuscitated animals for 1 h. At 24 h after ROSC, rats were sacrificed for histological analysis. The vilai signs was monitored for 1 h in goup sham, rats were sacrificed for histological analysis after survival 24 h. The major outcome measure was rates of ROSC, and the secondary was the survival rates of 24 h. Blood samples were drawn for blood gas analysis during resuscitation in the pathologic findings. Results Rates of ROSC were higher in group A and group C compared with group B and group D, but the difference was not significant. Survival rates of 24 h were compared, group A and group C were significantly higher than group B and group D(P<0.05), and the tissue damage in group A and group C were milder than group B and group D. Conclusions Conventional bystander CPR was associated with a higher survival of 24 h than compression-only CPR. Conventional bystander CPR might be the preferable approach of resuscitation for adult patients with witnessed out-of-hospital CA, whether cardiogenic or non-cardiogenic CA. Key words: Cardiac arrest; Cardiopulmonary resuscitation; Artificial ventilation

Compression-to-ventilation ratio and incidence of rearrest—A secondary analysis of the ROC CCC trial

BackgroundPrevious work has demonstrated that when out-of-hospital cardiac arrest (OHCA) patients achieve return of spontaneous circulation (ROSC), but subsequently have another cardiac arrest prior to hospital arrival (rearrest), the probability of survival to hospital discharge is significantly decreased. Additionally, few modifiable factors for rearrest are known. We sought to examine the association between rearrest and compression-to-ventilation ratio during cardiopulmonary resuscitation (CPR) and to confirm the association between rearrest and outcomes. HypothesisRearrest incidence would be similar between cases treated with 30:2 or continuous chest compression (CCC) CPR, but inversely related to survival and good neurological outcome. MethodsWe conducted a secondary analysis of a large randomized-controlled trial of CCC versus 30:2 CPR for the treatment of OHCA between 2011 and 2015 among 8 sites of the Resuscitation OutcomesConsortium (ROC). Patients were randomized through an emergency medical services (EMS) agency-level cluster randomization design to receive either 30:2 or CCC CPR. Case data were derived from prehospital patient care reports, digital defibrillator files, and hospital records. The primary analysis was an as-treated comparison of the proportion of patients with a rearrest for patients who received 30:2 versus those who received CCC. In addition, we assessed the association between rearrest and both survival to hospital discharge and favorable neurological outcome (Modified Rankin Score≤3) in patients with and without ROSC upon ED arrival using multivariable logistic regression adjusting for age, sex, initial rhythm and measures of CPR quality. ResultsThere were 14,109 analyzable cases that were determined to have definitively received either CCC or 30:2 CPR. Of these, 4713 had prehospital ROSC and 2040 (43.2%) had at least one rearrest. Incidence of rearrest was not significantly different between patients receiving CCC and 30:2 (44.1% vs 41.8%; adjusted OR: 1.01; 95% CI: 0.88, 1.16). Rearrest was significantly associated with lower survival (23.3% vs 36.9%; adjusted OR: 0.46; 95%CI: 0.36-0.51) and worse neurological outcome (19.4% vs 30.2%; adjusted OR: 0.46; 95%CI: 0.38, 0.55). ConclusionRearrest occurrence was not significantly different between patients receiving CCC and 30:2, and was inversely associated with survival to hospital discharge and MRS.

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

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

Clinical application of cardiopulmonary resuscitation with abdominal lifting and compression in emergency treatment

To investigate the clinical value of cardiopulmonary resuscitation (CPR) with abdominal lifting and compression on patients with breathing and cardiac arrest induced by severe chest trauma. Sixty-six breathing and cardiac arrest patients induced by severe chest trauma admitted to the General Hospital of Jingyuan Coal Industry Group Company from October 2011 to October 2016 were enrolled, and they were divided into abdominal lifting and compression group (n = 32) and unarmed abdominal compression group (n = 34) by random number table. The patients in both two groups were given the airway open, respiration support, defibrillation treatment, venous access establishment, vasoactive drugs application and other conventional treatments. On the basis of the routine treatment, the patients in abdominal lifting and compression group were given application of abdominal lifting and compression device with 100 times/min frequency and continuously alternating press down to lift the abdomen, the amplitude of pressing and pulling were 3-5 cm below or above the original level of the abdomen. Those in unarmed abdominal compression group were given abdominal CPR pressing method by hand, the frequency of pressing and depth of subsidence was the same as abdominal lifting and compression group. Heart rate (HR) and arterial blood gas at 30 minutes after CPR as well as the success rate of resuscitation were compared between the two groups. The changes in HR, mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) before and 30 minutes and 60 minutes after CPR were dynamically observed in patients with restoration of spontaneous circulation (ROSC) after abdominal lifting and compression CPR treatment. Compared with the unarmed abdominal compression group, HR (bmp: 136.13±6.14 vs. 148.45±5.16) and arterial partial pressure of carbon dioxide [PaCO2 (mmHg, 1 mmHg = 0.133 kPa): 48.51±2.60 vs. 62.51±2.50] at 30 minutes after CPR in abdominal lifting and compression group were significantly lowered, and arterial partial pressure of oxygen (PaO2) was significantly increased (mmHg: 88.07±3.92 vs. 74.12±2.12, all P < 0.05). Four patients with ROSC were found in abdominal lifting and compression group, and 2 in unarmed abdominal compression group. The success rate of resuscitation in abdominal lifting and compression group was significantly higher than that of unarmed abdominal compression group (12.50% vs. 5.82%, P < 0.05). In 4 patients with ROSC after abdominal lifting and compression CPR showed a downward trend in HR and an upward trend in MAP and SpO2 with CPR time prolongation. The effect of abdominal lifting and compression CPR is better than that of unarmed abdominal compression CPR, which is of great value for the life saving of patients with breathing and cardiac arrest induced by severe chest trauma.

Abdominal lifting and compression cardiopulmonary resuscitation for treatment of a 84-year old cardiac arrest patient

Abdominal lifting and compression cardiopulmonary resuscitation for treatment of a 84-year old cardiac arrest patient

Effectiveness of 100 Beats per Minute Music on Cardiopulmonary Resuscitation Compression Rate Education: A Manikin Study

Introduction Recent cardiopulmonary resuscitation (CPR) guidelines emphasize the importance of high-quality chest compression. The aim of this study is to determine the effect of education using music on the chest compression rate. Methods This randomised, open-labeled study enrolled 81 medical students. They were randomly divided into three groups. After they were educated in CPR according to the American Heart Association 2010 guidelines, they performed 100 chest compressions using a mannequin capable of collecting each compression depth and speed. After that, the control group received a verbal feedback about their own results. The metronome group was also notified of their own results, and listened to the metronome sound at 100 beats per minute (bpm). The music group listened to the music (about 100 bpm). Twenty-four hours after their CPR education, chest compressions were performed again with the method identical to the first evaluation. The results were compared using multivariate analysis of variances. Result Compression rate (bpm): There was a significant difference between the control (mean, 110.4; 95% CI: 104.4, 116.5) and metronome group (mean, 98.5; 95% CI: 91.6, 105.4) after education (p=0.01). There was a significant difference between control and music group (mean, 98.2; 95% CI: 94.6, 101.8) after education (p&lt;0.001) There were no differences between the music and metronome group before or after education (p=0.50, p=0.94). However, the variance of music group was significantly less than the metronome group (p=0.01). Compression depth (inches): there was no difference between the groups according to the CPR education method. (Control: 1.8±0.3; Metronome group: 1.6±0.2; Music group: 1.7±0.3 p=0.09) Conclusion Both education method of using music and metronome are more effective than conventional method. However the effect of using music may be better than using metronome.

Optimal chest compression rate in cardiopulmonary resuscitation: a prospective, randomized crossover study using a manikin model.

When performing cardiopulmonary resuscitation (CPR), the 2010 American Heart Association guidelines recommend a chest compression rate of at least 100 min, whereas the 2010 European Resuscitation Council guidelines recommend a rate of between 100 and 120 min. The aim of this study was to examine the rate of chest compression that fulfilled various quality indicators, thereby determining the optimal rate of compression. Thirty-two trainee emergency medical technicians and six paramedics were enrolled in this study. All participants had been trained in basic life support. Each participant performed 2 min of continuous compressions on a skill reporter manikin, while listening to a metronome sound at rates of 100, 120, 140, and 160 beats/min, in a random order. Mean compression depth, incomplete chest recoil, and the proportion of correctly performed chest compressions during the 2 min were measured and recorded. The rate of incomplete chest recoil was lower at compression rates of 100 and 120 min compared with that at 160 min (P=0.001). The numbers of compressions that fulfilled the criteria for high-quality CPR at a rate of 120 min were significantly higher than those at 100 min (P=0.016). The number of high-quality CPR compressions was the highest at a compression rate of 120 min, and increased incomplete recoil occurred with increasing compression rate. However, further studies are needed to confirm the results.

Investigation of low back and shoulder demand during cardiopulmonary resuscitation

Limited research has examined the effect of different compression-ventilation ratios on the ergonomic demand of performing cardiopulmonary resuscitation (CPR) over time. This study aimed to compare the biomechanical demand of performing continuous chest compression CPR (CCC-CPR) and standard CPR (30:2 compression to breath ratio). Fifteen CPR certified individuals performed both standard CPR and CCC-CPR, randomly assigned, for three 2-min periods. Trunk and upper limb muscle activation, lumbar spine posture and compression force applied to a testing mannequin chest were measured throughout each CPR trial. No differences in muscle activation of spine posture were observed, however chest compression force decreased over the two minutes (p < 0.0001). Further, this drop in force was larger and initiated immediately during the CCC-CPR trials. This immediate drop in force during the CCC-CPR trials may be an anticipatory adjustment in order to be able to sustain continuous compressions for the full 2 min duration.

Standard versus Abdominal Lifting and Compression CPR.

Background. This study compared outcomes of abdominal lifting and compression cardiopulmonary resuscitation (ALP-CPR) with standard CPR (STD-CPR). Materials and Methods. Patients with cardiac arrest seen from April to December 2014 were randomized to receive standard CPR or ALP-CPR performed with a novel abdominal lifting/compression device. The primary outcome was return of spontaneous circulation (ROSC). Results. Patients were randomized to receive ALP-CPR (n = 40) and STD-CPR (n = 43), and the groups had similar baseline characteristics. After CPR, 9 (22.5%) and 7 (16.3%) patients in the ALP-CPR and STD-CPR groups, respectively, obtained ROSC. At 60 minutes after ROSC, 7 (77.8%) and 2 (28.6%) patients, respectively, in the ALP-CPR and STD-CPR groups survived (P = 0.049). Patients in the ALP-CPR group had a significantly higher heart rate and lower mean arterial pressure (MAP) than those in the STD-CPR group (heart rate: 106.8 versus 79.0, P < 0.001; MAP: 60.0 versus 67.3 mm Hg, P = 0.003). The posttreatment PCO2 was significantly lower in ALP-CPR group than in STD-CPR group (52.33 versus 58.81, P = 0.009). PO2 was significantly increased after ALP-CPR (45.15 to 60.68, P < 0.001), but it was not changed after STD-CPR. PO2 after CPR was significantly higher in the ALP-CPR group (60.68 versus 44.47, P < 0.001). There were no differences between genders and for patients who are > 65 or ≤ 65 years of age. Conclusions. The abdominal lifting and compression cardiopulmonary resuscitation device used in this study is associated with a higher survival rate after ROSC than standard CPR.