Continuous Chest Compression Cardiopulmonary Resuscitation Research Articles

Effects of ‘Rescuer’ Rotating Time on the Quality of Chest Compressions: 1-Minute Vs. 2-Minute Intervals

Introduction Fatigue can influence the quality of continuous chest compression cardiopulmonary resuscitation (CCC-CPR). This study was conducted to compare the effect of ‘rescuer’ rotating time on the quality of chest compressions at 1-minute and 2-minute intervals. Methods The present semi-experimental study was conducted on 70 non-professional ‘rescuers’ as 35 two-person teams using a crossover design. All teams performed eight 2-minute cycles of CCC-CPR with a rotation of 1 minute and 2 minutes. Quality metrics of the chest compression rate, appropriate depth of compression, and total rate of compressions at the end of eight 2-minute cycles were used to assess the quality of the chest compressions. Results The study results showed that the number of chest compressions with an adequate depth performed by the non-professional rescuers in the 1- and 2-minute scenarios wererespectively 118.18 and 100.87. There was no significant difference in the number of chest compressions between the two scenarios at the end of the CCC-CPR, but the number of compressions with sufficient depth in the 1-minute scenario was better than that in the 2-minute scenario. Conclusion The study showed that although the rate of chest compression had a downward trend in the 1-minute scenario, rescuers maintained 100 to 120 chest compressions after 16 minutes. This means that non-professional rescuers replacement after 1 minute can increase chest compression with sufficient depth.

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.

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.

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.

The physiological effects and quality of chest compressions during CPR at sea level and high altitude

BackgroundRescuers that undergo acute ascent without acclimatization can experience acute mountain sickness. Although performing cardiopulmonary resuscitation (CPR) for a short period requires intensive effort at sea level, performing CPR at high altitude is even more exhausting and can endanger the rescuer. Therefore, we conducted a pilot study to compare the quality of resuscitation in health professionals at high altitude (3100 m) and that at sea level. MethodsThirty-eight participants were asked to performed continuous chest compression CPR (CCC-CPR) for 5 minutes at sea level and at high altitude. Cardiopulmonary resuscitation recording technology was used to objectively quantify the quality of the chest compressions (CCs), including the depth and rate thereof. ResultsAt high altitude, rescuers showed a statistically significant decrease in blood oxygen saturation and an increase in systolic blood pressure, diastolic blood pressure, heart rate, and fatigue, as measured with the Borg score, after CCC-CPR compared with resting levels. The analysis of the time-dependent deterioration in the quality of CCC-CPR showed that the depth of CCs declined from the mean depth of the first 30 seconds after CCC-CPR to that at more than 120 seconds after CCC-CPR at both sea level and high altitude. The average number of effective CCs declined after CCC-CPR was performed for 1 minute at sea level and high altitude. ConclusionsThe quality of CC rapidly declined at high altitude. At high altitude, the average number of effective CC decreases; and this decrease became significant after continuous CCs had been performed for 1 minute.

CPR PRO® Device Reduces Rescuer Fatigue during Continuous Chest Compression Cardiopulmonary Resuscitation: A Randomized Crossover Trial Using a Manikin Model

BackgroundThe performance of high-quality chest compressions with minimal interruptions is one of the most important elements of the “Chain of Survival.” ObjectivesTo evaluate the impact of a novel CPR PRO® (CPRO) device for manual chest compression on rescuer fatigue, pain, and cardiopulmonary resuscitation (CPR) quality. MethodsRandomized crossover trial of 24 health care professionals performing continuous chest compression CPR for 10 min with a CPRO device and conventional manual CPR (MCPR). Data about chest compressions were recorded using a manikin. Rescuers' physiologic signs were recorded before and after each session, and heart rate (HR) data were tracked continuously. Fatigue was assessed with ratings of perceived exertion, and pain questionnaire. ResultsAll subjects completed 10 min of CPR with both methods. Significantly more rest breaks were taken during MCPR sessions (1.7 ± 2 vs. 0.21 ± 0.72). Subjects' perceived exertion was higher after MCPR, as well as the average (120.7 ± 16.8 vs. 110.8 ± 17.6) and maximal HR (134.3 ± 18.5 vs. 123.42 ± 16.5) during testing. Subjects reported more pain in the hands, especially the wrist, after performing MCPR. Average depth of compressions was higher with the CPRO device (4.6 ± 7.0 vs. 4.3 ± 7.9) and declined more slowly over time. Other CPR quality parameters, such as the correct position and complete release of pressure, were also better for CPRO CPR. ConclusionsCPRO device reduces rescuer fatigue and pain during continuous chest compression CPR, which results in a higher quality of CPR in a simulation setting.

Comparison of CPR outcome predictors between rhythmic abdominal compression and continuous chest compression CPR techniques

ObjectiveBystander cardiopulmonary resuscitation (CPR) provides treatment for out-of-hospital cardiac arrest since perfusion of vital organs is critical to resuscitation. Alternatives to standard CPR are evaluated for effectiveness based upon outcome...

A 10-s rest improves chest compression quality during hands-only cardiopulmonary resuscitation: A prospective, randomized crossover study using a manikin model

ObjectivesThis study was designed to assess changes in cardiopulmonary resuscitation (CPR) quality and rescuer fatigue when rescuers are provided with a break during continuous chest compression CPR (CCC-CPR). MethodsThe present prospective, randomized crossover study involved 63 emergency medical technician trainees. The subjects performed three different CCC-CPR methods on a manikin model. The first method was general CCC-CPR without a break (CCC), the second included a 10-s break after 200 chest compressions (10/200), and the third included a 10-s break after 100 chest compressions (10/100). All methods were performed for 10min. We counted the total number of compressions and those with appropriate depth every 1min during the 10min and measured mean compression depth from the start of chest compressions to 10min. ResultsThe 10/100 method showed the deepest compression depth, followed by the 10/200 and CCC methods. The mean compression depth showed a significant difference after 5min had elapsed. The percentage of adequate compressions per min was calculated as the proportion of compressions with appropriate depth among total chest compressions. The percentage of adequate compressions declined over time for all methods. The 10/100 method showed the highest percentage of adequate compressions, followed by the 10/200 and CCC methods. ConclusionWhen rescuers were provided a rest at a particular time during CCC-CPR, chest compression quality increased compared with CCC without rest. Therefore, we propose that a rescuer should be provided a rest during CCC-CPR, and specifically, we recommend a 10-s rest after 100 chest compressions.

Continuous chest compression cardiopulmonary resuscitation training promotes rescuer self-confidence and increased secondary training

Recent work suggests that delivery of continuous chest compression cardiopulmonary resuscitation is an acceptable layperson resuscitation strategy, although little is known about layperson preferences for training in continuous chest compression cardiopulmonary resuscitation. We hypothesized that continuous chest compression cardiopulmonary resuscitation education would lead to greater trainee confidence and would encourage wider dissemination of cardiopulmonary resuscitation skills compared to standard cardiopulmonary resuscitation training (30 compressions: two breaths). Prospective, multicenter randomized study. Three academic medical center inpatient wards. Adult family members or friends (≥ 18 yrs old) of inpatients admitted with cardiac-related diagnoses. In a multicenter randomized trial, family members of hospitalized patients were trained via the educational method of video self-instruction. Subjects were randomized to continuous chest compression cardiopulmonary resuscitation or standard cardiopulmonary resuscitation educational modes. Cardiopulmonary resuscitation performance data were collected using a cardiopulmonary resuscitation skill-reporting manikin. Trainee perspectives and secondary training rates were assessed through mixed qualitative and quantitative survey instruments. Chest compression performance was similar in both groups. The trainees in the continuous chest compression cardiopulmonary resuscitation group were significantly more likely to express a desire to share their training kit with others (152 of 207 [73%] vs. 133 of 199 [67%], p = .03). Subjects were contacted 1 month after initial enrollment to assess actual sharing, or "secondary training." Kits were shared with 2.0 ± 3.4 additional family members in the continuous chest compression cardiopulmonary resuscitation group vs. 1.2 ± 2.2 in the standard cardiopulmonary resuscitation group (p = .03). As a secondary result, trainees in the continuous chest compression cardiopulmonary resuscitation group were more likely to rate themselves "very comfortable" with the idea of using cardiopulmonary resuscitation skills in actual events than the standard cardiopulmonary resuscitation trainees (71 of 207 [34%] vs. 57 of 199 [28%], p = .08). Continuous chest compression cardiopulmonary resuscitation education resulted in a statistically significant increase in secondary training. This work suggests that implementation of video self-instruction training programs using continuous chest compression cardiopulmonary resuscitation may confer broader dissemination of life-saving skills and may promote rescuer comfort with newly acquired cardiopulmonary resuscitation knowledge. URL: http://clinicaltrials.gov. Unique identifier: NCT01260441.

Educational impact of continuous chest compression cardiopulmonary resuscitation

Educational impact of continuous chest compression cardiopulmonary resuscitation

Continuous chest compression cardiopulmonary resuscitation following out-of-hospital cardiac arrest

Continuous chest compression cardiopulmonary resuscitation following out-of-hospital cardiac arrest

A clinical study on the neonatal continuous chest compression cardiopulmonary resuscitation by different moduses of artificial respiration

Objective To investigate the easier and more effective moduses of artificial respiration to the neonatal continuous chest compression eardiopulmonary resuscitation. Methods The experience of the treatment on 66 inpatient neonates(with 84 vices cardiac arrest) by continuous chest compression cardiopulmonary resuscitation was summarized. Based on different moduses of artificial respiration matched with mask-gasbag pressure breathing or tracheal intubation pressure breathing to cardiopulmonary resuscitation(CPR), and according to the principles of therandomized block design,sixty-six neonates in cardiac arrest were randomly divided into two groups of A and B. Fun-damental therapeutics in these two groups were alike. A group(38 cases with 53 vices cardiac arrest) was with mask-gasbag pressure breathing. B group(28 cases with 31 vices cardiac arrest) was with tracheal intubation gasbag pres-sure breathing. Time of cardiac arrest (Tca), time of cardiac restore independent rhythm(Tr), Time of cardiopul-monary resuscitation completed(Tc), achievement ratio of cardiopulmonary resuscitation, and 24 hours survival rateof these two groups were compared. Results Compared with B group, there was no significant deviation of Pca, Tr,Tc, the successful rate of CPR and 24 hours survival rate in A group. Comparing A group to B group, the Tea[ (0.99±0.75)rain vs (0.92±0.69)min, P = 0.69];Tr[(3.58±2.15)rain vs (3.66±2.01)min, P = 0.87];Tc [(23.28±9.26)min vs (23.73±9.51)min,P=0.84];suecessful rate of CPR [88.68% vs 83.87% ,P>0.05];24h survival rate [84.21% vs 82.14 %, P > 0.05 ]. Conclusion The mask-gasbag pressure breathing was an easy,safe and effective artificial respiration method for the neonatal continuous chest compression cardiopulmonary resusci-tation. Only in a few eases with airway resistance heightening was the modus of tracheal intubation gasbag pressure breathing applied. Key words: Cardiopulmonary resuscitation; Heart massage; Heart arrest; Respiration,artificial; Neonates

Rescuer Fatigue: Standard versus Continuous Chest‐Compression Cardiopulmonary Resuscitation

Continuous chest-compression cardiopulmonary resuscitation (CCC-CPR) has been advocated as an alternative to standard CPR (STD-CPR). Studies have shown that CCC-CPR delivers substantially more chest compressions per minute and is easier to remember and perform than STD-CPR. One concern regarding CCC-CPR is that the rescuer may fatigue and be unable to maintain adequate compression rate or depth throughout an average emergency medical services response time. The specific aim of this study was to compare the effects of fatigue on the performance of CCC-CPR and STD-CPR on a manikin model. This was a prospective, randomized crossover study involving 53 medical students performing CCC-CPR and STD-CPR on a manikin model. Students were randomized to their initial CPR group and then performed the other type of CPR after a period of at least two days. Students were evaluated on their performance of 9 minutes of CPR for each method. The primary endpoint was the number of adequate chest compressions (at least 38 mm of compression depth) delivered per minute during each of the 9 minutes. The secondary endpoints were total compressions, compression rate, and the number of breaks taken for rest. The students' performance was evaluated on the basis of Skillreporter Resusci Anne (Laerdal, Wappingers Falls, NY) recordings. Primary and secondary endpoints were analyzed by using the generalized linear mixed model for counting data. In the first 2 minutes, participants delivered significantly more adequate compressions per minute with CCC-CPR than STD-CPR, (47 vs. 32, p = 0.004 in the 1st minute and 39 vs. 29, p = 0.04 in the 2nd minute). For minutes 3 through 9, the differences in number of adequate compressions between groups were not significant. Evaluating the 9 minutes of CPR as a whole, there were significantly more adequate compressions in CCC-CPR vs. STD-CPR (p = 0.0003). Although the number of adequate compressions per minute declined over time in both groups, the rate of decline was significantly greater in CCC-CPR compared with STD-CPR (p = 0.0003). The mean number of total compressions delivered in the first minute was significantly greater with CCC-CPR than STD-CPR (105 per minute vs. 58 per minute, p < 0.001) and did not change over 9 minutes in either group. There were no differences in compression rates or number of breaks between groups. CCC-CPR resulted in more adequate compressions per minute than STD-CPR for the first 2 minutes of CPR. However, the difference diminished after 3 minutes, presumably as a result of greater rescuer fatigue with CCC-CPR. Overall, CCC-CPR resulted in more total compressions per minute than STD-CPR during the entire 9 minutes of resuscitation.

Eighth grade students become proficient at CPR and use of an AED following a condensed training programme

To evaluate a new, 1-h, condensed training programme to teach continuous chest compression cardiopulmonary resuscitation (CCC-CPR) and automated external defibrillator (AED) skills to a cohort of eight grade public school students. Thirty-three eligible subjects completed the programme; mean age 13.7 years; 48.5% female. Eight participants reported some prior training in CPR and AED use. Following initial training, 29/33 (87.8%) subjects demonstrated proficiency at CCC-CPR and AED application/operation in a mock adult cardiac arrest scenario. At four-weeks, 28/33 (84.8%) subjects demonstrated skill retention in similar scenario testing. Subjects also showed improvement in written knowledge regarding AED use as shown by scores on an AHA based written exam (60.9% versus 77.3%; p<0.001). With our focused, condensed training program, eighth grade public school students became proficient in CCC-CPR and AED use. This is the first study to document the ability of middle school students to learn and retain CCC-CPR and AED skills for adult sudden cardiac arrest victims with such a curriculum.