Correct Compression Rate Research Articles

Accuracy of two-rescuer adult CPR performed by medical registrars at a South African university.

Cardiopulmonary resuscitation (CPR) is performed to manually keep brain function intact until the patient's spontaneous blood circulation and breathing are restored. In South Africa, registrars, who are qualified doctors training to specialise in a medical field, are usually the team leaders and oversee junior doctors and nurses during resuscitation. This study aimed to determine the accuracy of the execution of two-rescuer adult CPR on a Resusci-Anne® manikin performed by registrars from the University of the Free State, South Africa. A cross-sectional study was conducted. From a target population of 142 registrars, 47 participated, of whom 44 were included in the analysis. During five cycles of CPR, compression quality was assessed. During a subsequent five cycles, airway management was assessed. Participants were evaluated executing CPR on the Resusci-Anne® manikin, with a recently Basic Life Support trained student researcher as second rescuer. A modified version of the American Heart Association's tick sheet for two-rescuer adult CPR was completed by two student researchers. Department, gender and the date of the most recent CPR training attended were recorded. The median total percentage score was 82.2% (range 33.3% to 100.0%). Results showed that 88.6% of registrars consistently demonstrated correct hand placement, 25.0% correct compression rate, 93.2% correct compression depth, and 61.4% allowed complete chest recoil during compressions. Consistently correct E-C technique was found in 77.3%, and correct ventilation rate in 93.2%. Only 63.6% correctly managed an open airway, and 61.4% achieved visible chest rise. A consistently correct compression-to-ventilation ratio was performed by 59.1% of registrars. The study found that registrars were not consistently performing high-quality CPR on a Resusci-Anne® manikin and identified areas needing attention. The results of this study highlight the need for compulsory CPR training and regular fire drills for registrars.

Effect of the Brief Instructional Video Intervention on the Quality of Cardiopulmonary Resuscitation.

Background: Chest compressions are the basis of cardiopulmonary resuscitation (CPR), and high-quality chest compressions can improve survival rate in patients with out-of-hospital cardiac arrest. Although many efforts have been made to improve the quality of CPR in inexperienced adults, the results are still not high, especially during emergencies. The primary purpose of this study is to investigate whether a brief instructional chest compression-only CPR video could improve chest compression quality in inexperienced adults. Methods: One hundred adults with no CPR experience (age: 20.28 ± 2.28 years; women: 50, men: 50) participated in this study. Participants completed body composition and handgrip strength measurements, and performed two CPR quality tests on the Laerdal® Little Anne QCPR Manikin, namely without video-CPR (WV-CPR) and video-CPR (V-CPR). The WV-CPR quality test was performed first. After 2 minutes of continuous chest compression, the participants rested for 10 seconds and repeated 3 cycles (phase 1, phase 2, and phase 3). After resting for more than 72 hours, V-CPR quality test was conducted. During the V-CPR with video intervention, the participants also continued to compress the chest for 2 minutes, and then rested for 10 seconds, repeating 3 cycles. Results: In phase 1, compared with WV-CPR, the V-CPR has a significant increase (p < 0.001) in chest compression fraction (CCF) (56.31 ± 33.22% vs. 41.82 ± 32.30%) and percent of correct compression rate (PCCR) (96.17 ± 8.45% vs. 26.31 ± 37.55%). In addition, the V-CPR has significantly lower (p < 0.001) chest compression rate (CCR) (110.85 ± 2.40 cpm vs. 128.86 ± 24.52 cpm) and rating of perceived exertion (RPE) (11.89 ± 2.25 vs. 12.87 ± 2.25). For phases 2 through 3, V-CPR and WV-CPR achieved significant differences in CCF, CCD, CCR, PCCR, and RPE (p < 0.01). There were significant differences (p < 0.05) in CCF, CCD, chest compression rebound rate, and RPE among the different administration stages of both WV-CPR and V-CPR. Conclusions: The results of this study revealed that a brief instructional chest compression-only CPR video could improve chest compression quality for inexperienced adults by reducing fatigue and CCR, and increasing CCF and PCCR.

The relationship between upper extremity functional performance and anthropometric features and the quality criteria of cardiopulmonary resuscitation.

This study aims to examine the effect of upper extremity performance using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) on cardiopulmonary resuscitation (CPR) quality criteria according to the European Resuscitation Council (ERC) Guidelines for Resuscitation 2015, including chest compression rate, depth, and recoil. This simulation-based study included 105 paramedic students (43 males, 62 females; median age: 19 years; range, 18 to 20 years) attending a two-year paramedic program between February 2018 and April 2018. The CKCUEST was used to determine upper extremity performance scores, including the touch number, normalized, and power score of the paramedic students. A TrueCPR® feedback device was used to measure CPR quality criteria throughout the study. The characteristics of the providers, such as height, weight, body mass index (BMI), and fat-free mass were also analyzed. Adequate compression depth had a positive correlation with body fat-free mass (r=0.397, p<0.001), power score (r=0.326, p=0.001), height (r=0.326, p=0.001), weight (r=0.314, p=0.001), and BMI (r=0.204, p=0.037). Full chest recoil had a negative correlation with the power score (r=-0.249, p=0.010) and height (r=-0.219, p=0.025). None of the variables were significantly different between the groups with and without the correct compression rate. In the receiver operating characteristic curve analysis for power score and correct compression depth as 100%, the area under the curve was 0.845 (p<0.001). The power score combination of upper extremity functionality and the rescuer's weight is the main factor affecting chest compression depth. However, this score is negatively correlated with full chest recoil.

Leg-heel chest compression as an alternative for medical professionals in times of COVID-19.

ObjectiveTo evaluate leg-heel chest compression without previous training as an alternative for medical professionals and its effects on distance to potential aerosol spread during chest compression.Methods20 medical professionals performed standard manual chest compression followed by leg-heel chest compression after a brief instruction on a manikin. We compared percentage of correct chest compression position, percentage of full chest recoil, percentage of correct compression depth, average compression depth, percentage of correct compression rate and average compression rate between both methods. In a second approach, potential aerosol spread during chest compression was visualized.ResultsOur data indicate no credible difference between manual and leg-heel compression. The distance to potential aerosol spread could have been increased by leg-heel method.ConclusionUnder special circumstances like COVID-19-pandemic, leg-heel chest compression may be an effective alternative without previous training compared to manual chest compression while markedly increasing the distance to the patient.

Smartphone apps to support laypersons in bystander CPR are of ambivalent benefit: a controlled trial using medical simulation

BackgroundBystander-initiated resuscitation is essential for surviving out-of-hospital cardiac arrest. Smartphone apps can provide real-time guidance for medical laypersons in these situations. Are these apps a beneficial addition to traditional resuscitation training?MethodsIn this controlled trial, we assessed the impact of app use on the quality of resuscitation (hands-off time, assessment of the patient’s condition, quality of chest compression, body and arm positioning). Pupils who have previously undergone a standardised resuscitation training, encountered a simulated cardiac arrest either (i) without an app (control group); (ii) with facultative app usage; or (iii) with mandatory app usage. Measurements were compared using generalised linear regression.Results200 pupils attended this study with 74 pupils in control group, 65 in facultative group and 61 in mandatory group. Participants who had to use the app significantly delayed the check for breathing, call for help, and first compression, leading to longer total hands-off time. Hands-off time during chest compression did not differ significantly. The percentage of correct compression rate and correct compression depth was significantly higher when app use was mandatory. Assessment of the patient’s condition, and body and arm positioning did not differ.ConclusionsSmartphone apps offering real-time guidance in resuscitation can improve the quality of chest compression but may also delay the start of resuscitation. Provided that the app gives easy-to-implement, guideline-compliant instructions and that the user is familiar with its operation, we recommend smartphone-guidance as an additional tool to hands-on CPR-training to increase the prevalence and quality of bystander-initiated CPR.

Analysis of Basic Life Support Training Provided to Pharmacy Students Using Feedback Device

The quality of chest compression affects survival after sudden cardiac arrest, particularly when it occurs out of hospital. Pharmacy students should acquire basic life support skills as part of the model core curriculum of pharmacy education. Here, we trained first-year students at the Faculty of Pharmacy to deliver cardiopulmonary resuscitation and used a manikin with a real-time feedback device that quantified chest compression skills. Students were classified into shallow compressions (SC; <50 mm) and deep compressions (DC; ≥50 mm) groups based on the depth of chest compressions measured prior to training. After training, the mean compression depth (mm) was significantly shallower for the SC, than the DC group and many students in the SC group did not reach a depth of 50 mm. Similarly, students were classified into slow compression rate (SR; ≤120/min) and rapid compression rate (RR; >120/min) groups based on the results of training in the rate of chest compressions. Significant differences in mean compression rates were not found between the groups. However, correct compression rate (%), the percentage of maintaining 100-120 compression/min was significantly higher in the SR, than in the RR group. Chest compression rates correlated with compression depth, and chest compression tended to be too shallow in group that was too fast. The quality of chest compression might be improved by delivering chest compressions at a constant rate within the recommended range.

Wearing a N95 mask increases rescuer's fatigue and decreases chest compression quality in simulated cardiopulmonary resuscitation.

ObjectivesN95 mask is essential for healthcare workers dealing with the coronavirus disease 2019 (COVID-19). However, N95 mask causes discomfort breathing with marked reduction in air exchange. This study was designed to investigate whether the use of N95 mask affects rescuer's fatigue and chest compression quality during cardiopulmonary resuscitation (CPR).MethodsAfter a brief review of CPR, each participant performed a 2-minute continuous chest compression on a manikin wearing N95 (N95 group, n = 40) or surgical mask (SM group, n = 40). Compression rate and depth, the proportions of correct compression rate, depth, complete chest recoil and hand position were documented. Participants' fatigue was assessed using Borg score.ResultsSignificantly lower mean chest compression rate and depth were both achieved in the N95 group than in the SM group (p < 0.05, respectively). In addition, the proportion of correct compression rate (61 ± 19 vs. 75 ± 195, p = 0.0067), depth (67 ± 16 vs. 90 ± 14, p < 0.0001) and complete recoil (91 ± 16 vs. 98 ± 5%, p = 0.0248) were significantly decreased in the N95 group as compared to the SM group. At the end of compression, the Borg score in the N95 group was significantly higher than that in the SM group (p = 0.027).ConclusionWearing a N95 mask increases rescuer's fatigue and decreases chest compression quality during CPR. Therefore, the exchange of rescuers during CPR should be more frequent than that recommended in current guidelines when N95 masks are applied.

The use of mental metronomes during simulated cardiopulmonary resuscitation training.

To evaluate the effect of a mental metronome on chest compression rate at the point of training and 10 weeks later. A prospective observational study was performed using veterinary students without training in CPR. Students received a lecture and demonstration of CPR. The "Song group" (SG) listened to "Stayin' Alive" performed by the Bee Gees and were asked to think about the tempo during chest compressions. The "No Song group" (NSG) was given no guidance on achieving the correct chest compression rate. After the demonstration, both groups were instructed to perform chest compressions at a rate of 100 compressions per minute on a canine manikin, and the actual rate of compressions administered was calculated (Assessment 1). This task was repeated approximately 10 weeks later (Assessment 2). Eighteen students were in the SG and 12 in the NSG. Seventy-eight percent of the SG performed chest compressions between 90 and 110 per minute during Assessment 1, compared with 50% during Assessment 2. The NSG had an 8% success rate at both assessments. Compression rate variance did not change in in either group over time. Mental metronomes are valuable teaching tools that can help students to perform chest compressions at the recommended rate.

Basic Life-Support Learning in Undergraduate Students of Sports Sciences: Efficacy of 150 Minutes of Training and Retention after Eight Months.

Several professional groups, which are not health professionals, are more likely to witness situations requiring basic life support (BLS) due to the nature of their job. The aim of this study was to assess BLS learning after 150 min of training in undergraduate students of sports science and their retention after eight months. Participants trained on BLS (150-min session: 30 theory, 120 practice). After training (T1) and after 8 months (T2), we evaluated their performance of the BLS sequence and two minutes of cardiopulmonary resuscitation (CPR). At T1, the 23 participants presented a mean score of 72.5 ± 21.0% in the quality of the CPRs (compressions: 78.6 ± 25.9%, ventilation: 69.9 ± 30.1%). More than 90% of the participants acted correctly in each step of the BLS sequence. At T2, although the overall quality of the CPR performed did not decrease, significant decreases were observed for: correct hand position (T1: 98.2 ± 8.8, T2: 77.2 ± 39.7%), compression depth (T1: 51.4 ± 7.9, T2: 56.0 ± 5.7 mm), and compression rate. They worsened opening the airway and checking for breathing. In conclusions, participants learned BLS and good-quality CPR after the 150-min training session. At eight months they had good retention of the BLS sequence and CPR skills. Training on airway management and the position of the hands during CPR should be reinforced.

Evaluation of the thoracic compression technique using APPs. Do they help or hinder cardiopulmonary resuscitation?

ObjectiveTo evaluate the quality of cardiopulmonary resuscitation (CPR) by lay people when guided by a mobile phone application with real-time feedback, with the comparison of three different mobile phone applications (APPs). DesignA cross-sectional quasi-experimental study was carried out. ParticipantsA sample of 113 nursing students participated in the study. InterventionsThree hands-only CPR tests with continuous compressions were performed: (i) without external help; (ii) with the mobile phone turned off; and (iii) guided by APP. Three different APPs were randomly assigned (Pocket CPR®, CPR Pro® and Massage cardiaque et DSA®). The mannequin Laerdal Resusci Anne QCPR (Stavanger, Norway) 2.0.0.14 software was used. Variables of primary interestAPPs used. Demographic variables characterizing the study sample. Independent variables: mean depth, mean rate, percentage of correct hand positioning, percentage of compressions with correct re-expansion, percentage of compressions with correct depth, percentage of compressions at the correct rate, and overall quality of CPR. ResultsOverall CPR quality was 33.3±32.7% using Pocket CPR, 10.9±22.72% using CPR Pro and 7.8±9.2% using Massage cardiaque et DSA. None of the APPs produced a statistically significant improvement. The percentage of time that the resuscitator managed to maintain a correct compression rate improved when using all three APPs. ConclusionsCardiopulmonary resuscitation guided by phone APPs did not improve the overall quality of compressions during resuscitation, though it improved the percentage of compressions performed at the correct rate.

The TrueCPR device in the process of teaching cardiopulmonary resuscitation: A randomized simulation trial.

Background:International resuscitation guidelines emphasize the importance of high quality chest compressions, including correct chest compression depth and rate and complete chest recoil. The aim of the study was to assess the role of the TrueCPR device in the process of teaching cardiopulmonary resuscitation in nursing students.Methods:A prospective randomized experimental study was performed among 94 first year students of nursing. On the next day, the participants were divided into 2 groups—the control group practiced chest compressions without the use of any device for half an hour, and the experimental group practiced with the use of TrueCPR. Further measurement of chest compressions was performed after a month.Results:The chest compression rate achieved the value of 113 versus 126 (P < .001), adequate chest compression rate (%) was 86 versus 68 (P < .001), full chest release (%) 92 versus 69 (P = .001), and correct hand placement (%) 99 versus 99 (P, not significant) in TrueCPR and standard BLS groups, respectively. As for the assessment of the confidence of chest compression quality, 1 month after the training, the evaluation in the experimental group was statistically significantly higher (91 vs 71; P < .001) than in the control group.Conclusions:Cardiopulmonary resuscitation training with the use of the TrueCPR device is associated with better resuscitation skills 1 month after the training. The participants using TrueCPR during the training achieved a better chest compression rate and depth with in international recommendations and better full chest release percentage and self-assessed confidence of chest compression quality comparing with standard cardiopulmonary resuscitation training.

The use of dispatcher assistance in improving the quality of cardiopulmonary resuscitation: A randomised controlled trial

AimsThe introduction of dispatcher assistance (DA) services has led to increased bystander cardiopulmonary resuscitation (CPR) participation rates. However, the extent to which DA improves CPR quality remains unclear. This study aimed to evaluate the efficacy of DA in improving CPR quality among healthcare professionals and laypersons within a multi-ethnic Southeast Asian population. MethodsA parallel, randomised controlled, open label trial was performed. Four hundred and twelve participants were recruited via convenience sampling in a public location. In a simulated cardiac-arrest scenario, the participants were randomised to perform CPR with DA over the phone (DA+) or CPR without DA (DA-). The ratio of participant assignment to DA+ and DA- was 1:1. The primary outcomes were CPR compression depth, compression rate, no-flow time, complete release of pressure between compressions, and hand location. The assessment involved CPR manikins and human assessors. ResultsA larger proportion of participants in DA + achieved the correct compression rate (34.3% vs 18.1%, p < 0.001). There was no difference in the other primary outcomes.A subgroup analysis revealed that healthcare professionals in DA+ had a higher proportion of correct hand location compared to those in DA- (82.1% vs. 53.5%, p < 0.05). There was no significant difference in CPR quality among laypersons with valid CPR certification regardless of whether they received DA. ConclusionDA should be provided to laypersons without valid CPR certification, as well as healthcare professionals. The identification of gaps in the current DA protocol highlights areas where specific changes can be made to improve CPR quality.

Abstract 227: The Acceptability and Impact of a Pilot Community Hands-Only Cardiopulmonary Resuscitation Training Program in India

Background: Sudden Cardiac Arrest (SCA) is a leading cause of global mortality. In India, 700,000 people die from SCA annually, many of which are under the age of 50. Immediate bystander CPR improves chances of survival, however, CPR education and training are difficult in a developing country such as India. In collaboration with University of Illinois Global Health Program, the Indian American Medical Association (Illinois), SHARE INDIA, and the American Heart Association we studied native rural Indian populations, hoping to enhance CPR education and skills training. This is the first rural community CPR project in India involving a university residency-training program from the USA. Methods: We conducted hands-only CPR training (based on the latest AHA guidelines) in the Telangana State in India, recruiting 582 participants with the help of local health outreach workers. A pre-training survey was used to assess baseline knowledge and impressions of CPR. This was followed by training in hands-only CPR consisting of an oral presentation followed by interactive CPR manikin training. A post-course survey was conducted after training. Chi square test and McNemar’s test were used for the analysis of data using SAS. Results: Of 582 participants, 65% were males and the mean age was 19.4 + 5.9. Gender was not associated with pre/post-test CPR knowledge, comfort with CPR, or belief in CPR efficacy. However, in paired analysis, there were significant differences (p&lt;0.0001) in all knowledge and perception measures from pre-to-post training. While only 6% knew the correct compression rate pre-training, 96% knew the correct answer post-training (4% vs. 94% in females, 6% vs. 96% in males). Similar results were seen for the compression depth variable. Training also improved comfort level in performing CPR (64% vs. 87% in females and 70% vs. 89% in males) and belief that CPR can save lives (49% vs. 96% in females and 51% vs. 97% in males). Conclusions: The program was successful in enhancing knowledge, comfort, and perceptions of CPR. Given the high prevalence of SCA in India, training the public in hands-only CPR can be a cost-effective care strategy in resource-limited areas. Due to the success of this pilot, we are planning to continue the program.

349 The Effect of Athletic Chest Protective Equipment on the Performance of Manual and Mechanical Cardiopulmonary Resuscitation: A Simulation Study

Sudden cardiac arrest in athletes is a rare event, yet remains a leading causes of death in athletes. A small percent of these events is due to commotio cordis (CC), secondary to direct striking trauma to the chest. Many athletes wear various types of athletic chest protectors (ACP) to help prevent the incidence of CC. Studies indicate that almost 40% of cases occurred despite the use of ACPs. There has been little research to evaluate the impact of these ACPs on the quality of cardiopulmonary resuscitation (CPR) compressions. Numerous studies have indicated that the quality of CPR during a cardiac arrest is correlated to patient outcome and overall mortality. In this study, we aim to observe: (1) whether the presence of ACPs will impact the quality of bystander CPR performance (2) whether the use of a LUCAS (mechanical compression) device will lead to a difference in CPR performance as compared to traditional compressions (3) whether the presence of ACP gear will have a detrimental effect on depth, rate, and hand positioning of both bystander and LUCAS CPR. This study was an observational, prospective study of a convenience sample of 26 residents of all levels of training, from a single emergency medicine residency. Residents performed CPR on a high fidelity Laerdal mannequin that provided real-time computer feedback and measured compression depth, rate, and proper hand placement. Multiple trials of CPR were performed: baseline CPR for both 1 minute and 2 minute cycles, and CPR on a mannequin wearing the ACP. The ACP used was a common, commercially available HEART-GARD. We also measured the time required to remove the ACP prior to initiating CPR. LUCAS CPR performance was measured both at baseline and over the ACP. For bystander CPR, there was a statistically significant difference in both percentage of correct hand placement and compression rate for baseline versus ACP compressions (85% versus 57%, p<0.05; 138 versus 142, p<0.05, respectively). Difference in compression depth were not significant (51.08 versus 50.08mm, p=0.39). With LUCAS CPR, there was no significant difference noted in aspects of CPR performance with or without an ACP in place. When comparing bystander versus LUCAS CPR quality, a significant difference was noted in compression rate (138 versus 101, p<0.01), but not in overall depth or hand placement when compressions were performed either at baseline or with ACP in place. Lastly, average time to remove the ACP prior to CPR initiation was noted to be 5.4 seconds. Previous research has shown that many variables have a critical impact on overall CPR quality, including compression depth, rate and hand placement. In our study, the use of an ACP had a significant impact on hand placement during bystander CPR. This may have a detrimental effect on bystander CPR quality. Considering ACP removal required only 5.4 seconds, it may be beneficial to remove the ACP prior to starting of bystander CPR. However, ACP equipment was shown to have no significant impact when a LUCAS device is utilized for mechanical CPR. In addition, there was a significant difference between resident and LUCAS CPR in rate of compressions, which plays a critical role in CPR quality.

Can a Software-Based Metronome Tool Enhance Compression Rate in a Realistic 911 Call Scenario Without Adversely Impacting Compression Depth for Dispatcher-Assisted CPR?

The prospective, randomized, controlled study involved simulated 911 cardiac arrest calls made by layperson-callers and handled by certified emergency medical dispatchers (EMDs) at four locations in Salt Lake City, Utah USA. Participants were randomized into two groups. In the experimental group, layperson-callers received CPR pre-arrival instructions with metronome assistance. In the control group, layperson-callers received only pre-arrival instructions. The primary outcome measures were correct compression rate (counts per minute [cpm]) and depth (mm). A total of 148 layperson-callers (57.4% assigned to experimental group) participated in the study. There was a statistically significant association between the number of participants who achieved the target compression rate and experimental study group (P=.003), and the experimental group had a significantly higher median compression rate than the control group (100 cpm and 89 cpm, respectively; P=.013). Overall, there was no significant correlation between compression rate and depth. An automated software metronome tool is effective in getting layperson-callers to achieve the target compression rate and compression depth in a realistic DA-CPR scenario.Scott G, Barron T, Gardett I, Broadbent M, Downs H, Devey L, Hinterman EJ, Clawson J, Olola C. Can a software-based metronome tool enhance compression rate in a realistic 911 call scenario without adversely impacting compression depth for dispatcher-assisted CPR? Prehosp Disaster Med. 2018;33(4):399-405.

Prehospital CPR training performed with visual feedback

INTRODUCTION: Swedish firefighters are a part of the emergency medical services. Therefore, they perform prehospital cardiopulmonary resuscitation (CPR) on a regular basis. Training becomes crucial for maintaining the CPR skills and increasing the patients’ chances of survival. Training with visual feedback is for Swedish firefighters a new way of training CPR. The aim of this study was to evaluate firefighters’ perception of a CPR manikin with visual feedback. METHOD: This study had a qualitative approach. Data were collected by interviews with 16 firefighters after performing CPR on a manikin with visual feedback. The data were analyzed with a manifest content analysis. RESULTS: Visual feedback makes it easy to identify and maintain correct compression rate. There is a need for identifying too deep compressions. Uncertainty regarding the closeness to the stomach arises when using the whole hand during compressions instead of just the wrist. To accomplish an open airway requires a bit of adjustment of the manikins’ head. DISCUSSION: To train and learn CPR is feasible with visual feedback. The firefighters can maintaing a correct compression rate and correct compression depth during the sessions. Ventilating a patient with bag-valvemask or pocket mask may require training with visual feedback to guarantee the firefighters being able to secure an open airway of the patient. All these skills are essential and improve the chance of survival for the patients.

Is a mechanical-assist device better than manual chest compression? A randomized controlled trial.

BackgroundChest compression quality is a determinant of survival from sudden cardiac arrest. The CPR RsQ Assist Device (CPR RAD) is a new cardiopulmonary resuscitation device for chest compression. It is operated manually but it does not pull up on the chest on the up stroke. The aim of this study was to compare the CPR RAD with standard manual compression in terms of chest compression quality in a manikin model.MethodsParticipants were randomly assigned to either the device or manual chest compression group. Each participant performed a maximum of 4 minutes of hands-only compression with or without the device. During chest compression, the following quality parameters from the manikin were recorded: compression rate, compression depth, and correctness of hand position.ResultsDuration of chest compression was significantly higher in device users compared with manual compression (223.93±36.53 vs 179.67±50.81 seconds; P<0.001). The mean compression depth did not differ in a statistically significant way between manual compression and device at 2 minutes (56.42±6.42 vs 54.25±5.32; P=0.052). During the first and second minutes, compression rate was higher in cases of standard compression (133.21±15.95 vs 108±9.45; P<0.001 and 127.41±27.77 vs 108.5±9.93; P<0.001). There was no statistically significant difference in the percentage of participants who employed compression that was too shallow or exhibited incorrect hand position.ConclusionThe CPR RAD is more effective in chest compression compared with manual chest compression, as using the device led to better results in terms of fatigue reduction and correct compression rate than standard manual compression.

A novel educational outreach approach to teach Hands-Only Cardiopulmonary Resuscitation to the public

ReviewThe American Heart Association set goals in 2010 to train 20 million people annually in cardiopulmonary resuscitation and to double bystander response by 2020. These ambitious goals are difficult to achieve without new approaches. MethodsThe main objective is to evaluate a new approach to cardiopulmonary resuscitation instruction using a self-instructional kiosk to teach Hands-Only CPR to people at a busy international airport. This is a prospective, observational study evaluating a new approach to teach Hands-Only CPR to the public from July 2013 to February 2016. The American Heart Association developed a Hands-Only CPR Kiosk for this project. We assessed the number of participants who viewed the instructional video and practiced chest compressions as well as the quality metrics of the chest compressions. ResultsIn a 32-month period, there were 23478 visits to the Hands-Only CPR Kiosk and 9006 test sessions; of those practice sessions, 26.2% achieved correct chest compression rate, 60.2% achieved correct chest compression depth, and 63.5% had the correct hand position. ConclusionsThere is noticeable public interest in learning Hands-Only CPR by using an airport kiosk and an airport is an opportune place to engage a layperson in learning Hands-Only CPR. The average quality of Hands-Only CPR by the public needs improvement and adding kiosks to other locations in the airport could reach more people and could be replicated in other major airports in the United States.

Passive ultra-brief video training improves performance of compression-only cardiopulmonary resuscitation

BackgroundBystander compression-only cardiopulmonary resuscitation (CPR) improves survival after out-of-hospital cardiac arrest. To broaden CPR training, 1–2min ultra-brief videos have been disseminated via the Internet and television. Our objective was to determine whether participants passively exposed to a televised ultra-brief video perform CPR better than unexposed controls. MethodsThis before-and-after study was conducted with non-patients in an urban Emergency Department waiting room. The intervention was an ultra-brief CPR training video displayed via closed-circuit television 3–6 times/hour. Participants were unaware of the study and not told to watch the video. Pre-intervention, no video was displayed. Participants were asked to demonstrate compression-only CPR on a manikin. Performance was scored based on critical actions: check for responsiveness, call for help, begin compressions immediately, and correct hand placement, compression rate and depth. The primary outcome was the proportion of participants who performed all actions correctly. ResultsThere were 50 control and 50 exposed participants. Mean age was 37, 51% were African-American, 52% were female, and 10% self-reported current CPR certification. There were no statistically significant differences in baseline characteristics between groups. The number of participants who performed all actions correctly was 0 (0%) control vs. 10 (20%) exposed (difference 20%, 95% confidence interval [CI] 8.9–31.1%, p<0.001). Correct compression rate and depth were 11 (22%) control vs. 22 (44%) exposed (22%, 95% CI 4.1–39.9%, p=0.019), and 5 (10%) control vs. 15 (30%) exposed (20%, 95% CI 4.8-35.2%, p=0.012), respectively. ConclusionPassive ultra-brief video training is associated with improved performance of compression-only CPR.

Could Hong Kong Primary Schoolchildren be Taught to Perform Compression-Only CPR: A Pilot Study

Objective To evaluate whether Hong Kong primary schoolchildren could be taught to perform compression-only CPR. Design Prospective experimental trial Subjects Primary schoolchildren of age 9-12 years old from different Cub Scout packs attended a 2 hour voluntary compression-only CPR training session between late 2014 and mid-2015. Main outcome measures Cardiopulmonary resuscitation (CPR) knowledge in the format of pre- and post-test multiple choices questions (MCQ). Psychomotor skills assessment including correct hand position, compression depth, compression rate and chest wall recoil between each compression. Results A total of 112 primary schoolchildren attended the training session, in them 72% were boys. Pretest score and post-test score was 2.81/5 and 4.82/5, respectively. The difference was statistically significant (p&lt;0.05). About 96% of subjects had correct hand position at all time during CPR. Mean compression rate was 119/minute. Mean compression depth was 3 cm. About 47% of subjects had 100% complete recoil of chest wall following compression. Conclusion Primary schoolchildren above 9 years old are able to acquire essential knowledge and skills in compression-only CPR. Their physical strength may limit their ability to perform effective chest compression; it is still worthwhile to advocate CO-CPR education in primary schoolchildren in Hong Kong in order to raise their interest in this life saving skills and to equip them with essential cognitive skills in emergency situations. To achieve optimal cost-effectiveness and a compression depth of at least 4 cm, body weight of 53 kg or above should be considered as a selection criterion.