CPR Performance Research Articles

Simulation-Based Training in High-Quality Cardiopulmonary Resuscitation Among Neonatal Intensive Care Unit Providers.

IntroductionAmerican Heart Association guidelines recommend the use of feedback devices for CPR provider resuscitation training. There is paucity of published literature regarding the utility of these devices especially in neonates and infants. We sought to evaluate if simulation-based education and debriefing using a CPR feedback device would improve CPR performance on an infant manikin in a cohort of NICU nurses as evaluated by CPR feedback device.MethodsWe conducted a prospective, observational simulation study to assess the quality of chest compressions by NICU nurses before and after debriefing using CPR quality data captured by an accelerometer-based device. Chest compression (CC) depth, rate, recoil, CC fraction and nursing confidence level related to performing a high-quality CPR were compared before and after debriefing using paired t-test and Wilcoxon rank sum test.ResultsA total of 62 NICU nurses participated in the study and all of them were Neonatal Resuscitation Program (NRP) certified. There was a significant improvement in CC depth and CC fraction [mean + SD values = 0.79 in + 0.17 (pre-debrief), 0.86 in + 0.21 (post-debrief) (p = 0.034) and 56.8% + 17.7 (pre-debrief), 70.8% + 18.4 (post-debrief) (0.0014), respectively]. There was no difference in CC rate (p = 0.36) and recoil (p = 0.25) between pre and post structured debriefing. The confidence level of nurses in all CPR dynamics (appropriate CC rate, CC depth, team communication, minimizing interruption in CC and coordinating CC with ventilation) was significantly higher after simulation and structured debriefing. All the nurses used 3:1 compression: ventilation ratio of NRP despite the patient being a 4 month old premature baby in the NICU.ConclusionsSimulation training and debriefing of NICU nurses using CPR feedback device improved their chest compression quality on an infant mannequin and their confidence level for performing high-quality CPR. NICU providers tend to use NRP protocol of 3:1 compression: ventilation ratio during CPR in the NICU irrespective of age of the infant.

Dispatcher Self-assessment and Attitude Toward Video Assistance as a New Tool in Simulated Cardiopulmonary Resuscitation.

IntroductionVideo-assisted cardiopulmonary resuscitation (V-CPR) describes an advanced telephone-assisted CPR (T-CPR), in which emergency medical service (EMS) dispatchers view a live video steam of the resuscitation. Dispatchers ‘ general attitudes toward and self-assessment in V-CPR have not been previously investigated.Material and MethodsWe conducted this quantitative analysis along with a pilot study on V-CPR. After conducting V-CPR with laypersons in a simulation, EMS dispatchers were given questionnaires with 21 items concerning their personal attitude toward V-CPR and their self-assessment in providing instructions. The actual CPR performance achieved was recorded and compared to the dispatchers’ self-assessments.ResultsDispatchers completed 49 questionnaires, and the data is presented descriptively. Over 80% strongly agreed that V-CPR was helpful in guiding and that their feedback improved CPR quality. Fifty-one percent agreed that video images supported them in making a diagnosis, while 44.9% disagreed. A vast majority (80–90% each) strongly agreed that V-CPR helped them recognize CPR issues such as compression point, compression rate, and deterioration. In contrast, data for improved compression depth and release were weaker. Thirty percent found V-CPR to be more stressful or exhausting than T-CPR. A majority stated they would prefer V-CPR as an addition to T-CPR in the future. There was a huge gap between dispatchers’ own view of CPR effort and measured CPR quality.ConclusionDispatchers generally embrace V-CPR and praise the abilities it provides. Our results indicate that the use of V-CPR did not automatically result in an overall improvement in guideline-compliant CPR quality.

Efficacy of virtual reality techniques in cardiopulmonary resuscitation training: protocol for a meta-analysis of randomised controlled trials and trial sequential analysis

IntroductionCardiopulmonary resuscitation (CPR) is the most critical procedure in the rescue of patients with sudden cardiac death (SCD). The success rate of CPR remains far below expectations, which made CPR...

Analysis of “code blue” application and results: a single center experience

Aim: This study was prepared to analyze the “Code Blue” application and results in Hitit University Erol Olçok Training and Research Hospital.
 Material and Method: Whole of the code blue calls issued in our hospital in 2019 were retrospectively examined and evaluated within the framework of the necessary legal permissions. In this context, arrival time of the code blue team at the scene, CPR performance, duration, results of application and demographic information of patient, place, date and time data were collected. The obtained data were analyzed using the SPSS (Statistical Package for Social Science).
 Results: Between 01.01.2019 and 31.12.2019 a total of 748 code blue notifications were evaluated. The average time for the blue code team to reach the patient was 2.06 minutes. Code blue call was made mostly in intensive care units, by nurses and in January. Patients who underwent code blue intervention 55.89% of them were male and 44.11% were female. Code blue calls were requested the most was the range of 61-80 ages. The oldest patient who received CPR was 105 years old, and the youngest was 2 years old. Besides, code blue call reason is most respiratory+cardiac arrest (243), cardiac arrest (199) and respiratory arrest (109). The results of the whole code blue interventions in 2019, it was figured out that 401 of the patients were dead, 135 of them were taken into intensive care, 173 of them were monitored in the service, 25 people were transferred to the emergency, 12 calls were wrong calls and 2 calls for exercise.
 Conclusion: The internationally determined intervention period for the patient to not lose his vital functions to survive is 2 -5 minutes. As a result, code blue application in our hospital has been successfully implemented in accordance with the standards, with effective and rapid intervention.

Abstract 13209: Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest

Background: Little is known about the provision of care by law enforcement (LE) personnel within modern EMS systems. We evaluated LE performance of bystander CPR (BCPR) and associated outcomes in OHCA across Arizona. Methods: A total of 5,654 OHCA cases (1/1/2019-12/31/2019) were evaluated using the Save Hearts in Arizona Registry and Education (SHARE) cardiac arrest registry. Data were abstracted from all EMS patient care records (PCRs). If two parties provided BCPR, the first to give compressions was considered the provider for this analysis. Cases identified as “Stranger” or “Unknown” BCPR were manually evaluated for narrative data to identify BCPR provider when possible. Results: BCPR was provided in 2285 cases [48.8%; (95% CIs 47.4%, 50.3%)] after excluding 850 cases that occurred in healthcare facilities where personnel are duty-bound to provide CPR. LE provided BCPR in 444 patients [19.4% (17.8%, 21.1%)], second only to family/spouse [1143 pts; 50.0% (48.0%, 52.1%)]. Overall, 279 patients survived to hospital discharge [12.2%, (10.9%, 13.6%)]. The Table shows the rates of BCPR in each provider category and the associated rates of survival. Of note is that the rate of bystander AED use was more than four times higher in LE BCPR [6.3% (4.23%, 8.99%)] than family-provided BCPR [1.5% (0.87%, 2.37%; p < 0.0001)], but was still very low. Conclusions: In this statewide study that included more than 130 EMS agencies from frontier to urban settings, LE personnel were frequently involved in the care of OHCA patients within the 911 system response. To our knowledge, this magnitude of provision of BCPR by LE (nearly one in five BCPR cases) has not been reported previously. Furthermore, the consequential rate of LE response to OHCA provides the opportunity to significantly increase AED use. Our findings support the widespread and intentional training of LE in CPR and AED use and has the potential to improve survival in diverse settings.

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

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

PulsePoint dispatch associated patient characteristics and prehospital outcomes in a mid-sized metropolitan area

BackgroundMobile phone-based dispatch of volunteers to out-of-hospital cardiac arrests (OHCA) has been shown to increase the likelihood of early CPR and AED application. In the United States, limited characterization of patients encountered as a result of such systems exists. AimsExamine prehospital case characteristics and outcomes from a multi-year deployment of PulsePoint Respond in Pittsburgh, Pennsylvania. MethodsPulsePoint event timing, location, and associated prehospital electronic health records (ePCRs) were obtained for EMS-encountered OHCA cases that did and did not generate PulsePoint alerts within the service area of Pittsburgh EMS from July 2016 to October 2020. ePCRs were reviewed and OHCA case characteristics were extracted according to the Utstein template. PulsePoint-associated OHCA and non-PulsePoint-associated OHCA were compared. ResultsOf 840 total PulsePoint dispatches, 64 (7.6%) were for OHCA associated with a resuscitation attempt. Forty-one (64.1%) were witnessed, 38 (59.4%) received bystander CPR, and 13 (20.0%) of these patients had an AED applied prior to EMS arrival. Twenty-seven (39.7%) had an initial shockable rhythm, and 31 (48.4%) patients achieved ROSC in the field. In the city of Pittsburgh, there were 1229 total OHCA during the study period, with an estimated 29.6% occurring in public. When PulsePoint-associated and publicly occurring non-PulsePoint-associated OHCA were compared, baseline characteristics (age, sex, witnessed status) were similar, but PulsePoint-associated OHCA received more bystander CPR (p = 0.008). ConclusionsA minority of PulsePoint dispatches in Pittsburgh were triggered by true OHCA. The majority of OHCA during the study period occurred within private residences where PulsePoint responders are not currently dispatched. PulsePoint dispatches were associated with prognostically favorable OHCA characteristics and increased bystander CPR performance.

Compression depth measured by accelerometer vs. outcome in patients with out-of-hospital cardiac arrest

BackgroundAnalyses of data recorded by monitor-defibrillators that measure CPR depth with different methods show significant relationships between the process and outcome of CPR. Our objective was to evaluate whether chest compression depth was significantly associated with outcome based on accelerometer-recordings obtained with monitor-defibrillators from a single manufacturer, and to assess whether an accelerometer-based analysis corroborated evidence-based practice guidelines on performance of CPR. Methods and resultsWe included 5434 adult patients treated from seven US and Canadian cities between January 2007 and May 2015. These had mean (SD) age of 64.2 (17.2) years, mean compression depth of 45.9 (12.7) mm, ROSC sustained to ED arrival of 26%, and survival to hospital discharge of 8%. For survival to discharge, the adjusted odds ratios were 1.15 (95% CI, 0.86, 1.55) for cases within 2005 depth range (38–51 mm), and 1.17 (95% CI, 0.91, 1.50) for cases within 2010 depth range (>50 mm) compared to those with an average depth of <38 mm. The adjusted odds ratio of survival was 1.33 (95% CI, 1.01, 1.75) for cases within 2015 depth range (50 to 60 mm) for at least 60% of minutes. ConclusionsThis analysis of patients with OHCA demonstrated that increased chest compression depth measured by accelerometer is associated with better survival. It confirms that current evidence-based recommendations to compress within 50–60 mm are likely associated with greater survival than compressing to another depth.

Deliberate practice in resuscitation training using a feedback device, and the effects of the physical characteristics of the rescuer on the acquisition and retention of cardiopulmonary resuscitation skills: Randomized clinical trial

BackgroundCardiopulmonary resuscitation (CPR) skills decline rapidly and rescuers’ physical characteristics could impact on their performance. Our aim was to analyse the effects of deliberate practice using a feedback device (FD) on the CPR performance of nursing students prior to, immediately after, and three months after training, considering their physical characteristics. MethodSixty nursing students participated in this randomized clinical trial (control group n = 28; training group n = 32). Their physical characteristics (weight, height, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)% index, handgrip strength, and CPR position strength) were measured before starting the trial. The training group followed a CPR training programme based on deliberate practice, providing feedback on their performance using an FD. All participants were evaluated during two-minute CPR compression/ventilation cycles. ResultsThe training group showed an improved ability to perform chest compressions (F(2, 115.2) = 13.3; p < .001; ω2p = 0.17) and ventilations (F(2, 115.3) = 102.1; p < .001; ω2p = 0.63), improving their overall quality of CPR (F(2, 115.2) = 40.1; p < .001; ω2p = 0.40). The physical characteristics of the participants did not affect CPR performance in any study phase. ConclusionsA structured training programme based on deliberate practice using an FD had a positive effect on the acquisition of CPR skills by participants, while their physical characteristics had no impact on performance.

Diagnostic performance of cerebroplacental and umbilicocerebral ratio in appropriate for gestational age and late growth restricted fetuses attempting vaginal delivery: a multicenter, retrospective study

Background Cerebroplacental Doppler studies have been advocated to predict the risk of adverse perinatal outcome (APO) irrespective of fetal weight. Objective To report the diagnostic performance of cerebroplacental (CPR) and umbilicocerebral (UCR) ratios in predicting APO in appropriate for gestational age (AGA) fetuses and in those affected by late fetal growth restriction (FGR) attempting vaginal delivery. Study design Multicenter, retrospective, nested case-control study between 1 January 2017 and January 2020 involving five referral centers in Italy and Spain. Singleton gestations with a scan between 36 and 40 weeks and within two weeks of attempting vaginal delivery were included. Fetal arterial Doppler and biometry were collected. The AGA group was defined as fetuses with an estimated fetal weight and abdominal circumference >10th and <90th percentile, while the late FGR group was defined by Delphi consensus criteria. The primary outcome was the prediction of a composite of perinatal adverse outcomes including either intrauterine death, Apgar score at 5 min <7, abnormal acid-base status (umbilical artery pH < 7.1 or base excess of more than −11) and neonatal intensive care unit (NICU) admission. Area under the curve (AUC) analysis was performed. Results 646 pregnancies (317 in the AGA group and 329 in the late FGR group) were included. APO were present in 12.6% AGA and 24.3% late FGR pregnancies, with an odds ratio of 2.22 (95% CI 1.46–3.37). The performance of CPR and UCR for predicting APO was poor in both AGA [AUC: 0.44 (0.39–0.51)] and late FGR fetuses [AUC: 0.56 (0.49–0.61)]. Conclusions CPR and UCR on their own are poor prognostic predictors of APO irrespective of fetal weight.

Can parental simulation improve neonatal CPR performance? A pilot study.

Basic life support training and instruction is recommended for parents of premature infants discharged from the hospital. In order to assess the short-term efficacy of basic life support simulation, in addition to the institutional training, a prospective single-blinded randomized interventional study was performed. The study group received, besides the institutional training, an additional simulation training. The control group had only traditional training. A test assessment was followed approximately a week later and evaluated by two investigators. Fifty parents participated. Nineteen (38%) were in the study group. The study group showed a significant improvement in all the parameters assessed.Conclusion: The addition of a simulation encounter before discharge may improve short-term parental performance of basic life support. What is Known: • Parents of newborns at risk receive institutional training in basic life support. • The retention of knowledge from this training is a point of concern for parents. What is New: • A single simulation encounter for parents improved resuscitation performance. • Simulation for parents may be an important and useful tool to improve the efficacy of basic life support training.

Longitudinal effect of high frequency training on CPR performance during simulated and actual pediatric cardiac arrest

Study aimTo determine the impact of high-frequency CPR training on performance during simulated and real pediatric CPR events in a pediatric emergency department (ED). MethodsProspective observational study. A high-frequency CPR training program (Resuscitation Quality Improvement (RQI)) was implemented among ED providers in a children’s hospital. Data on CPR performance was collected longitundinally during quarterly retraining sessions; scores were analyzed between quarter 1 and quarter 4 by nonparametric methods. Data on CPR performance during actual patient events was collected by simultaneous combination of video review and compression monitor devices to allow measurement of CPR quality by individual providers; linear mixed effects models were used to analyze the association between RQI components and CPR quality. Results159 providers completed four consecutive RQI sessions. Scores for all CPR tasks during retraining sessions significantly improved during the study period. 28 actual CPR events were captured during the study period; 49 observations of RQI trained providers performing CPR on children were analyzed. A significant association was found between the number of prior RQI sessions and the percent of compressions meeting guidelines for rate (β coefficient -0.08; standard error 0.04; p = 0.03). ConclusionsOver a 15 month period, RQI resulted in improved performance during training sessions for all skills. A significant association was found between number of sessions and adherence to compression rate guidelines during real patient events. Fewer than 30% of providers performed CPR on a patient during the study period. Multicenter studies over longer time periods should be undertaken to overcome the limitation of these rare events.

A Survey of Knowledge on and Attitudes toward Cardiopulmonary Resuscitation and Automated External Defibrillators in China

Objectives: The aim of this study was to determine the current knowledge levels on cardiopulmonary resuscitation and automated external defibrillators of Chinese citizens. Methods: A face-to-face questionnaire survey on the knowledge of and attitudes toward the use of CPR and AEDs during an OHCA event was conducted in three high-traffic train stations in Hangzhou and Taizhou, China. The survey included questions on previous experience with CPR, recognition of cardiac arrest, CPR-related concerns, and AED knowledge. Results: A total of 6268 participants were surveyed about their knowledge of and attitudes toward the use of CPR and AEDs. A total of 5981 valid questionnaires, including 3008 from female respondents (50.2%) and 2973 from male respondents (49.8%), were retrieved. The participants were geographically distributed as follows: 18.5% from western China, 19.5% from central China, and 77.0% from eastern China. The educational level, regular residence, and sex of the respondents, as well as legislative policies, were relevant to the knowledge of and attitudes toward the use of CPR and AEDs for OHCA events. The results showed that men were more active than women in terms of CPR training and implementation, as well as had more knowledge and used AEDs more often. More people in eastern and central China had witnessed CPR performance, would pay for CPR training, and would be willing to perform CPR if there was a related legislative policy. Moreover, educational level was crucial to the knowledge of and attitudes toward the use of CPR and AEDs during OHCA events. Conclusions: Chinese citizens lack CPR and AED knowledge and training compared with people in developed countries. We recommend that the state should increase public awareness of CPR and AEDs in China. Mass education, policy implementation, specialized training, and legislative action should be carried out.

Cardiopulmonary resuscitation skill training and retention in teens (CPR START): A randomized control trial in high school students

AimHigh school students are currently the largest group of individuals in the US receiving CPR training every year. This study examines the effect of adding a real-time visual feedback device to a standard instructor-led CPR course on skill acquisition and retention in high school students. MethodsAll study participants underwent baseline CPR skill testing and received a standard instructor-led compression-only CPR course. We then randomized students to a ‘Feedback Group’, consisting of 2 min of CPR training using a real-time visual feedback device, or ‘Standard Group’ that continued to practice on the inflatable manikin. CPR skills for all students were tested afterwards using the feedback device and reported as a compression score (CS) derived from their chest compression depth, rate, hand position, and full chest recoil. We compared the CS at baseline, week-0 (immediately post-intervention), week-10, week-28, and week-52 between groups. ResultsA total of 220 students were included in the analyses (Feedback Group = 110, Standard Group = 110). Both groups showed similar CPR performance at baseline. At week-0, the Feedback Group had a significantly higher CS compared to the Standard Group (adjusted difference: 20% [95% CI: 11%–29%; p < 0.001]). This difference attenuated over time but remained significant at the week-10 and week-28 follow-up; however, by the week-52 follow-up, there was no significant difference between groups. ConclusionsUsing a real-time visual feedback device during CPR training significantly improves skill acquisition and retention in high school students and should be integrated into the high school CPR curriculum.

Clinical Features of Children with Abusive Head Injury and Apparent Life-Threatening Events Upon Presentation to a Children’s Hospital

Background: The symptoms of child abuse and ALTE are similar. Diagnosing child abuse in those who present with an ALTE may be difficult since the symptoms are similar, and bruising is not always seen in those abused. Approximately only 50% of infants who have bruising are found to be abused. There is limited literature showing bruises to the face or blood in the nose or mouth are distinguishing features of those abused infants who initially present to the Emergency Department (ED) for ALTE. Objective: To determine if bruises or contusions to the face or body in infants occur more often in those who present to the ED as an ALTE but found to have Abusive Head Injury (AHI) versus those who present as ALTE and not found to have AHI. A secondary aim was to determine if blood in the mouth and/or nose was present in those with ALTE but found to have AHI. Methods: Retrospective case-control study of infants Results: There were 49 patients in the study: 20 AHI and 29 non-AHI. All infants in both groups had apnea as a presenting symptom. There were no differences in race or gender between groups. No patients in the non-AHI group had retinal hemorrhages. There was not a significant difference in CPR performed prior to arriving to the ED between groups. Intubation was performed with higher frequency in the AHI patients than non-AHI patients (62% vs 0%, p=0.002 by Fisher’s Exact Test). All nine patients requiring intubation were in the AHI group and had intracranial bleeds. Bruises were present with higher frequency in the abused than non-abused group (31% vs 0%, P=0.017 by Fisher’s Exact Test). All bruises were found on patients’ bodies and none on their faces. There were 2 patients with blood from the nose but those were in the non-AHI group and had received CPR. Conclusions: Infants with ALTE who have AHI are more likely to present with bruising to the body, retinal hemorrhages, and intracranial bleeds than infants who have AHI. Blood in the nose does not identify those with AHI. The performance of CPR does not differentiate between groups but the need for intubation was associated with AHI.

Factors related to CPR performance ability of dental hygenists working in dental hospitals

Factors related to CPR performance ability of dental hygenists working in dental hospitals

The clinical practice of small animal CPR and compliance with RECOVER guidelines in Switzerland: an internet-based survey.

Objective: In 2012, the Reassessment Campaign on Veterinary Resuscitation (RECOVER) published the first evidence-based small animal CPR guidelines. Even though a RECOVER-based CPR approach has been shown to improve patient outcomes, guideline awareness and compliance is necessary to see such benefits. Our study aimed to characterize Swiss small animal veterinary CPR practices and assess their compliance with RECOVER guidelines. Methods: A nationwide, internet-based survey was conducted, and invitations distributed via Swiss veterinary society mailing lists. Questions covered respondents' demographics, CPR preparedness, Basic Life Support (BLS) and Advanced Life Support (ALS) techniques, and awareness of RECOVER guidelines. Percentages of group total (95% confidence interval) were calculated. Results: One-hundred and fifty respondents were grouped by level of expertise into board-certified specialists (BCS, n = 19), veterinarians with additional post-graduate training (PGT, n = 27), and general practitioners with (GPE, n = 30), and without emergency duties (GPG, n = 74). Of BCS respondents, 58% (36-77%) were familiar with the RECOVER guidelines, compared to 8% (4-17%) of GPG. Large disparities in preparedness, BLS, and ALS techniques emerged among the levels of expertise. Incompliance with preparedness measures varied from 89% (69-98%) in BCS to 100% (95-100%) in GPG and was predominantly due to failure to attend regular CPR training. BLS compliance ranged from 26% (12-49%) in BCS to 5% (2-13%) in GPG, and incompliance was mostly characterized by targeting lower than recommended chest compression rates. ALS compliance varied from 21% (9-43%) in BCS to 0% (0-5%) in GPG and was compromised by limitations in the resuscitation environment such as lacking access to a defibrillator, monitoring equipment, and rescue drugs. Conclusion: Awareness of RECOVER guidelines in Switzerland is acceptable in specialists, but inadequate among general practitioners and CPR practices are largely not in agreement with RECOVER guidelines. An educational strategy is needed to improve Swiss small animal CPR knowledge and performance.

Abstract 251: Characterizing Bystanders and Their Actions in Response to Out of Hospital Cardiac Arrest

Background: Bystander actions upon witnessing a cardiac arrest are crucial to improving patient survival. Bystander perceptions and actions when witnessing a cardiac arrest are complex and not well understood. Our study has three primary aims: 1) To characterize CA bystanders demographics, 2) To understand the events from patient collapse until EMS arrival, with a focus on telecommunicator or dispatcher-assisted CPR (T-CPR), and 3) Bystander knowledge/ training in CPR and their actions at the time of CA. Methods: This is a prospective observational study conducted on bystanders of out of hospital cardiac arrests (OHCA) serviced by EMS agencies in southeast Michigan. OHCA patients were identified from 3/2018- 12/2019, and bystanders of these events surveyed. Surveys were mailed to non-medical addresses with an introductory letter and paper survey. A phone interview was conducted to describe bystander demographics, events from collapse to EMS arrival, and their actions including CPR performance. We inquired regarding telecommunicator CPR instructions (T-CPR), and if CPR was not performed what were the barriers. Results: During our study period, 126 surveys were mailed, and of these 47 bystander surveys were completed. The majority of events occurred in private homes (37/47,78.7%). Few patients (10, 21.2%) survived to discharge. The bystander and patient age were (mean, range)were 62.9 (30-91 ) and 69.3 (30-100) respectively. The majority were female 27/47(57.4%), most 43/47 (91.4%) knew the patient and were family (34/47,72.3%). Bystanders knew the patient a median(range) of 32 (0-68) years. A majority of bystanders (31/47,66.0%) had CPR training and 19 performed CPR. Of the 14/47 (27.8%) that received T-CPR instructions, 9 performed CPR. CPR trained bystanders that did not perform CPR(8/31), identified panic, assessment barriers and physical reasons for not performing CPR. Conclusion: In this preliminary work, we identify that bystanders to OHCA are most often family, of similar age to the patient and knew the patient for decades. CPR educational programs should prepare trainees to know that they may well respond to loved ones. Further researcher characterizing bystanders and their actions are needed to improve cardiac arrest outcomes.

Abstract 229: Cardiopulmonary Resuscitation Compliance of Clinical Nurses Using Feedback Technology from the Zoll R Series Defibrillator

Use of technology driven devices aimed at providing audio-visual feedback during CPR have been developed, however research is limited to their usefulness effecting chest compression quality of clinical nurses who are often first to respond and begin chest compression on patients experiencing cardiac arrest. This study aimed to examine CPR chest compression compliance of nurses with and without feedback from the Zoll R Series® defibrillator on a manikin. Hypothesis: Audio-visual feedback technology use from the Zoll R Series defibrillator improves the percentage of appropriate chest compression depth and rate of nurses during a CPR manikin demonstration exercise. Methods: Thirty-four nurses participated using an AHA approved manikin. Each nurse performed two minutes of uninterrupted chest compressions without feedback, followed by a rest period and two minutes of uninterrupted chest compressions using feedback technology from the defibrillator. Compression data for rate and depth and total compressions in target within AHA 2015 ECC Guidelines were recorded by the defibrillator and entered into Zoll RescueNet® software. Demographics obtained for years of BLS and ACLS certification. Results: Of the 34 nurses, mean years of ACLS certification was 3.4 years and 11.7 certified years of BLS. Compressions performed with feedback showed a higher percentage of compressions in target (M = 87.37, SD= 15.95) including rate (M= 86.33, SD =15.13) and depth (M= 97.12, SD = 5.63) of compressions compared to percent compressions in target without feedback (M= 64.42, SD = 30.54) including rate (M= 65.73, SD = 32.44) and depth (M=93.34, SD = 19.99) of compressions. Twenty nine or 85% of the 34 nurses improved chest compression performance using feedback. No significant correlation found between years of BLS and ACLS certification and pre and post feedback compliance. Conclusions: Defibrillators offering verbal encouragement and a visual display allow for adjustments in rate and depth of compressions to maintain chest compressions compliance within ECC Guidelines. Further studies should investigate whether the incorporation of feedback technology use in mock code and CPR training sessions could improve CPR performance of healthcare providers including nurses.

FAMILY PRESENCE AND THE PRESS EFFECTS ON PREHOSPITAL CARDIOPULMONARY RESUSCITATION: ATTITUDES OF A GROUP OF EMERGENCY CAREGIVERS

There have been many studies regarding family presence during cardiopulmonary resuscitation and most of them are about emergency services or intensive care units. However, the issue has not been studied enough in terms of prehospital emergency medicine and the perspective of prehospital emergency caregivers. In this study, it is aimed to present the attitudes of a group of prehospital emergency care professionals to family presence and the press effects during prehospital cardiopulmonary resuscitation. The data for this descriptive research was collected from the participants of 63 prehospital caregivers in Afyonkarahisar. The data was collected using a questionnaire designed by the authors and the responses summarized by using frequencies and percentages. Descriptive statistics were used to characterize the sample and each of the survey items. The local ethics committee approval was obtained. Most participants were strongly opposed to family presence and the press during CPR. The highest mean in the phrases that “I don’t want any press member to be there when I perform CPR on a patient.” There is no significant difference in family presence during CPR between the role and year of the experience. Prehospital emergency caregivers mostly have negative attitude towards family presence and the press during CPR. They mostly think the presence of significant others and being watched adversely affects their CPR performance. Disturbing effect on caregivers is not only related to the presence of family members or to other significant others but also the press. Family presence and the press effect on prehospital cardiopulmonary resuscitation are crucial issues that need more attention.