Effective Chest Compressions Research Articles

Optimizing the effectiveness of cardiopulmonary resuscitation by medical students in a blended learning environment

Guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care are based on the ILCOR International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiopulmonary Care with Treatment Recommendations. High-quality rate was defined as ≥100 compressions per minute, with a depth of ≥50 millimeters (mm), allowing for full (100%) chest rotation and a compression fraction approaching 100%. In our study, we found that chest compression depth ≥50 mm was achieved by 12 (30%) participants in the distance (1) training group, whereas in the face-to-face (2) training group, 35 (83%) students achieved effective chest compression depth (χ2P=23.84; p=0.000). When analyzing the frequency of chest compressions in the group of distance (1) students, the median was 100 (95-110) compressions/min compared to 105 (95-110) compressions/min in the group of full-time (2) students (Kr-U: χ2=0.28, p=0.59), no statistical difference in compliance with recommendations for the frequency of compressions was found in both groups (p<0.001). Evaluation of the effectiveness of CPR, success, consisted of the average depth of chest compressions (≥50 mm) and the average frequency of chest compressions (100-120 compressions per minute). Success in performing CPR was achieved by 7 (18%) students in the distance learning group (1) and by 31 (74%) participants in the face-to-face (2) learning group (χ2P=26.12; p=0.000), which is 4.4 times better. During the work, it was found that the success of CPR has a significant correlation (p<0.05) with the depth of compressions (rs=0.46), with the number of compressions (rs=0.55) and with the face-to-face learning group (rs=0.56). In addition, an analysis of student satisfaction with CPR skills was conducted and we found that in the distance learning group 34 (85%) students were dissatisfied with their results, while in face-to-face learning only 7 (17%) were dissatisfied, that is, 9% acquired these skills during the training.

Impact of anthropometric factors on chest compression depth during CPR provided by children aged 11–14 in a community-wide study

ObjectiveTo assess the depth of chest compressions (CC) provided by schoolchildren and their relation with providers’s anthropometric characteristics. MethodsWe organized 1-hour hands-on training sessions for 11-14y.o. in volunteering schools. After training, willing subjects performed 2 min of recorded continuous CCs by means of Laerdal Resusci Anne® with CPRMeter2®, with visual feedback. Compression pace was given by metronome; instructors supervised the correct body position. Collected data included age, sex, as well as measured body weight and height. ResultsWe analyzed records from N = 702 children (mean age: 12.76 ± 1.02 years, 379 (51.63%) boys) out of 761 participating in the study. Their mean median compression depth (MCD) was 46.70 ± 7.74 mm, which was below minimal effective CC depth advised by current guidelines (50 mm). This corresponded to low mean fraction of CCs ≥ 50 mm (CCF ≥ 50 mm, 42.86 ± 33.67%), and only 42.88% of children achieving at least 50% of compressions ≥ 50 mm. Boys had significantly higher mean MCD and CCF ≥ 50 mm than girls (MCD: 49.34 ± 7.05 mm vs 45.97 ± 8.07 mm, p < 0.0001; CCF ≥ 50 mm: 50.23 ± 32.90% vs 40.40 ± 34.97%, p < 0.0001). Age differentiated children who achieved at least 50% of compressions ≥50 mm from those who did not with AUC of 0.69 (for cut-off of 12.1 years: 85% sensitivity, 41% specificity), whereas weight offered an improved prediction (AUC 0.74; for cut-off 44.8 kg: 77.4% sensitivity, 61.1% specificity). ConclusionsSex, age and anthropometric factors are significant CC quality factors. Children with higher body weight are more likely to deliver CCF50%≥50 mm. Among the studied population, children ≥12 years old provided more effective chest compressions.

Drone-Facilitated Real-Time Video-Guided Feedback Helps to Improve the Quality of Lay Bystander Basic Life Support. A Randomized Controlled Simulation Trial

Objectives Telephone instructions are commonly used to improve cardiopulmonary resuscitation (CPR) by lay bystanders. This usually implies an audio but no visual connection between the provider and the emergency medical telecommunicator. We aimed to investigate whether video-guided feedback via a camera drone enhances the quality of CPR. Methods We conducted a randomized controlled simulation trial. Lay rescuers performed 8 min of CPR on an objective feedback manikin. Participants were randomized to receive telephone instructions with (intervention group) or without (control group) a drone providing a visual connection with the telecommunicator after a 2-min run-in phase. Performed work (total compression depth minus total lean depth) was the primary outcome. Secondary outcomes were the proportion of effective chest compressions, average compression depth, subjective physical strain measured every 2 min, and dexterity in the nine-hole peg test after the scenario. Outcomes were compared using the t- and Mann Whitney-U tests. A two-sided p-value of <0.05 was considered significant. Results We included 27 individuals (14 (52%) female, mean age 41 ± 14 years). Performed work was greater in the intervention than in the control group (41.3 ± 7.0 vs. 33.9 ± 10.9 m; absolute difference 7.5, 95% CI 1.4 to 14.8; p = 0.046), with higher average compression depth (49 ± 7 vs. 40 ± 13 mm; p = 0.041), and higher proportions of adequate chest compressions (43 (IQR 14–60) vs. 3 (0–29) %; p = 0.041). We did not find any significant differences regarding the remaining secondary outcomes. Conclusion Video-guided feedback via drones might be a helpful tool to enhance the quality of telephone-assisted CPR in lay bystanders.

Kalıpyargı Tehditinin Kardiopulmoner Resüsitasyon Performansı Üzerine Etkisi: Bir Randomize Kontrollü Manken Çalışması

Objective: Stereotype threat (ST) can lead to decreased performance when individuals face the possibility of confirming negative stereotypes associated with their group. During the Coronavirus disease 2019 (COVID-19) pandemic, non-Intensive Care Unit physicians (non-ICUp) were assigned to work in ICUs. However, social media emphasized the inadequacy of knowledge and skills among these physicians. Given the negative judgments, the study aimed to evaluate the cardiopulmonary resuscitation (CPR) performances of these physicians and investigate the effect of ST. Methods: A total of 63 non-ICUp and 53 Intensive Care Unit physicians (ICUp) physicians working in COVID-19 ICUs were randomly assigned to control and experimental groups. In the experimental group, ST was manipulated by presenting the study’s aim as measuring the difference in CPR performances between ICUp and non-ICUp physicians. The control group received no information. Participants were videotaped while performing a standard CPR scenario and evaluated by independent instructors and mannequin scores. Results: Overall CPR scores were higher among ICUp. Non-ICUp performed better in the ST condition regarding effective chest compression (p=.02) and correct compression rates per minute (p=.02) compared to the control condition. However, ICUp had lower scores for correctly placing chest compressions in the ST condition (p=.03). Conclusion: The higher CPR performance among ICUp was expected. However, the hypothesis suggesting lower performance for non-ICUp under ST conditions was not supported. Inconsistent results regarding the ST effect could be influenced by moderating factors such as task difficulty, knowledge about the existing stereotype, and motivation to perform well. The interaction between the physicians’ specialty and situational factors highlights the importance of creating realistic training environments that simulate high-pressure situations, ultimately contributing to the development of competent and confident healthcare professionals. Future research should further explore the impact of ST-based training on interactions and performance among different healthcare professionals. Keywords: Stereotype threat, intensive care unit, cardiopulmonary resuscitation, CovId-19

Impact of Personal Protective Equipment on Cardiopulmonary Resuscitation and Rescuer Safety

Background. High-quality cardiopulmonary resuscitation (CPR) is a key element in the rescue of cardiac arrest patients but is difficult to achieve in circumstances involving aerosol transmission, such as the COVID-19 pandemic. Methods. This prospective randomized crossover trial included 30 experienced health care providers to evaluate the impact of personal protective equipment (PPE) on CPR quality and rescuer safety. Participants were asked to perform continuous CPR for 5 minutes on a manikin with three types of PPE: level D-PPE, level C-PPE, and PAPR. The primary outcome was effective chest compression per minute. Secondary outcomes were the fit factor by PortaCount, vital signs and fatigue scores before and after CPR, and perceptions related to wearing PPE. Repeated-measures ANOVA was used, and a two-tailed test value of 0.05 was considered statistically significant. Results. The rates of effective chest compressions for 5 minutes with level D-PPE, level C-PPE, and PAPRs were 82.0 ± 0.2%, 78.4 ± 0.2%, and 78.0 ± 0.2%, respectively ( p = 0.584 ). The fit-factor test values of level C-PPE and PAPRs were 182.9 ± 39.9 vs. 198.9 ± 9.2 ( p &lt; 0.001 ). The differences in vital signs before and after CPR were not significantly different among the groups. In addition, the fatigue and total perception scores of wearing PPE were significantly higher for level C-PPE than PAPRs: 3.8 ± 1.6 vs. 3.0 ± 1.6 ( p &lt; 0.001 ) and 27.9 ± 5.4 vs. 26.0 ± 5.3 ( p &lt; 0.001 ), respectively. Conclusion. PAPRs are recommended when performing CPR in situations where aerosol transmission is suspected. When PAPRs are in short supply, individual fit-tested N95 masks are an alternative. This trial is registered with NCT04802109.

Effective ventilation and chest compressions during neonatal resuscitation – the role of the respiratory device

Background The success of cardiopulmonary resuscitation (CPR) in newborns largely depends on effective lung ventilation; however, a direct randomized comparison using different available devices has not yet been performed. Methods Thirty-six professionals were exposed to a realistic newborn CPR scenario. Ventilation with either a bag-valve mask (BVM), T-piece, or ventilator was applied in a randomized manner during CPR using a Laerdal manikin. The primary outcome was the number of unimpaired inflations, defined as the peak of the inflation occurring after chest compression and lasting at least 0.35 s before the following chest compression takes place. The secondary outcomes were tidal volume delivered and heart compression rate. To simulate potential distractions, the entire scenario was performed with or without a quiz. Statistically, a mixed model assessing fixed effects for experience, profession, device, and distraction was used to analyze the data. For direct comparison, one-way ANOVA with Bonferroni‘s correction was applied. Results The number of unimpaired inflations was highest in health care professionals using the BVM with a mean ± standard deviation of 12.8 ± 2.8 (target: 15 within 30 s). However, the tidal volumes were too large in this group with a tidal volume of 42.5 ± 10.9 ml (target: 25–30 ml). The number of unimpaired breaths with the mechanical ventilator and the T-piece system were 11.6 (±3.6) and 10.1 (±3.7), respectively. Distraction did not change these outcomes, except for the significantly lower tidal volumes with the T-piece during the quiz. Conclusions In summary, for our health care professionals, ventilation using the mechanical ventilator seemed to provide the best approach during CPR, especially in a population of preterm infants prone to volutrauma.

Teaching Cardiopulmonary Resuscitation to Later Elementary School Students

Bystander cardiopulmonary resuscitation (CPR) rates remain low in the United States. Training children is a proposed method to increase this rate, but data on the compression efficacy of US elementary school-aged children are scarce. We hypothesized that fourth and fifth graders could learn how to respond to cardiac arrests and provide effective chest compressions. We conducted a nonrandomized before-and-after study with fourth- and fifth-grade elementary students. Two 2-hour CPR educational sessions were held. Two weeks later, skills were assessed using a de novo checklist, and manikin-analyzed compression effectiveness (dichotomized at 50% efficacy) was analyzed using Chi-squared tests. We used paired t tests to evaluate knowledge change on identical pre- and post-tests. Secondary analysis evaluated associations between compression effectiveness and grade, age, sex, and body mass index (BMI) using Chi-squared tests. Three hundred fifty-six students completed the study. The mean change in test scores measuring CPR knowledge increased from 8.2 to 9.3 (1.1, 95% confidence interval [CI] 0.9 to 1.2). Self-reported adequate CPR knowledge increased from 44% to 97% (odds ratio [OR] 44.17, 95% CI 12.62 to 154.62). Seventy-two percent of students completed >7/11 predefined resuscitation steps, and 76% delivered ≥50% effective compressions. Grade was significantly associated with achieving ≥50% effective compression (OR 2.02, 95% CI, 1.19 to 3.43). Age, BMI, and sex were not significantly associated with greater compression efficacy. Most students were able to learn hands-only CPR, apply their knowledge during a simulated cardiac arrest scenario, and deliver effective chest compressions. Students' confidence and willingness to perform CPR increased after the intervention.

Development of an automatic device performing chest compression and external defibrillation: An animal-based pilot study.

Automatic chest compression devices (ACCDs) can promote high-quality cardiopulmonary resuscitation (CPR) and are widely used worldwide. Early application of automated external defibrillators (AEDs) along with high-quality CPR is crucial for favorable outcomes in patients with cardiac arrest. Here, we developed an automated CPR (A-CPR) apparatus that combines ACCD and AED and evaluated its performance in a pilot animal-based study. Eleven pigs (n = 5, A-CPR group; n = 6, ACCD CPR and AED [conventional CPR (C-CPR)] group) were enrolled in this study. After 2 min observation without any treatment following ventricular fibrillation induction, CPR with a 30:2 compression/ventilation ratio was performed for 6 min, mimicking basic life support (BLS). A-CPR or C-CPR was applied immediately after BLS, and resuscitation including chest compression and defibrillation, was performed following a voice prompt from the A-CPR device or AED. Hemodynamic parameters, including aortic pressure, right atrial pressure, coronary perfusion pressure, carotid blood flow, and end-tidal carbon dioxide, were monitored during resuscitation. Time variables, including time to start rhythm analysis, time to charge, time to defibrillate, and time to subsequent chest compression, were also measured. There were no differences in baseline characteristics, except for arterial carbon dioxide pressure (39 in A-CPR vs. 33 in C-CPR, p = 0.034), between the two groups. There were no differences in hemodynamic parameters between the groups. However, time to charge (28.9 ± 5.6 s, A-CPR group; 47.2 ± 12.4 s, C-CPR group), time to defibrillate (29.1 ± 7.2 s, A-CPR group; 50.5 ± 12.3 s, C-CPR group), and time to subsequent chest compression (32.4 ± 6.3 s, A-CPR group; 56.3 ± 10.7 s, C-CPR group) were shorter in the A-CPR group than in the C-CPR group (p = 0.015, 0.034 and 0.02 respectively). A-CPR can provide effective chest compressions and defibrillation, thereby shortening the time required for defibrillation.

KIDS SAVE LIVES: Basic Life Support Education for Schoolchildren: A Narrative Review and Scientific Statement From the International Liaison Committee on Resuscitation.

Basic life support education for schoolchildren has become a key initiative to increase bystander cardiopulmonary resuscitation rates. Our objective was to review the existing literature on teaching schoolchildren basic life support to identify the best practices to provide basic life support training in schoolchildren. After topics and subgroups were defined, a comprehensive literature search was conducted. Systematic reviews and controlled and uncontrolled prospective and retrospective studies containing data on students <20 years of age were included. Schoolchildren are highly motivated to learn basic life support. The CHECK-CALL-COMPRESS algorithm is recommended for all schoolchildren. Regular training in basic life support regardless of age consolidates long-term skills. Young children from 4 years of age are able to assess the first links in the chain of survival. By 10 to 12 years of age, effective chest compression depths and ventilation volumes can be achieved on training manikins. A combination of theoretical and practical training is recommended. Schoolteachers serve as effective basic life support instructors. Schoolchildren also serve as multipliers by passing on basic life support skills to others. The use of age-appropriate social media tools for teaching is a promising approach for schoolchildren of all ages. Schoolchildren basic life support training has the potential to educate whole generations to respond to cardiac arrest and to increase survival after out-of-hospital cardiac arrest. Comprehensive legislation, curricula, and scientific assessment are crucial to further develop the education of schoolchildren in basic life support.

KIDS SAVE LIVES: Basic Life Support Education for Schoolchildren: A Narrative Review and Scientific Statement From the International Liaison Committee on Resuscitation

BACKGROUNDBasic life support education for schoolchildren has become a key initiative to increase bystander cardiopulmonary resuscitation rates. Our objective was to review the existing literature on teaching schoolchildren basic life support to identify the best practices to provide basic life support training in schoolchildren. METHODSAfter topics and subgroups were defined, a comprehensive literature search was conducted. Systematic reviews and controlled and uncontrolled prospective and retrospective studies containing data on students <20 years of age were included. RESULTSSchoolchildren are highly motivated to learn basic life support. The CHECK-CALL-COMPRESS algorithm is recommended for all schoolchildren. Regular training in basic life support regardless of age consolidates long-term skills. Young children from 4 years of age are able to assess the first links in the chain of survival. By 10 to 12 years of age, effective chest compression depths and ventilation volumes can be achieved on training manikins. A combination of theoretical and practical training is recommended. Schoolteachers serve as effective basic life support instructors. Schoolchildren also serve as multipliers by passing on basic life support skills to others. The use of age-appropriate social media tools for teaching is a promising approach for schoolchildren of all ages. CONCLUSIONSSchoolchildren basic life support training has the potential to educate whole generations to respond to cardiac arrest and to increase survival after out-of-hospital cardiac arrest. Comprehensive legislation, curricula, and scientific assessment are crucial to further develop the education of schoolchildren in basic life support.

An Evaluation of the Quality of CPR Chest Compressions Performed on Football-Equipped and Obese Simulation Manikins

Objective Protective athletic equipment may hamper the delivery of effective chest compressions. Unfortunately, an algorithm for managing cardiac arrest emergencies with equipment-laden athletes has yet to be established by national CPR certifying agencies. Further, athletes classified as being overweight or obese carry adipose in the thoracic region, which has been reported to inhibit the ability of rescuers to provide quality chest compressions. Thus, the purpose of this study was two-fold. The first purpose was to assess the ability of emergency responders to perform CPR chest compressions on an obese manikin. The second purpose was to analyze the effect of American football protective equipment on the performance of chest compressions by emergency responders. Methods Fifty emergency responders completed four 2-minute bouts of compression-only CPR. The scenarios included performing chest compressions on both traditional and obese CPR manikins, and performing chest compressions over a set of shoulder pads/chest protector that is used in the sport of American football on both traditional and obese manikins. Results The most notable outcomes in this study were related to chest compression depth, which fell well below the minimum recommended depth published by the American Heart Association in all conditions. Mean compression depth was significantly lower when performed on the obese manikin (avg over pads = 32.8, SD = 9.2 mm; avg no pads = 38.2, SD = 9.1 mm) compared to the traditional manikin (avg over pads = 40.0, SD = 10.9 mm; avg no pads = 40.8, SD = 14.8 mm), with statistical analyses revealing a significant effect due to both manikin size (p < 0.001) and the presence of equipment (p = 0.003), and a statistically significant interaction effect (p = 0.035). Chest recoil data revealed a statistically significant effect due to both manikin size (p = 0.017) and the presence of chest/shoulder safety pads (p = 0.003). Conclusion Within this sample of emergency responders, chest compressions were adversely affected both by the equipment and obesity. Additionally, the traditional manikin received comparable chest compressions regardless of the presence or absence of football protective equipment, albeit both conditions resulted in poor depth performance.

Left ventricle segmentation in transesophageal echocardiography images using a deep neural network.

There has been little progress in research on the best anatomical position for effective chest compressions and cardiac function during cardiopulmonary resuscitation (CPR). This study aimed to divide the left ventricle (LV) into segments to determine the best position for effective chest compressions using the LV systolic function seen during CPR. We used transesophageal echocardiography images acquired during CPR. A deep neural network with an attention mechanism and a residual feature aggregation module were applied to the images to segment the LV. The results were compared between the proposed model and U-Net. The results of the proposed model showed higher performance in most metrics when compared to U-Net: dice coefficient (0.899±0.017 vs. 0.792±0.027, p<0.05); intersection of union (0.822±0.026 vs. 0.668±0.034, p<0.05); recall (0.904±0.023 vs. 0.757±0.037, p<0.05); precision (0.901±0.021 vs. 0.859±0.034, p>0.05). There was a significant difference between the proposed model and U-Net. Compared to U-Net, the proposed model showed better performance for all metrics. This model would allow us to evaluate the systolic function of the heart during CPR in greater detail by segmenting the LV more accurately.

The association of chest compressor&amp;apos;s physical activity level with the quality of continuous chest compressions during a stimulated cardiac arrest in an education center

Background: Cardiopulmonary resuscitation (CPR) is a lifesaving procedure performed by qualified rescuers. The quality of CPR depends on effective chest compression (CC) characteristics: rate, depth, hand position, and chest recoil. Besides CC, previous research has proven that physical activity level (PAL) varies among rescuers and affects CPR quality. This study aims to assess the association between PAL and the quality of continuous chest compressions-cardiopulmonary resuscitation (CCC-CPR) for 5 minutes by qualified rescuers at the National Guard Hospital in Jeddah (NGHA-J). Methods: This is a cross-sectional study. The global physical activity questionnaire was used to measure the participants&amp;apos; PALs, and the SimMan 3G mannequin was used to measure the four CC characteristics. The recommended sample size is 45 of the rescuers at NGHA-J. Results: A total of 45 members were involved in the study, and most participants were 27 (60%) males. Most participants are classified as having high PAL 21(46.67%). The study indicates that there is no significant effect among the PALs and the CCC-CPR effectiveness according to (p 0.65) which is determined by the non-parametric Kruskal Wallis test. The optimal effective CCs between the three groups of PALs were achieved by the moderate PAL participants with a median of 47.5 (IQR 35). Conclusion: The study findings deny any relationship between the quality of the CCC-CPR and the PAL of the rescuers.

160 CARDIOPULMONARY RESUSCITATION IN MICROGRAVITY

Abstract Introduction The increase of human space missions in microgravity conditions has led the scientific community to investigate the potential effects on astronauts' bodies. There is a high incidence of cardiovascular complications, with cardiac arrest being among the most difficult to manage. On earth, guidelines regarding cardiopulmonary resuscitation are constantly updated; however, in microgravity, the literature on the subject is still lacking. The aim of this study is to review the available literature and lay the foundation for further nursing developments in this regard. Materials and Methods A literature review was conducted by consulting Pubmed as the database. The research question was, "How is CPR performed on the astronaut suffering from cardiac arrest during space flight?" As inclusion criteria, we considered all relevant studies in the literature in the last 10 years, using MeSH terms. Results and Discussion The studies reviewed showed that there are 5 possible methods of cardiopulmonary resuscitation in the space environment (Consensus of 2015) : the Reverse Bear Hug Method; the Side-Straps Method; the Evetts-Russomano Method; the Handstand Method; and the Waist Straddle Method. Mackaill et all, through a simulation on a parabolic flight, a dummy and 10 different operators, demonstrated that the Russomano maneuver is capable of sustaining the cardiac circulation by conferring effective manual chest compressions. Hinkelbein et all, drafted a first guideline regarding resuscitation maneuvers. The results of the study also show that defibrillation and ventilation appear to be techniques that have not yet been investigated. The belief remains that BLSD and ALS protocols can be applied in the same manner as applied on Earth. Schimtz et all, with an RCT study that included 15 volunteers and a simulation dummy placed underwater (an environment similar to space characteristics), studied 2 different resuscitation techniques, comparing the Schimtz-Hinkelbein Method and the Cologne Method. The former method demonstrated a better depth and frequency of repetitions of manual compressions. Subsequently, Forti and his collaborators, highlighted the application of automatic mechanical compression devices generating effective compressions. Conclusion To date there is little evidence to state with certainty that exclusively one method of cardiopulmonary resuscitation is effective in the aerospace environment. Since the emergency of cardiac arrest is a major problem there is a need to study these processes more thoroughly and entrust health care professionals with the management, practice and theory of such space dynamics also in view of the arrival of the nursing presence during missions in space.

Capnography: Principles and application in critical care medicine

Capnography has become an essential monitoring tool in perioperative and critical care setting. It helps monitor dynamic physiological processes more precisely and promptly, compared to other monitoring modalities. Methods to measure and display carbon dioxide concentrations in respired gases include infrared spectrography, mass spectrography, Raman spectrography, photoacoustic analysers or colorimetry. It is used to confirm correct endotracheal tube placement, ensure effective and consistent chest compression, detect return of spontaneous circulation and diagnose alterations in haemodynamics and ventilation of critically ill patient. It helps to optimise fluid resuscitation and monitor shock progression by providing insight into adequacy of tissue perfusion. Thus, a detailed study and interpretation of capnographic waveform is essential.

Comparison of different methods of more effective chest compressions during cardiopulmonary resuscitation (CPR) in the dental chair

IntroductionWhen performing cardiopulmonary resuscitation (CPR) on a patient who has suffered a cardiopulmonary arrest during dental treatment, few dental chairs have sufficient stability to perform effective chest compressions. We previously proposed a method of stabilizing the backrest of a dental chair using a support stool. As a result, we confirmed that the vertical displacement of the backrest could be significantly reduced. In the present study, we verified the effectiveness of the stool stabilization method using several dental chairs (flat and curved) with significantly different backrest shapes. MethodsVertical displacement of the backrests of dental chairs was recorded. Data were obtained at three different stool positions (without a stool, under the chest at the level that participants were performing manual chest compressions, and under the shoulders). Reduction displacement ratios were calculated to evaluate the effectiveness of the stool positions. ResultsThe method significantly reduced the vertical displacement of the backrest for all types. When the curvature of the backrest was large, the reduction in vertical displacement was 40% when the stool was placed under the chest at the level of manual chest compressions and 65% when placed underneath the shoulder. In the case of a flat dental chair, this reduction was 90% when using a stool in either position, compared to no stool. ConclusionWhen we need to perform CPR on a patient in the dental chair, placing a stool under the shoulders allows effective manual chest compression by firmly supporting the backrest of a dental chair of any shape.

P125 Evaluation of chest compression's effectiveness with different combinations of depth and rate - a secondary analysis of a randomized simulation study

P125 Evaluation of chest compression's effectiveness with different combinations of depth and rate - a secondary analysis of a randomized simulation study

A Comparison of Two Stool Positions for Stabilizing a Dental Chair During CPR.

Most dental chairs lack sufficient stability to perform effective manual chest compression (MCC) during cardiopulmonary resuscitation (CPR). A stabilizing stool can significantly reduce backrest vertical displacement in all chair types; however, a severely curved exterior backrest may negatively impact the stool's effectiveness. This study evaluated the efficacy of 2 stool positions for stabilizing a dental chair during MCC. Chest compressions were performed on a manikin positioned in a dental chair while vertical displacement of the chair backrest during MCC was recorded using video and measured. Vertical displacement data were captured with no stool and with a stabilizing stool in 2 different positions. Reduction ratios were calculated to evaluate the effectiveness of the 2 stool positions. With no stool, the backrest median (interquartile range) vertical displacement during chest compressions was 16.5 (2.5) mm as compared with 12.0 (1.5) mm for the stabilizing stool positioned under the area of MCC and 8.5 (1.0) mm under the shoulders. The stool positioned under the shoulders produced a significantly increased calculated reduction ratio of 48% (14%) compared with 27% (20%) under the area of MCC (P < .001). Positioning a stabilizing stool under the shoulders was more effective at reducing vertical displacement of the dental chair backrest during chest compressions than positioning the stool under the area of MCC.

Efficacy of heads-up CPR compared to supine CPR positions: Systematic review and meta-analysis.

Background and AimCardiopulmonary resuscitation (CPR) in full‐coded patients requires effective chest compressions with minimal interruptions to maintain adequate perfusion to the brain and other vital organs. Many novel approaches have been proposed to attain better organ perfusion compared to traditional CPR techniques. The purpose of this review is to investigate the safety and efficacy of heads‐up CPR versus supine CPR.MethodsWe searched PubMed Central, SCOPUS, Web of Science, and Cochrane databases from 1990 to February 2021. After the full‐text screening of 40 eligible studies, only seven studies were eligible for our meta‐analysis. We used the RevMan software (5.4) to perform the meta‐analysis.ResultsIn survival outcome, the pooled analysis between heads‐up and supine CPR was (risk ratio = 0.98, 95% confidence interval [CI] = 0.17–5.68, p = 0.98). The pooled analyses between heads‐up CPR and supine CPR in cerebral flow, cerebral perfusion pressure and coronary perfusion pressure outcomes, were (mean difference [MD] = 0.10, 95% CI = 0.03–0.17, p = 0.003), (MD = 12.28, 95% CI = 5.92–18.64], p = 0.0002), and (MD = 8.43, 95% CI = 2.71–14.14, p = 0.004), respectively. After doing a subgroup analysis, cerebral perfusion was found to increase during heads‐up CPR compared with supine CPR at 6 min CPR duration and 18 to 20 min CPR duration as well.ConclusionOur study suggests that heads‐up CPR is associated with better cerebral and coronary perfusion compared to the conventional supine technique in pigs' models. However, more research is warranted to investigate the safety and efficacy of the heads‐up technique on human beings and to determine the best angle for optimization of the technique results.

Compression Device-Assisted Extracorporeal Cardiopulmonary Resuscitation Cannulation in Pediatric Patients-A Simulation Study.

Background: Surgical neck cannulation for pediatric extracorporeal cardiopulmonary resuscitation (ECPR) requires multiple interruptions of manual chest compressions to facilitate the procedure. Effective uninterrupted CPR is essential to prevent neurological injury. We hypothesized that an automated chest compression device can be used to provide effective and uninterrupted chest compressions during pediatric neck ECPR cannulation. The feasibility of surgically cannulating the right carotid artery and right internal jugular vein in an infant during ongoing automated chest compressions was tested in a simulation study. Methods: A working prototype of a pediatric chest compression device was designed to provide automated chest compressions on an infant CPR manikin at the rate of 120 compressions/minute. A feedback device attached to the manikin was used to monitor the effectiveness of CPR. A synthetic artery, vein along with carotid sheath and skin was utilized to simulate surgical neck exploration. ECPR simulation was conducted using the compression device to provide chest compressions. Results: Four ECPR simulations were conducted during which vessel sparing (n = 2) and non-vessel sparing (n = 2) cannulation of the right internal carotid artery and right internal jugular vein were performed during ongoing mechanical chest compressions. All four cannulations were successfully performed without the need to interrupt chest compressions. Conclusions: In a simulated environment, pediatric ECPR neck cannulation with uninterrupted chest compressions may be accomplished using an automated chest compression device. The strategy of compression device-assisted ECPR cannulation requires further study and could potentially reduce the neurological complications of ECPR.