External Chest Compression Research Articles

Analysis of factors affecting in-hospital emergency response capability based on objective assessment

To analyze the factors affecting the quality of cardiopulmonary resuscitation (CPR) performed by medical staff in hospital and to explore the training methods to enhance their in-hospital emergency response capabilities. A cross-sectional study was conducted, involving medical staff of intensive care unit (ICU) and general internal medicine wards in China-Japan Friendship Hospital in December 2021. The American Heart Association (AHA) resuscitation quality improvement (RQI) model was used to evaluate the skills of the subjects in performing external chest compressions and bag-mask ventilation on adult and infant simulators. While ICU subjects were undergoing RQI model objective assessment, two instructors also provided subjective scoring for their operations. The study compared the differences in RQI model objective assessment scores between ICU and general internal medicine ward subjects, between doctors and nurses, in the RQI model objective scoring for adult and infant resuscitation, in the scoring differences of different positions for chest compressions, and the differences between traditional subjective scoring and RQI objective scoring when ICU subjects were assessed for compression and ventilation. A total of 75 medical staffs were enrolled, consisting of 50 from the ICU (including 24 doctors and 26 nurses) and 25 from the general internal medicine wards (including 10 doctors and 15 nurses). The ICU medical staff's scores for adult resuscitation skills were significantly higher than those of the general internal medicine ward medical staff [adult compression score: 82.5 (66.0, 96.5) vs. 65.0 (52.5, 74.5), adult ventilation score: 82.0 (68.8, 98.0) vs. 61.0 (48.0, 82.0), both P < 0.01]. The nursing group's compression scores for both adult and infant were significantly higher than those of the doctor group [adult compression score: 77.0 (68.5, 89.5) vs. 63.0 (40.8, 90.3), infant compression score: 54.4±25.1 vs. 41.5±18.5, both P < 0.05]. The compression and ventilation scores for the infant were significantly lower than those for adult resuscitation [compression score: 48 (29, 65) vs. 76 (58, 90), ventilation score: 56 (42, 75) vs. 76 (60, 96), both P < 0.01]. When the rescuer was positioned on the right side of the model, the compression score for the adult significantly increased [79.0 (65.0, 92.0) vs. 65.0 (51.3, 77.0), P < 0.05]. The ICU medical staff's traditional subjective scores of compression and ventilation assessments for adult were significantly higher than the RQI model objective scores [adult compression score: 88.8 (79.4, 92.5) vs. 82.5 (66.0, 95.5), adult ventilation score: 95.0 (80.0, 98.1) vs. 82.0 (68.8, 98.0), both P < 0.01]. Rich experience in emergency rescue is related to the improvement of CPR skills, and performing chest compressions from the right side of the adult model is more effective. Objective scoring of resuscitation skills based on the RQI model may more accurately reflect the performance of the trainees.

The Efficiency of the Constraint-Led Approach in Teaching External Chest Compressions to Medical Students

The Efficiency of the Constraint-Led Approach in Teaching External Chest Compressions to Medical Students

A novel CPR-assist device vs. established chest compression techniques in infant CPR: A manikin study

IntroductionGuidelines for infant CPR recommend the two-thumb encircling hands technique (TTT) and the two-finger technique (TFT) for chest compression. Some devices have been designed to assist with infant CPR, but are often not readily available. Syringe plungers may serve as an alternative infant CPR assist device given their availability in most hospitals. In this study, we aimed to determine whether CPR using a syringe plunger could improve CPR quality measurements on the Resusci-Baby manikin compared with traditional methods of infant CPR. MethodsCompression area with a diameter of 1 to 2 cm is recommended in previous infant CPR device researches. In this is a randomized crossover manikin study, we examined the efficacy of the Syringe Plunger Technique (SPT) which uses the plunger of the 20 ml syringe with a 2 cm diameter flat piston, commonly available in hospital, for infant External Chest Compressions (ECC). Participants performed TTT, TFT and SPT ECC on Resusci® Baby QCPR® according to 2020 BLS guidelines. ResultsSixty healthcare providers participated in this project. The median (IQR) ECC depths in the TTT, TFT and SPT in the first minute were 41 mm (40–42), 40 mm (38–41) and 40 mm (39–41), respectively, with p < 0.001. The median (IQR) ECC recoil in the TTT, TFT and SPT groups in the first minute was 15% (1–93), 64% (18–96) and 53% (8–95), respectively, with p = 0.003. The result in the second minute had similar findings. The SPT had the best QCPR score and less fatigue. ConclusionThe performance of chest compression depth and re-rebound ratio was statistically different among the three groups. TTT has good ECC depth and depth accuracy but poor recoil. TFT is the complete opposite. SPT can achieve a depth close to TTT and has a good recoil performance as TFT. Regarding comprehensive performance, SPT obtains the highest QCPR score, and SPT is also less fatigued. SPT may be an effective alternative technique for infant CPR.

Association of Training in Basic Life Support with the Evolution of Cardiopulmonary Resuscitation Performed by Firefighters.

This study aimed to compare the results of professional technical and anthropometric anamnesis data with the transmission of external chest compressions performed by military firefighters at different execution times. The objective was to evaluate the performance and perceived effort of the sequence of external chest compressions performed in two minutes, as well as the evolution of the technique over time. This was a descriptive, correlational study involving adult firefighters who were members of a specific firefighter group, comprising a population of 105 individuals with a voluntary sample of 44 participants. The study used a Bayesian statistical approach to provide probabilistic expressions. The participants had an average work experience of 17 years, an average age of 38.6 years, an average weight of 81.48 kilograms, an average height of 176 centimeters, and an average of 2.5 qualifications. The results indicated that the firefighters performed external chest compressions with excellent technique and a moderate level of perceived effort in a two-minute evaluation. The evaluation of the evolution of the technique over time showed that the participants were able to maintain high-quality compressions for an average of 6 minutes, with a maximum of 20 uninterrupted minutes. The study underscores the critical role of professional firefighters in performing and maintaining high-quality external chest compressions, which has the potential to reduce morbidity and mortality in cases of cardiorespiratory arrest.

Conhecimento sobre primeiros socorros de servidores de instituições de ensino infanto- juvenil

First aid consists of the first assistance to an accident or sudden illness victim, outside the hospital environment, with or without risk of death. The present study aims to assess the competences and skills related to first aid training with educational workers. This is a pre and post-test experimental research of an educational intervention action carried out by nurses with 31 teachers and 53 employees from three public educational institutions in the city of Ponta Grossa, Parana State, Brazil. The technological application ‘QCPR Learner’ was used to assess practical skills and an instrument for assessing theoretical knowledge, applied before and after the intervention. It was found that 35.7% were successful in the theoretical test and 58% in the practical test before training and that there was a significant improvement in the correct answers in the post-test, when compared to the pre-test, in the themes: cardiorespiratory arrest, external chest compression, bleeding and tooth avulsion (p = 0.000). Regarding the quality of chest compressions before and after the educational intervention, there was a significant improvement in the variables: correct depth, correct frequency and effectiveness of the compressions (p

Unexpected carboxyhemoglobin half-life during cardiopulmonary resuscitation: a case report

BackgroundCardiac arrest (CA) following CO poisoning (CO-induced CA) exposes patients to an extremely high risk of mortality and remains challenging to treat effectively. Terminal carboxyhemoglobin elimination half-life (COHbt1/2) is critically affected by ventilation, oxygen therapy, and cardiac output, which are severely affected conditions in cases of CA.Case presentationAsystole occurred in an 18-year-old woman after unintentional exposure to CO in her bathroom. Cardiopulmonary resuscitation (CPR) was started immediately, including mechanical ventilation with a fraction of inspired oxygen (FiO2) of 1.0 and external chest compressions with a LUCAS® device. CPR was stopped after 101 min, as it was unsuccessful. During this period, we calculated a COHbt1/2 of 40.3 min using a single compartmental model.ConclusionsThis result suggests that prolongation of CPR time needed to back COHb at 10%, a level more compatible with successful return of spontaneous circulation (ROSC), could be compatible with a realistic CPR time. Calculating COHbt1/2 during CPR may help with decision-making regarding the optimal duration of resuscitation efforts and further with HBO2 or ECLS. Further evidence-based data are needed to confirm this result.

Virtual Reality Simulator versus Conventional Advanced Life Support Training for Cardiopulmonary Resuscitation Post-Cardiac Surgery: A Randomized Controlled Trial.

External chest compressions are often ineffective for patients arresting after cardiac surgery, for whom emergency resternotomy may be required. A single-blinded randomized controlled trial (RCT) was performed, with participants being randomized to a virtual reality (VR) Cardiac Surgical Unit Advanced Life Support (CSU-ALS) simulator training arm or a conventional classroom CSU-ALS training arm. Twenty-eight cardiothoracic surgery (CTS) residents were included and subsequently assessed in a moulage scenario in groups of two, either participating as a leader or surgeon. The primary binary outcomes were two time targets: (1) delivering three stacked shocks within 1 min and (2) resternotomy within 5 min. Secondary outcomes were the number of protocol mistakes made and a questionnaire after the VR simulator. The conventional training group administered stacked shocks within 1 min in 43% (n = 6) of cases, and none in the VR group reached this target, missing it by an average of 25 s. The resternotomy time target was reached in 100% of the cases (n = 14) in the conventional training group and in 83% of the cases (n = 10) in the VR group. The VR group made 11 mistakes in total versus 15 for those who underwent conventional training. Participants reported that the VR simulator was useful and easy to use. The results show that the VR simulator can provide adequate CSU-ALS training. Moreover, VR training results in fewer mistakes suggesting that repetitive practice in an immersive environment improves skills.

DETERMINING THE EFFECTIVENESS OF CARDIOPULMONARY RESUSCITATION USING A MANIKIN

Objectives: Many studies have shown that people applying cardiopulmonary resuscitation (CPR) cannot make sustained and effective CPR due to fatigue, sweaty hands, broken ribs, inability to determine the correct area etc. Thus, this study aimed to determine the effectiveness and sustainability of CPR quality using a CPR manikin by following the 2015 CPR guidelines.Material and Method: This study was carried out with 153 student volunteers from seven different health sciences programmes at Izmir University of Economics. All students were trained in first aid and basic life support in the previous school academic year. The time and effectiveness of CPR applied on a CPR manikin (Ambu® Manikin) were measured. The students’ body positioning, blowing capacities, depth of pressures and effective pressure durations were evaluated and numerical data were analysed by t-test. P-value &amp;lt;0.05 was accepted as statistically significant. Data were analysed using SPSS version 21.Results: Of the 153 student volunteers, 60.1% were female and 39.9% were male. The average student age was 20.32 ± 03 years, the average height was 169.20 ± 26 cm and the average weight was 65.12 ± 42 kg. The average effective CPR duration was 2.95 ± 0.86 min, the average pressure depth was 4.33 cm and the average depth of pressures and effective pressure was 0.6 liters. The position of the arms was correct in 83% of the students. In 81% of the cases, the application site was correctly determined. Moreover, 68.6% of the students were able to sustain the pumping activity of the heart. In all parameters other than the arms position, male students had better results than female students. CPR is a very important live-saving method to increase the chance of survival. However, this practice is ineffective unless applied correctly and timely.Conclusion: This study showed that manual chest compression on the manikin became ineffective in both speed and effectiveness just within minutes. This shows that there is a very important deficiency in this area where human life depends on minutes. Thus, developing and commissioning auxiliary external chest compression device that can perform CPR, especially in pre-hospital setting, ambulance and emergency departments, is important.

Effect of thoracic stiffness on chest compression performance - A prospective randomized crossover observational manikin study

IntroductionHuman thoracic stiffness varies and may affect the performance during external chest compression (ECC). The Extra Compression Spring Resusci® QCPR Anne manikin is a high-fidelity training model developed for ECC training that can account for varying levels of thoracic stiffness. The aim of this study was to use this training model to investigate the effects of thoracic stiffness on ECC biomechanics and qualities. MethodsFifty-two participants performed standard ECC on the manikin with different thoracic springs to simulate varying levels of thoracic stiffness. The MatScan Pressure Measurement system was used to investigate the ECC pressure and force distribution. ResultsThe hard spring group’s performance had a better complete recoil ratio (90.06 ± 24.84% vs. 79.75 ± 32.17% vs. 56.42 ± 40.15%, p < 0.001 at second minute), but was more inferior than the standard and soft spring groups in overall quality, ECC depth (34.17 ± 11.45 mm vs. 41.25 ± 11.42 mm vs. 51.88 ± 7.56, p < 0.001 at second minutes), corrected depth ratio, and corrected rate ratio. The hard spring group had less radial-ulnar peak pressure difference (kgf/cm2) than the other two groups (−0.28 ± 0.38 vs. −0.30 ± 0.43 vs. −0.47 ± 0.34, p = 0.01), demonstrating that more symmetrical pressure was applied in the hard spring group. The soft spring group had better ECC depth, corrected depth ratio, corrected rate ratio, and overall quality, but its performance in complete recoil was inferior, and unbalanced pressure was more liable to cause injury. Hard springs caused operator fatigue easily. ConclusionThe thoracic stiffness greatly affected the performance of ECC. Our findings provided information for more effective ECC practices and training.

Evaluation of resuscitative endovascular balloon occlusion of the aorta catheter placement and comparison to resuscitative thoracotomy with aortic clamping in cadaver dogs.

To describe placement of an aortic occlusion catheter in aortic zone 1 (Z1) and aortic zone 3 (Z3) in dogs and to compare time to placement in these zones with and without external chest compressions (ECC). Additional evaluations of time to placement in Z1 with time for resuscitative thoracotomy with aortic clamping (RT-AC) were performed. Prospective ex vivo study. University teaching hospital. Ten canine cadavers. Ten cadaver dogs were obtained from client donation after euthanasia. Cadavers were randomized to have balloon catheter placement into the right or left femoral artery via cutdown, with or without ECC. The xiphoid was used as an external anatomical landmark for Z1, and the spinous process of the 5th lumbar vertebra was used for Z3. Balloon placement was confirmed with radiography. Time to balloon placement in Z1 and Z3 and time to RT-AC were recorded. Median body weight was 23.5kg (9-40kg). Median time to Z1 placement was 6.6 minutes (4.6-12.4minutes) with ECC and 6.9 minutes (3.3-13.1minutes) without ECC and was not statistically different (P=0.5). Median time to RT-AC was 1 minute (0.6-1.4minutes), which was significantly faster than time to balloon placement in Z1 with or without ECC (P=0.004 and P=0.002, respectively). Endovascular balloon occlusion of the aorta can be achieved by cutdown with and without ECC, but RT-AC is faster. Successful balloon position in Z1 could be achieved with knowledge of external anatomical landmarks, but landmarks for Z3 need further study.

Biomechanical analysis of force distribution in one-handed and two-handed child chest compression- a randomized crossover observational study

BackgroundEven force distribution would generate efficient external chest compression (ECC). Little research has been done to compare force distribution between one-hand (OH) and two-handed (TH) during child ECC. Therefore, this study was to investigate force distribution, rescuer perceived fatigue and discomfort/pain when applying OH and TH ECC in children.MethodsCrossover manikin study. Thirty-five emergency department registered nurses performed lone rescuer ECC using TH and OH techniques, each for 2 min at a rate of at least 100 compressions/min. A Resusci Junior Basic manikin equipped with a MatScan pressure measurement system was used to collect data. The perceived exertion scale (modified Borg scale) and numerical rating scale (NRS) was applied to evaluate the fatigue and physical pain of delivering chest compressions.ResultsThe maximum compression force (kg) delivered was 56.58 ± 13.67 for TH and 45.12 ± 7.90 for OH ECC (p < 0.001). The maximum-minimum force difference force delivered by TH and OH ECC was 52.24 ± 13.43 and 41.36 ± 7.57, respectively (p < 0.001). The mean caudal force delivered by TH and OH ECC was 29.45 ± 16.70 and 34.03 ± 12.01, respectively (p = 0.198). The mean cranial force delivered by TH and OH ECC was 27.13 ± 11.30 and 11.09 ± 9.72, respectively (p < 0.001). The caudal–cranial pressure difference delivered by TH and OH ECC was 19.14 ± 15.96 and 26.94 ± 14.48, respectively (p = 0.016). The perceived exertion and NRS for OH ECC was higher than that of the TH method (p < 0.001, p = 0.004, respectively).ConclusionsThe TH method produced greater compression force, had more efficient compression, and delivered a more even force distribution, and produced less fatigue and physical pain in the rescuer than the OH method.Trial registrationThe Cheng Kung University Institutional Review Board A-ER-103-387. http://nckuhirb.med.ncku.edu.tw/sitemap.php

Knowledge, attitude, and practice of paramedics in Qatar regarding the use of personal protective equipment against COVID-19

Background: Internationally, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, causing corona virus disease (COVID-19), has increased the demand on healthcare services and resources1. The proper use of personal protective equipment (PPE) by paramedics has recently become apparent2. The risk of COVID-19 transmission has increased during prehospital life-saving procedures generating aerosols such as non-invasive ventilation, tracheal intubation, and external chest compressions, especially when working in a confined ambulance compartment3. Paramedics are encouraged to increase body-surface-isolation by donning additional PPE (high-filtration facemasks/face shields/surgical gowns/surgical hoods) during all patient encounters2. This study aimed to better understand paramedics’ knowledge, attitude, and practice of PPE utilization in the State of Qatar during the COVID-19 pandemic. Methods: This prospective and quantitative study focused on the collection of descriptive data utilizing a purpose-designed online survey. Around 1300 frontline paramedics employed by Hamad Medical Corporation Ambulance Service (HMCAS) were invited via email to participate in the study. Results: 282 paramedics completed the survey. 90.4% were male and 78.7% had a bachelor&apos;s degree. 97.1% completed the mandatory HMCAS online infection control training program, 82.9% completed an N95 mask fit test in the last 5 years, and 91.5% completed the hand hygiene training program. The study found paramedics to be knowledgeable about COVID-19 and its transmission (98.2%) (Table 1). Paramedics’ attitude was mainly positive towards the use of PPE to prevent the spread of the virus which was synchronous with their practice. Conclusion: An effective model to curb the spread of COVID-19 amongst healthcare workers must consider the knowledge, attitude, and practice of first responders. This sample demonstrated a strong knowledge of COVID-19 and its transmission. Their overall positive attitude and good infection control practices were a demonstrative effort to mitigate risks associated with the spread of the virus in the prehospital setting.

Effects of manual hyperinflation with rib cage compression and endotracheal suctioning on arterial blood gas parameters in mechanically ventilated patients at a university hospital, Egypt

BackgroundManual hyperinflation and expiratory rib cage compression are methods of chest physiotherapy. They are commonly applied but their value and their early utilization managing mechanically ventilated remain questionable. The purpose of the study was to investigate the effects of manual hyperinflation with rib cage compression and endotracheal suctioning on arterial blood gas parameters in mechanically ventilated patients.ResultsSeventy mechanically ventilated patients at a teaching hospital in Egypt were assigned to the clinical trial study. The age of more than half of the studied samples ranged between 60 and 69 years with a mean age of 53.64 ± 16.44 years. Initially, the ABG parameters were assessed. Then, the patients were exposed to manual hyperinflation for 5 min and 20 min external expiratory chest compression followed by endotracheal suctioning. Later, ABG parameters were assessed again and compared to the initial one. The findings revealed significant differences in ABG parameters before and after completion of MHI and ERCC and ETT suctioning in relation to PaO2 (t = 3.892) and SaO2 (t= 5.904). Also, it showed significant improvement in PaO2 and SaO2 after the completion of interventions, while no significant differences were found in other ABG parameters. This study was registered retrospectively with an ISRCTN number 39983 on 5/6/2021.ConclusionApplying manual hyperinflation with rib cage compression and endotracheal suctioning improved mainly the arterial oxygenation parameters in mechanically ventilated patients despite no significant changes observed in other ABG parameters.

Identification of an optimal CPR chest compression protocol.

In this study, we used a high-fidelity integrated computational model of the respiratory and cardiovascular systems to investigate cardiopulmonary resuscitation (CPR) after cardiac arrest in a virtual healthy subject. For the purpose of this work, a newly developed thoracic model has been integrated to the current model, to study the influence of external chest compressions upon the arrested circulation during CPR. We evaluated the chest compression (CC) parameters, namely, end compression force, compression rate, and duty cycle to optimize the coronary perfusion pressure and the systolic blood pressure, using a genetic algorithm. While the sternal displacement associated with the CC force agreed with the ERC guidelines, the CC rate and duty cycle were respectively higher and lower than the ones recommended by the ERC guidelines. The effect of these CC parameters on cardiac output (CO) were also assessed. The end compression force was the parameter with the largest impact on CO, while the compression rate and duty cycle scarcely influence it.Relevance- Our results may aid in understanding the underlying pathophysiology of cardiac arrest and help guide research into the refinement of CPR strategies, without sacrificing animals or conducting clinical trials, which are difficult to undertake in crisis scenarios.

Effectiveness on Simulation Teaching Regarding Cardio Pulmonary Resuscitation among Workers of State Transport Depot

Introduction: Cardiopulmonary resuscitation is the technique of life-saving procedure in that artificial ventilation uses external chest compressions to maintain circulation flow of the heart and oxygenation during cardiac arrest. Many peoples in the developed and developing countries have taken known education of Cardiopulmonary resuscitation training which was launched jointly by Universal Medical Assistance International Center.&#x0D; Objectives: 1. To evaluate the previous knowledge and skill regarding CPR among workers of ST Depot. 2. To evaluate effectiveness and correlation the post-test knowledge and skill score regarding CPR among workers of ST Depot. 3. To identify the association with the post-test skill score regarding CPR among workers of ST Depot.&#x0D; Methodology: In this study, will the effectiveness of simulation teaching regarding cardiopulmonary resuscitation the sample will be the 100 ST depot workers. The workers will select according to inclusion and exclusion criteria as well as the Purposive sampling technique. One group pre-test and post-test design. It will be conducted at State Transport Depot. Wardha Maharashtra, India respectively. The data will be collected by using questionnaires and an observational checklist for simulation teaching on cardiopulmonary resuscitation.&#x0D; Conclusion: It is concluded that the effectiveness of simulation teaching on CPR was found to be effective in improving the knowledge and skill of workers of ST depot.

Resuscitation After Cardiac Surgery Awareness an Egyptian Multicentre Survey

Abstract Introduction There has been an increasing recognition that cardiac surgery patients have different resuscitative needs than other medical and surgical patients who experience in-hospital cardiac arrest. This was addressed in the 2010 European Resuscitation Council Guidelines and the 2010 American Heart Association Guidelines. However, it’s unknown how widely the guidelines are practiced, or a training protocol is followed in different units in Egypt. Objectives This national survey aims to identify the views and common practice of Egyptian cardiac teams regarding resuscitation after cardiac surgery. Methods A 21-question survey is created based on a prior survey used by the EACTS guidelines committee. Questions included the following topics: Participants demographics, Prevalence of cardiac arrest in the intensive care unit, Cardiac arrest with ventricular fibrillation or non-shockable rhythm, Emergency resternotomy technique, Training and arrest protocols. Survey dissemination was through social media platforms, mobile messaging applications and emails during the time period between November 2020 and January 2021. Results Of 126 responses, 95 were suitable for inclusion. Responses were from 11 centres across Egypt. 68.5% of the respondents were surgeons while cardiac anaesthetists and intensivists formed 12.6% and 18.9% respectively. 76.8% of participants were middle-grade doctors, consultant participation was 23.2%. The median annual number of cases performed in the units was 480 and this ranged from 10 to 3000. The average percentage of cardiac arrests was 7%, Median survival to hospital discharge of all arrests was 33% For patients who go into VF after cardiac surgery, respondents would attempt a mean of 5 shocks with only 24.2% commencing defibrillation shocks before external cardiac massage, while the majority initiating CPR immediately. They would perform emergency resternotomy in a mean time of 12 mins and in 15 mins if the rhythm was not shockable. 56.8% would give 1 mg of adrenaline as soon the cardiac arrest was established, only 6.3% thought that it should be given rarely or not at all. If a surgeon was not immediately available 36.8% of respondents would be happy for any trained personnel to perform the emergency resternotomy while 58.9% expect only the surgeon to perform the resternotomy. 49.4% of the participants have not practised any training to perform an emergency sternotomy. 41% of the respondents state they occasionally practice or talk with the staff about it. Only 9.5% practice regularly on emergency sternotomies. 25% assume current training is enough and does not need modification, while 75% think tailored training is important and staff should be oriented about it in the future. Conclusion An action plan is required to improve the awareness of the junior surgeons with the Cardiac Advanced Life Support Protocol. Proper training of the intensive care staff to implement the protocol in a timely organised manner is needed. Assessment of the rhythm before starting external chest compressions is the corner stone in cardiac patients undergoing cardiac arrest. VF/pVT rhythm, 3 defibrillation shocks are given first; for the non- shockable rhythm, the emergency pacing switched on, this is followed by compressions till resternomtomy. Emergency resternotomy under 5 minutes is the only effective way to save patients with tamponade and extreme hypovolemia.

Design of a portable external cardiac compression device

Cardiopulmonary resuscitation (CPR) guidelines emphasize that external chest compressions should be started as soon as possible when CPR is performed in patients with cardiac arrest. Moreover, those guidelines stress on fast and hard compressions to make the chest fully rebound and minimize non-pressing time. Current mechanical recovery device has several problems such as displacement of the pressing position, high price, difficult to move, and easy dislocation of piston. Because of the physical loss of high-intensity unarmed CPR, the depth and frequency of external chest compression will decrease with the extension of CPR time, leading to CPR failure. Besides, there are other problems caused by non-professional staff, such as the deviation of compression position, the inaccuracy of compression depth and the unsatisfactory rebound of the chest wall. Based on the above factors, the medical staff from the intensive care unit of the Eighth Medical Center of the Chinese People's Liberation Army General Hospital designed a portable external chest cardiac compressor based on international CPR guidelines which obtained the National Utility Model Patent of China (ZL 2018 2 1173254.3). The portable external chest cardiac compressor is composed of a positioning sucker, elastic body, mounting shell, and pressing components. Rapid and accurate compression positioning, visible compression depth and full chest rebound can be achieved. This device is mobile, easy to operate, and suitable for a broad crowd and various occasions.

Manual external chest compression reverses respiratory failure in children with severe air trapping.

We report manual external chest compression (MECC) as an effective treatment for acute respiratory failure due to severe air trapping. In this retrospective study, we describe our experience with MECC administered to five children suffering from severe air trapping as a consequence of severe asthma or bronchiolitis. These children were admitted to the Pediatric Intensive Care Unit (PICU) with clinical and blood gases parameters compatible with acute respiratory failure. Before intubation MECC was performed. The results of blood gasses before, during, and after MECC showed gradual changes in PCO2 over time indicating the improvement in tidal volume and ventilation. Respiratory failure resolved in all five children within 4 h with no complications. The need for intubation and mechanical ventilation was avoided, and all children were discharged from the PICU within 48 h.

Biomechanical analysis of force distribution in one-handed and two-handed adult chest compression: a randomised crossover observational study

IntroductionThe standard method of chest compression for adults is a two-handed procedure. One-handed external chest compression (ECC) is used in some situations such as during transport of patients who had...

Paradoxical Effect of Chest Wall Compression on Respiratory System Compliance: A Multicenter Case Series of Patients With ARDS, With Multimodal Assessment

Paradoxical Effect of Chest Wall Compression on Respiratory System Compliance: A Multicenter Case Series of Patients With ARDS, With Multimodal Assessment