High-quality CPR Research Articles

Mechanical chest compression does not seem to improve outcome after out-of hospital cardiac arrest. A single center observational trial

AimRecently three large post product placement studies, comparing mechanical chest compression (cc) devices to those who received manual cc, found equivalent outcome results for both groups. Thus the question arises whether those results could be replicated using the devices on a daily routine. MethodsWe prospectively enrolled 948 patients over a 12 months period. Chi-Square test and Mann–Whitney-U test were used to assess differences between “manual” and “mechanical” cc subgroups. Uni- and multivariate Cox regression hazard analysis were used to assess the influence of cc type on survival. ResultsA mechanical cc device was used in 30.1% (n=283) cases. Patients who received mechanical cc had a significantly worse neurological outcome – measured in cerebral performance category (CPC) – than the manual cc group (56.8% vs. 78.6%, p=0.009). Patients receiving mechanical cc were significantly younger, more were male and were more likely to have bystander CPR and an initially shock-able ECG rhythm. There was no difference in the quality of CPR that might explain the worse outcome in mechanical cc patients. ConclusionEven with high quality CPR in both, manual and mechanical cc groups, outcome in patients who received mechanical cc was significantly worse. The anticipated benefits of a higher compression ratio and a steadier compression depth of a mechanical cc device remain uncertain. In this study selection for mechanical cc was not standardized, and was non-random. This merits further investigation. Further research on how mechanical cc is chosen and used should be considered.Clinical trial registration: https://ekmeduniwien.at/core/catalog/2013/ (EK-Nr:1221/2013)

A mechanical chest compressor closed-loop controller with an effective trade-off between blood flow improvement and ribs fracture reduction.

Chest compression (CC) is a significant emergency medical procedure for maintaining circulation during cardiac arrest. Although CC produces the necessary blood flow for patients with heart arrest, improperly deep CC will contribute significantly to the risk of chest injury. In this paper, an optimal CC closed-loop controller for a mechanical chest compressor (OCC-MCC) was developed to provide an effective trade-off between the benefit of improved blood perfusion and the risk of ribs fracture. The trade-off performance of the OCC-MCC during real automatic mechanical CCs was evaluated by comparing the OCC-MCC and the traditional mechanical CC method (TMCM) with a human circulation hardware model based on hardware simulations. A benefit factor (BF), risk factor (RF) and benefit versus risk index (BRI) were introduced in this paper for the comprehensive evaluation of risk and benefit. The OCC-MCC was developed using the LabVIEW control platform and the mechanical chest compressor (MCC) controller. PID control is also employed by MCC for effective compression depth regulation. In addition, the physiological parameters model for MCC was built based on a digital signal processor for hardware simulations. A comparison between the OCC-MCC and TMCM was then performed based on the simulation test platform which is composed of the MCC, LabVIEW control platform, physiological parameters model for MCC and the manikin. Compared with the TMCM, the OCC-MCC obtained a better trade-off and a higher BRI in seven out of a total of nine cases. With a higher mean value of cardiac output (1.35L/min) and partial pressure of end-tidal CO2 (15.7mmHg), the OCC-MCC obtained a larger blood flow and higher BF than TMCM (5.19 vs. 3.41) in six out of a total of nine cases. Although it is relatively difficult to maintain a stable CC depth when the chest is stiff, the OCC-MCC is still superior to the TMCM for performing safe and effective CC during CPR. The OCC-MCC is superior to the TMCM in performing safe and effective CC during CPR and can be incorporated into the current version of mechanical CC devices for high quality CPR, in both in-hospital and out-of-hospital CPR settings.

Visual assessment of CPR quality during pediatric cardiac arrest: Does point of view matter?

AimIn many clinical settings, providers rely on visual assessment when delivering feedback on CPR quality. Little is known about the accuracy of visual assessment of CPR quality. We aimed to determine how accurate pediatric providers are in their visual assessment of CPR quality and to identify the optimal position relative to the patient for accurate CPR assessment. MethodsWe videotaped high-quality CPR (based on 2010 American Heart Association guidelines) and 3 variations of poor quality CPR in a simulated resuscitation, filmed from the foot, head and the side of the manikin. Participants watched 12 videos and completed a questionnaire to assess CPR quality. ResultsOne hundred and twenty-five participants were recruited. The overall accuracy of visual assessment of CPR quality was 65.6%. Accuracy was better from the side (70.8%) and foot (68.8%) of the bed when compared to the head of the bed (57.2%; p<0.001). The side was the best position for assessing depth (p<0.001). Rate assessment was equivalent between positions (p=0.58). The side and foot of the bed were superior to the head when assessing chest recoil (p<0.001). Factors associated with increased accuracy in visual assessment of CPR quality included recent CPR course completion (p=0.034) and involvement in more cardiac arrests as a team member (p=0.003). ConclusionHealthcare providers struggle to accurately assess the quality of CPR using visual assessment. If visual assessment is being used, providers should stand at the side of the bed.

4종류의 구급장비 및 마루(Floor) 위에서 시행한 가슴압박 에너지(kg)측정 실험에 관한 연구

The purpose of this study is to investigate the effect of high quality CPR using the 4 types of rescue device equipment and chest compressions energy measurement in pre-hospital settings. So, we used the mode to insert load cell in ALS Skill master Manikin to develop CFMM(Compression Force Measurement Manikin) on main stretcher, CPR board, long spine board, scoop stretcher and floor. And, our research team could know that the main stretcher needed average force of 32.55 (<TEX>${\pm}1.01$</TEX>) kg, CPR board of 27.23 (<TEX>${\pm}1.08$</TEX>) kg, long spine board of 27.13 (<TEX>${\pm}1.18$</TEX>) kg, Scoop Stretcher of 27.38 (<TEX>${\pm}1.05$</TEX>) kg and Floor of 27.24 (<TEX>${\pm}0.93$</TEX>) kg. CPR board must be necessary in the case of CPR on main stretcher in a moving ambulance. But if the condition of patient's back surface is the removable stretcher and the long spine plate, the patient doesn't have to be spent time to use a CPR board. Furthermore, this research suggests to consider that how to take advantage of the education to students for the equipment to check in real time the energy(kg) requirement of chest compressions.

A new chest compression depth feedback algorithm for high-quality CPR based on smartphone.

Although many smartphone application (app) programs provide education and guidance for basic life support, they do not commonly provide feedback on the chest compression depth (CCD) and rate. The validation of its accuracy has not been reported to date. This study was a feasibility assessment of use of the smartphone as a CCD feedback device. In this study, we proposed the concept of a new real-time CCD estimation algorithm using a smartphone and evaluated the accuracy of the algorithm. Using the double integration of the acceleration signal, which was obtained from the accelerometer in the smartphone, we estimated the CCD in real time. Based on its periodicity, we removed the bias error from the accelerometer. To evaluate this instrument's accuracy, we used a potentiometer as the reference depth measurement. The evaluation experiments included three levels of CCD (insufficient, adequate, and excessive) and four types of grasping orientations with various compression directions. We used the difference between the reference measurement and the estimated depth as the error. The error was calculated for each compression. When chest compressions were performed with adequate depth for the patient who was lying on a flat floor, the mean (standard deviation) of the errors was 1.43 (1.00) mm. When the patient was lying on an oblique floor, the mean (standard deviation) of the errors was 3.13 (1.88) mm. The error of the CCD estimation was tolerable for the algorithm to be used in the smartphone-based CCD feedback app to compress more than 51 mm, which is the 2010 American Heart Association guideline.

구급차 내에서의 심폐소생술 방법에 관한 연구

이 연구는 소방에 근무하는 응급구조사에 의해 시행되는 구급차 내 심폐소생술 방법에 관한 연구이다. 연구 대상은 경기도 관할 780명으로 2012년 보수교육 종료 후 설문을 통하여 수집하였다. 일반적 특성, 가슴압박 방법(한 손 가슴압박 VS 두 손 가슴압박), 심폐소생술 방법(표준심폐소생술 VS 가슴압박소생술) 등에 대하여 Chi-square test, t-test. ANOVA로 분석하였다. 한 손을 이용한 가슴압박 14.0%, 두 손을 이용한 가슴압박 86.0%를 보였고, 표준심폐소생술(가슴압박 VS 인공호흡)은 28.3%, 가슴압박소생술 71.7%를 보였다. 고품질의 심폐소생술을 위해서는 심정지 환자의 구급 출동만이라도 운전자 포함 3명 이상의 응급구조사가 출동할 수 있도록 탄력적인 인력 운영 방안이 필요하며, 역량 강화를 위한 심폐소생술의 정기적인 교육이 필요하다. The purpose of this study is to investigate the CPR within ambulance. The Subjects were 890 emergency medical technicians in fire department in Gyeonggido. After continuing education program, the emergency medical technicians completed the questionnaires from January to February, 2012. Questionnaire consisted of demographic characteristics, method of chest compression (one handed or two handed), chest compression - ventilation ratio, and hands only CPR. Data were analyzed by frequency analysis and Chi-square test, t-test. One-way analysis of variance (ANOVA) was followed by Scheffe post-hoc test to analyze changes in all parameters between all groups. One handed chest compression accounted for 14.0% and two handed chest compression accounted for 86.0%. Hands only CPR accounted for 71.7% and standard CPR (30:2) accounted for 28.3%. In order to perform the high quality CPR, as least three persons must be dispatched in the ambulance. The flexible management of manpower may improve the survival from the cardiac arrest. A systemic approach for educating and training EMT's in CPR is needed.

High Quality CPR and Mass Training: Is it achievable combination?

Purpose: ILCOR 2010 Guidelines stressed the importance of High Quality CPR to improve survival in cardiac arrest but it is also necessary to trainmore andmore people to increase the frequency of bystander CPR. The aim of this study is to evaluate the quality of chest compression after Mass Training and compare it to classic BLSD training. Methods: We enrolled 136 lay people (18–35 years) untrained in CPR onto one of two courses: course A (55 people) and course B (81 people). Course A was Mass Training consisting of 30min of theory and 45-min of practice performed on a personal low-budget inflatablemanikin (LaerdalMiniAnne)with an instructor:attendee:manikin ratio of 1:15:15. Course B was a classic BLSD course characterized by 1-h of theory and 4-h of practice on a classic BLS manikin (Laerdal LittleAnne) with an instructor:attendee:manikin ratio of 1:5:1. At the end of both courses and for each participant we evaluated 1-min compression-only CPR using a monitored manikin (Laerdal Wireless SkillReporter). The measured parameters were: compressions per minute (Cmin), percentage of adequate compression depth (target 5 cm,max 6 cm) (Cdepth%) and percentage of correctly released compressions (target 0 cm) (Crel%). Results: There was no difference between course A and course B regarding the Cmin median (115 (IQR, 108–121) vs. 120 (IQR, 113–126)) and the Crel% median (96% vs. 95%), whilst the Cdepth% median was better in Course A (89.1% vs. 67%). Conclusions:Results showthatMassTraining is at least as effective as classic BLSD Training according to all parameters analyzed. Mass Training attendees reached the target of chest compression depth more often than those on BLSD. This could be due to using a personal manikin instead of sharing one. Mass Training achieves the goal of training more and more people in High Quality CPR.

ABSTRACT 771

Background and aims: Pediatric Advanced Life Support (PALS) is designed to teach providers the skills needed during emergencies especially codes. Over a ten year period, survival of in-hospital cardiac arrest has improved but not the risk of brain damage. Resuscitation techniques are assessed during megacodes using low-fidelity mannequins and readiness is assumed adequate wirh certification. However due to infrequency of codes, skills decay may occur. Aims: This study was performed to assess the quality and timeliness of resucitation care and also to identify common skill deficiencies during simulated pediatric codes. Methods: An IRB waived descriptive study was performed on PALS certified participants which consisted of 21 physicians and 13 nurses. Each were presented with a variety of pulseless arrest code scenarios ranging from PEA to unstable SVT at the SimLab on a high fidelity manequin, Laerdal SimBaby. Majority of the physicans and half of the nurses had simulation experience. Essential resuscitation skills in providing a high quality CPR was collected and recorded by an independent observer. Results: Performance of both groups was similar in most parameters tested. The physicians performed significantly better than the nurses in airway management. However, both groups performed poorly on immediate provision of of high quality CPR. Other unsatisfactory skills identified were asynchronous ventilation, inadequate frequency of compressions and failure to rotate chest compressors. Although correct rhythm was recognized, decision to defibrillate or cardiovert was delayed. Conclusions: PALS certification does not guarantee satisfactory CPR. Simulation based medical education can help identify and strengthen resuscitation skills and should be incorporated with PALS certification.

Lifeguards’ cardiopulmonary resuscitation quality performance: Self-perception vs. Reality

Purpose: ILCOR 2010 Guidelines stressed the importance of High Quality CPR to improve survival in cardiac arrest but it is also necessary to trainmore andmore people to increase the frequency of bystander CPR. The aim of this study is to evaluate the quality of chest compression after Mass Training and compare it to classic BLSD training. Methods: We enrolled 136 lay people (18–35 years) untrained in CPR onto one of two courses: course A (55 people) and course B (81 people). Course A was Mass Training consisting of 30min of theory and 45-min of practice performed on a personal low-budget inflatablemanikin (LaerdalMiniAnne)with an instructor:attendee:manikin ratio of 1:15:15. Course B was a classic BLSD course characterized by 1-h of theory and 4-h of practice on a classic BLS manikin (Laerdal LittleAnne) with an instructor:attendee:manikin ratio of 1:5:1. At the end of both courses and for each participant we evaluated 1-min compression-only CPR using a monitored manikin (Laerdal Wireless SkillReporter). The measured parameters were: compressions per minute (Cmin), percentage of adequate compression depth (target 5 cm,max 6 cm) (Cdepth%) and percentage of correctly released compressions (target 0 cm) (Crel%). Results: There was no difference between course A and course B regarding the Cmin median (115 (IQR, 108–121) vs. 120 (IQR, 113–126)) and the Crel% median (96% vs. 95%), whilst the Cdepth% median was better in Course A (89.1% vs. 67%). Conclusions:Results showthatMassTraining is at least as effective as classic BLSD Training according to all parameters analyzed. Mass Training attendees reached the target of chest compression depth more often than those on BLSD. This could be due to using a personal manikin instead of sharing one. Mass Training achieves the goal of training more and more people in High Quality CPR.

Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial

ObjectiveTo compare integrated automated load distributing band CPR (iA-CPR) with high-quality manual CPR (M-CPR) to determine equivalence, superiority, or inferiority in survival to hospital discharge. MethodsBetween March 5, 2009 and January 11, 2011 a randomized, unblinded, controlled group sequential trial of adult out-of-hospital cardiac arrests of presumed cardiac origin was conducted at three US and two European sites. After EMS providers initiated manual compressions patients were randomized to receive either iA-CPR or M-CPR. Patient follow-up was until all patients were discharged alive or died. The primary outcome, survival to hospital discharge, was analyzed adjusting for covariates, (age, witnessed arrest, initial cardiac rhythm, enrollment site) and interim analyses. CPR quality and protocol adherence were monitored (CPR fraction) electronically throughout the trial. ResultsOf 4753 randomized patients, 522 (11.0%) met post enrollment exclusion criteria. Therefore, 2099 (49.6%) received iA-CPR and 2132 (50.4%) M-CPR. Sustained ROSC (emergency department admittance), 24h survival and hospital discharge (unknown for 12 cases) for iA-CPR compared to M-CPR were 600 (28.6%) vs. 689 (32.3%), 456 (21.8%) vs. 532 (25.0%), 196 (9.4%) vs. 233 (11.0%) patients, respectively. The adjusted odds ratio of survival to hospital discharge for iA-CPR compared to M-CPR, was 1.06 (95% CI 0.83–1.37), meeting the criteria for equivalence. The 20min CPR fraction was 80.4% for iA-CPR and 80.2% for M-CPR. ConclusionCompared to high-quality M-CPR, iA-CPR resulted in statistically equivalent survival to hospital discharge.

Awareness of basic life support among dental practitioners.

Background:It is important that every member of our community should be trained in effective BLS technique to save lives. At least doctors including dental practitioners, and medical and paramedical staff should be trained in high quality CPR, as it is a basic medical skill which can save many lives if implemented timely.Aim:Our aim was to study the awareness of Basic Life Support (BLS) among dental students and practitioners in New Delhi.Materials and Methods:This cross sectional study was conducted by assessing responses to 20 selected questions pertaining to BLS among dental students, resident doctors/tutors, faculty members and private practitioners in New Delhi. All participants were given a printed questionnaire where they had to mention their qualifications and clinical experience, apart from answering 20 questions.Statistical Analysis:Data was collected and evaluated using commercially available statistical package for social sciences (SPSS version 12).Results:One hundred and four responders were included. Sadly, none of our responders had complete knowledge about BLS. The maximum mean score (9.19 ± 1.23) was obtained by dentists with clinical experience between 1-5 years.Conclusion:To ensure better and safer healthcare, it is essential for all dental practitioners to be well versed with BLS.

Out of Hospital Cardiac Arrest Management by First Responders: Retrospective Review of a Fire Fighter First Responder Program

Introduction Over 9,500 people die annually in Australia from sudden cardiac arrest, with strong evidence suggesting early high quality CPR and early counter shock being paramount for improving survival from cardiac arrest. It has also been shown that first responder programs have been able to reduce response times and increase survival rates for out-of-hospital cardiac arrest. The objective of this study was to examine data from the first seven years of an Australian out-of-hospital cardiac arrest first responder program where fire fighters provided basic life support. Methods This study was a retrospective cohort study of all cardiac arrests attended by the Metropolitan Fire and Emergency Services Board (MFESB) as part of the Emergency Medical Response program over a seven-year period in Melbourne, Victoria, Australia. Results The MFESB attended 4,450 cardiac arrests. The majority of patients presented in asystole 669 (63.7%) with just 243 (23.1%) presenting in a shockable rhythm. The majority of patients in cardiac arrest were males (64.2%) and the mean age of the patients was 67.5 years. The MFESB median response time during the study period was 5.7 minutes (IQR 2.25 minutes), range of 0.15 minutes to 31.7 minutes, which remained stable over the seven years. Patients spent a median time of 4.6 minutes (0.02 seconds to 36.5 minutes) in the care of fire fighters prior to the arrival of EMS. The rhythm on handover to paramedics was asystole in 787 (75.1%) cases with no shockable rhythms. One in three (31.3%) patients received bystander CPR, with a significant rise in the rate of bystander CPR occurring over the last two years. Conclusion This study demonstrated acceptable response times to cardiac arrests and a low bystander CPR rate prior to arrival of the MFESB. The incidence of a shockable rhythm on arrival of the MFESB was low with the main rhythm being asystole. The main rhythm on handover to paramedics was asystole with non-shockable rhythms. Further research is required to determine the effect on patient outcomes.

Abstract 285: Does the Real-Time Audio Feedback From an Automated External Defibrillator Enhance Cardiopulmonary Resuscitation Quality During Emergency Resuscitation?

Objective: The 2010 AHA guidelines have outlined the importance of providing early high-quality CPR in conjunction with an AED to enhance survial outcomes post sudden cardiac arrest. However, there is little information available as to how real-time feedback may positively enhance the quality of compression rates. The purpose of this study was to evaluate the impact of CPR feedback given by out-of-hospital (OOH) responders following SCA. Response to feedback was gauged by analysing changes in the impedance cardiogram (ICG) and ECG waveforms recorded by the AED during OOH resuscitation in an attempt to establish if the rescuer responded to audible instruction. Methods: Data was collected from events recorded by HeartSine Samaritan AEDs over a five month period. A total of nine events were received and assessed. Event files that included the ECG and ICG recordings were downloaded using SaverEvo® Software and analysed. Data also included the time of each instruction, the nature of the instruction (e.g. push harder, push faster, push slower, good compressions) and the associated changes in the ECG and ICG waveforms were interpreted to assess reaction times where appropriate. Findings: A total of 177 instructional CPR prompts were given to the rescuers over nine events, 70 (39.5%) of which resulted in a positive modification of CPR rate or force. On average there was a 1.44 second delay in reaction time to each prompt. Of the 70 positive changes in the ICG, 30 of the cases showed a corresponding change in the ECG indicating that the ICG is a better indicator of CPR efficacy. Conclusions: This study demonstrates that real-time feedback during CPR is beneficial in enhancing the quality of CPR in emergency resuscitation. Even where there was no response to the prompt, CPR at least continued at the same rate suggesting that there was no detrimental affect on the quality of CPR. Furthermore, the results indicate that ICG is an effective way to monitor the quality of rescuer CPR.

Mortality Factors in Out-of-Hospital Cardiac Arrest Patients: A Nationwide Population-based Study in Taiwan

Survival after an out-of-hospital cardiac arrest (OHCA) depends on the integrity of the community chain of survival, including optimal and high-quality CPR, early defibrillation, and postresuscitation care. Older OHCA patients may have worse outcomes than the younger ones. This study aimed to find out the influence of age and other factors on the outcomes of OHCAs. We analyzed the original claims data of the National Health Insurance from 2005 to 2007, and identified all patients who were sent to the emergency department with OHCA. Traumatic OHCA patients and patients without codes for intubation and CPR were excluded. Survival rates between the different groups were identified. Factors such as age, sex, pre-existing comorbidities, and different hospital levels were adjusted in a logistic regression model for survival. A total of 1673 OHCA cases were identified. Overall, the 1-month survival rates were similar in each year. However, the survival rates for those who were treated in medical centers improved from 3.4% (2005) to 6.8% (2007) ( p < 0.01). Of all OHCA patients admitted to the emergency room, patients older than 75 years of age had significantly worse survival rates. Patients with the same profile, but who were admitted to hospitals, had nonsignificant worse survival rates. Our study shows that age is no longer an important factor for survival in admitted patients. In addition, medical centers are better for the OHCA patients, after adjusting for other factors. This finding suggests that we still need to try our best to treat older OHCA patients without discrimination.

Peri-mortem laparotomy in a patient with a ruptured intra-abdominal pregnancy

Intra-abdominal pregnancies can present at an advanced stage of pregnancy and can have the potential for life-threatening rupture and haemorrhage. The purpose of this case report was to discuss the early recognition and prompt management options of a patient with a life threatening ruptured intra-abdominal pregnancy. We report what we believe to be the first case of a patient who presented with an intra-abdominal pregnancy who underwent a peri-mortem laparotomy in the Emergency Centre following a cardiac arrest, and who exhibited a return to spontaneous circulation (ROSC). Peri-mortem laparotomy/thoracotomy coupled with high quality CPR and resuscitation may be lifesaving in a patient with a life threatening ruptured intra-abdominal pregnancy. Les grossesses extra-utérines peuvent se présenter à un stade avancé de la grossesse et peuvent entraîner une rupture mortelle et une hémorragie. L’objet de cette observation était de discuter de l’identification précoce et des options de prise en charge rapide d’une patiente présentant une grossesse extra-utérine rompue mortelle. Nous faisons état de ce qui semble être le premier cas de patiente se présentant avec une grossesse extra-utérine et ayant subi une césarienne périmortem au service des urgences suite à un arrêt cardiaque, avec retour spontané de la circulation. Une césarienne/thoracotomie périmortem, associée à une réanimation cardio-respiratoire de qualité et aux techniques de réanimation, peut sauver la vie d’une patiente présentant une grossesse extra-utérine rompue mortelle.

Bone Cement Implantation Syndrome ( BCIS ) – A Case Report

A 51 year old male was admitted in our hospital with fracture neck of right femur and posted for bipolar hemiarthroplasty. Spinal anaesthesia was given in L2L3 space using 3.5ml 0.5% bupivacaine heavy with 25mcg fentanyl, with 25G quincke needle. During application of the high viscosity gentamycin bone cement, patient developed severe hypotension, bradycardia, hypoxia and cardiac arrest. High quality CPR started immediately, patient intubated and intravenous adrenaline 1mg given. After successful resuscitation surgery continued under general anaesthesia. Patient was post operatively ventilated and monitored in surgical ICU for next 6 hours and he made a full recovery.

이동 중 주들것에서 심폐소생술을 위해 개발된 보조발판(C-step)의 적용 효과

흉부압박의 중단을 최소화하는 심폐소생술은 환자의 생존율 향상을 위한 중요한 요소이다. 본 연구의 목적은 이동 중 주들것에서 보조발판(C-step) 장착 여부에 따른 심폐소생술 정확도 및 오류를 파악하는 데 있다. 연구대상자는 C도 10개 소방서에 근무하고 있는 1급 응급구조사 70명(대조군 35명, 실험군 35명)으로 주들것에서 심폐소생술 정확도가 측정되었다. 연구결과 C-step을 적용한 주들것에서 심폐소생술은 적절한 흉부압박 높이와 안정된 자세를 제공해 흉부압박 정확도를 높이고(t=65.104, p=.000), 인공호흡 시 적절한 환기량을 공급하여 인공호흡 정확도를 높이며(t=5.207, p=.000) 심폐소생술 자신감 또한 향상시키는 것으로 나타났다(t=-10.612, p=.000). 결론적으로 주들것에 C-step 장착은 고품질의 심폐소생술(high quality CPR)을 충실히 수행해 심정지 환자의 생존율을 높이는데 도움이 될 것으로 사료된다. CPR with minimized hands-off time is one of integral factors for the improvement of the survival rate of patients. The purpose of this study was to examine the relationship of the installation of C-steps on the main stretcher to CPR accuracy and errors. The subjects in this study were 70 paramedics in 10 firehouses in the province of C(35 for control group, 35 for experimental group), and their CPR accuracy on the main stretchers was checked. As a result, it's found that the main stretchers equipped with the C-steps served to boost the accuracy of chest compression by creating suitable environments for that in terms of height and posture(t=65.104, p=.000), to improve the accuracy of artificial respiration by providing a proper amount of ventilation(t=5.207, p=.000), and to bolster the self-confidence of the paramedics about CPR(t=-10.612, p=.000). In conclusion, the mounting of C-steps on the main stretcher is expected to be of use for the improvement of the survival rate of cardiac-arrest patients by ensuring the precise performance of high-quality CPR.

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Introduction: Children transferred from community hospitals lacking specialized pediatric care are more ill than those presenting directly to pediatric care centers. Outcomes improve with pediatric consultation as does survival if providers adhere to management guidelines. Little research exists regarding whether telemedicine virtual presence can improve adherence to guidelines. Hypothesis: To evaluate impact of pediatric critical care medicine(PCCM) consultation via telemedicine vs. telephone on community hospital adherence to guidelines. Methods: We conducted a randomized controlled trial of in situ mock scenarios using high fidelity simulation of critically ill children presenting to a community hospital that progressed to cardiopulmonary arrest(CPA). Scenarios were randomized to PCCM consultation via telemedicine(intervention) or telephone(control). Primary outcome measure was time to verbalize intent to defibrillate pulseless ventricular tachycardia(PVT). Results: 30 scenarios were completed: 15 intervention and 15 control. Median time(interquartile range-IQR) to verbalizing intent to defibrillate PVT for scenarios was 36 seconds(IQR:12-63); in study arms: Intervention 33(IQR:12-63) vs. Control 39(IQR:11-103), p=0.6. Median time to actual defibrillation for scenarios was 223 seconds(IQR:149-277); in study arms: Intervention 214(IQR:154-262) vs. Control 232(IQR:149-348), p=0.8. Defibrillation in?180 seconds occurred in 37% of scenarios; in study arms: Intervention 33% vs. Control 40%, p=0.7. Correct compression:ventilation ratio was used in 67% of scenarios; in study arms: Intervention 80% vs. Control 53%, p=0.12. Verbalizing request for or use of backboard during CPR occurred in 80% of scenarios; in study arms: Intervention 100% vs. Control 60%, p=0.006. Conclusions: In simulated CPAs, telemedicine did not reduce time to verbalizing intent to defibrillate PVT, but trended toward improved adherence to CPR guidelines for compression:ventilation ratio and improved use of backboard as an adjunct to high quality CPR. This study revealed ways to enhance telemedicine consult, such as providing unobstructed views of the monitor and ensuring there is a focus on high quality resuscitation, i.e. defibrillating in?180 seconds.

Abstract 44: Outcomes of OHCA Not Improved After New Guideline Implementation in Taiwan: Nationwide Population-Based Research Using National Health Insurance Data

Background: Survival after out-of-hospital cardiac arrest (OHCA) depends on the integrity of the community chain of survival, including high quality CPR, early defibrillation, better hospital and post-resuscitation care. Recent studies from US showed the outcomes from OHCAs improved significantly after implementation of new resuscitation guideline. Our study, by using the population- based National Health Insurance data, was aimed to assess the factors associated patient outcomes and the improvement after guidelines 2005 implementation in Taiwan. Methods: From the claim data of one million beneficiaries of Taiwan National Health Insurance during the year of 2005 to 2008, all of patients who were sent to emergency department with diagnosis of OHCA were identified from the database (ICD 798, 798.1, 798.2, 798.9). Traumatic OHCA and patients without codes for intubation and CPR were excluded in our study. Factors such as age, gender, preexisting co-morbidities and different hospital levels were adjusted in a logistic regression model for survival analysis. All the survival cases were followed up for one year in our data-set. Results: 2,375 OHCA cases were identified from the four-year dataset. The survival rates were 7.3%(2005), 7.5%(2006), 7.2%(2007) and 6.5%(2008) (p&gt;0.05). And the survival rates was 7.4% in medical centers, 7.8% in regional hospitals and 5.0% in district hospitals (p&gt;0.05). In the logistic regression analysis model, for all the OHCA patients admitted to ER and to hospitals, none of the factors (including the age, gender, preexisting co-morbidities and different hospital levels) were significant for survival. Conclusions: After adjusting for age, gender and preexisting co-morbidities, our study shows that OHCA patients had equal outcomes between medical centers and non-medical centers. And our data also showed non-significant outcome improvement after guidelines 2005 implementation in Taiwan.

PALS update 2010

During the past decade, guidelines for cardiopulmonary resuscitation have focused on the importance of high quality CPR. The purpose is to temporarily maintain a circulation to vital organs until specialized treatment is available. In, essence, it has been a revolution in pediatric resuscitation in terms of coming full circle to the 1960s when basic CPR was first developed. A fifth component to the pediatric chain of survival has been added with emphasis on integrated post cardiac arrest care. With mounting scientific evidences, American Heart Association published new Pediatric Advanced life support 2010 guidelines in accordance with the established five yearly cycle of guideline changes.