Interruptions In Compressions Research Articles

High Variability in the Duration of Chest Compression Interruption is Associated With Poor Outcomes in Pediatric Extracorporeal Cardiopulmonary Resuscitation.

To determine the association between chest compression interruption (CCI) patterns and outcomes in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Cardiopulmonary resuscitation (CPR) data were collected using defibrillator-electrode and bedside monitor waveforms from pediatric ECPR cases between 2013 and 2021. Duration and variability of CCI during cannulation for ECPR was determined and compared with survival to discharge using Fishers exact test and logistic regressions with cluster-robust se s for adjusted analyses. Quaternary care children's hospital. Pediatric patients undergoing ECPR. None. Of 41 ECPR events, median age was 0.7 years (Q1, Q3: 0.1, 5.4), 37% (15/41) survived to hospital discharge with 73% (11/15) of survivors having a favorable neurologic outcome. Median duration of CPR from start of ECPR cannulation procedure to initiation of extracorporeal membrane oxygenation (ECMO) flow was 21 minutes (18, 30). Median duration of no-flow times associated with CCI during ECMO cannulation was 11 seconds (5, 28). Following planned adjustment for known confounders, survival to discharge was inversely associated with maximum duration of CCI (odds ratio [OR] 0.91 [0.86-0.95], p = 0.04) as well as the variability in the CCI duration (OR 0.96 [0.93-0.99], p = 0.04). Cases with both above-average CCI duration and higher CCI variability ( sd > 30 s) were associated with lowest survival (12% vs. 54%, p = 0.009). Interaction modeling suggests that lower variability in CCI is associated with improved survival, especially in cases where average CCI durations are higher. Shorter duration of CCI and lower variability in CCI during cannulation for ECPR were associated with survival following refractory pediatric cardiac arrest.

Simulation-based Comparison of British and Australian Advanced Life Support Guidelines.

Cardiac arrest is a major health concern that has been linked to poor disease outcomes. Cardiopulmonary resuscitation (CPR) is a critical protocol for restoring spontaneous circulation. The guidelines used by medical staff differ across different countries. A comparison of these guidelines can help in designing more efficient Advanced Life Support (ALS) protocols. The goal in this study was to compare the guidelines for interruption of compression during CPR (hands-off time) for ALS protocols provided by Australian and United Kingdom (UK) resuscitation councils. The author designed a simulation-based study using a mannequin and a defibrillator, and then recruited six participants. Three participants were certified ALS practitioners who followed UK guidelines, and three were certified ALS practitioners who followed Australian guidelines. Each participant received a random task assignment for each scenario, as a team leader, performer of cardiopulmonary resuscitation, or assistant. The team leader and the chest compressor were unaware of the shockability of each case's rhythm. Eight minutes total were spent on 10 CPR trials, each lasting four cycles. A video of the simulation was recorded for automated timekeeping. An independent sample t-test was used to compare the amount of hands-off time (seconds) throughout each cycle between two procedures. For purposes of calculating statistical significance, a 0.05 P-value was employed. The mean duration of second cycle hands-off time (seconds) in the UK ALS protocol was statistically significantly longer than the Australian ALS (t = -2.100; P = 0.05). For shockable rhythms, the hands-off time of the UK ALS protocol was significantly longer than Australian ALS protocol, as reflected in the second cycle (t = -0.621; P < 0.001), third cycle (t = -8.083; P < 0.001), and fourth cycle (t = -5.814; p < 0.001), while the difference in the first cycle between groups was not statistically significant. (t = -0.258; P = 0.803). This simulation-based study demonstrated that the UK ALS guidelines led to an increased duration of hands-off time during the second cycle. The hands-off time in the shockable rhythms was also higher during the second, third, and fourth cycles in the UK ALS protocol compared to the Australian ALS protocol. These points must be focused on in future revisions of the UK ALS guidelines. For better results, it is critical to limit hands-off time between chest compression cycles.

LUCAS Device Use Associated with Prolonged Pauses During Application and Long Chest Compression Intervals

ABSTRACT Background Tenets of high-quality out-of-hospital cardiac arrest (OHCA) resuscitation include early recognition and treatment of shockable rhythms, and minimizing interruptions in compressions. Little is known about how use of a mechanical compression device affects these elements. We hypothesize that use of such a device is associated with prolonged pauses in compressions to apply the device, and long compression intervals overall. Methods We systematically abstracted CPR metrics from 4 months of adult non-traumatic OHCA cases, each of which had at least 10 minutes of resuscitation, used a LUCAS device, and had a valid monitor file attached to the patient care report. Our primary outcomes of interest were the duration of each pause in compressions and the duration of compressions between pauses, stratified by whether or not the LUCAS device was used/applied during the segment. Each pause was further evaluated for a possible associated procedure based on pre-defined criteria. Descriptive statistics, chi-square, and Kruskal-Wallis tests were used as appropriate. Results Fifty-eight cases were included, median age 62.5 years (IQR 49.3-70.8), 47% female, 66% non-White. Overall, 633 compression-pause segments were analyzed (517 with and 116 without LUCAS applied). Spacing of pauses was significantly longer with the LUCAS than without [median (IQR) 133 (82-213) seconds vs. 38 (18-62) seconds, p < 0.05]. When using a LUCAS, compressions were continuous for at least 3 minutes in 166/517 segments, at least 4 minutes in 89/517 segments, and at least 5 minutes in 56/517 segments. Without a LUCAS, compressions were longer than 3 minutes in 7/116 segments. Pauses exceeded 10 seconds more frequently with LUCAS application (32/38) than airway management or defibrillation (27/80, p < 0.05). Peri-LUCAS pauses exceeded 30 seconds in 6/38 cases. Conclusion LUCAS use was associated with long compression intervals without identifiable pauses to assess for pulse or cardiac rhythm, and device application was associated with longer pauses than airway management or defibrillation. The clinical significance and effect on patient outcomes remain uncertain and require further study.

Abstract 199: Femoral Artery Doppler Ultrasound Blood Flow Patterns Predict Intrinsic Pulsatility In Cardiac Arrest Patients Receiving Active Chest Compressions

Introduction: Pulse detection requires chest compression interruption, which is associated with poor outcomes in cardiac arrest. Currently no modality can reliably identify return of spontaneous circulation with ongoing chest compressions. Hypothesis We hypothesized that patients with intrinsic pulsatility have anterograde dominant blood flow (ADF) on arterial Doppler ultrasound; whereas those with intrinsic pulselessness have bidirectional blood flow moving antero/retrograde during chest compression/decompression. Methods: We conducted a prospective, diagnostic accuracy study on a convenience sample of adult Emergency Department (ED) cardiac arrest patients with a femoral arterial line in place. Immediately prior to a pulse check, pulsed-wave Doppler ultrasound of the common femoral artery was performed during active chest compressions. Bidirectional flow was present when the anterograde flow waveform was equal in peak systolic velocity to the retrograde flow waveform. All other Doppler waveforms were ADF. A pulse was present when there was an arterial line waveform. Sensitivity, specificity, and accuracy of ADF versus bidirectional flow for predicting pulsatility was assessed. Results: We enrolled 42 patients and performed 104 pulse checks: a pulse was present for 73 (70.2%) and absent in 31 (29.8%). ADF was present in 82 (78.9%) and bidirectional flow was present in 22 (21.2%). Sensitivity of ADF for detecting a pulse was 95.9% (95% CI: 91.3%-100.0%). Specificity of bidirectional flow for detecting pulselessness was 61.3% (95% CI: 44.1-78.4%) and accuracy was 85.6% (95% CI: 77.3-91.7%). Patients with ADF have 36.9 times the odds of having an arterial line pulse compared with patients with bidirectional flow (OR: 36.9; 95% CI: 9.5-144.4). Conclusion: In ED cardiac arrest patients, ADF on Doppler ultrasound has high sensitivity for detecting an arterial line pulse. Further studies are needed to further evaluate this novel finding.

Tracheal Intubation during Advanced Life Support Using Direct Laryngoscopy versus Glidescope® Videolaryngoscopy by Clinicians with Limited Intubation Experience: A Systematic Review and Meta-Analysis.

The use of the Glidescope® videolaryngoscope might improve tracheal intubation performance in clinicians with limited intubation experience, especially during cardiopulmonary resuscitation (CPR). The objective of this systematic review and meta-analysis is to compare direct laryngoscopy to Glidescope® videolaryngoscopy by these clinicians. PubMed/Medline and Embase were searched from their inception to 7 July 2020 for randomized controlled trials, including simulation studies. Studies on adult patients or adult-sized manikins were included when direct laryngoscopy was compared to Glidescope® videolaryngoscopy by clinicians with limited experience in tracheal intubation (&lt;10 intubations per year). The primary outcome was the intubation first-pass success rate. Secondary outcomes were time to successful intubation and chest compression interruption duration during intubation. The risk of bias was assessed with the Cochrane risk of bias tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). We included 4 clinical trials with 525 patients and 20 manikin trials with 2547 intubations. Meta-analyses favored Glidescope® videolaryngoscopy over direct laryngoscopy regarding first-pass success (clinical trials: risk ratio [RR] = 1.61; 95% confidence interval [CI]: 1.16-2.23; manikin trials: RR = 1.17; 95% CI: 1.09-1.25). Clinical trials showed a shorter time to achieve successful intubation when using the Glidescope® (mean difference = 17.04 s; 95% CI: 8.51-25.57 s). Chest compression interruption duration was decreased when using the Glidescope® videolaryngoscope. The certainty of evidence ranged from very low to moderate. When clinicians with limited intubation experience have to perform tracheal intubation during advanced life support, the use of the Glidescope® videolaryngoscope improves intubation and CPR performance compared to direct laryngoscopy.

Back Plate Marking of a Mechanical Chest Compression Device to Reduce the Duration of Chest Compression Interruptions.

ObjectiveTo compare the effectiveness of applying the back plate marking method vs the standard method, to a mechanical chest compression device, in regards to reducing the duration of chest compression interruptions during a simulated cardiac arrest.MethodsAn experimental study, one group pretest posttest design, conducted in a university-based hospital from November 2020 to October 2021. The study recruited 20 participants including emergency medical residents and paramedics. The participants were randomized into three-person teams and applied the device in both standard and back plate marking methods in sequential order. Teams were required to use a mechanical chest compression device in a manikin-based OHCA simulation to assess performance.ResultsThe median time pause for the deployment of the upper part of the device was significantly reduced (16 vs 21s, P < 0.01) in the back plate marking method, as was the total pause for device deployment (31.5 vs 38.75s, P = 0.03) and the proportion of total hands-off time attributable to device application interruption (43.08% vs 49.18%, P = 0.02). There was no difference between groups in the duration of all compression interruptions (70.5 vs 82.75s, P = 0.20) and compression fractions (77.85 vs 76.91%, P = 0.19).ConclusionThe back plate marking method was a significantly reduced time of the deployment of the upper part of the device and in regards to the overall pause for device deployment, but there was no difference in CPR quality between the two methods.

Effect of peer videorecording feedback CPR training on students’ practical CPR skills: a randomized controlled manikin study

BackgroundThe aim of this study was to compare one-month acquisition and half-a-year quality retention of cardiopulmonary resuscitation (CPR) skills after initial training of medical students between peer videorecording feedback training (PVF) and traditional peer verbal feedback training (TVF).MethodsParticipants were randomly assigned to the PVF group (n = 62) and the TVF group (n = 65). All participants received a 45-min CPR training program performed by an American Heart Association basic life support-certified instructor, and then they began two hours of practice in groups. During interactive peer learning, students cooperated in couples of a doer and a helper to realize maximization of each other’s learning. In the PVF group, training performance feedback came from peers based on practice videorecording. In the TVF group, feedback came from peers verbally without videorecording. CPR quality was tested at 1 and 6 months after training.ResultsAfter 1 month of initial training, the PVF group had a better presentation of CPR skills acquisition than the TVF group. Compared to the TVF group, the PVF group had significantly higher total scores, compression depth, appropriate compression depth, and complete chest recoil (p < 0.05). Moreover, compression interruption was a significantly positive change in the PVF group compared to the TVF group (p < 0.05). However, after 6 months, proportions of appropriate compression depth in the PVF group were better than those in the TVF group (p < 0.05). The differences in total scores, compression depth, appropriate compression depth, complete chest recoil and compression interruption were non-significant (all p > 0.05).ConclusionsCompared to TVF, PVF is more effective in enhancing CPR skill acquisition at 1 month. After half a year, CPR skill quality was obviously reduced in both groups, and no difference in CPR quality was found between the two groups.

The Feasibility of Using Point-of-Care Ultrasound During Cardiac Arrest in Children: Rapid Apical Contractility Evaluation.

Resuscitation guidelines emphasize minimal interruption of compressions during cardiopulmonary resuscitation. Point-of-care ultrasound (POCUS) enables the clinician to visualize cardiac contractility and central artery pulsatility. The apical 4-chamber (A4), subxiphoid (SX), and femoral artery views may be used when defibrillator pads or active compressions preclude parasternal cardiac views. We hypothesized that clinicians can rapidly obtain interpretable POCUS views in healthy children from the A4, SX, and femoral positions. A prospective study of pediatric emergency medicine providers in an urban academic hospital was performed. Stable patients of 12 years or younger were scanned. Sonologists were each allotted 10 seconds to acquire A4, SX, and femoral views. Two attempts at each view were allowed. The primary outcome was whether cardiac and femoral artery scans were interpretable for contractility and pulsatility, respectively. The secondary outcome was whether cardiac scans were interpretable for effusion or right ventricular strain. A POCUS expert reviewed scans to confirm interpretability. Twenty-two sonologists performed a total of 50 scans on 22 patients. A view that was interpretable for contractility was obtained on the first attempt in 86% of A4 and 94% of SX scans. A femoral view that was interpretable for pulsatility was obtained on the first attempt in 74% of scans. Expert review was concordant with sonologist interpretation. Pediatric emergency medicine physicians can obtain interpretable cardiac and central artery views within 10 seconds most of the time. Point-of-care ultrasound has the potential to enhance care during pediatric resuscitation. Future studies on the impact of POCUS pulse checks in actual pediatric resuscitations should be performed.

The factor influencing the rate of ROSC for nontraumatic OHCA in New Taipei city.

Return of spontaneous circulation (ROSC) from out-of-hospital cardiac arrest (OHCA) is critical for the Emergency Medical Services System. When compared to other developed countries, Taiwan has lower rate of ROSC in OHCA patients.We conducted a retrospective study of cardiac arrest using The Emergency Medical Service Dispatching Center in Northern Taiwan and The Prehospital Care System of New Taipei City Paramedic Service. Patients suffering from nontraumatic OHCA between August of 2019 to February of 2020 were included. We analyzed the cardiopulmonary resuscitation (CPR) quality parameters such as chest compression interruptions, bystander CPR, shockable rhythm, CPR interruption, chest compression fraction (CCF) average, patient transportation in buildings, and adrenaline injection during CPR. Multivariable logistic regression analysis was performed to assess the relationship between potential independent variables and ROSC.In our study, we involved 1265 subjects suffering from nontraumatic OHCA, among which 587 patients met inclusion criteria. We identified that CCF> 0.8, chest compression interruption greater than 3 times, and patient transportation in the building were the most critical factors influencing ROSC. However, patient transportation in a building was identified as a dependent predictor variable (P = .4752).We concluded that CCF > 0.8 and chest compression interruption greater than 3 times were essential factors affecting the CPR ROSC rate. The most significant reason for suboptimal CCF and CPR interruption is patient transportation in a building. Improving the latter point could facilitate high-quality CPR.

Chest Compression Fraction and Factors influencing it.

Introduction:Chest compression fraction (CCF) is the cumulative time spent providing chest compressions divided by the total time taken for the entire resuscitation. Targeting a CCF of at least 60% is intended to limit interruptions in compressions and maximize coronary perfusion during resuscitation. We aimed to identify the mean CCF and its relationship with various factors affecting it.Methods:Patients presenting to the emergency department in cardiac arrest at a single center were prospectively included in this study. Resuscitation was provided by trained health-care providers. The feedback device Cprmeter2™ was placed on the patient's sternum at the beginning of resuscitation. The total time taken for the entire resuscitation was noted by the device and CCF calculated.Results:The mean CCF was analyzed using descriptive statistics and was found to be 71.60% ± 7.52%. The total duration of resuscitation (R = −0.55, P = < 0.001, min-max, 2.02–34.31, mean 12.25 ± 6.54), number of people giving chest compressions (R = −0.48, P = < 0.001, min-max, 1–6, mean 4.04 ± 1.12), and total number of team members in resuscitation (R = −0.50, P = < 0.001, min-max, 4–10, mean 6.65 ± 1.32) had negative correlation with CCF. Diurnal variation (day, n = 35; mean 69.20% ± 7% and night, n = 20; mean 75.80% ± 5.6%, P = 0.001) and patients receiving defibrillation (receiving n = 10 mean 67.00% ± 4.11% and not receiving n = 45 mean 72.62 ± 7.42%, P = 0.005) were found to significantly affect CCF.Conclusion:The mean CCF for cardiac arrest patients was well within the targets of guideline recommendation. CCF decreased when resuscitation lasted longer, during daytime when the defibrillator was used, the total team members increased, and also when the number of people giving chest compressions increased. CCF during resuscitation may improve if there is a focus on improving these factors and requires validation in multicentric settings.

Abstract 10412: Duration of Interruptions in Chest Compressions Increases with Increasing Number of Interventions During Cardiac Arrest

Introduction: The American Heart Association recommends limiting chest compression interruptions to ≤10 seconds because prolonged interruptions are detrimental to survival in cardiac arrest. Determining the causes of interruptions is important to structure teams to minimize interruption time. This study sought to determine 1) whether performing more interventions during an interruption increases interruption time and 2) whether the time into the resuscitation in which the interruption occurs affects the duration of the interruption. Hypothesis: We hypothesize that the median duration of an interruption increases as the number of interventions increases and that the median duration of an interruption increases if it occurs later in the resuscitation. Methods: In January 2018 our Emergency Department (ED) began video recording all cardiac arrest resuscitations. These videos are reviewed by a committee of physicians, nurses, technicians, and research staff, and specific data points are confirmed by a physician. The duration of each interruption and cause of each intervention performed during each interruption was recorded. Results: A total of 122 patients with 798 chest compression interruptions from January 2018 to December 2020 were included in our analysis. Median age was 78 years and 44% were female. The median duration of interruptions was 13 seconds (interquartile range [IQR]: 10, 18) when no interventions were performed, 12 seconds (IQR: 8, 18) with 1 intervention, 17 seconds (IQR: 12, 26) with 2 interventions, and 19 seconds (IQR: 13, 24) with 3 or 4 interventions (p&lt;0.0001). The median duration of interruptions was 14 seconds (IQR: 10, 22) in the first quartile of resuscitation length, 14 seconds (IQR: 10, 20) in quartile 2, 14 seconds (IQR: 10, 24) in quartile 3, and 11 seconds (IQR: 8, 18) in quartile 4 (p=0.0058). Conclusions: Our findings demonstrate that the median duration of chest compression interruptions increases as the number of interventions performed during that interruption increases. Additionally, interruption duration was shortest when the interruption was performed later in the resuscitation. These findings suggest that interruptions in chest compressions can be minimized by performing fewer tasks during the interruption.

Comparing audio- and video-delivered instructions in dispatcher-assisted cardiopulmonary resuscitation with drone-delivered automatic external defibrillator: a mixed methods simulation study.

This study compared first responders’ cardiopulmonary resuscitation (CPR) performance when a dispatcher provides audio instructions only and when both audio and video instructions are given. In the simulation, an automatic external defibrillator (AED) was delivered via drone in response to a cardiac arrest occurring outside a hospital setting. Participants’ qualitative experiences were also explored.An exploratory sequential mixed methods design was used. AEDs were delivered to college students via drone with one group receiving both audio and video instructions and the other receiving audio-only instruction, and differences in CPR performance and accuracy were compared. After completion, focus group interview data were collected and analyzed. Video-based instruction was found to be more effective in the number of chest compressions (p < 0.01), chest compression rate (p < 0.01), and chest compression interruptions (p < 0.01). The accuracy of the video group for the chest compression region was high (p = 0.05). Participants’ experiences were divided into three categories: “unfamiliar but beneficial experience,” “met helper during a desperate and embarrassing situation,” and “diverse views on drone use.” Our results lay the groundwork for a development plan for providing emergency medical services using drones, as well as the preparation of guidelines for dispatchers on the provision of video instructions.

Assessment of chest compression interruptions during advanced cardiac life support

AimTo identify potentially avoidable factors responsible for chest compression interruptions and to evaluate the influence of chest compression fraction on achieving return of spontaneous circulation and survival to hospital discharge. MethodsIn this prospective observational study, each resuscitation managed by mobile medical teams from August 1st, 2016, to August 1st, 2018 was video recorded using a body-mounted GoPro camera. The duration of all chest compression interruptions was recorded and chest compression fraction was calculated. All actions causing an interruption of at least 10 s were analyzed. ResultsTwo hundred and six resuscitations of both in- and out-of-hospital cardiac arrest patients were analysed. In total 1867 chest compression interruptions were identified. Of these, 623 were longer than 10 s in which a total of 794 actions were performed. In 4.3% of the registered pauses, cardiopulmonary resuscitation was interrupted for more than 60 s. The most performed actions during prolonged interruptions were rhythm/pulse checks (51.6%), installation/use of mechanical chest compression devices (11.1%), cardiopulmonary resuscitation provider switches (6.7%) and ETT placements (6.2%). No statistically significant relationship was found between chest compression fraction and return of spontaneous circulation or survival. ConclusionThe majority of chest compression interruptions during resuscitation were caused by prolonged rhythm checks, cardiopulmonary resuscitation provider switches, incorrect use of mechanical chest compression devices and ETT placement. No association was found between chest compression fraction and return of spontaneous circulation, nor an influence on survival. This was presumably caused by the high baseline chest compression fraction of >86%.

Effect of Advanced Airway Management by Paramedics During Out-of-Hospital Cardiac Arrest on Chest Compression Fraction and Return of Spontaneous Circulation.

PurposeTo obtain effective systemic blood flow and coronary perfusion by chest compressions during cardiopulmonary resuscitation, it is recommended that the interruption time of chest compressions be kept to a minimum, and that the chest compression fraction (CCF) should be kept high. In this study, we examined the effects of advanced airway management by paramedics in out-of-hospital cardiac arrest (OHCA) cases on CCF and on return of spontaneous circulation (ROSC) before arrival at the hospital.Participants and MethodsA total of 283 adult, non-traumatic OHCA cases who were in cardiopulmonary arrest at the time of EMS contact between April 2015 and March 2017 were registered for this study. We retrospectively investigated the presence or absence of advanced airway clearance, CCF and ROSC during CPR. CCF was calculated by measuring the chest compression interruption time from the ECG waveform recorded on a semiautomatic defibrillator (Philips HeartStart MRX). The data obtained were recorded on a computer, and comparisons between groups were examined using an untested t-test and χ2- test.ResultsOf the 283 patients with OHCA, 159 were included in the analysis. The CCF of the AAM group was 89.4%, which was significantly higher than that in the BMV group (84.3%) (P<0.01). Forty-one patients had ROSC at the time of arrival at the hospital, and the CCF of ROSC patients was 89.7%, which was significantly higher than that of non-ROSC patients (87.2%) (P<0.01). ROSC was also obtained in 31.8% of the patients in the AAM group, which was significantly higher than that in the BMV group (12.2%).ConclusionIn this study, we found that advanced airway management during prehospital emergency transport by paramedics showed high CCF and ROSC rates and contributed to improving the prognosis of OHCA patients through high-quality resuscitation.

The inefficiency of ventilation in basic resuscitation. Should we improve mouth-to-mouth ventilation training of nursing students?

ObjectiveTo analyse the differences in the quality of the basic cardiopulmonary resuscitation (CPR) between the algorithms of compressions with rescue ventilation (CPR [30:2]) and chest compressions only (CPR [C/O]). In addition, the specific objective was to study the effectiveness of the physical manoeuvre of mouth-to-mouth ventilations performed by nursing students after the completion of a simulation training program in Basic Life Support (BLS) standardized in the study plan approved for the Nursing Degree at a Spanish university. Research methodology: analytical, quasi-experimental, cross-sectional study with clinical simulation of 114 students enrolled in the third year of the Nursing Degree. Results: the mean depth of chest compressions was 47.6 mm (SD 9.5) for CPR [30:2] and 45 mm (SD 8.8) when CPR [C/O] was performed (t = 5.39, p < 0.0001, CI95% 1.69–3.65). The compressions with complete chest re-expansion were 106 (SD 55) for CPR [30:2] and 138 (SD 85) for CPR [C/O] [t = −4.75, p < 0.0001, CI95% −44.6 – (−18.4)]. Of the participants, 28.1% correctly ventilated with the head-tilt/chin-lift manoeuvre (Fisher: p < 0.0001). Conclusions: As a whole, CPR with only chest compressions offers great advantages with respect to standard CPR, minimizing interruptions in compressions, maintaining coronary and cerebral perfusion and thus increasing the likelihood of return of spontaneous circulation. The problem of rescuers fatigue could be reduced with a greater number of relays between rescuers. We believe that is important to improve the acquisition of competencies in the management of the airway and the ventilation devices (such as the bag-valve mask).

Abstract 206: Effect of Airway Strategy Upon Chest Compression Quality in the Pragmatic Airway Resuscitation Trial

Background: Chest compression (CC) quality is associated with improved out-of-hospital (OHCA) outcomes. Airway management efforts may adversely influence CC quality. We sought to compare the effects of initial laryngeal tube (LT) and initial endotracheal intubation (ETI) airway management strategies upon chest compression fraction (CCF), rate and interruptions in the Pragmatic Airway Resuscitation Trial (PART). Methods: We analyzed CPR process files collected from adult OHCA enrolled in PART. We used automated signal processing techniques (MATLAB) to identify and calculate CC quality measures. We defined a CC interruption as ≥3 second pause in chest compressions. We determined CC fraction, rate and interruptions (number and total duration) in 1-minute epochs for the entire resuscitation. We compared differences in CC quality between LT and ETI using t-tests. We repeated the analysis stratified by time before/after airway insertion as well as by successive 3-minute time segments. We also compared CC quality between single vs. multiple airway insertion attempts, as well as between BVM-only vs. ETI or LT. Results: Of 3,004 patients enrolled in PART, CPR process data were available for 1,996 (1,001 LT, 995 ETI). Mean resuscitation duration was: LT 22.6±10.8 min, ETI 25.3±11.3 min. Mean CC fraction (88% vs. 87%, p=0.045) and rate (114 vs. 114 bpm, p=0.59) were similar between LT and ETI. Median number of CC interruptions was similar between LT and ETI (11 vs. 12). Total CC interruption duration was lower for LT than ETI (160 vs. 181 sec, p=0.002); this difference was largest before airway insertion (56 vs. 78 sec, p=0.001). There were no differences in CC quality when stratified by 3-min time epochs. Total CC interruption duration was shorter for single than multiple airway insertion attempts (127 vs. 153 sec, p=0.005). Total CC interruption duration was shorter for BVM-only than LT or ETI (104 vs. 135 sec, p&lt;0.001). Conclusion: In PART, compared with ETI, LT was associated with shorter total CC interruption duration but not other CC quality measures. Single-attempt airway insertion and BVM-only were associated with shorter total CC interruption duration. OHCA airway management may influence CC quality.

Abstract 130: Mechanical, Team-focused, Video-Reviewed Cardiopulmonary Resuscitation Improves Trends in Survival to Discharge and Cardiac Arrest Performance Measures

Background: Our previous research demonstrated an improvement in ROSC after implementing a bundle including mechanical, team-focused, video-reviewed cardiopulmonary resuscitation (MTV-CPR) for cardiac arrest patients in our ED. The aims of this study are to assess trends in cardiac arrest outcomes and improvements in cardiac arrest performance measures after the implementation of our MTV-CPR intervention. Methods: In 2018, our ED began using mechanical CPR; a new team-focused strategy with nurse led ACLS; and biweekly video-review of cardiac arrests. The primary outcome of this study was to evaluate the annual trend in survival to discharge from 2017 (the year before implementing MTV-CPR) through 2019. Secondary outcomes included ROSC and survival to admission. The Cochrane-Armitage test was used to evaluate annual trends in outcomes over the 3-year study period. We also sought to determine if an improvement in cardiac arrest performance measures occurred over the two years of our MTV-CPR intervention using Wilcoxon rank sum and two-sample t-tests. Cardiac arrest performance measures are listed in the table. Results: The groups were similar at baseline over the 3-year study period. 291 patients were included in the study (96 in 2017, 96 in 2018, and 99 in 2019). Survival to discharge improved from 3.1% in 2017 to 5.2% in 2018 to 10.1% in 2019 (p= 0.043); ROSC improved from 26% to 41.7% to 40.4% (p=0.038); survival to admission went from 19.8% to 25% to 29.3% but was not significantly different (p=0.124). Results for cardiac arrest performance measures are reported in the table. There were significant reductions in time to bed transfer, rhythm determination, mechanical CPR placement, and duration of each chest compression interruption due to ultrasound. Conclusions: Implementation of our MTV-CPR intervention for cardiac arrest patients resulted in improved trends in survival to discharge and ROSC, as well as improvements in multiple cardiac arrest performance measures.

Over the head and lateral position technique for cardiopulmonary resuscitation: which one is better?

Background: A high rate of cardiac arrest requires high-quality CPR. A valuable CPR rescuer has lower success than two or more rescuers, especially with the use of BVM. There is a complexity encountered with lateral CPR position as a commonly used position, which is the difficulty of position movement from compression to ventilation. On the other hand, Over the Head CPR position is used as an alternative position, which is considered more effective than a lateral position. It is also considered to be able to overcome the obstacles found in CPR with a single rescuer using BVM ventilation in the lateral position so that study is required to compare the quality of CPR between the two CPR positions.Technique: The quality of CPR between Over the Head position CPR and Lateral position CPR is compared. The technique testing was carried out on 24 students using a mannequin. CPR quality components include compression ratios: ventilation, speed, depth, hand placement, chest recoil, and the amount of time of chest compression interruption were observed strictly. The overall CPR quality score, particularly in terms of compression speed and the minimum interruption time of chest compression on Over the Head position, is better than lateral position CPR.Conclusion: Over the Head position, CPR significantly produces a better quality of CPR than Lateral position CPR.

Pulse rate as an alternative, real-time feedback indicator for chest compression rate: a porcine model of cardiac arrest.

Feedback indicators can improve chest compression quality during cardiopulmonary resuscitation (CPR). However, the application of feedback indicators in the clinic practice is rare. Pulse oximetry has been widely used and reported to correlate spontaneous circulation restoration during CPR. However, it is unclear if pulse oximetry can monitor the quality of chest compression. We hypothesized that pulse rate monitored by pulse oximetry can be used as a feedback indicator of the chest compression rate during CPR in a porcine model of cardiac arrest. Seven domestic male pigs (30–35 kg) were utilized in this study. Eighteen intermittent chest compression periods of 2 min were performed on each animal. Chest compression and pulse oximetry plethysmographic waveforms were recorded simultaneously. Chest compression and pulse rates were calculated based on both waveforms. Compression interruption and synchronous pulse interruption times were also measured. Agreement was analyzed between pulse rates and synchronous chest compression rates, as well as between compression interruption times and synchronous pulse interruption times. A total of 126 compression periods of 2 min were performed on seven animals. Interclass correlation coefficients and Bland–Altman analysis revealed reliable agreement between pulse rates and synchronous chest compression rates. Similarly, compression interruption and synchronous pulse interruption times obtained also showed high agreement. Pulse rate can be used as an alternative indicator of chest compression rate during CPR in a porcine model of cardiac arrest. Pulse interruption time also can be used to reflect compression interruption time precisely in this model.

Metrics of mechanical chest compression device use in out-of-hospital cardiac arrest.

ObjectiveThe quality of cardiopulmonary resuscitation (CPR) affects outcomes from cardiac arrest, yet manual CPR is difficult to administer. Although mechanical CPR (mCPR) devices offer high quality CPR, only limited data describe their deployment, their interaction with standard manual CPR (sCPR), and the consequent effects on chest compression continuity and patient outcomes. We sought to describe the interaction between sCPR and mCPR and the impact of the sCPR‐mCPR transition upon outcomes in adult out‐of‐hospital cardiac arrest (OHCA).MethodsWe analyzed all adult ventricular fibrillation OHCA treated by the Anchorage Fire Department (AFD) during calendar year 2016. AFD protocols include the immediate initiation of sCPR upon rescuer arrival and transition to mCPR, guided by patient status. We compared CPR timing, performance, and outcomes between those receiving sCPR only and those receiving sCPR transitioning to mCPR (sCPR + mCPR).ResultsAll 19 sCPR‐only patients achieved return of spontaneous circulation (ROSC) after a median of 3.3 (interquartile range 2.2–5.1) minutes. Among 30 patients remaining pulseless after sCPR (median 6.9 [5.3–11.0] minutes), transition to mCPR occurred with a median chest compression interruption of 7 (5–13) seconds. Twenty‐one of 30 sCPR + mCPR patients achieved ROSC after a median of 11.2 (5.7–23.8) additional minutes of mCPR. Survival differed between groups: sCPR only 14/19 (74%) versus sCPR + mCPR 13/30 (43%), P = 0.045.ConclusionIn this series, transition to mCPR occurred in patients unresponsive to initial sCPR with only brief interruptions in chest compressions. Assessment of mCPR must consider the interactions with sCPR.