Interruptions In Compressions Research Articles

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.

Conhecimento de acadêmicos e profissionais de saúde sobre Suporte Básico de Vida

Introdução: Avaliação inadequada e desconhecimento dos procedimentos aplicáveis em emergências são fatores que podem resultar maior morbidade e mortalidade. Objetivo: Revisar sistematicamente estudos da literatura nacional sobre o conhecimento de acadêmicos e profissionais da saúde em suporte básico de vida e parada cardiorrespiratória. Métodos: Revisão sistemática de estudos publicados em periódicos indexados nas bases SciELO e LILACS. Descritores: “Reanimação Cardiopulmonar”, “Suporte Básico de Vida”, “Parada Cardíaca”, “Educação em Saúde” e “Conhecimento”. Foram incluídos artigos completos publicados até dezembro de 2018. Esses analisaram o conhecimento de acadêmicos e/ou profissionais da saúde sobre suporte básico de vida e seus procedimentos, assim como, estratégias de ensino. Foram excluídos estudos com profissionais de nível técnico e/ou, com condutas hospitalares e/ou suporte avançado de vida. Resultados: As buscas identificaram 60 artigos, sendo 16 incluídos. Desses, onze eram observacionais e cinco de intervenção. Os estudos observacionais identificaram o desconhecimento de 1.178 acadêmicos e 335 profissionais sobre a identificação da parada cardiorrespiratória, sequência do suporte básico de vida, relação ventilação/compressão, interrupção das compressões e uso do desfibrilador externo automático. Os estudos de intervenção, envolvendo 24 estudantes e 189 profissionais, indicaram que estratégias de aprendizagem ativas podem melhorar o conhecimento. Conclusão: Os resultados indicam que acadêmicos e profissionais da saúde apresentam limitações no conhecimento sobre parada cardiorrespiratória e suporte básico de vida, o que pode implicar em maiores agravos e menor sobrevida para pacientes em emergência.

Enhancing CPR During Transition From Prehospital to Emergency Department: A QI Initiative.

High-quality cardiopulmonary resuscitation (CPR) increases the likelihood of survival of pediatric out-of-hospital cardiac arrest (OHCA). Maintenance of high-quality CPR during transition of care between prehospital and pediatric emergency department (PED) providers is challenging. Our objective for this initiative was to minimize pauses in compressions, in alignment with American Heart Association recommendations, for patients with OHCA during the handoffs from prehospital to PED providers. We aimed to decrease interruptions in compressions during the first 2 minutes of PED care from 17 seconds (baseline data) to 10 seconds over 12 months. Our secondary aims were to decrease the length of the longest pause in compressions to <10 seconds and eliminate encounters in which time to defibrillator pad placement was >120 seconds. Our multidisciplinary team outlined our theory for improvement and designed interventions aimed at key drivers. Interventions included specific roles and responsibilities, CPR handoff choreography, and empowerment of frontline providers. Data were abstracted from video recordings of patients with OHCA receiving manual CPR on arrival. We analyzed 33 encounters between March 2018 and July 2019. We decreased total interruptions from 17 to 12 seconds during the first 2 minutes and decreased the time of the longest single pause from 14 to 7 seconds. We saw a decrease in variability of time to defibrillator pad placement. Implementation of a quality improvement initiative involving CPR transition choreography resulted in decreased interruptions in compressions and decreased variability of time to defibrillator pad placement.

Correction: Real-time feedback improves chest compression quality in out-of-hospital cardiac arrest: A prospective cohort study.

[This corrects the article DOI: 10.1371/journal.pone.0229431.].

Closing the Gap: Optimizing Performance to Reduce Interruptions in Cardiopulmonary Resuscitation.

The American Heart Association recommends minimizing pauses of chest compressions and defines high performance resuscitation as achieving a chest compression fraction greater than 80%. We hypothesize that interruption times are excessively long, leading to an unnecessarily large impact on chest compression fraction. A retrospective study using video review of a convenience sample of clinically realistic in situ simulated pulseless electrical activity cardiopulmonary arrests. Johns Hopkins Children's Center; September 2013 to June 2017. Twenty-two simulated patients. A framework was developed to characterize interruptions. Two new metrics were defined as follows: interruption time excess (the difference between actual and guideline-indicated allowable duration of interruption from compressions), and chest compression fraction potential (chest compression fraction with all interruption time excess excluded). Descriptive statistics were generated for interruption-level and event-level variables. Differences between median chest compression fraction and chest compression fraction potential were assessed using Wilcoxon rank-sum test. Comparisons of interruption proportion before and after the first 5 minutes were assessed using the X test statistic. Seven-hundred sixty-six interruptions occurred over 22 events. Median event duration was 463.0 seconds (interquartile range, 397.5-557.8 s), with a mean 34.8 interruptions per event. Auscultation and intubation had the longest median interruption time excess of 13.0 and 7.5 seconds, respectively. Median chest compression fraction was 76.0% (interquartile range, 67.7-80.7 s), and median chest compression fraction potential was 83.4% (interquartile range, 80.4-87.4%). Comparing median chest compression fraction to median chest compression fraction potential found an absolute percent difference of 7.6% (chest compression fraction: 76.0% vs chest compression fraction potential: 83.4%; p < 0.001). This lays the groundwork for studying inefficiency during cardiopulmonary resuscitation associated with chest compression interruptions. The framework we created allows for the determination of significant avoidable interruption time. By further elucidating the nature of interruptions, we can design and implement targeted interventions to improve patient outcomes.

Causes of Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation.

BackgroundInterruptions in chest compressions contribute to poor outcomes in out‐of‐hospital cardiac arrest. The objective of this retrospective observational cohort study was to characterize the frequency, reasons, and duration of interruptions in chest compressions and to determine if interruptions changed over time.Methods and ResultsAll out‐of‐hospital cardiac arrests treated by the Seattle Fire Department (Seattle, WA, United States) from 2007 to 2016 with capture of recordings from automated external defibrillators and manual defibrillators were included. Compression interruptions >1 second were classified into categories using audio recordings. Among the 3601 eligible out‐of‐hospital cardiac arrests, we analyzed 74 584 minutes, identifying 30 043 pauses that accounted for 6621 minutes (8.9% of total resuscitation duration). The median total interruption duration per case decreased from 115 seconds in 2007 to 72 seconds in 2016 (P<0.0001). Median individual interruption duration decreased from 14 seconds in 2007 to 7 seconds in 2016 (P<0.0001). Among interruptions >10 seconds, median interruption duration decreased from 20 seconds in 2007 to 16 seconds in 2016 (P<0.0001). Cardiac rhythm analysis accounted for most compression interruptions. Manual ECG rhythm analysis and pulse checks accounted for 41.6% of all interruption time (median individual interruption, 8 seconds), automated external defibrillator rhythm analysis for 13.7% (median, 17 seconds), and manual rhythm analysis and shock delivery for 8.0% (median, 9 seconds).ConclusionsMedian duration of chest compression interruptions decreased by half from 2007 to 2016, indicating that care teams can significantly improve performance. Reducing compression interruptions is an evidence‐based benchmark that provides a modifiable process quality improvement goal.

Association of ultrasound-related interruption during cardiopulmonary resuscitation with adult cardiac arrest outcomes: A video-reviewed retrospective study

ObjectivesTo determine the association of focused transthoracic echocardiography (ECHO) related interruption during cardiopulmonary resuscitation (CPR) with patient outcomes in the Emergency Department (ED). MethodsThis was a retrospective, single center, cohort study, conducted in an urban community teaching ED. Eligible study subjects were adult patients in the ED with sustained cardiac arrest. Exclusion criteria include traumatic cardiac arrest and age less than 18. All resuscitations were video recorded and were subsequently reviewed by 2 study investigators. The no-flow time from chest compression interruption was analyzed using video review and separated into ECHO-related and non-ECHO related. Our primary outcome was patient survival to hospital discharge and the secondary outcome was the rate of return of spontaneous circulation (ROSC). Multivariate logistic regression analyses were performed to examine the associations between independent variables and outcomes. ResultsFrom January 2016 to May 2017, a total of 210 patients were included for final analysis. The median total no-flow time observed on video was 99.5 s (IQR: 54.0–160.0 s). Among these, a median of 26.5 s (IQR: 0.0–59.0 s) was ECHO-related and a median of 60.5 s (IQR: 34.0–101.9) was non-ECHO-related. The ECHO-related no-flow time between 77 and 122 s (OR: 7.31, 95 % confidence interval [CI]: 1.59–33.59; p-value = 0.01) and ECHO-related interruption ≦ 2 times (OR: 8.22, 95% CI: 1.51–44.64; p-value = 0.01) were positively associated with survival to hospital discharge. ECHO-related interruption ≦ 2 times (OR: 5.55, 95% CI: 2.44–12.61; p-value < 0.001) was also positively associated with ROSC. ConclusionShort ECHO-related interruption during CPR was positively associated with ROSC and survival to hospital discharge. While ECHO can be a valuable diagnostic tool during CPR, the no-flow time associated with ECHO should be minimized.

The changes in cardiopulmonary resuscitation guidelines: from 2000 to the present.

This review aims to determine the changes made in the cardiopulmonary resuscitation (CPR) guidelines from 2000 to the present. The study was mainly undertaken by using International Guidelines from American Heart Association. The main change of CPR was chest compression skill. The guidelines have improved high-quality CPR through the change of chest compression skill. The latest adult CPR guidelines are as follows: (a) push chest quickly (100–120/min), (b) compress appropriately (5–6 cm), (c) relax chest fully (complete chest recoil), (d) avoid interruption of compression, and (e) avoid hyperventilation. The understanding of the latest CPR skills will be helpful in improving survival rate from sudden cardiac death.

In this December issue

Primary aeromedical retrievals are a direct scene response to patients with a critical injury or illness using a medically equipped aircraft. In Australia, information on primary retrieval taskings are kept by multiple service providers. A literature review found some preliminary but piecemeal insight into such retrievals. Several areas for research action and service outcome improvements can be developed with a national pre-hospital and retrieval registry. The creation of such a registry will allow analysis of the frequency and context of retrievals, comparison across services and more sophisticated data interrogation. A retrospective and hospital-based case–control study of clinical factors in all thunderstorm asthma patients who presented to one ED in November 2016 concludes that oral beta-blockers, a younger age and Asian-born heritage are risk factors for thunderstorm asthma. Evidence-based care for patients with acute traumatic spinal cord injury (TSCI) in the ED has a critical impact on long-term outcomes. Acute hypotension post-injury compromises spinal cord perfusion and extends neurological damage. Published guidelines recommend mean arterial BP maintenance between 85–90 mmHg for 7 days post-injury; the extent to which this is followed in Australia is unknown. A prospective observational study of adults with TSCI, treated at 48 hospitals across two Australian states that care given was inconsistent for hypotensive patients. Specialist care and more severe injury increased guideline compliance. Level 1 evidence is needed plus consistent guideline implementation and clinician training to improve TSCI management and outcomes. We publish a study that tries to identify out of hospital cardiac arrest (OOHCA) patients who might benefit from a future pre-hospital ECPR programme in a moderately sized city. Using data from 2014, the authors conclude that 63 patients in their study group could have derived benefit from a pre-hospital ECPR programme. Further analyses of pre-hospital ECPR logistics and economics are needed. Focussed echocardiography is a useful tool in cardiopulmonary resuscitation; it helps for prognosis, to identify reversible causes of cardiac arrest and to guide management and procedures. Many clinicians have reservations regarding its widespread adoption as it leads to prolonged interruption of cardiac compressions. Also the lack of a clear protocol for use of focussed echocardiography into the rhythm check causes confusion amongst teams not familiar with using it, as well as safety concerns for the sonographer during delivery of a shock. COACHRED is a guide for focussed echocardiography during rhythm check in a safe and timely manner. In a simulation environment it is possible to incorporate focussed echocardiography into the rhythm check while keeping the interruption to chest compressions within the timeframe prescribed by international. Are parental estimates of a child's weight reliable? We publish a study which concludes that the answer is yes, subject to one important caveat; children of Polynesian/Pacific ethnicity were less likely to have an accurate parental weight estimation. We publish a retrospective review of non-traumatic brain injury patients that presented to the EDs in two urban hospitals and received computed tomography of the brain (CTB) from January 2014–December 2016. Data from one hospital was used to develop a clinical decision rule for clinically significant CTB findings. Clinically significant CTB findings were defined as acute infarction, intracranial neoplasm, intracranial haemorrhage, acute hydrocephalus, cerebral oedema and intracranial infection. Patients from another hospital were used as a validation cohort to evaluate the clinical decision rule (CDR) and compare them to four previously derived CDRs. The CDR developed in the present study achieved the highest and a moderate specificity when compared with four other pre-existing CDRs for non-traumatic brain injury patients. The August issue of this journal published a review of a coronial inquest into the death of a woman from a tiger snake bite. During the inquest, there was considerable debate and conflict of opinions between three experts. We publish a letter from one of the experts involved. We publish some correspondence on assessment scoring in the ED.

COACHRED: A protocol for the safe and timely incorporation of focused echocardiography into the rhythm check during cardiopulmonary resuscitation.

Focused echocardiography may be a useful tool in cardiopulmonary resuscitation for prognostication, to identify certain reversible causes of cardiac arrest, and to guide further management and procedures. Nonetheless, many clinicians have reservations regarding its widespread adoption due to evidence that it leads to prolonged interruption of cardiac compressions. Furthermore, the lack of a clear protocol for the inclusion of focused echocardiography into the rhythm check can lead to confusion in teams not familiar with incorporating the modality, as well as safety concerns for the echosonographer during delivery of a shock. We propose the protocol COACHRED to guide the use of focused echocardiography during rhythm check in a safe and timely manner. This approach incorporates the best strategies identified to date that minimise interruptions to chest compressions. We demonstrate that, in a simulation environment, it is achievable to incorporate focused echocardiography into the rhythm check while keeping the interruption to chest compressions within the timeframe prescribed by international guidelines.

CPR-induced consciousness: attention required for caregivers and medication

Introduction and Purpose: CardioPulmonary Resuscitation Induced Consciousness (CPRIC) can have a severe psychological impact on the patient, but also on the professionals. 1 Rice D.T. et al. Resuscitation. 2016; 103: e15-e16 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 2 Olaussen A. et al. Resuscitation. 2015; 86: 44-48 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar We noted increasing caregiver's reports on CPRIC, including hints of avoidance, stress reactions and professional dysfunction. 2 Olaussen A. et al. Resuscitation. 2015; 86: 44-48 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar , 3 Krage R. et al. Emerg Med J. 2017; 34: 728-733 Google Scholar CPRIC was associated with repetitive interruption of compressions, decreased compression depth, and their feeling of offering substandard care. Suggestions for pain- sedation management include opioids, 4 In’t Veld, et al., Landelijk Protocol Ambulancezorg, Zwolle (NL), 2014. Google Scholar benzodiazepam and ketamine. 1 Rice D.T. et al. Resuscitation. 2016; 103: e15-e16 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 5 Olaussen A. et al. Resuscitation. 2017; 113: 44-50 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar We assessed frequency and severity of CPRIC induced psychological impact for caregivers as well as their interventions if CPRIC occurred.

Hemodynamic effects of chest compression interruptions during pediatric in-hospital cardiopulmonary resuscitation

AimAnimal studies have established deleterious hemodynamic effects of interrupting chest compressions. The objective of this study was to evaluate the effect of interruptions on invasively measured blood pressures (BPs) during pediatric in-hospital cardiac arrest (IHCA). MethodsThis was a single-center, observational study of pediatric (<18 years) intensive care unit IHCAs in patients with invasive arterial catheters in place. Interruptions were defined as ≥1 s between chest compressions. Diastolic BP (DBP) and systolic BP (SBP) were determined for individual compressions. For the primary analysis, the average DBP and SBP of the 20 compressions preceding each interruption were compared to the average DBP and SBP of the first 20 compressions following each interruption utilizing non-parametric paired analyses. Linear regression evaluated the change in DBP during interruptions and following interruptions. ResultsThirty-two IHCA events met inclusion criteria, yielding 161 evaluable interruptions. The median age was 2.1 years. Return of circulation was achieved in 24 (75%). The median interruption duration was 2.4 [1.4, 7.0] seconds. Most patients were intubated pre-arrest and received epinephrine during CPR. BPs were not different pre- vs. post-interruption (DBP: 28.7 [21.6, 38.2] vs. 28.3 [21.0, 37.4] mmHg, p = 0.81; SBP: 82.0 [51.7, 116.7] vs. 85.4 [55.7, 122.2] mmHg, p = 0.07). DBP decreased 8.41 ± 0.73 mmHg (p < 0.001) during the first second of interruptions and 0.19 ± 0.02 mmHg/s (p < 0.001) in subsequent seconds. ConclusionsBPs following chest compression interruptions did not differ from pre-interruption BPs. These findings suggest that in the setting of high-quality in-hospital CPR, brief chest compression interruptions do not have persistent detrimental hemodynamic impact.

HANDS-ON DEFIBRILLATION WITH SAFETY DRAPES: AN ANALYSIS OF CURRENT LEAK TO RESCUERS

Interruptions in compressions reduce the efficacy of cardiopulmonary resuscitation (CPR) and are inevitable during hands-off or “all-clear” periods for shocks. Clinical exam gloves were found to facilitate safe contact with patients during shock delivery but the safety of this practice has been

Cardiovascular risk factors differently affect the survival of patients undergoing manual or mechanical resuscitation

BackgroundChest compression is a decisive element of cardio-pulmonary resuscitation (CPR). By applying a mechanical CPR device, compression interruptions can be minimised. We examined the efficiency of manual and device-assisted resuscitation as well as the effects of cardiovascular risk factors on the outcome of resuscitation.MethodsIn our retrospective, randomised 3-year study the data of adult patients suffering non-traumatic, out-of-hospital, sudden cardiac death (SCD) were analysed (n = 287). The data were retrieved by processing case reports, Utstein sheets and acute coronary syndrome sheets. We compared the data of patients undergoing manual (n = 232) and device-assisted resuscitation (LUCAS-2, n = 55). The primary endpoint was the on-site restoration of spontaneous circulation (ROSC).Results and conclusionIn 37% of the cases ROSC happened. With respect to ROSC an insignificantly more favourable tendency was demonstrated in the case of device-assisted resuscitation (p = 0.072). In the Lucas group, a higher success rate occurred even in the case of prolonged resuscitation. We found a better outcome in the Lucas group in the case of CPR started a longer time after the SCD (p < 0.05). A positive correlation was established between age and unsuccessful resuscitation (p = < 0.017; r = 0.125). An unfavourable correlation was observed between hypertension and the outcome of resuscitation (p = 0.018; r = 0.143). According to our results the presence of left ventricular hypertrophy poses 5.1-fold risk of unsuccessful CPR (CI: 4.97–5.29).Advanced age and structural heart diseases can play a role in the genesis of SCD. Importantly, left ventricular hypertrophy and hypertension negatively affect survival.

Resuscitative Endovascular Balloon Occlusion of the Aorta Improves Cardiac Compression Fraction Versus Resuscitative Thoracotomy in Patients in Traumatic Arrest

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is emerging as an alternative to resuscitative thoracotomy for proximal aortic control in select patients with exsanguinating hemorrhage below the diaphragm. The purpose of this study is to compare interruptions in closed chest compression or open chest cardiac massage during REBOA versus resuscitative thoracotomy. From May 2014 to December 2016, patients in arrest who received aortic occlusion with REBOA or resuscitative thoracotomy were included. Total cardiac compression time was defined as the total time that closed chest compression was performed for REBOA patients and the total time that closed chest compression (before resuscitative thoracotomy) and open chest cardiac massage (after thoracotomy) were performed for resuscitative thoracotomy patients. Cardiac compression fraction was defined as the time compressions occurred during the entire resuscitation phase. All resuscitations were captured by multiview, time-stamped videography. Fifty patients with aortic occlusion after arrest were enrolled: 22 REBOA and 28 resuscitative thoracotomy. Most were men (86%) (median age 30.2 years, interquartile range [IQR] 24.9 to 42.3; median Injury Severity Score 27, IQR 16 to 42; neither differed between groups). The median duration of total cardiac compression time was 945 seconds (IQR 697 to 1,357) for REBOA versus 496 seconds (IQR 375 to 933) for resuscitative thoracotomy. During initial resuscitation, compressions occurred 86.5% of the time (SD 9.7%) during resuscitation with REBOA versus 35.7% of the time (SD 16.4%) in patients receiving resuscitative thoracotomy. Cardiac compression fraction improved after open cross clamp in resuscitative thoracotomy patients to 73.2% of the time (SD 18.0%) but remained significantly less than the same period for REBOA (86.7%; SD 9.4%). Mean cardiac compression fraction for REBOA was significantly improved over that for resuscitative thoracotomy (86.2% [SD 9.1%] versus 55.3 [SD 17.1%]; mean difference 31.0%; 95% confidence interval for difference 22.7% to 39.23%; P<.001). Median pause in resuscitation related to procedural tasks was 0 seconds (IQR 0 to 13) for REBOA and 148 seconds (IQR 118 to 223) in resuscitative thoracotomy. Total duration of interruptions of cardiac compressions is shorter for patients receiving REBOA versus resuscitative thoracotomy before and during resuscitation with aortic occlusion. Markers for perfusion during resuscitation must be examined to understand the effects of cardiac compressions and aortic occlusion on patients in arrest because of hemorrhagic shock.

How much experience do rescuers require to achieve successful tracheal intubation during cardiopulmonary resuscitation?

AimThe cardiopulmonary resuscitation (CPR) guidelines recommend that endotracheal intubation (ETI) should be performed only by highly skilled rescuers. However, the definition of ‘highly skilled’ is unclear. This study evaluated how much experience with ETI is required for rescuers to perform successful ETI quickly without complications including serious chest compression interruption (interruption time <10 s) or oesophageal intubation during CPR. MethodsThis was a clinical observation study using review of CPR video clips in an urban emergency department (ED) over 2 years. Accumulated ETI experience and performance of ETI were analysed. Main outcomes were 1) ‘qualified ETI’: successful ETI within 60 s without complications and 2) ‘highly qualified ETI’: successful ETI within 30 s without complications. ResultsWe analysed 110 ETIs using direct laryngoscopy during CPR. The success rate improved and the time to successful ETI decreased with increasing experience; however, the total interruption time of chest compression did not decrease. A 90% success rate for qualified ETI required 137 experiences of ETIs (1218 days of training). A 90% success rate for highly qualified ETI required at least 243 experiences of ETIs (1973 days of training). ConclusionsAccumulated experience can improve the ETI success rate and time to successful ETI during CPR. Because ETI must be performed quickly without serious interruption of chest compression during CPR, becoming proficient at ETI requires more experience than that required for non-arrest patients. In our analysis, more than 240 experiences were required to achieve a 90% success rate of highly qualified ETI.

Manikin study showed that counting inflation breaths out loud improved the speed of resuming chest compressions during two-person paediatric cardiopulmonary resuscitation.

We investigated whether counting inflation breaths out loud during cardiopulmonary resuscitation (CPR) led to an earlier resumption of chest compressions. In this randomised controlled manikin simulation study, conducted from February 2015 to April 2015, 32 fourth-year Korean medical students, equally divided into study and control groups, performed 10 cycles of 15:2 CPR while administering inflation breaths using a bag mask. The first study participant counted the number of inflation breaths out loud, and the second study participant was told to perform chest compressions as soon as they heard their colleague say two. The control group did not count out loud. The groups were blinded to the study outcomes and put in separate rooms. The median chest compression interruption time was shorter in the study group than the control group (40 vs 46 seconds, p < 0.01, r = 0.70), and the median chest compression fraction (CCF) was higher (68 vs 62%, p < 0.01, r = 0.71). Other quality outcomes related chest compressions and ventilation did not differ between the groups. Counting the number of inflation breaths out loud was a simple method that improved the speed of resuming chest compressions and increased CCFs in 15:2 CPR.

Rhythm analysis in CPR

It's necessary to interrupt cardiopulmonary resuscitation (CPR) for a reliable automatic external defibrillator (AED) rhythm analysis, because the mechanical activity from the chest compressions introduces artifacts in the electrocardiogram (ECG) that substantially lower the capacity of an AED to judge cardio-electric rhythm. However, repeated interruptions of compression will reduce the quality of CPR, which in turn affect the prognosis of patients with cardiac arrest (CA). In order to improve the quality of CPR, reduce the interruptions of chest compression and implement accurate defibrillation, people have made many efforts on identifying ECG rhythm in CPR. The studies can be grouped into two broad categories: those based on the artificial mixture of ECG data and CPR artifacts and those based on CA data recorded during CPR. This article introduced researches for rhythm recognition in CPR, including sources and characteristics of CPR artifacts, methods of rhythm analysis, and provided a basis for the study of how to improve the accuracy of cardio-electric rhythm recognition.

Ventilation strategies during out-of-hospital cardiac arrest: a problem that should not be neglected

The ventilation strategies of cardiopulmonary resuscitation (CPR) in patients out-of-hospital cardiac arrest (OHCA) is very important and has received more attention. In the past 10 years, many researches have focused on how to adjust the ratio and time of compression ventilation, minimize the frequency and times of chest compression interruption, and improve the success rate of restoration of spontaneous circulation (ROSC). The ventilation strategies that no ventilation and hyperventilation in the process of CPR are not supported by recent researches for their drawbacks and controversies, but passive ventilation (delayed ventilation) is strongly supported by a great deal of researches. There is debate about whether the use of advanced airway is recommended during the CPR process. How to define the best tidal volume, respiratory rate and fraction of inspired oxygen in CPR to ensure the best ratio of ventilation and blood flow will be the focus and difficulty of investigating ventilation strategies during CPR in further study.

A Turbine-Driven Ventilator Improves Adherence to Advanced Cardiac Life Support Guidelines During a Cardiopulmonary Resuscitation Simulation.

Research has shown that increased breathing frequency during cardiopulmonary resuscitation is inversely correlated with systolic blood pressure. Rescuers often hyperventilate during cardiopulmonary resuscitation (CPR). Current American Heart Association advanced cardiac life support recommends a ventilation rate of 8-10 breaths/min. We hypothesized that a small, turbine-driven ventilator would allow rescuers to adhere more closely to advanced cardiac life support (ACLS) guidelines. Twenty-four ACLS-certified health-care professionals were paired into groups of 2. Each team performed 4 randomized rounds of 2-min cycles of CPR on an intubated mannikin, with individuals altering between compressions and breaths. Two rounds of CPR were performed with a self-inflating bag, and 2 rounds were with the ventilator. The ventilator was set to deliver 8 breaths/min, pressure limit 22 cm H2O. Frequency, tidal volume (VT), peak inspiratory pressure, and compression interruptions (hands-off time) were recorded. Data were analyzed with a linear mixed model and Welch 2-sample t test. The median (interquartile range [IQR]) frequency with the ventilator was 7.98 (7.98-7.99) breaths/min. Median (IQR) frequency with the self-inflating bag was 9.5 (8.2-10.7) breaths/min. Median (IQR) ventilator VT was 0.5 (0.5-0.5) L. Median (IQR) self-inflating bag VT was 0.6 (0.5-0.7) L. Median (IQR) ventilator peak inspiratory pressure was 22 (22-22) cm H2O. Median (IQR) self-inflating bag peak inspiratory pressure was 30 (27-35) cm H2O. Mean ± SD hands-off times for ventilator and self-inflating bag were 5.25 ± 2.11 and 6.41 ± 1.45 s, respectively. When compared with a ventilator, volunteers ventilated with a self-inflating bag within ACLS guidelines. However, volunteers ventilated with increased variation, at higher VT levels, and at higher peak pressures with the self-inflating bag. Hands-off time was also significantly lower with the ventilator. (ClinicalTrials.gov registration NCT02743299.).