Lay Rescuers Research Articles

Abstract 21289: The Presence of Warning Labels on AEDs Decreases the Odds of Device Use by Lay Rescuers

Background: Significant resources have been invested in public access defibrillation programs; however, the true rate of lay rescuer AED use remains unknown. Even in circumstances where the device location is known, numerous potential barriers to lay rescuer use remain. Among these is the presence of warning labels (e.g. “Trained Responders Only”), which may induce anxiety and reinforce a state of low self-efficacy. The purpose of this study was to determine if the presence of warning labels on or near public access defibrillators influences lay rescuer self-reported willingness to utilize such devices in an emergency scenario. Methodology: This prospective cross-sectional survey study utilized a simple random sample of adults age 18-65. Healthcare providers were excluded. Participants were asked a series of questions regarding their past experiences with CPR/AED training and were then shown a static picture of an AED. Two versions of the picture were alternated between participants in a random fashion with half of participants seeing a warning label on the device. Participants were asked about their willingness to utilize the device if faced with a victim of cardiac arrest. Comparisons were made between participants in the two groups to determine the potential influence of warning labels on self-reported willingness to render aid. Reported experience and demographics (e.g. age, gender, income, education, etc.) were used for control purposes. Results: Most participants (71%, N=500) indicated a willingness to assist, but fewer participants were willing to assist when presented with a warning label (65%) then when no such label was present (75%). The odds of lay rescuer AED use was significantly decreased in the presence of a warning label (OR=0.51, 95% CI=0.34, 0.75). Conclusion: The presence of warning labels on an AED decreased the odds of device use by lay rescuers, but it is unknown if actual human performance would be consistent with such responses in the face of an actual emergency.

Exploring How Lay Rescuers Overcome Barriers to Provide Cardiopulmonary Resuscitation: A Qualitative Study.

Survival rates after out-of-hospital cardiac arrest (OHCA) vary considerably among regions. The chance of survival is increased significantly by lay rescuer cardiopulmonary resuscitation (CPR) before Emergency Medical Services (EMS) arrival. It is well known that for bystanders, reasons for not providing CPR when witnessing an OHCA incident may be fear and the feeling of being exposed to risk. The aim of this study was to gain a better understanding of why barriers to providing CPR are overcome. Using a semi-structured interview guide, 10 lay rescuers were interviewed after participating in eight OHCA incidents. Qualitative content analysis was used. The lay rescuers were questioned about their CPR-knowledge, expectations, and reactions to the EMS and from others involved in the OHCA incident. They also were questioned about attitudes towards providing CPR in an OHCA incident in different contexts. The lay rescuers reported that they were prepared to provide CPR to anybody, anywhere. Comprehending the severity in the OHCA incident, both trained and untrained lay rescuers provided CPR. They considered CPR provision to be the expected behavior of any community citizen and the EMS to act professionally and urgently. However, when asked to imagine an OHCA in an unclear setting, they revealed hesitation about providing CPR because of risk to their own safety. Mutual trust between community citizens and towards social institutions may be reasons for overcoming barriers in providing CPR by lay rescuers. A normative obligation to act, regardless of CPR training and, importantly, without facing any adverse legal reactions, also seems to be an important factor behind CPR provision. Mathiesen WT , Bjørshol CA , Høyland S , Braut GS , Søreide E . Exploring how lay rescuers overcome barriers to provide cardiopulmonary resuscitation: a qualitative study. Prehosp Disaster Med. 2017;32(1):27-32.

Results of Out-of-Hospital Cardiopulmonary Arrest Cases with Intervention by Lay Rescuers and Emergency Health Workers

Aim: In this study, all interventions made by lay rescuers and health professionals and the shortcomings for cardiopulmonary arrest management outside the hospital were examined. Materials and Methods: The study was conducted between December 2012 and May 2014 in the Emergency Department of Gaziantep University. To ensure orderly and standardized records, a study form was prepared that consisted of 31 questions. The time and location of the cardiac arrest, information regarding the lay rescuers and professional health workers, and the practices followed during transport and at the emergency service were examined. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) for Windows software version 22.0, and p<0.05 was accepted as statistically significant. Results: Of the 205 cardiac arrests, 69.8% were male and 30.2% were female. The mean age in all of the cases was 58.34±19.1 years. The cardiac arrests mostly occurred in the home environment (62.4%) and happened between 13.00 and 20.00 hours (43.4%). The most frequent conditions that caused a worsening of the cases were syncope (unresponsiveness) (35.6%). The people who identified the cardiac arrest case and called for help by informing emergency health personnel (EHP) were mostly family members (50.7%). The activation time was 14.27±20.30 min. The time to arrive at the scene was 8.4±6.4 (1–35) min. Lay rescuers performed resuscitation in 19.5% of cases. The most frequent rhythms on the arrival of the EHP were asystole (74.1%). EHP evaluated the glaskow coma scale (GCS) of 88.3% of the cases as ≤7 at the scene. EHP performed basic life support (BLS) on all cases (100%) and endo-tracheal intubation (ETI) on 29.3% of the cases at the scene. The on-scene time and transport time to ED were 8.09±8.82 and 9.02±7.92 (1-50) min, respectively. The average duration of CPR at ED was 35.15±16.9 min. Of all the cases, 7.8% were discharged from intensive care unit (ICU) to homes. Of all the cases, 77.6% died at the ED, and 14.6% died in ICU. Conclusion: The intervention rate by lay rescuers was far less than the international rates. The survival rates were generally below the internationally reported rates. There is no adequate public awareness in our area for identifying cardiac arrest in patients and for initiating early chest compressions. (Eurasian J Emerg Med 2016; 15: 7-14)

Abstract 12080: 9-1-1 Caller Descriptions of Gasping During Out-of-Hospital Cardiac Arrest

Background: Abnormal breathing, or “gasping,” frequently occurs during cardiac arrest and has been associated with increased survival. During 9-1-1 calls, early recognition of gasping may allow dispatchers to identify OHCA and to start CPR instructions promptly. Objective: To characterize lay rescuers’ descriptions of abnormal breathing during OHCA. Methods: 9-1-1 audio recordings of 4,279 confirmed OHCAs (10/10-7/14) in Arizona were reviewed by program personnel. Terms used by lay rescuers to describe victims’ breathing were recorded in a structured database. Results: Abnormal breathing (as opposed to “not breathing”) was described in 542/4279 (13%) calls. There were 623 verbal descriptions. A total of 50 different terms were used. However, the top 8 accounted for 83% and the remaining 42 descriptions (“Other”) comprised only 17% of all terms used. “Gasping” was the most commonly used term (30%; 187/623), followed by “snoring” (15%; 95/623; Figure). Conclusion: Lay rescuers used a wide variety of terms to describe abnormal breathing in documented OHCA. However, 8 terms accounted for 83% of descriptions. Familiarizing 9-1-1 telecommunicators with the most commonly used terms may improve the accuracy of recognition and hasten the identification of OHCA.

Comparison of Fatigue During Cardiocerebral Resuscitation with Different Compression Rates Among Layperson and Professional Rescuers

Nearly 383,000 out-of-hospital sudden cardiac arrests occur annually in the United States, with 88 percent occurring at home. Cardiopulmonary resuscitation continues to evolve and emphasizes higher frequency chest compressions, ≥ 100 compressions per min (cpm), and “hands-only” cardiocerebral resuscitation (CCR), particularly for lay rescuers. Greater compression frequency may accelerate rescuer fatigue and limit the time a single rescuer may provide circulation. PURPOSE: To quantify the differences in heart rate, RPE and time to fatigue at 80 cpm vs. 100 cpm in solo rescuers, and to determine if aerobic fitness and chest strength/endurance were predictive of the ability to sustain CCR. METHODS: Sixty-one subjects, 20 men aged 20-56 yrs and 41 women aged 20-45 yrs performed two trials of uninterrupted chest compressions on a manikin for up to 15 min per trial. Each subject performed, in random order, one trial at 80 cpm and another trial at 100 cpm with at least 5 min rest between trials. The manikin provided continuous biofeedback regarding rate and depth of compressions. Relative cardiorespiratory fitness and chest strength/endurance were estimated via YMCA step and bench press tests. Logistic regression was used to identify predictors of the ability to sustain compressions for 15 min. RESULTS: There were no significant differences (p>0.05) in mean HR (125.6 vs. 129.0 bpm), RPE (5.2 vs. 5.9), or trial duration (11:22 vs. 11:07 min) between the 80 cpm and 100 cpm trials. Professional rescuers were more likely to complete the 15 min 100 cpm trial than lay rescuers (p=.0346), and men were more likely than women (p=.0068). High relative chest strength/endurance was a significant predictor of completion of the 100 cpm trial (p=0.0188), but relative cardiorespiratory fitness was not. Wrist pain, muscular fatigue, and shoulder pain were the leading reasons for terminating compressions before the 15 min trial end point. CONCLUSIONS: Chest, shoulder and arm muscular strength and endurance are more important determinants of fatigue than cardiorespiratory fitness when performing CCR. Persons likely to perform CCR should develop and maintain chest, shoulder and arm muscle strength and endurance. Lay and women solo rescuers should consider lower compression frequencies during CCR when relief will be delayed.

Abstract 283: Hands-off Time During Lay Rescuer Basic Life Support Remains High After a Standard Basic Life Support Course

The current international guidelines for resuscitation recommend high quality chest compressions with minimal interruptions as important prerequisite for optimal survival after cardiac arrest. During the standard four hours BLS course of the European Resuscitation Council (ERC) the participants learn to provide chest compressions, ventilations and to use an automated external defibrillator. We know that lay rescuers are able to learn these skills. However, it is unclear whether lay rescuers manage to minimize interruptions of chest compressions. Objective: To evaluate the no-flow fraction (NFF) during lay rescuer BLS including chest compressions, ventilation and the use of an AED. Methods: 24 participants of a BLS/ AED course were assessed before (T1) and after (T2) the BLS training in a standardized scenario in pairs of 2 rescuers. We used a Resusci Anne Simulator manikin (Laerdal, Norway) and a Lifepak 1000 AED trainer device for the assessment. The scenario was an adult patient with cardiac arrest and persistent ventricular fibrillation (VF), duration of the scenario was 5 minutes. 28 lay persons served as control group and were assessed in pairs of 2 rescuers twice at the same day. Two-sided t-test was used to test differences between groups and between test scenarios (T1 vs. T2), p&lt;.05 was considered significant. Results: The NFF decreased from 0.68 ± 0.1 (before the course) to 0.5 ± 0.07 (after the course), p=.000. In the control group the NFF was 0.63 ± 0.1 (scenario 1) and 0.59 ± 0.14 (second scenario), p=.244. Conclusion: A standard BLS course reduces the interruptions of chest compressions during lay rescuer CPR. However, 50% of the scenario no chest compressions are given. Interruptions are mainly due to ventilations or related to the use of the AED. Further research is necessary to improve the BLS algorithm regarding reduction of interruptions.

Abstract 22: Experienced Impact and Post-Traumatic Stress Symptoms of Dispatched Local Lay Rescuers Performing Basic Life Support

Aim: A text message (TM) alert system for OHCA has been implemented in part of the Netherlands. This system uses TM from EMS dispatch to alert local lay rescuers (TM-responders [TMRs]) living &lt;1000m radius of the OHCA victim, to either go directly to the victim and perform CPR, or to a nearby AED first. Over 14 000 TMRs and &gt;1500 AEDs were registered in a database residing with the dispatch center. We studied the level of experienced impact shortly after performing BLS and compared it with the Impact of Event Scale (IES) score 4-6 wks afterwards. Methods: With each TM-alert an email was sent to the TMRs with a link to an online questionnaire. We analyzed all questionnaires from 15-02-2013 to 21-04-2014 which were filled out median 5h after EMS call. We counted the experienced impact level (no, little, bearable, much, unbearable). All firstly arrived TMRs who provided BLS±AED use prior to EMS arrival, participated in a semi-structured interview by telephone median 4 days after resuscitation. To assess if TMRs had post-traumatic stress symptoms (PTSS), the IES was sent to all interviewees 4-6 wks after the resuscitation. Scores 0-8 indicated subclinical, 9-25 mild, 26-43 moderate, and ≥44 severe stress. A score &gt;25 indicated PTSS. Results: The dispatcher activated the TM-alert system 697 times, alerting 18 742 TMRs. 4799 completed the questionnaire. Of these, 1639 responded to the call and 353 arrived on scene, participating in the resuscitation. We interviewed 148 first arriving TMRs of whom 137 also completed the IES. Comparison between level of experienced impact and IES score is shown in the figure. None showed PTSS (median: 1, 25th-75th percentile: 0-8, max. 25). Of all TMRs experiencing no/little impact, 13% was grouped as mild. Of all TMRs experiencing bearable impact, 22% scored mild and of all TMRs experiencing much impact, 44% scored mild. Conclusion: TMRs do not show PTSS 4-6 wks after performing BLS, even if their experienced level of impact is considerable shortly after the event.

Duration of Ventilations During Cardiopulmonary Resuscitation by Lay Rescuers and First Responders

Background— The 2010 guidelines for cardiopulmonary resuscitation allow 5 seconds to give 2 breaths to deliver sufficient chest compressions and to keep perfusion pressure high. This study aims to determine whether the recommended short interruption for ventilations by trained lay rescuers and first responders can be achieved and to evaluate its consequence for chest compressions and survival. Methods and Results— From a prospective data collection of out-of-hospital cardiac arrest, we used automatic external defibrillator recordings of cardiopulmonary resuscitation by rescuers who had received a standard European Resuscitation Council basic life support and automatic external defibrillator course. Ventilation periods and total compressions delivered per minute during each 2 minutes of cardiopulmonary resuscitation cycle were measured, and the chest compression fraction was calculated. Neurological intact survival to discharge was studied in relation to these factors and covariates. We included 199 automatic external defibrillator recordings. The median interruption time for 2 ventilations was 7 seconds (25th–75th percentile, 6–9 seconds). Of all rescuers, 21% took &lt;5 seconds and 83% took &lt;10 seconds for a ventilation period; 97%, 88%, and 63% of rescuers were able to deliver &gt;60, &gt;70, and &gt;80 chest compressions per minute, respectively. The median chest compression fraction was 65% (25th–75th percentile, 59%–71%). Survival was 25% (49 of 199), not associated with long or short ventilation pauses when controlled for covariates. Conclusions— The great majority of rescuers can give 2 rescue breaths in &lt;10 seconds and deliver at least 70 compressions in a minute. Longer pauses for ventilations are not associated with worse outcome. Guidelines may allow longer pauses for ventilations with no detriment to survival.

Halktan ilkyardım uygulayıcısı eğitimi ve toplu yaşam alanlarında otomatik eksternal defibrilatör (OED)

Lay rescuer training and AED in public area The management applied in the first minutes of sudden life threatening situations affects and determines the survival. Treatable diseases can be managed in emergency departments by association of 112 that held the professional medical support and emergent activation system. The most important key point is the survival of the patient until administration of the professional medical support. This role belongs to the lay rescuer in public. These trainings are afforded nationwide in developed countries and have successful results. The approach and management of public lay rescuer for vital patient were investigated in this review.

Abstract 254: Quality of 2-Minute Continuous Chest Compressions by Medical Students and Lay Rescuers

Background: The performing of quality chest compressions is highly emphasized in the American Heart’s 2010 Guidelines. Moreover, it addresses the importance of continuous chest compressions (hands-only) as the best approach when faced with a sudden cardiac arrest victim when a ventilation barrier device is not available. Hypothesis: We hypothesized that first-year medical students perform two-minute continuous chest compressions with lower quality than those performed by lay rescuers who had Heartsaver ® CPR AED training at least every 2 years. Methods: The volunteers initially attained the Heartsaver® CPR AED course. After approximately 30 minutes they performed 2 minutes continuous chest compressions in the Resusci Anne training mannequin, with a PC reporting system. Results: When comparing the 76 medical students with the 74 trained lay rescuers, the average age (20 vs. 40 years), the male gender (54% vs. 92%), the mean body mass index (24.9 vs. 27.3 kg/m2) and physical activity (55% vs. 36%) presented significant differences, p&lt;0.01, p&lt;0.01, p&lt;0.01 and p=0.04, respectively. Regarding the quality of chest compressions, the average rate (121 vs. 124 compression/minute), duty cycle (47% vs. 45%), the percentage of compressions with correct hand positioning (87% vs. 90%) and the average depth (45 vs. 49 mm), showed no significant difference, p=0.05, p=0.06, p=0.32 and p=0.10, respectively. However, the percentage of adequate depth compressions (43% vs. 58%) and the percentage of compressions without error (36% vs. 50%) revealed a significant difference, p=0.01 and p&lt;0.01. Conclusion: In conclusion, the results show that important parameters like the percentage of compressions with adequate depth and compressions without error had a significant difference, demonstrating that although being lay rescuers, the constant cardiac resuscitation training allows performing higher quality chest compressions than those performed by medical students. It’s need ongoing training of medical students, because they must perform good-quality chest compressions too.

Lay rescuers are unable to adhere to the narrower range for chest compression rate recommended by the 2010 ERC guidelinesStatus: PendingCategory: Basic Life Support

Lay rescuers are unable to adhere to the narrower range for chest compression rate recommended by the 2010 ERC guidelinesStatus: PendingCategory: Basic Life Support

Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest

Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest

Video Calls for Dispatcher-assisted Cardiopulmonary Resuscitation Can Improve the Confidence of Lay Rescuers—Surveys After Simulated Cardiac Arrest

Video Calls for Dispatcher-assisted Cardiopulmonary Resuscitation Can Improve the Confidence of Lay Rescuers—Surveys After Simulated Cardiac Arrest

Abstract 233: Duration of Ventilations During CPR by Lay Rescuers Does Not Interfere with Delivering Chest Compressions

Objective: In the AHA and ERC Guidelines 2005 (G2005) and 2010 for cardiopulmonary resuscitation the importance of minimally interrupted chest compressions (cc) is emphasized. The time taken to give two breaths should not be more than 5 s to allow for a sufficient number of cc delivered. The feasibility of this recommendation for lay rescuers was questioned after manikin studies. This study aims to determine if the expected short interruption for ventilations by trained lay rescuers can be achieved in reality. Methods: The Arrest study is a prospective database of all out-of-hospital cardiac arrest in the province North-Holland, in the Netherlands. We used Automatic External Defibrillator (AED) recordings where the chest impedance or sternal displacement was recorded during lay rescuer CPR. We excluded ECGs with a c:v ratio of 15:2, incomplete or technical deficient ECGs. Lay rescuers had received a standard ERC BLS and AED course in the past. A ventilation period was defined as a regular interruption of cc during the CPR cycle for more then 3 s where impedance changes suggest ventilations or during ventilation prompts. The chest compression fraction (ccf) was the time of the cycle that was used for cc. We analyzed the duration of each ventilation- and cc period, as well as the number of cc and ventilations during each 2 minutes CPR cycle. Results: We included all 222 AED recordings from lay rescuer CPR from September 2010 until March 2011, trained according to the G2005. The median (IQR) interruption time for two ventilations was 7.4 s (5.8-9.3 s). Of all, 19.4% of rescuers took &gt;10 seconds for a ventilation period. Of the lay rescuers 97% was able to give ≥60 cc min -1 and 66% to give ≥80 cc min -1 . The median ccf (IQR) was 76.7% (71.4-83.4%). Conclusion: For the great majority of lay rescuers it is feasible to give two rescue breaths in less than 7 s and to give at least 60 compressions per minute. Trained lay rescuers can deliver compressions and ventilate as recommended by the Guidelines.

Abstract 220: Analysis of Actual CPR Through a Review of YouTube Video: Poor Performance Is Common in Professional and Lay Rescuers

INTRODUCTION: Numerous studies have shown the performance of CPR in both prehospital and hospital settings often fails to meet recommended standards. We sought to analyze the quality of lay rescuer (LR) and professional rescuer (PR) CPR performance in real resuscitation events captured on video on the website YouTube.com. METHODS: We searched YouTube for videos of actual adult CPR recorded by bystanders. Videos which were staged for teaching, commercial use or entertainment were excluded. A convenience sample of 50 videos of CPR (in and out-of-hospital) was analyzed. Demographics and CPR quality parameters were collected. Compression depth was subjectively evaluated as adequate or inadequate (ie. not forceful enough). RESULTS: The 50 videos collected were uploaded between 12/2009 and 2/2011. They ranged from :07 to 9:57 minutes in length. Forty-two of 50 (84%) were of out-of-hospital arrests. CPR was done by LR in 17 and PR in 43. The mean chest compression (CC) rate was 110/m (SD 30, range 49-200) for all rescuers, 101/m (SD 29, range 46-166) for LR and 113/m (SD 28, range 49-200) for PR. In both groups, 40% of CC were slower than the recommended rate of 100/m. Inadequate release or leaning was seen in 66% of the time overall (11/17 (65%) of LR and 23/43 (53%) of PR). CC depth was adequate in 18/50 (36%) for both groups (3/17 for LR and 17/43 for PR). Depth was inadequate in 31/50 (62%) for both groups (14/17 for LR and 25/43 for PR). Compression depth adequacy was indeterminate in 1 video where the chest could not be seen. The mean time for rescue breath delivery was 7.8s (SD 4.4, range 3.4-25) overall, 6.3s (SD 3.1) for LR, 14.7s (SD 5.2) for PR. For PR, the mean ventilation rate by BVM alone or after intubation was 31/m (SD 17, range 3-66). 88% of ventilations were faster than the recommended 8-10/m. CONCLUSIONS: In actual bystander-recorded CPR, typical measures of CPR quality are often poor. Slow compression rates, excessive ventilation and significant periods of ‘leaning’ are common, in lay as well as professional rescuers. Mean CC rate is close to recommended rates, but with a very wide range making overall compliance poor. Poor compression depth was more common in LR CPR.

Abstract 222: Public Access Defibrillation Programs with Automated External Defibrillators Need Targeted Cardiopulmonary Resuscitation Training: Lessons from a Local Japanese City Database

Background: Public access defibrillation (PAD) with automated external defibrillator (AED) is well known as a common and good implication in the public location for out of hospital cardiac arrests (OHCAs). In Japan, AED is being implemented in public and residential space, and could be used by bystander since July 2004. PAD may improve survival from sudden OHCA, however, the effect for OHCA in a local Japanese city outcome and characteristics remains unclear. Here we examined to identify the clinical outcome, prevalence and problem of PAD five years later since 2004. Methods and Results: We studied 836 OHCAs in Gifu city between 2009 and 2010 using Gifu city emergency medical service database. Of these, only 42 (5.02%) were attached with AED (male 25 (mean 67.5 year-old), female 17 (mean 88.7 year-old)). After written informed consent was obtained, we interviewed and characterized bystanders. Location of OHCA were nursing home (n=27 (64.3%)), prison (n=6 (14.3%)), sports institution (n=3 (7.2%)), public space (n=3 (7.2%)), and others (shopping mall, hotel, and office). The incidence in nursing home was significantly older than other group (86.7 vs. 56.9 year-old) (p &lt; 0.01). Bystander cardiopulmonary resuscitation (CPR) was performed 36 (86%) with 50% witnessed. AED records showed the incidence of ventricular fibrillation was 26% (n=11), and asystole was 52%. Eight patients were shock delivered and eleven patients got return of spontaneous circulation by CPR and AED. The one month survival rate after OHCA was 14% (n=6). Lay rescuers were almost staff of the institution (n=38 (90%)) and the rate of health care provider (HCP) was 33% (n=14). We obtained and analyzed the data of 22 bystanders (including HCP (n=3)). Twenty one bystanders participated in any CPR training (non AHA program) within five years and the half of them within one year. However 18 (81.8%) bystanders had some difficulty and environmental stress in practical AED use as a PAD program. Conclusions: PAD with AED need to be more appropriately education and implementation with constant PAD program including targeted CPR training, such as AHA program.

Increasing Bystander CPR Rates

JAMA Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest Bentley J. Bobrow, MD; Daniel W. Spaite, MD; Robert A. Berg, MD; Uwe Stolz, PhD, MPH; Arthur B. Sanders, MD; Karl B. Kern, MD; Tyler F. Vadeboncoeur, MD; Lani L. Clark, BS; John V. Gallagher, MD; J. Stephan Stapczynski, MD; Frank LoVecchio, DO; Terry J. Mullins, MBA; Will O. Humble, MPH; Gordon A. Ewy, MD Context: Chest compression–only bystander cardiopulmonary resuscitation (CPR) may be as effective as conventional CPR with rescue breathing for out-of-hospital cardiac arrest. Objective: To investigate the survival of patients with out-of-hospital cardiac arrest using compression-only CPR (COCPR) compared with conventional CPR. Design, Setting, and Patients: A 5-year prospective observational cohort study of survival in patients at least 18 years old with out-of-hospital cardiac arrest between January 1, 2005, and December 31, 2009, in Arizona. The relationship between layperson bystander CPR and survival to hospital discharge was evaluated using multivariable logistic regression. Main Outcome Measure: Survival to hospital discharge. Results: Among 5272 adults with out-of-hospital cardiac arrest of cardiac etiology not observed by responding emergency medical personnel, 779 were excluded because bystander CPR was provided by a health care professional or the arrest occurred in a medical facility. A total of 4415 met all inclusion criteria for analysis, including 2900 who received no bystander CPR, 666 who received conventional CPR, and 849 who received COCPR. Rates of survival to hospital discharge were 5.2% (95% confidence interval [CI], 4.4%-6.0%) for the no bystander CPR group, 7.8% (95% CI, 5.8%-9.8%) for conventional CPR, and 13.3% (95% CI, 11.0%-15.6%) for COCPR. The adjusted odds ratio (AOR) for survival for conventional CPR vs no CPR was 0.99 (95% CI, 0.69-1.43), for COCPR vs no CPR, 1.59 (95% CI, 1.18-2.13), and for COCPR vs conventional CPR, 1.60 (95% CI, 1.08-2.35). From 2005 to 2009, lay rescuer CPR increased from 28.2% (95% CI, 24.6%-31.8%) to 39.9% (95% CI, 36.8%-42.9%; P P P Conclusion: Among patients with out-of-hospital cardiac arrest, layperson compression-only CPR was associated with increased survival compared with conventional CPR and no bystander CPR in this setting with public endorsement of chest compression–only CPR. JAMA. 2010;304(13):1447-1454. doi:10.1001/jama.2010.1392

Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest

Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest

Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest

Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest

A New Defibrillator Mode to Reduce Chest Compression Interruptions for Health Care Professionals and Lay Rescuers: A Pilot Study in Manikins

Background. Chest compression interruptions are detrimental during the resuscitation of cardiac arrest patients, especially immediately prior to shock delivery. Objective. To evaluate the effect of use of a new defibrillator technology, which filters compression-induced artifact and provides reliable rhythm analysis with automatic defibrillator charging during chest compressions, on preshock chest compression interruption. Methods. Thirty subjects (20 basic life support [[BLS]]; 10 advanced life support [[ALS]]) worked in pairs to perform two randomly ordered simulated cardiac resuscitations with the defibrillator operating in either standard mode (ALS == manual; BLS == automated external defibrillator [[AED]]) or the new Analysis and Charging during CPR (AC-CPR) mode. During each resuscitation simulation, rescuers switched roles as chest compressor and defibrillator operator every two segments of CPR (one segment == 2 minutes of chest compressions, rhythm analysis, and shock delivery, if appropriate), for eight total segments. The participants rested ≥30 minutes between trials and received brief AC-CPR training (BLS == 30 seconds; ALS == 5 minutes). Heart rate and perceived exertion were measured with pulse oximetry and the Borg scale, respectively. Results. Mean (± standard deviation) preshock chest compression pause time was considerably shorter in each CPR segment with AC-CPR versus standard defibrillator operation (2.13 ± 0.99 sec vs. 10.93 ± 1.33, p < 0.0001), demonstrating effective use of AC-CPR with minimal training. Despite reduced chest compression interruption with AC-CPR, rescuer fatigue and perceived exertion did not differ in any CPR segment with standard defibrillator operation versus AC-CPR (p == 0.2–1.0). Conclusions. Preshock pause time is reduced by 80%% utilizing a novel technology that employs automated analysis and charging during chest compression. Although chest compression pause time is reduced with the use of the new technology, participants do not excessively fatigue.