Manual Defibrillation Research Articles

In search of an effective teaching approach for skill acquisition and retention: Teaching manual defibrillation to junior medical students

Introduction Although overloaded curricula, the increasing student to educator ratio, limited resources, insufficient curriculum alignment and the unpredictable clinical learning environment contribute to the decay of clinical skill competency, the problem of poor skill retention often lies in inadequate skill acquisition which is associated with the quality of the instruction. The aim of the study was to investigate the influence of three different instructional approaches on the acquisition and retention of skills in order to determine which method would be best suited for teaching in simulation in a resource-constrained environment. Methods A randomised controlled trial design was used to compare the efficacy of the traditional, Peyton's four-stage, and a modified five-step method. Regarding the latter, George and Doto's five-step method was altered to include peer teaching and feedback with a tutor in a supervisory role. Groups of first year students were taught ‘manual defibrillation'. Subsequent to the teaching session as well as at two months later, students' skills were tested. Additional qualitative data regarding students' perceptions of the different teaching strategies they were exposed to were obtained by means of questionnaires. Results None of the three instructional approaches proved to be superior in acquisition or retention. Previous studies reported similar findings. The lack of differentiation between the three teaching methods might be attributed to the fact that all three methods included practice with feedback in one form or another. Numerous studies have identified these as critical components leading to effective learning in a simulation-based learning environment. Conclusion Considering that the three instructional approaches were similar in terms of skill acquisition and retention, incorporating peer teaching and feedback is a feasible strategy in a resource-limited environment.

Abstract 98: The Association Between Manual Mode Defibrillation, Preshock Pause Duration and Appropriate Shock Delivery When Employed by Basic Life Support Paramedics During Out-of-Hospital Cardiac Arrest

BACKGROUND: Pre-shock pause duration of < 20 seconds is associated with improved survival after cardiac arrest. Manual mode defibrillation has been associated with the shortest duration of pre-shock pause but is largely practiced by paramedics (EMT-P) whereas defibrillator only providers (EMT-D) routinely use the defibrillator in automatic mode. OBJECTIVE: We sought to explore the relationship between manual mode defibrillation, pre-shock pause duration and shock appropriateness when defibrillation is provided by EMT-P vs. EMT-D level of providers. METHODS: We performed a retrospective review of all treated non-traumatic adult OHCA presenting in a shockable rhythm over a one year period beginning January 1, 2012. Our primary outcome measure was the proportion of manual mode shocks delivered by EMT-D’s with pre- shock pause duration of < 20 secs when compared to EMT-P’s. Our secondary outcome measures were the duration of pre-, post- and peri-shock pause and the proportion of appropriate shocks (defined as correct identification and shock delivery to patients in a shockable rhythm) delivered by either level of provider. This study had a power of 90% to detect an absolute difference of 15% between provider levels in proportion of shocks delivered with pre-shock pause duration <20 secs. RESULTS: Among 2019 treated OHCA, 335(20%) presented in a shockable rhythm. Manual defibrillation was performed in 155 (46%) of these cases (196 shocks by EMT-P, 143 shocks by EMT-D). There were no differences in the proportion of shocks delivered with pre-shock pause duration <20 secs (EMT-P 82.8% vs EMT-D 84.8%, p =.65) nor pre-shock pause duration (sec) (median, Q1, Q3); EMT-P: 12.0 (7.0,17.0) vs. EMT-D: 11.0 (5.0,17.0), p= .13 while EMT-D had shorter peri- shock pause duration (sec) (median, Q1, Q3); EMT-P: 17.0 (12.0, 23.0) vs. EMT-D: 15.0 (9.0, 22.0), p =.03. There were no differences in the rate of inappropriate shocks (EMT-P 1.0% vs EMT-D 0.7%), p=1.0. CONCLUSIONS: Manual mode defibrillation by EMT-D’s produced similar measures of pre-shock pause when compared to EMT-P’s without increasing the rate of inappropriate shocks. More widespread use of EMT-D manual mode defibrillation may have the potential to decrease shock pause duration and improve survival.

Evaluation of prehospital use of manual defibrillators; the dangers of inappropriate or delayed defibrillation

Evaluation of prehospital use of manual defibrillators; the dangers of inappropriate or delayed defibrillation

Defibrillators

Defibrillators

Emergency skills learning on video (ESLOV): A single-blinded randomized control trial of teaching common emergency skills using self-instruction video (SIV) versus traditional face-to-face (FTF) methods

Background: Self-instruction video (SIV) has been widely explored as a teaching mode for cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED), but not with other basic emergency skills.Aim: To evaluate the effectiveness of SIV in teaching other basic emergency skill in comparison with traditional face-to-face (FTF) methods.Methods: Participants were randomized into SIV and FTF groups. Each group was assigned to learn basic airway management (BAM), cervical collar application (CCA), manual cardiac defibrillation (MCD), and emergency extremity splinting (EES) skills. Confidence level was assessed using questionnaires, and skills performances were assessed using calibrated-blinded assessors through an Objective Structured Clinical Examination (OSCE).Results: Forty-five participants took part in the assessment exercises. There were no significant differences between both groups, on all four skill categories. The mean OSCE-score of an individual category between the FTF-group vs. the SIV-group were as follows: BAM (10.23 ± 1.04 vs. 10.04 ± 1.49; p = 0.62); CCA (7.86 ± 4.39 vs. 7.13 ± 4.12; p = 0.57); MCD (8.24 ± 0.89 vs. 7.58 ± 1.14; p = 0.39); EES (5.43 ± 2.11 vs. 4.63 ± 2.30; p = 0.23). The composite mean score for the FTF-group was 6.85, and for the SIV-group was 6.20 (p < 0.05). There was no significant different in the level of confidence for both groups.Conclusion: SIV is as effective as FTF in teaching and learning basic emergency skills.

Beyond the pre-shock pause: the effect of prehospital defibrillation mode on CPR interruptions and return of spontaneous circulation

AimsThe pattern of interruptions to chest compressions in pre-hospital cardiac arrests in Wellington, New Zealand, was examined prospectively to determine whether the mode of defibrillation chosen by paramedics influenced interruptions, shock success and the return of spontaneous circulation (ROSC). MethodsA prospective observational cohort study of 44 adult cardiac arrests in which 203 shocks were administered by Wellington Free Ambulance (WFA) paramedics was undertaken to compare Code-stat® electronic records from Medtronic® Lifepak 12 and Lifepak 15 defibrillators used in semi-automated (AED) or manual mode. Interruptions during the 30s prior to shock delivery as well as pre-shock and post-shock pauses were calculated. Shock success and ROSC were the outcome measures. ResultsPre-shock pauses were shorter in manual mode (median 3s, IQR 2–5) versus AED mode (median 4s, IQR 3–6; p=0.003). Interruptions of CPR in the 30s prior to shock delivery were also shorter in manual mode (median 7s, IQR 4–11) versus AED mode (median 14s, IQR 12–16; p=<0.001). Shock success rates and post-shock pauses were not statistically different between modes. ROSC was significantly higher in manual mode (18.49%) versus AED mode (8.33%, p=0.042). ConclusionWhen paramedics used the defibrillator in manual mode as compared to AED mode, interruptions to CPR during the 30s prior to shock delivery were significantly reduced and pre-shock pauses were also shorter. This was associated with increased ROSC. Manual defibrillation should be the preferred option for appropriately trained paramedics. Training in this locality has been changed accordingly.

The effects of the victims body movements on rhythm recognition by automated external defibrillatorsStatus: PendingCategory: Defibrillation

Sudden cardiac arrest is a significant medical problem. Quick access to Automated External Defibrillators (AEDs) improves the rate of survival. AEDs via a complicated computer programs recognize shockable or non-shockable rhythms. The gasping, certain body movements, shaking and disturbances during the transport can have influence and might lead to incorrect rhythm recognition. The study was focused on specificity and sensitivity of diagnosis of rhythm recognition by the AEDs. To check the recognition rate in the event of obvious disturbance artifacts, several attempts with the AED and manual defibrillators while in AED mode has been conducted in healthy volunteers.

Automated External Defibrillators for Cardiac Arrests in Hospitals

The use of automated external defibrillators (AEDs) instead of manual defibrillators after in-hospital cardiac arrest on general wards was associated with lower survival rates among patients with an initial rhythm that was nonshockable. Patients with an initial rhythm that was shockable showed no association between outcome and AED use. Level of evidence: 2B (individual cohort study)

The Effect of the AED and AED Programs on Survival of Individuals, Groups and Populations

The automated external defibrillator (AED) is a tool that contributes to survival with mixed outcomes. This review assesses the effectiveness of the AED, consistencies and variations among studies, and how varying outcomes can be resolved. A worksheet for the International Liaison Committee on Resuscitation (ILCOR) 2010 science review focused on hospital survival in AED programs was the foundation of the articles reviewed. Articles identified in the search covering a broader range of topics were added. All articles were read by at least two authors; consensus discussions resolved differences. AED use developed sequentially. Use of AEDs by emergency medical technicians (EMTs) compared to manual defibrillators showed equal or superior survival. AED use was extended to trained responders likely to be near victims, such as fire/rescue, police, airline attendants, and casino security guards, with improvement in all venues but not all programs. Broad public access initiatives demonstrated increased survival despite low rates of AED use. Home AED programs have not improved survival; in-hospital trials have had mixed results. Successful programs have placed devices in high-risk sites, maintained the AEDs, recruited a team with a duty to respond, and conducted ongoing assessment of the program. The AED can affect survival among patients with sudden ventricular fibrillation (VF). Components of AED programs that affect outcome include the operator, location, the emergency response system, ongoing maintenance and evaluation. Comparing outcomes is complicated by variations in definitions of populations and variables. The effect of AEDs on individuals can be dramatic, but the effect on populations is limited.

Practical management of sudden cardiac arrest on the football field

Sudden cardiac arrest (SCA) remains a tragic occurrence on the football field. The limits of preparticipation cardiovascular screening make it compulsory that prearranged emergency medical services be available at all...

Effectiveness of using automated external defibrillator by trained healthcare professionals on survival outcomes among adult patients after in-hospital cardiac arrest: a systematic review.

Review question/objective The objective of this review is to synthesise the best available evidence of the effectiveness of using automated external defibrillator by trained healthcare professionals on survival outcomes in adult patients after in-hospital cardiac arrest. More specifically, the objectives are to identify: the effectiveness of using automated external defibrillator by trained healthcare professionals on return of spontaneous circulation and survival to hospital discharge in adult patients after in-hospital cardiac arrest. Inclusion criteria Types of participants This review will consider studies that include adults 18 years old and above; suffering from cardiac arrest requiring chest compression in in-patient wards, emergency department and out-patient procedures in hospital; presenting with an initial index pulseless (for example, but not limited to, ventricular fibrillation and pulseless ventricular tachycardia, asystole or pulseless electrical activities); presence or absence of co-morbidities such as congestive heart failure, myocardial infarction, diabetes mellitus, renal, hepatic or respiratory insufficiency, motor, cognitive or functional deficits, acute stroke, acute non-stroke neurological disorder, pneumonia, hypotension, sepsis, major trauma, metabolic or electrolyte abnormality, metastatic or haematology malignancy. The exclusion criteria are any age group who suffered out-of-hospital cardiac arrest or adults 18 years old and above suffered in-hospital cardiac arrest with a ‘do not resuscitate’ order (DNR). Types of intervention(s) This review will consider as interventions any use of commercially available automated external defibrillator by trained healthcare professionals for in-hospital cardiac arrest. The comparator of interest is use of manual/standard external defibrillator by trained healthcare professionals for in-hospital cardiac arrest. Types of outcomes This review will consider studies that include the following outcome measures: 1. survival with a return of spontaneous circulation for at least 20 minutes during resuscitation 2. survival to hospital discharge regardless of time to discharge 3. initial cardiac arrest rhythms

AP064 Manual defibrillation according to the 2010 European Resuscitation Council (ERC) Guidelines – Is there a consensus? Report from 6th International Emergency Medicine Championships

p<0.05, airway opening p<0.05 and breathing assessment p<0.05, respectively between the age of students with assessment of consciousness p<0.01 and breathing assessment p<0.05. Conclusions: We considered that the most important factors that can influence the level of knowledge’s acquisition necessary for effective BLS maneuvers are younger age and the presence of medical background in participants. In light of the objectives of this study shows the need to put more emphasis on preparing students with medical background present, to be sure that they will purchase during clinical placements and course information necessary to make correct and effective resuscitation maneuvers.

013 Resuscitation feedback and targeted education improves quality of pre-hospital resuscitation in Scotland

Objectives and BackgroundsOut-of-hospital cardiac arrest is a leading cause of mortality and neurological morbidity in the UK. Cardiopulmonary resuscitation is vital to maintaining cerebral and cardiac perfusion until return of...

Inappropriate external defibrillation

In critically ill patients, alterations of the electrocardiogram (ECG) signal in monitors should be promptly evaluated as rapid interventions could be lifesaving. This requires taking into account the clinical condition of the patient and a series of other indicators about the patient's status. ECG artifacts could potentially precipitate an inappropriate management course leading to unnecessary diagnostic and therapeutic interventions [1]. We report and discuss a case where incorrect interpretation of the ECG signal led to an inappropriate medical decision to deliver external defibrillation. A 68 year old woman with ischemic cardiomyopathy (ejection fraction 26%) presented to a regional hospital with decompensated congestive heart failure (CHF). She had received an implantable cardioverter-defibrillator (ICD) (Medtronic Secura VR, MN, USA) about one month prior for primary prevention of sudden cardiac death. She soon developed respiratory distress requiring intubation andwas transferred to our center via air ambulance for further management. During transport, an ECG monitor tracing (Fig. 1) prompted manual external defibrillation at 360 V (Medtronic Lifepak 12, MN, USA). Upon arrival, shewas transferred to the intensive care unit (ICU) for closemonitoring. No abnormal rhythms were detected on telemetry. ICD interrogation revealed no detection of ventricular arrhythmias or therapies. After further management in the ICU including diuresis for CHF, she was

Part 6: Defibrillation

Part 6: Defibrillation

Part 6: Electrical Therapies

The recommendations for electrical therapies described in this section are designed to improve survival from SCA and life-threatening arrhythmias. Whenever defibrillation is attempted, rescuers must coordinate high-quality CPR with defibrillation to minimize interruptions in chest compressions and to ensure immediate resumption of chest compressions after shock delivery. The high first-shock efficacy of newer biphasic defibrillators led to the recommendation of single shocks plus immediate CPR instead of 3-shock sequences that were recommended prior to 2005 to treat VF. Further data are needed to refine recommendations for energy levels for defibrillation and cardioversion using biphasic waveforms.

Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators

Basic life support (BLS) refers to maintaining airway patency and supporting breathing and the circulation, without the use of equipment other than a protective device.1 This section contains the guidelines for adult BLS and for the use of an automated external defibrillator (AED). It also includes recognition of sudden cardiac arrest, the recovery position and management of choking (foreign-body airway obstruction). Guidelines for the use of manual defibrillators and starting in-hospital resuscitation are found in Sections 3 and 4.

Defibrillation and resuscitation in a piglet model of pediatric ventricular fibrillation following AHA 2005 guidelines

To evaluate the efficacy and safety of defibrillation on children according to AHA 2005 recommendations Pig resembles human in the chest configuration, anatomy and physiology of the cardiovascular and pulmonary systems. Piglets weighing 7.0 Kg ± 1.4kg, 14.0kg ± 2.8kg, 25.0kg ± 5.0kg respectively, which represented children 1 to 8 yr old were induced ventricular fibrillation (VF). An adult biphasic AED was used in conjunction with pediatric attenuating electrodes which could deliver 50-J shock for 2 min and two min of cardiopulmonary resuscitation (CPR) immediately followed it. If VF did not reverse, 70-J shock combined with CPR was used, and the protocol was repeated five times. If an organized cardiac rhythm with mean aortic pressure more than 60 mmHg persisted for an interval of 5 minutes, the animal was regarded as successfully resuscitated. If the AED recognized a "non-shockable" rhythm, CPR was also performed immediately for 2 min. The same resuscitation program was exercised on piglets of manual defibrillator group. Neurologic alertness score, hemodynamic and myocardial functions were evaluated, autopsy was routinely performed to document possible injuries. In the AED group, 14 out of 15 animals, were successfully resuscitated, among them 11 piglets were resuscitated by 50-J defibrillation combined with cardiopulmonary resuscitation, and other three recovered to normal by 1 or 2 times of 70-J shocks and CPR. All animals in manual defibrillator group were successfully resuscitated by 50-J shocks and CPR. Left ventricular ejection fraction and fractional area change were reduced significantly during 3-4 hr post-resuscitation (P<0.05) and returned to baseline ranges at the end of 72 hr. There was no evidence of myocardial and pulmonary damage during autopsy, and neurologic recovery was also normal. Data of blood gas analysis, blood electrolytes and myocardial enzymes does not show any statistically significant difference (P> 0.05) in the groups. 50 J biphasic dose defibrillation combined with effective CPR, successfully terminated VF without adverse effects on myocardial function and survival in a piglet defibrillation model for young children 1 to 8 yr of age. The new guidelines recommendation that one shock immediately followed by CPR is reasonable. Adults AED combined with pediatric electrodes is feasible to the diagnosis and treatment of pediatric VF model. But the user should not rely too much on AED's "automatic" function, but should accumulate and integrate his experience with AED technology.

Delaying a shock after takeover from the automated external defibrillator by paramedics is associated with decreased survival

Introduction The purpose of this study was to investigate whether the takeover by Advanced Life Support [ALS] trained ambulance paramedics from rescuers using an automated external defibrillator [AED] delays shocks and if this delay is associated with decreased survival after out-of-hospital cardiac arrest [OHCA]. Methods We analyzed continuous ECG recordings of LIFEPAK AEDs and associated manual defibrillator recordings of OHCA of presumed cardiac cause, prospectively collected from July 2005 to July 2009. The primary outcome measure was survival to discharge. Among 693 patients treated with AEDs, 110 had a shockable initial rhythm and a shockable rhythm during ALS takeover. We measured the time interval between the expected shock if the AED would remain attached to the patient and the first observed shock given by the manual defibrillator [shock timing]. Results Survival was 62% (13/21) if the shock was given early (<−20 s), 52% (11/21; odds ratio [OR] = 0.68, ns) if given on time (−20 to 20 s), 29% (10/34; OR = 0.26, 95% confidence interval [CI] = 0.08–0.81; P = 0.02) if the shock was 20–150 s delayed and 21% (7/34; OR = 0.16, 95% CI = 0.05–0.54; P = 0.003) if the shock was delayed >150 s. The OR for trend was 0.41, 95% CI = 0.25–0.71; P = 0.001. The association between shock timing and survival was significant for patients with more than 150 s shock delay (OR = 0.19; 95% CI = 0.04–0.71; P = 0.02) or for trend in shock timing (0.42, 95% CI = 0.20–0.84; P = 0.02) after multivariable adjustment for prognostic factors age and slope of ventricular fibrillation. Conclusions ALS takeover delays the next shock delivery in almost two-third of cases. This delay is associated with decreased survival.