Percentage Of Compressions Research Articles

Release velocity improvement with a new metronome-guided chest compression protocol: preliminary results of the RITMICO study

Abstract Introduction Annually, emergency medical services treat over 350’000 out-of-hospital cardiac arrests in the U.S. and over 25’000 in Europe. Outcomes vary widely, according also to the quality of the CardioPulmonary Resuscitation (CPR) provided. Recently, it was demonstrated how, on top of the compression phase, chest release phase is also important to obtain an adequate heart and brain perfusion. However, no studies describe how to ameliorate this parameter during resuscitation. Purpose We investigated if a modified metronome-guided procedure might improve chest compression release velocity during CPR simulation on standard manikin, compared to the standard procedure. Methods We developed a double-click metronome for CPR: the first click corresponds to chest compression and the second to the end of chest release. Volunteers with different levels of expertise in CPR and with a valid BLS-D certification have been included in the study. Each subject performed two CPR manikin simulations following a 4-min protocol with the standard and the modified metronome (Figure 1), in a random order. An Automated External Defibrillator (AED) equipped with pads allowed continuous measurement of CPR quality during simulations. Three CPR parameters have been measured: compression depth, rate and release velocity. CPR simulation was guided only by the external metronome, all audio prompts from the AED were silenced. The two procedures have been compared, in terms of CPR quality, using Wilcoxon signed-ranks test. Impact of subject-specific factors on the difference in CPR quality has been evaluated using stepwise regression. Results 151 volunteers were included in the study, 23 of them have been excluded due to incomplete data recording. Comparison between the two procedures (Figure 2) showed a significant increase of median chest compression depth (p<<0.001) and release velocity (p<0.05) with the modified metronome. Percentage of compressions within the optimal range was significantly higher for compression depth (p<0.05) and significantly lower for compression rate (p<0.01) with the modified metronome. Chest compression release velocity difference was not statistically significant (p=0.20). No significant impact of sex, age and level of expertise was observed. Conclusions The double-click metronome significantly increased CPR quality in terms of both compression depth and release velocity. The decrease of compressions within the optimal rate range in the modified procedure could be due to lack of familiarity with the new rhythm and needs further evaluation. Our study represents the first trial trying to improve chest compression release velocity. Demonstrating the efficacy of this procedure could pave the way to clinical trials in real resuscitations to confirm the potential impact on the outcome of out-of-hospital cardiac arrest.Study protocolComparison between the two procedures

The effect of audiovisual feedback of monitor/defibrillators on percentage of appropriate compression depth and rate during cardiopulmonary resuscitation

BackgroundHigh quality cardiopulmonary resuscitation (CPR) is one of the key elements of the survival chain in cardiac arrest. Audiovisual feedback of chest compressions have been suggested to be beneficial by increasing the quality of CPR in the simulated cardiac arrests.MethodsA prospective before and after study was performed to investigate the effect of a real-time audiovisual feedback system on CPR quality during in-hospital cardiac arrest in intensive care units from November 2018 to February 2022. In the feedback period, CPR was performed with the aid of the real-time audiovisual feedback system. The primary outcome was the percentage of compressions with both adequate depth (5.0–6.0 cm) and rate (100–120/minute).ResultsA total of 27,295 compressions in 30 cardiac arrests in the no-feedback period and 27,965 compressions in 30 arrests in the feedback period were analyzed. The percentage of compressions with both adequate depth and rate was 11.8% in the feedback period and 16.8% in the no-feedback period (P < 0.01). The percentage of compressions with adequate rate in the feedback period was lower than that in the no-feedback period (67.3% vs. 75.5%, P < 0.01). The percentage of beyond-target depth with the feedback was significantly higher than that without feedback (64.2% vs. 51.4%, P < 0.01).ConclusionReal-time audiovisual feedback system did not increase CPR quality and was associated with a higher percentage of compression depth deeper than the recommended 5.0–6.0 cm. It is essential to explore more effective ways of implementing feedback in real clinical settings to improve of the quality of CPR.Trial registrationNCT03902873 (study start: Nov. 2018, initial release April 2019, retrospectively registered).

Efficacy of in-bed chest compressions depending on provider position during in-hospital cardiac arrest: a controlled manikin study.

In contrast to the pre-hospital environment, patients with in-hospital cardiac arrest are usually lying in a hospital bed. Interestingly, there are no current recommendations for optimal provider positioning. The present study evaluates in bed chest compression quality in different provider positions during in-hospital-cardiac-arrest. Paramedics conducted four resuscitation scenarios: manikin lying on the floor with provider position kneeling next to the manikin (control group), manikin lying in a hospital bed with the provider kneeling astride, kneeling beside or standing next to the manikin. A resuscitation board was not used according to the current guideline recommendations. Quality of resuscitation, compression depth, compression rate and percentage of compressions with complete chest rebound were recorded. Afterwards, the paramedics were asked about subjective efficiency and fatigue. Data were analyzed using Generalized-Linear-Mixed-Models and, in addition, by non-parametric Friedman test. A total of 60 participants were recruited. The total quality of chest compressions was significantly higher in floor-based control position compared to the standing (P<.001) and both kneeling positions (P<.05). Also, the compression depth was significantly more guideline compliant in the control (P<.001) and the kneeling position (P<.05) compared to the standing position. The compression frequency as well as the complete chest wall recoil did not differ significantly. The standing position was rated as more fatiguing than the other positions (p≤0.001), kneeling beside as subjectively more efficient than the standing position (P<0.001). In case of an in-bed resuscitation high quality chest compressions are possible. Kneeling astride or beside the patient should be preferred because these positions demonstrated a good chest compression quality and were more efficient and less exhaustive.

Evaluation of compressor fatigue at 150 compressions per minute during cardiopulmonary resuscitation using a large dog manikin.

To determine whether CPR providers can perform chest compressions (CC) appropriately at a rate of 150 compressions per minute during a 2-minute cycle and to identify the presence of rescuer fatigue. High fidelity simulator study. University veterinary teaching hospital. Sixty subjects, 30 women and 30 men. Subjects performed CC at 150 compressions per minute on a dog manikin for 2 minutes. Real-time depth of compressions, compression release, and compression rate were measured using a CPR training device. Demographic data from the subjects were analyzed alongside data obtained from the monitoring device. Only 38.3% of participants were able to perform CC with appropriate depth and release at 150 compressions per minute during a 2-minute cycle. There was a decay in the quality of CC between the first and the second minute. The number of compressions and percentage of compressions with correct release were similar among various genders, ages, and professions. In contrast, the percentage of compressions with correct depth was significantly higher among individuals with higher body mass index (correlation coefficient [r]=0.293; P=0.023) and higher biceps brachii muscle circumference during muscle contraction (r=0.423; P=0.001). This study suggests that increasing the compression rate to 150 compressions per minute in large dogs using the thoracic pump technique might not be viable because most participants were not able to sustain enough appropriate CC. Rescuer fatigue affects compression depth at this rate, leading to a decay in CPR quality.

Assessment of over-the-head resuscitation method in an inflatable rescue boat sailing at full speed. A non-inferiority pilot study

IntroductionDrowning is a public health problem. Interrupting the drowning process as soon as possible and starting cardiopulmonary resuscitation (CPR) can improve survival rates. Inflatable rescue boats (IRBs) are widely used worldwide to rescue drowning victims. Performing CPR in special circumstances requires adjusting the position based on the environment and space available. The aim of this study was to assess the quality of over-the-head resuscitation performed by rescuers aboard an IRB in comparison to standard CPR. MethodsA quasi-experimental, quantitative, cross-sectional pilot study was conducted. Ten professional rescuers performed 1 min of simulated CPR on a QCPR Resuscy Anne manikin (Laerdal, Norway) sailing at 20 knots using two different techniques: 1) standard CPR (S-CPR) and 2) over-the-head CPR (OTH-CPR). Data were recorded through the APP QCPR Training (Laerdal, Norway). ResultsThe quality of CPR was similar between S-CPR (61%) and OTH-CPR (66%), with no statistically significant differences (p = 0.585). Both the percentage of compressions and the percentage of correct ventilations did not show significant differences (p > 0.05) between the techniques. ConclusionThe rescuers can perform CPR maneuvers with acceptable quality in the IRB. The OTH-CPR technique did not show inferiority compared to S-CPR, making it a viable alternative when boat space or rescue conditions do not allow the conventional technique to be performed.

Are smart glasses feasible for dispatch prehospital assistance during on-boat cardiac arrest? A pilot simulation study with fishermen.

The aim of the study was to explore feasibility of basic life support (BLS) guided through smart glasses (SGs) when assisting fishermen bystanders. Twelve participants assisted a simulated out-of-hospital cardiac arrest on a fishing boat assisted by the dispatcher through the SGs. The SGs were connected to make video calls. Feasibility was assessed whether or not they needed help from the dispatcher. BLS-AED steps, time to first shock/compression, and CPR's quality (hands-only) during 2 consecutive minutes (1st minute without dispatcher feedback, 2nd with dispatcher feedback) were analyzed. Reliability was analyzed by comparing the assessment of variables performed by the dispatcher through SGs with those registered by an on-scene instructor. Assistance through SGs was needed in 72% of the BLS steps, which enabled all participants to perform the ABC approach and use AED correctly. Feasibility was proven that dispatcher's feedback through SGs helped to improve bystanders' performance, as after dispatcher gave feedback via SGs, only 3% of skills were incorrect. Comparison of on-scene instructor vs. SGs assessment by dispatcher differ in 8% of the analyzed skills: greatest difference in the "incorrect hand position during CPR" (on-scene: 33% vs. dispatcher: 0%). When comparing the 1st minute with 2nd minute, there were only significant differences in the percentage of compressions with correct depth (1st:48 ± 42%, 2nd:70 ± 31, p = 0.02). Using SGs in aquatic settings is feasible and improves BLS. CPR quality markers were similar with and without SG. These devices have great potential for communication between dispatchers and laypersons but need more development to be used in real emergencies.

Cardiopulmonary resuscitation: difficulty in maintaining sufficient compression depth at the appropriate rate

Over the last 50 years, the recommended chest compression for cardiopulmonary resuscitation (CPR) has become faster and deeper, but maintaining deep compressions may be difficult at higher rates. Our study aimed to determine whether adequate compression (chest compression at an appropriate depth and rate) is being performed in emergency departments (ED). We also investigated the effect of adequate compression performance on the return of spontaneous circulation (ROSC). This prospective observational study was conducted at the EDs of two urban academic medical centers. We included adult patients (age ≥18 years) with cardiac arrest who underwent CPR in the ED between May and November 2020. We excluded patients with cardiac arrest related to trauma, repeated arrest except the first, and those for whom a monitor-defibrillator (ZOLL X-series) was not used. The following data were obtained from the monitor-defibrillator devices: compression depth, rate, chest compression fraction, CPR time, and percentage of compressions at the recommended rate and, at the recommended depth, at over and below rates, and depth, and at the appropriate depth and rate. Our study included 50 patients, from whom 441 chest compression sequences were obtained and analyzed. The mean compression depth, rate, and fraction were 6.48 ± 0.87 cm, 117 ± 5/min, 92.1 ± 3.70%, respectively. As the compression rate increased, the depth decreased, and most compressions were over-depth. Adequate compression (appropriate depth at recommended rate) was observed in 97 of the 441 compression sequences (21.9%). Below-depth and below-rate percentages were higher in the deceased group than that in the ROSC group (9.7 ± 15.2% vs. 3.3 ± 3.5%, p = 0.27; 2.7 ± 2.6% vs. 1.2± 0.9%, p = 0.06). The global ratio of chest compression showed low compliance with the recommended rate and depth, even when performed by skilled ED staff.

The Effects of an Intervention Based on the Flipped Classroom on the Learning of Basic Life Support in Schoolchildren Aged 10-13 Years: A Quasi-Experimental Study.

Most out-of-hospital cardiac arrests are attended first by bystanders who are usually friends and/or relatives of the victim. Therefore, the objective of this research was to analyse the impact of a training process based on the flipped classroom on basic life support skills in primary education students. The sample consisted of 308 children (148 experimental group (EG) and 160 control group (CG)) between 10 and 13 years old (M = 10.68 ± 0.64) from 2 schools in Galicia, Spain. The data reveal that the quality parameters are obtained in the number of total compressions in 2 min (CG = 213 and EG = 217; p = 0.024) and in the percentage of correct compressions (CG = 87.23% and EG = 91.6%; p = 0.013) except for the mean depth and the percentage of correct compressions, which were not reached in any case. Regarding the application of an effective discharge with the Automated external defibrillator (AED), there were no significant differences in the time used by schoolchildren between both methods (p = 0.795), but 97.5% (n = 156) of the CG and 100% (n = 148) of the EG are able to do it in just over 1 min. Based on the results obtained, we can conclude that a training program based on the flipped classroom is as effective and viable as traditional training in psychomotricity on CPR techniques and the application of an effective discharge using an AED.

Comparison of chest compression quality between 2-minute switch and rescuer fatigue switch: A randomized controlled trial.

Background:Rescuers performing chest compressions (CCs) should be rotated every 2 min or sooner if rescuers become fatigued. Is it preferable to switch rescuers when they become fatigued in such cases? This study was performed to compare the quality of CCs between two scenarios in hospitalized patients with cardiac arrest: 2-minute rescuer switch and rescuer fatigue switch.Methods:This randomized controlled trial involved 144 health-care providers, randomized to switch CC on the manikin model with 2-minute or rescuer fatigue. We recorded the CC quality for 20 min.Results:There were no significant differences in the percentage of target compressions, mean depth of compressions, or mean compression rate between the two groups. However, the rescuer fatigue switch group showed a significantly lower frequency of interruptions (4 vs. 9 times, P < 0.001) and a longer duration of each compression cycle (237 vs. 117 sec, P < 0.001). The change in the respiratory rate from before to after performing compressions was significantly greater in the 2-minute switch group (12 vs. 8 bpm, P = 0.036).Conclusion:The use of a rescuer fatigue switch CC approach resulted in no decrease in the quality of CC, suggesting that it may be used as an alternate strategy for managing in-hospital cardiac arrest.

Quality of chest compressions performed by school-age children — a quasi-experimental simulation-based study

Introduction: Most of the research worldwide mentions that cardiopulmonary resuscitation (CPR) training should be conducted among children. The knowledge of life-saving practices of CPR should be made available to various groups of society, including children. The present study shows the results of such experiments done with children, especially with regard to out-of-hospital cardiac arrest (OHCA). Children are apt learners and thus can be of great help in case of sudden OHCA, to their grandparents, for example. Material and methods: This study aimed to find out if children aged 7–12 have the ability to perform quality chest compressions (CC), which is one of the most important activities in CPR. The study involved 447 children from public elementary schools who never had practical classes in cardiopulmonary resuscitation before. The following parameters were defined as primary outcomes: chest compression fraction (CCF), session time, mean depth, rate of compressions, percentage of compressions at the correct depth, recoil, and the correct rate of compression. Results: The results showed that the compression rate improves with training; however, the mean depth of compression still remains a great problem. Conclusions: Although children aged 7–12 are not really in a position to perform a high-quality CPR, the importance and role of CPR training cannot be neglected. Such training results in the betterment of the quality of CPR.

Learning to resuscitate at school. Study in 8-12 year-old schoolchildren

ObjectiveTo quantitatively assess the learning capacity of school children aged between 8-12 years in basic life support (theory and practice) after a feasible school training programme. Material and methodsQuasi-experimental study with a convenience sample of 567 pupils in 3rd and 5th year of Primary Education, and first year of Compulsory Secondary Education, from 3 public schools in Galicia. They received 2h (one theoretical and another practical) of basic life support training by their Physical Education teachers, as part of the school program. The children were evaluated by a theoretical test and a practical skill test that measured the quality of chest compressions, and assessed the performance of the basic life support sequence. ResultsThe level of knowledge increased with respect to the baseline, and was higher in the higher grades (P < .001). The complete basic life support sequence was carried out by 16.5% of pupils in the 3rd year of Primary Education, 54.4% of pupils in the 5th year of Primary Education, and 28.5% of pupils in the 1st year of Secondary Education (P = .030). The following compression quality parameters improved significantly with age: continuity of compressions (P < .001), percentage of compressions performed at correct depth (P = .002), and median depth (P < .001), while the percentage of compressions with correct decompression decreased significantly (P < .001). ConclusionsAlthough their anthropometric characteristics may not allow them to achieve the ideal quality of this manoeuvre, a 2h theoretical and practical training programme, taught by Physical Education teachers, helps to improve the ability of children younger than 13 years old to recognise the emergency, start the chain of survival, and initiate chest compressions.

Physical activity and quality of cardiopulmonary resuscitation: A secondary analysis of the MANI-CPR trial.

The association between the level of physical activity and quality of cardio-pulmonary resuscitation (CPR) performed by laypeople is unclear. The aim of this study was to evaluate the associations between physical activity level and laypeople performance during an eight-minute scenario of CPR. This study was a secondary analysis of the MANI-CPR Trial. The entire cohort of participants was grouped based on the level of physical activity assessed using the International Physical Activity Questionnaire (IPAQ) into a "low-moderate" level group and a "high" level group. Descriptive statistics were used for unadjusted analysis and multivariate logistic and linear regression models were also performed. A total of 492 participants who reached the score of "Advanced CPR performer" at the 1-min final test monitored by Laerdal Resusci Anne QCPR were included in this analysis; 224 with a low-moderate level and 268 with a high level of physical activity. A statistically significant difference was found for the outcome of percentage of compressions with adequate depth (low-moderate group: 87.8% [41·4%-99·3%], high group: 97% [63·2%-100%]; P=0·003). No associations remained significant after controlling for biometric characteristics of the participants, compression protocols and sex. Adequate quality CPR may not need high baseline level of physical activity to be performed by a lay rescuer.

Training frequency for educating schoolchildren in basic life support: very brief 4-month rolling-refreshers versus annual retraining—a 2-year prospective longitudinal trial

ObjectiveTo compare the effectiveness of 4-month rolling-refreshers and annual retraining in basic life support (BLS) on a sample of schoolchildren.DesignProspective longitudinal trial.Setting and participantsFour hundred and seventy-two schoolchildren (8–12 years...

Two-Thumb Technique Is Superior to Two-Finger Technique in Cardiopulmonary Resuscitation of Simulated Out-of-Hospital Cardiac Arrest in Infants.

BackgroundTo compare the 2‐finger and 2‐thumb chest compression techniques on infant manikins in an out‐of‐hospital setting regarding efficiency of compressions, ventilation, and rescuer pain and fatigue.Methods and ResultsIn a randomized crossover design, 78 medical students performed 2 minutes of cardiopulmonary resuscitation with mouth‐to‐nose ventilation at a 30:2 rate on a Resusci Baby QCPR infant manikin (Laerdal, Stavanger, Norway), using a barrier device and the 2‐finger and 2‐thumb compression techniques. Frequency and depth of chest compressions, proper hand position, complete chest recoil at each compression, hands‐off time, tidal volume, and number of ventilations were evaluated through manikin‐embedded SkillReporting software. After the interventions, standard Likert questionnaires and analog scales for pain and fatigue were applied. The variables were compared by a paired t‐test or Wilcoxon test as suitable. Seventy‐eight students participated in the study and performed 156 complete interventions. The 2‐thumb technique resulted in a greater depth of chest compressions (42 versus 39.7 mm; P<0.01), and a higher percentage of chest compressions with adequate depth (89.5% versus 77%; P<0.01). There were no differences in ventilatory parameters or hands‐off time between techniques. Pain and fatigue scores were higher for the 2‐finger technique (5.2 versus 1.8 and 3.8 versus 2.6, respectively; P<0.01).ConclusionsIn a simulation of out‐of‐hospital, single‐rescuer infant cardiopulmonary resuscitation, the 2‐thumb technique achieves better quality of chest compressions without interfering with ventilation and causes less rescuer pain and fatigue.

The Effectiveness of Distance Preparation of Students for the Practice of Carrying Out Resuscitation Measures

A study was carried out among 117 students of the medical faculty of the Amur State Medical Academy of the Ministry of Health of Russia, who were trained under the program of the discipline "Emergencies in the practice of a district therapist" within the framework of the curriculum. The data obtained indicate the effectiveness of the new remote method of preparation for the practice of CPR. The average value of the percentage of chest compressions (CHC) performed with the correct frequency in the group of students trained according to the proposed method is 34.1% more than among students preparing according to the traditional method.

Assessment of the Quality of Chest Compressions Performed by Health-Care Workers Under Simulated Conditions

Aim of the study: to investigate chest compression parameters by city hospital staff under simulated conditions with and without the use of a sensor device for quality control of chest compressions.Materials and Methods. The study was conducted in Moscow's multidisciplinary hospitals. The study included 359 medical staff members. The participants were divided into 4 groups: physicians (n=97) and nurses (n=82) from intensive care units (ICU) and physicians (n=92) and nurses (n=88) from specialized departments. Participants performed 2 minutes of chest compressions without a chest compressions quality control (CCQC) sensor, followed by 2 minutes of chest compressions using a defibrillator sensor with audiovisual prompts from the device turned on. The percentage of target compressions, rate and depth of compressions were analyzed.Results. Compression parameters in the group of ICU doctors were outside the reference range (% target compression — 0.5 (0.0; 14.5)%, rate 124.1±17.8 per minute, depth 5.6±1.1 cm), in the group of ICU nurses, the percentage of target compressions was 0.0 (0.0; 3.5)%, rate — 123.6±23.7 per minute, depth — 5.3±1.2 cm, in the group of specialist doctors the percentage of target compressions was 0.0 (0.0; 1.2) %, rate — 123.8±23.2 per minute, depth — 5.8±1.2 cm, in specialized nurses group the percentage of target compressions was 0.0 (0.0; 6.1)%, rate — 119.7±29.5 per minute, depth — 5.6±1.2 cm. There was a significant improvement in compression performance in all groups when the sensor device was used: in ICU physicians the percentage of target compressions was 81.6 (64.80; 87.90)%, rate — 124.1±17.8 per minute, depth — 5.5±0.2 cm; in ICU nurses the percentage of target compressions was 69.1 (47.4; 80.6), rate — 123.6±23.7 per minute, depth — 5.3±0.3 cm, in specialist doctors the percentage of target compressions was 69.30 (50.50; 78.70), rate — 123.8±23.2 per minute, depth — 5.4±0.3 cm, in specialized nurses the percentage of target compressions reached 63.70 (42.90; 75.80), rate — 119.7±29.5 per minute, depth — 5.4±0.3 cm. There were no differences in analysed compression parameters between staff in different departments or positions.Conclusion. Compression parameters (percentage of target compressions, rate, depth) were not influenced by the department where the staff member worked and the position held (doctor or nurse). The use of a compression quality sensor device has improved compression parameters by reducing rate and normalizing depth. The use of the sensor does not increase the percentage of target compressions to the maximum values, indicating the need for training by an instructor.

Sports safety matting diminishes cardiopulmonary resuscitation quality and increases rescuer perceived exertion.

Compliant surfaces beneath a casualty diminish the quality of cardiopulmonary resuscitation (CPR) in clinical environments. To examine this issue in a sporting environment, we assessed chest compression quality and rescuer exertion upon compliant sports safety matting. Twenty-seven advanced life support providers volunteered (13 male/14 female; mass = 79.0 ± 12.5 kg; stature = 1.77 ± 0.09 m). Participants performed 5 × 2 min, randomized bouts of continuous chest compressions on a mannequin, upon five surfaces: solid floor; low-compliance matting; low-compliance matting with a backboard; high-compliance matting; high-compliance matting with a backboard. Measures included chest compression depth and rate, percentage of adequate compressions, and rescuer heart rate and perceived exertion. Chest compression depth and rate were significantly lower upon high-compliance matting relative to other surfaces (p<0.05). The percentage of adequate compressions (depth ≥50 mm) was lowest upon high-compliance matting (40 ± 39%) versus low-compliance matting (60 ± 36%) and low-compliance matting with a backboard (59 ± 39%). Perceived exertion was significantly greater upon high-compliance matting versus floor, low-compliance matting, and low-compliance matting with a backboard (p<0.05). Providers of CPR should be alerted to the detrimental effects of compliant safety matting in a sporting environment and prepare to alter the targeted compression depth and rescuer rotation intervals accordingly.

The clinical effects of CPR meter on chest compression quality: a QI project

The clinical effects of CPR meter on chest compression quality: a QI project.&#x0D; Christopher Picard, Richard Drew, Domhnall O’Dochartaigh, Matthew J Douma, Candice Keddie, Colleen Norris.&#x0D; Background: High-quality chest compressions are the cornerstone of resuscitation. Training guidelines require CPR feedback, and pre-clinical data shows that feedback devices improve chest compression quality; but devices are not being used in many emergency departments, and their impact on clinical care is less well understood. Some services use defibrillator generated reports for quality improvement, but these measurements may be limited in scope and have not been rigorously compared to other tools.&#x0D; Methods: Laerdal CPRMeter 2 chest compression feedback devices were purchased using funds made available by a zone QI initiative. Initial training for implementation consisted of staff performing one minute of blinded chest compression using the feedback device, followed by one minute of chest compression unblinded. Staff were shown the raw percentage of chest compressions meeting target depth, release, and rate under both conditions as well as overall improvement. Following initial orientation, devices were incorporated into clinical care and all subsequent staff simulation and training. Clinically, use of the feedback device and completion or QI tracking forms was not mandated but was encouraged by drawing code participant names from completed forms for a free ACLS or PALS course. Data from all codes were automatically collected by the LifePak 20, data from any resuscitation using the Laerdal CPRmeter 2 were also automatically recorded when the device was used: these data were downloaded weekly. Completed questionnaire forms were submitted to the Clinical Educators and extracted as received.&#x0D; Evaluation Methods: Chest compression quality data was collected in two ways: first, using a Laerdal CPRMeter2, second, by downloading and analyzing cardiac arrest data from a LifePak20 defibrillator using CodeStatTM software. Device data were matched and synthesized by an emergency department CNE using Microsoft excel and IBM SPSS 26. Descriptive statistics (mean and standard deviations) are used to describe the data. Differences in chest compression quality and duration of resuscitations between resuscitation that did or did not use a feedback device or a backboard were compared using independent t-testing. Differences in chest compressions at the target depth, release, and rate between the numbers of staff involved were assessed using ANOVA. Agreement between devices (CPRMeter2 and LifePak) used during the resuscitations were evaluated using paired t-testing, Pearson correlations, and Bland-Altman plots. All tests were two-tailed with predetermined significance levels set at a=0.05.&#x0D; Results: Data collection occurred between August 2019 and December 2020. There were a total of 50 cardiac arrests included, 36 had questionnaire data returned, 36 had data collected from the CPR meter 2, 24 had data collected from the LifePak, and 10 had data collected using all three methods. The average duration of resuscitation (number of chest compressions) was 1079.56 (SD=858.25); there was no difference in the duration of resuscitation (number of chest compressions) between resuscitations using versus not using CPR feedback devices (p=0.673). Resuscitations utilizing chest compression feedback had a higher percentage of chest compressions at the target rate compared to resuscitations not using feedback (74.08% vs 42.18%, p=0.007). Resuscitations that utilized a backboard had a higher percentage of chest compressions at target depth (72.92% vs 48.73%, p=0.048). There were no differences noted in the duration of resuscitation attempt (p=0.167) or percentages of chest compressions at the target depth (p=0.181), release (p=0.538), or rate (p=0.656) between resuscitations with different sized teams (4-5, 6-7, 8-9, &gt;10 staff involved). There was a strong positive correlation (r=0.771, p=0.005, n=11) between the two measurement methods and chest compression rates, and no statistically significant difference in measured scores (p=0.999), with 100% of values falling within the Bland-Altman confidence intervals of 36.72 and -36.72, n=11. Interpretation of the levels of agreement between these two device measures methods should be done cautiously however, given the small sample size and wide confidence intervals.&#x0D; Implications&#x0D; 1) Incorporation of visual chest compression feedback and use of a backboard are fast andaffordable and significantly improved the percentage of chest compression at the target rateand depth.&#x0D; 2) There was no correlation between the size of the resuscitation team and the percentage ofchest compressions at the target depth, release or rate; nor was the feedback device useassociated with the duration of the resuscitation attempt.&#x0D; 3) The implications of improvement with the CPR meter suggests that areas or service not usingfeedback should consider implementing its use to achieve the target compression rate.&#x0D; 4) Compared to LifePak feedback alone the CPRMeter2 will also allow services to target depthand release targets as well as rate.

VirtualCPR: Virtual Reality Mobile Application for Training in Cardiopulmonary Resuscitation Techniques

Deaths due to heart diseases are a leading cause of death in Mexico. Cardiovascular diseases are considered a public health problem because they produce cardiorespiratory arrests. During an arrest, cardiac and/or respiratory activity stops. A cardiorespiratory arrest is rapidly fatal without a quick and efficient intervention. As a response to this problem, the Virtual system was designed in the present work. Virtual is a mobile virtual reality application to support learning and practicing of basic techniques of cardiopulmonary resuscitation (CPR) for experts or non-experts in CPR. Virtual implements an interactive virtual scenario with the user, which is visible by means of employment of virtual reality lenses. User’s interactions, with our proposal, are by a portable force sensor for integration with training mannequins, whose development is based on an application for the Android platform. Furthermore, this proposal integrates medical knowledge in first aid, related to the basic CPR for adults using only the hands, as well as technological knowledge, related to development of simulations on a mobile virtual reality platform by three main processes: (i) force measurement and conversion, (ii) data transmission and (iii) simulation of a virtual scenario. An experiment by means of a multifactorial analysis of variance was designed considering four factors for a CPR session: (i) previous training in CPR, (ii) frequency of compressions, (iii) presence of auditory suggestions and (iv) presence of color indicator. Our findings point out that the more previous training in CPR a user of the Virtual system has, the greater the percentage of correct compressions obtained from a virtual CPR session. Setting the rate to 100 or 150 compressions per minute, turning on or off the auditory suggestions and turning the color indicator on or off during the session have no significant effect on the results obtained by the user.

Effect of smartphone applications on cardiopulmonary resuscitation quality metrics in a mannequin study: A randomized trial.

OBJECTIVE:The aim of this randomized, cross-over trial is to reveal the effect of smartphone cardio-pulmonary resuscitation (CPR) feedback applications (App) on a group of lay rescuers' chest compression-only CPR quality metrics. Quality metrics is measured initially and after 3 months.METHODS:A floor-based Resusci Anne mannequin (Laerdal Medical, Stavanger, Norway) was used. Three scenarios (CPR with device App-on [scenario-a], CPR with device App-off [scenario-b], and hands-only CPR [scenario-c]) were randomly allocated to all participants. All the participants performed 2 min of hands only-CPR for each scenario. Data of mean chest compression rate, mean chest compression depth, and recoil were recorded and compared for each scenario.RESULTS:One hundred and thirty-seven first-year students from the Vocational School of Health Services in Turkey participated in this study to mimic lay rescuers. Difference in the initial mean rate of chest compressions was statistically significant when CPR was performed with device App-on (scenario-a) compared to scenarios b and c (P < 0.001, P < 0.001). Furthermore, difference in the mean chest compression rate at the 3rd month was statistically significant among the scenarios when CPR was performed with device App-on (scenario-a) (P = 0.002, P = 0.001). The difference in initial and 3rd month mean compression depth and the percentage of recoil was not statistically significant among the scenarios.CONCLUSION:This study shows that the mean chest compression rate and percentage of compressions with adequate rate improved with smartphone App-on, and these results were persistent up to 3 months.