Performing Chest Compressions Research Articles

Clinician Wire Puncture Injury to the Hand from Chest Compressions on a Patient with a Median Sternotomy: A Case Report

Standard precautions, including protections from blood and body fluid exposure, are designed to protect health care providers from infections. Sharps safety practices rarely include the potential for the unconscious patient’s own body to be a potential source of clinician percutaneous injury from sharp objects outside of the perioperative setting. This case report reviews a percutaneous injury to the hand of a physician who was performing chest compressions on a patient with an out-of-hospital cardiac arrest. The 76-year-old patient in cardiac arrest had undergone a medial sternotomy surgery 15 years before the arrest. The sternal wire rotated owing to the initial chest compressions, breaking the clinician’s nitrile glove and producing an open wound on the thenar region of the clinician’s right hand. Application of a 10 × 10 12-ply gauze pack on the chest of the patient in cardiac arrest allowed the resuscitation team to continue with the compressions with no further wounds from the wire. This case report is a novel contribution to the published literature and advances standard precautions considerations in patients with out-of-hospital cardiac arrest, with the sternotomy wire from previous surgery as a source of percutaneous clinician injury during chest compression.

Randomized Comparison of Two New Methods for Chest Compressions during CPR in Microgravity-A Manikin Study.

Background: Although there have been no reported cardiac arrests in space to date, the risk of severe medical events occurring during long-duration spaceflights is a major concern. These critical events can endanger both the crew as well as the mission and include cardiac arrest, which would require cardiopulmonary resuscitation (CPR). Thus far, five methods to perform CPR in microgravity have been proposed. However, each method seems insufficient to some extent and not applicable at all locations in a spacecraft. The aim of the present study is to describe and gather data for two new CPR methods in microgravity. Materials and Methods: A randomized, controlled trial (RCT) compared two new methods for CPR in a free-floating underwater setting. Paramedics performed chest compressions on a manikin (Ambu Man, Ambu, Germany) using two new methods for a free-floating position in a parallel-group design. The first method (Schmitz–Hinkelbein method) is similar to conventional CPR on earth, with the patient in a supine position lying on the operator’s knees for stabilization. The second method (Cologne method) is similar to the first, but chest compressions are conducted with one elbow while the other hand stabilizes the head. The main outcome parameters included the total number of chest compressions (n) during 1 min of CPR (compression rate), the rate of correct chest compressions (%), and no-flow time (s). The study was registered on clinicaltrials.gov (NCT04354883). Results: Fifteen volunteers (age 31.0 ± 8.8 years, height 180.3 ± 7.5 cm, and weight 84.1 ± 13.2 kg) participated in this study. Compared to the Cologne method, the Schmitz–Hinkelbein method showed superiority in compression rates (100.5 ± 14.4 compressions/min), correct compression depth (65 ± 23%), and overall high rates of correct thoracic release after compression (66% high, 20% moderate, and 13% low). The Cologne method showed correct depth rates (28 ± 27%) but was associated with a lower mean compression rate (73.9 ± 25.5/min) and with lower rates of correct thoracic release (20% high, 7% moderate, and 73% low). Conclusions: Both methods are feasible without any equipment and could enable immediate CPR during cardiac arrest in microgravity, even in a single-helper scenario. The Schmitz–Hinkelbein method appears superior and could allow the delivery of high-quality CPR immediately after cardiac arrest with sufficient quality.

The relationship between body mass index with quality of CPR compression in Nursing Students

<p><strong>Background: </strong>Coronary Heart Disease is one of the diseases that causes the most deaths in Indonesia. One of the causes of death from coronary heart disease is cardiac arrest. One of the help that can be given is CPR (Cardiopulmonary Resuscitation). CPR can be performed by ordinary people or trained personnel. The phenomenon that often occurs is that when compression is performed, students are often not optimal in providing compression in terms of compression depth. The impact of poor quality CPR can cause death, economic, psychological, social, and length of treatment.<strong></strong></p><p><strong>Objectives: </strong>This study aims to determine the relationship between Body Mass Index (BMI) and the Quality of Cardiac and Lung Resuscitation Compression in Nursing Students.<strong></strong></p><p><strong>Method: </strong>This study uses a descriptive analytic research, with an observational method using a cross sectional design using a total sampling of 46 respondents.</p><p><strong>Result: </strong>Based on the results of Fisher's Exact test, p-value < (0.001 < 0.05) was obtained so that there was a relationship between student BMI and quality into compression. The quality of nurses' chest compressions in performing chest compressions is lacking, even though some nurses have had cardiopulmonary resuscitation training. Someone who has a high and low BMI in the hospital, it was found that when doing chest compressions the patient gets tired quickly, a high BMI is difficult to do chest compressions when getting into bed.<strong></strong></p><p><strong>Conclusion: </strong>Body Mass Index can improve the quality of student compression in cardiopulmonary resuscitation. BMI indirectly plays an important role in the performance of nurses in order to provide optimal cardiopulmonary resuscitation.</p>

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.

Video simulation to learn pediatric resuscitation skills tailored to a low resource setting: A pilot program in Iquitos, Peru.

Introduction:The Hospital Regional de Loreto in Peru partners with the University of California Los Angeles Global Health Program to enhance educational experiences for US and Peruvian trainees. University of California Los Angeles Pediatric faculty led intermittent in-person code simulation sessions for Peruvian residents, and there is a need for regular education on this topic.Methods:University of California Los Angeles residents created a video simulation of a patient in respiratory distress. The video was presented to Hospital Regional de Loreto trainees in pediatrics. Stakeholder interviews and reuse of the video after initial presentation assessed acceptability of this mode of education by the site. Pre- and post-surveys using numerical rating scales evaluated the educational utility of this specific simulation video. Paired t-tests compared the pre- and post-surveys in the effectiveness of increasing the trainees’ comfort of specific resuscitation skills.Results:Stakeholder interviews revealed the video simulation was integrated into formal intern orientation trainings as well as used for resident and physician trainings multiple times in the year after the introduction. Twenty trainees completed the pre-intervention survey and 19 completed the post-intervention survey. Trainee comfort with code team leadership (2.6 ± 0.9, 3.5 ± 0.09, p = 0.03) and arrhythmia recognition/automated external defibrillator (AED) management (2.4 ± 0.9, 3.1 ± 0.9, p = 0.03) increased significantly with the video intervention. There was no significant difference in comfort with other skills. Overall, trainees rated the helpfulness of the video as an average of 4.2 (±1.1) out of 5. The most common positive feedback included the utility of reviewing medication dosing and the skill of performing chest compressions. The most common suggestions for improvement were to review more pathophysiology and simulate available resources at Hospital Regional de Loreto more realistically.Conclusion:E-learning is an acceptable mode of education in a resource-limited setting when tailored to the local context. This pilot project demonstrated short-term improvement in reported confidence and skills with some aspects of pediatric resuscitation.

Development of an Extended Reality Simulator for Basic Life Support Training.

Objective: Extended Reality (XR) is a simultaneous combination of the virtual and real world. This paper presents the details of the framework and development methods for an XR basic life support (XR-BLS) simulator, as well as the results of an expert usability survey. Methods: The XR-BLS simulator was created by employing a half-torso manikin in a virtual reality environment and using BLS education data that is in line with the 2020 American Heart Association guidelines. A head-mounted display (HMD) and hand-tracking device were used to perform chest compressions and ventilation and to enable the use of an automated external defibrillator in a virtual environment. A usability study of the XR-BLS simulator through an expert survey was also conducted. The survey consisted of a total of 8 items: 3, 2, and 2 questions about the ease of use of XR-BLS, delivery of training, and artificial intelligence (AI) instructor in the simulator, respectively. Results: The XR simulator was developed, and the expert survey showed that it was easy to use, the BLS training was well delivered, and the interaction with the AI instructor was clear and understandable. Discussion/Conclusion: The XR-BLS simulator is useful as it can conduct BLS education without requiring instructors and trainees to gather.

Future Prospects in Out-of-hospital Cardiac Arrest Management

Despite numerous advances in the management of out-of-hospital cardiac arrest (OHCA), survival with good neurological outcome did not improve significantly in the last years. The latest improvements and innovations from diagnosis to return of spontaneous circulation are discussed in this review. Education of the general population to life-saving techniques is mandatory in order to reduce the no-flow period. Sharpened education to cardiac arrest identification by dispatch centers and the use of mobile-phone applications dispatching nearby citizen to perform chest compressions also seem to be interesting leads. The systematic indexing of automated external defibrillators and drone-mediated on-scene delivery might reduce time-to-defibrillation. Cardiopulmonary resuscitation (CPR) aims to improve perfusion of major organs while reducing ischemia reperfusion injuries. Pre-hospital implementation of innovating medical responses such as resuscitative endovascular balloon occlusion of the aorta and extracorporeal circulation are currently being explored. The head and thorax elevation during CPR has also shown some promising results on experimental animal studies, but need to be confirmed by clinical studies. The question of optimal ventilation techniques is still under debate and invasive ventilation struggles to prove its superiority in the pre-hospital setting. Many current research studies are reconsidering the use of historical treatments of OHCA, such as epinephrine or amiodarone. Finally, the growing concern for good neurological outcome displayed by recent major clinical studies reflects the newly emphasized critical issue of neuroprotection during cardiac arrest.

Abstract 11939: Can Live Video Streaming From Bystander's Smartphone Improve the Quality of Chest Compressions in Real Out-of-Hospital Cardiac Arrest?

Introduction: Good quality of cardiopulmonary resuscitation (CPR) provided by bystanders is important for the outcome in out-of-hospital cardiac arrest (OHCA). A live video stream from the bystander’s smartphone to the medical dispatcher might improve the quality of chest compressions performed during CPR. Methods: At the Copenhagen Emergency Medical Services in Denmark, the medical dispatcher can add a live video to the emergency call. In case of OHCA, the medical dispatcher guides bystanders in dispatcher-assisted CPR (DA-CPR). After initiating chest compressions, the medical dispatcher can add live video streaming. A cohort study was conducted with an evaluation of performed chest compressions from the video footage before and after the dispatcher used the video to instruct CPR (video-instructed DA-CPR). Correct chest compressions were defined according to European Resuscitation Council Guidelines. Results: CPR was provided with a live video stream in 52 OHCA calls, in which 90 bystanders performed chest compressions. Thirty OHCA occurred at a public location, and more than four bystanders were present in 32 (62%) cases. In 26 cases, chest compressions were performed by more than one bystander. Eight (9%) bystanders performed correct chest compressions before video-instructed DA-CPR. For the bystanders first initiating insufficient CPR improvements were observed for: hand placement 58% (n=17/29), compressions rate 73% (n=17/21), and compressions depth 62% (n=19/31) following video-instructed DA-CPR. For the second bystander providing CPR (n=26) improvements were still observed for: hand placement 57% (n=4/7), compressions rate 73% (N=8/11), and compressions depth 53% (n=11/21) following video-instructed DA-CPR. For the third and fourth bystander (n=10), providing CPR improvements were seen for: hand placement 100% (n=2/2), compressions rate 50 % (n=2/4), and compressions depth 60% (n=3/5). Eighteen bystanders had a chest compressions performance measurement that could not be observed. Conclusions: A live video from the bystander`s smartphone to the medical dispatcher could improve the quality of chest compressions in CPR, and guidance seems important not just for the first bystander but for all bystanders performing CPR.

Chest compression efficacy of child resuscitators

Background: Chest compression efficacy determines blood flow in cardiopulmonary resuscitation (CPR) and relies on body mechanics, so resuscitator weight matters. Individuals of insufficient weight are incapable of generating a sufficient downward chest compression force using traditional methods. Aims: This study investigated how a resuscitator's weight affects chest compression efficacy, determined the minimum weight required to perform chest compressions and, for children and adults below this minimum weight, examine alternate means to perform chest compressions. Methods: Volunteers aged 8 years and above were enrolled to perform video-recorded, music-facilitated, compression-only CPR on an audible click-confirming manikin for 2 minutes, following brief training. Subjects who failed this proceeded to alternate modalities: chest compressions by jumping on the lower sternum; and squat-bouncing (bouncing the buttocks on the chest). These methods were assessed via video review. Findings: There were 57 subjects. The 30 subjects above 40kg were all able to complete nearly 200 compressions in 2 minutes. Success rates declined in those who weighed less than 40kg. Below 30 kg, only one subject (29.9 kg weight) out of 14 could achieve 200 effective compressions. Nearly all of the 23 subjects who could not perform conventional chest compressions were able to achieve effective chest compressions using alternate methods. Conclusion: A weight below 40kg resulted in a declining ability to perform standard chest compressions effectively. For small resuscitators, the jumping and squat-bouncing methods resulted in sufficient compressions most of the time; however, chest recoil and injuries are concerns.

Effectiveness of a Dispatcher-Assisted Cardiopulmonary Resuscitation Program Developed by the Thailand National Institute of Emergency Medicine (NIEMS).

Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS). This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1. There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P <.001). However, the CPR instruction did not translate into better performance or quality of chest compressions for the overall sample or for health care or non-health care providers. Those in the CPR-trained group applied chest compressions (initiated CPR) more quickly than those who initiated CPR based upon dispatch-based CPR instructions.

Live video from bystanders’ smartphones to improve cardiopulmonary resuscitation

AimTo investigate whether live video streaming from the bystander’s smartphone to a medical dispatcher can improve the quality of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA). MethodsAfter CPR was initiated, live video was added to the communication by the medical dispatcher using smartphone technology. From the video recordings, we subjectively evaluated changes in CPR quality after themedical dispatcher had used live video to dispatcher-assisted CPR (DA-CPR). CPR quality was registered for each bystander and compared with CPR quality after video-instructed DA-CPR. Data were analysed using logistic regression adjusted for bystander’s relation to the patient and whether the arrest was witnessed. ResultsCPR was provided with live video streaming in 52 OHCA calls, with 90 bystanders who performed chest compressions. Hand position was incorrect for 38 bystanders (42.2%) and improved for 23 bystanders (60.5%) after video-instructed DA-CPR. The compression rate was incorrect for 36 bystanders (40.0%) and improved for 27 bystanders (75.0%). Compression depth was incorrect for 57 bystanders (63.3%) and improved for 33 bystanders (57.9%). The adjusted odds ratios for improved CPR after video-instructed DA-CPR were; hand position 5.8 (95% CI: 2.8–12.1), compression rate 7.7 (95% CI: 3.4–17.3), and compression depth 7.1 (95% CI: 3.9–12.9). Hands-off time was reduced for 34 (37.8%) bystanders. ConclusionsLive video streaming from the scene of a cardiac arrest to medical dispatchers is feasible. It allowed an opportunity for dispatchers to coach those providing CPR which was associated with a subjectively evaluated improvement in CPR performance.

Modified Two-Rescuer CPR With a Two-Handed Mask-Face Seal Technique Is Superior To Conventional Two-Rescuer CPR With a One-Handed Mask-Face Seal Technique

Bag-valve-mask (BVM) ventilation using a two-handed mask-face seal has been shown to be superior to a one-handed mask-face seal during cardiopulmonary resuscitation (CPR). We aimed to compare CPR quality metrics during simulation-based two-rescuer CPR with a modified two-handed mask-face seal technique and two-rescuer CPR with the conventional one-handed mask-face seal technique. Participants performed two-rescuer CPR on a simulation manakin and alternated between the modified and conventional CPR methods. For the modified method, the first rescuer performed chest compressions and thereafter squeezed the BVM resuscitator bag during the ventilatory pause, while the second rescuer created a two-handed mask-face seal. For the conventional method, the first rescuer performed chest compressions and the second rescuer thereafter delivered rescue breaths by creating a mask-face seal with one hand and squeezing the BVM resuscitator bag with the other hand. Among the 40 participants that were enrolled, the mean ± standard deviation (SD) delivered respiratory volume was significantly higher for the modified two-rescuer method (319.4 ± 71.4 mL vs. 190.2 ± 50.5 mL; p < 0.0001). There were no statistically significant differences between the two methods with regard to mean ± SD compression rate (117.05 ± 9.67 compressions/min vs. 118.08 ± 10.99 compressions/min; p = 0.477), compression depth (52.80 ± 5.57 mm vs. 52.77 ± 6.77 mm; p = 0.980), chest compression fraction (75.92% ± 2.14% vs. 76.57% ± 2.57%; p = 0.186), and ventilatory pause time (4.62 ± 0.64 s vs. 4.56 ± 0.43 s; p = 0.288). With minor modifications to the conventional method of simulated two-rescuer CPR, rescuers can deliver significantly higher volumes of rescue breaths without compromising the quality of chest compressions.

Deliberate practice in resuscitation training using a feedback device, and the effects of the physical characteristics of the rescuer on the acquisition and retention of cardiopulmonary resuscitation skills: Randomized clinical trial

BackgroundCardiopulmonary resuscitation (CPR) skills decline rapidly and rescuers’ physical characteristics could impact on their performance. Our aim was to analyse the effects of deliberate practice using a feedback device (FD) on the CPR performance of nursing students prior to, immediately after, and three months after training, considering their physical characteristics. MethodSixty nursing students participated in this randomized clinical trial (control group n = 28; training group n = 32). Their physical characteristics (weight, height, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)% index, handgrip strength, and CPR position strength) were measured before starting the trial. The training group followed a CPR training programme based on deliberate practice, providing feedback on their performance using an FD. All participants were evaluated during two-minute CPR compression/ventilation cycles. ResultsThe training group showed an improved ability to perform chest compressions (F(2, 115.2) = 13.3; p < .001; ω2p = 0.17) and ventilations (F(2, 115.3) = 102.1; p < .001; ω2p = 0.63), improving their overall quality of CPR (F(2, 115.2) = 40.1; p < .001; ω2p = 0.40). The physical characteristics of the participants did not affect CPR performance in any study phase. ConclusionsA structured training programme based on deliberate practice using an FD had a positive effect on the acquisition of CPR skills by participants, while their physical characteristics had no impact on performance.

Immediate Bystander Cardiopulmonary Resuscitation to Sudden Cardiac Arrest During Sports is Associated with Improved Survival\u2014a Video Analysis

BackgroundSudden cardiac arrest (SCA) during sports can be the first symptom of yet undetected cardiovascular conditions. Immediate chest compressions and early defibrillation offer SCA victims the best chance of survival, which requires prompt bystander cardiopulmonary resuscitation (CPR).AimsTo determine the effect of rapid bystander CPR to SCA during sports by searching for and analyzing videos of these SCA/SCD events from the internet.MethodsWe searched images.google.com, video.google.com, and YouTube.com, and included any camera-witnessed non-traumatic SCA during sports. The rapidity of starting bystander chest compressions and defibrillation was classified as < 3, 3–5, or > 5 min.ResultsWe identified and included 29 victims of average age 27.6 ± 8.5 years. Twenty-eight were males, 23 performed at an elite level, and 18 participated in soccer. Bystander CPR < 3 min (7/29) or 3–5 min (1/29) and defibrillation < 3 min was associated with 100% survival. Not performing chest compressions and defibrillation was associated with death (14/29), and > 5 min delay of intervention with worse outcome (death 4/29, severe neurologic dysfunction 1/29).ConclusionsAnalysis of internet videos showed that immediate bystander CPR to non-traumatic SCA during sports was associated with improved survival. This suggests that immediate chest compressions and early defibrillation are crucially important in SCA during sport, as they are in other settings. Optimal use of both will most likely result in survival. Most videos showing recent events did not show an improvement in the proportion of athletes who received early resuscitation, suggesting that the problem of cardiac arrest during sports activity is poorly recognized.

Different perceptions of thorax anatomy and hand placement for chest compressions among healthcare professionals and laypersons: Implications for cardiopulmonary resuscitation

AimThe European Resuscitation Council guidelines recommend that the hand position for chest compressions is obtained by “placing the heel of your hand in the centre of the chest”. Importantly, guidelines are based on a study on healthcare professionals being extrapolated to laypersons. This study explored whether healthcare professionals and laypersons differ in anatomical knowledge necessary for obtaining the correct hand position for chest compressions and understanding of European Resuscitation Council guideline recommendations in the absence of a demonstration. MethodsWe asked laypersons and healthcare professionals to identify where to place the hands for chest compressions on digital pictures of the chest of a man and a woman. Both groups were asked to identify where to place the hands for chest compressions, the left nipple (positive control), the centre of the chest and to delineate the anterior area of the chest. ResultsIn total, 50 laypersons and 50 healthcare professionals were included. Healthcare professionals were significantly better at identifying the correct hand position for chest compressions compared to laypersons (male chest: P = 0.03, female chest: P < 0.0001) and delineating the anterior area of the chest. We found no significant difference between groups when instructed to identify the left nipple nor the centre of the chest (male chest: P = 0.57, female chest: P = 0.50). ConclusionLaypersons and healthcare professionals have different perceptions of chest anatomy and where to perform chest compressions suggesting that caution should be taken when extrapolating results from healthcare professionals to laypersons. The ERC 2015 guideline recommendations on hand placement for chest compressions seems understandable by both laypersons and healthcare professionals.

How should we teach cardiopulmonary resuscitation? Randomized multi-center study.

A 2017 update of the resuscitation guideline indicated the use of cardiopulmonary resuscitation (CPR) feedback devices as a resuscitation teaching method. The aim of the study was to compare the influence of two techniques of CPR teaching on the quality of resuscitation performed by medical students. The study was designed as a prospective, randomized, simulation study and involved 115 first year students of medicine. The participants underwent a basic life support (BLS) course based on the American Heart Association guidelines, with the first group (experimental group) performing chest compressions to observe, in real-time, chest compression parameters indicated by software included in the simulator, and the second group (control group) performing compressions without this possibility. After a 10-minute resuscitation, the participants had a 30-minute break and then a 2-minute cycle of CPR. One month after the training, study participants performed CPR, without the possibility of observing real-time measurements regarding quality of chest compression. One month after the training, depth of chest compressions in the experimental and control group was 50 mm (IQR 46-54) vs. 39 mm (IQR 35-42; p = 0.001), compression rate 116 CPM (IQR 102-125) vs. 124 CPM (IQR 116-134; p = 0.034), chest relaxation 86% (IQR 68-89) vs. 74% (IQR 47-80; p = 0.031) respectively. Observing real-time chest compression quality parameters during BLS training may improve the quality of chest compression one month after the training including correct hand positioning, compressions depth and rate compliance.

The impact of kids save lives program on Knowledge, skills and attitude of Greek students. Final results from 2 years of implementation

Abstract Funding Acknowledgements Type of funding sources: None. Background Sudden cardiac death is one of the main issues worldwide, with more than 700.000 deaths annually. It is strongly believed that the implementation of "Kids Save Lives" project in schools can change this situation. The Kids Save Lives initiative, endorsed by the World Health Organization in 2015, is teaching school children worldwide about the importance of CPR and how to perform it. In Greece this project is a suggestion of Ministry of Education to schools. Purpose Τo evaluate the level of theoretical knowledge, willingness to perform Cardiopulmonary resuscitation (CPR) and active skills of Greek secondary school students on the subject of Basic life Support before and after a "Kids Save Lives" program. Material – Method: Data collection took place on the academic periods of 2017-2018 and 2018-2019 and was performed in secondary schools of Thessaly’s region. A total of 5092 students (51,9% female, mean age 14.2 years) participated on the "Kids save Lives" program according to the European Resuscitation Council (ERC) and World Health Organization (WHO) statement. A 12 point questionnaire was answered by the students before and after completing the "kid saves lives" program, while practical skills were evaluated on manikins by experienced ERC Basic Life Support (BLS) Instructors. Results The training improves significantly the theoretical knowledge regarding Cardiopulmonary resuscitation (CPR), with the percentage of correct answers being 48,4% and 82,8%,before and after the course respectively (p &amp;lt; 0.001). The participants willingness to perform bystander CPR significantly increased after the completion of the course (93,7% before to 97,4% after, p &amp;lt; 0.001). Almost all of the participants (98.9%) could recognize the correct position near the victim and 91% performed chin lift maneuver and recognized cardiac arrest. More than 90% of the students performed chest compressions with the correct rate and placing their hands on the center of the chest (90,1% and 93.4%, respectively), whereas only 76.1% of the participants achieved the desired compression depth of 5 to 6 cm. Conclusions The overall results strongly recommend that the "Kids Save Lives" program can boost prospects for bystander CPR and indicate the necessity of implementation in a greater scale nationwide.

Correlation between real-time heart rate and fatigue in chest compression providers during cardiopulmonary resuscitation: A simulation-based interventional study.

Background:The American Heart Association guidelines recommend switching chest compression providers at least every 2 min depending on their fatigue during cardiopulmonary resuscitation (CPR). Although the provider's heart rate is widely used as an objective indicator for detecting fatigue, the accuracy of this measure is debatable.Objectives:This study was designed to determine whether real-time heart rate is a measure of fatigue in compression providers.Study design:A simulation-based prospective interventional study including 110 participants.Methods:Participants performed chest compressions in pairs for four cycles using advanced cardiovascular life support simulation. Each participant's heart rate was measured using wearable healthcare devices, and qualitative variables regarding individual compressions were obtained from computerized devices. The primary outcome was correct depth of chest compressions. The main exposure was the change in heart rate, defined as the difference between the participant's heart rate during individual compressions and that before the simulation was initiated.Results:With a constant compression duration for one cycle, the overall accuracy of compression depth significantly decreased with increasing heart rate. Female participants displayed significantly decreased accuracy of compression depth with increasing heart rate (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95–0.98; P < .001). Conversely, male participants displayed significantly improved accuracy with increasing heart rate (OR: 1.03; 95% CI: 1.02–1.04; P < .001).Conclusion:Increasing heart rate could reflect fatigue in providers performing chest compressions with a constant duration for one cycle. Thus, provider rotation should be considered according to objectively measured fatigue during CPR.

Effect of a dynamic mattress on chest compression quality during cardiopulmonary resuscitation.

In-hospital cardiac arrest is a medical emergency that occurs on a regular basis. As patients most at risk for an in-hospital cardiac arrest are usually positioned on a dynamic mattress, it is important to measure the effect of mattress compressibility on chest compression quality during cardiopulmonary resuscitation (CPR). High-quality CPR is essential for patient survival and good neurological outcome. To examine the effect of an inflated dynamic overlay mattress on chest compression quality during CPR and to explore the predictive effect of health care providers' anthropometric factors, hand positioning and mattress type on chest compression frequency and depth. Manikin-based single-blinded randomised controlled trial. Nursing students (N=70) were randomised to a control (viscoelastic foam mattress) or intervention group (inflated dynamic overlay mattress on top of a viscoelastic foam mattress) and had to perform chest compressions over a 2-minute period. Compression rate, depth and hand positioning were registered. The 2015 European Resuscitation Council (ERC) guidelines were used as a reference. The mean difference in chest compression depth between control and intervention groups was 2.86 mm (P= .043). Both groups met the guidelines for adequate chest compression quality, as recommended by the ERC. A predictive effect of health care providers' body height and weight, mattress type and hand positioning on compression depth could be demonstrated (P= .004). CPR in bedridden patients on a dynamic overlay mattress has a negative effect on the quality of chest compressions. Mean chest compression depth decreases significantly. However, clinical significance of the results may be debatable. Mattress type, body weight and hand positioning appear to be significant predictors for adequate chest compression depth. A firm surface under the patient is needed during CPR. Special attention must be paid to correct hand positioning during CPR.

Basic life support skills can be improved among certified basic life support instructors

BackgroundA correct visual skill demonstration is important when learning cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator (AED). Basic life support (BLS) instructors are expected to master and demonstrate CPR/AED skills correctly. The aim of this study was to evaluate certified BLS instructors’ competencies in demonstrating CPR and the use of an AED. MethodsCertified BLS instructors demonstrated CPR and the use of an AED on a resuscitation manikin. Skills were evaluated using data collected from the manikin and video recordings and compared to resuscitation guidelines. Further, instructors completed questionnaires on resuscitation guidelines and rating of their own CPR/AED skills. ResultsOverall, we analyzed data from 125 instructors. Of all chest compressions, only 22% were within guideline recommendations regarding depth. Instructors performed chest compressions with excessive depth (mean depth 64mm (7.3)) and a mean rate of 115min−1 (10.8). Only 25% of instructors placed the left AED electrode correctly (median distance 7.6cm (5.0;10.5)), while the right AED electrode usually was placed correctly (median distance 2.9cm (1.5;4.0), 85% placed correctly). Nearly half of the instructors failed to state correct answers regarding how to diagnose a cardiac arrest and where to place the AED electrodes. Despite their performance, instructors rated their BLS skills as good. ConclusionCertified BLS instructors’ have poor CPR/AED skills and several important knowledge gaps on CPR/AED guidelines in contrast to instructors’ self-reported skills. This highlights a need for improving BLS instructor education, including continuous faculty development to ensure optimal learning conditions for BLS course participants.