Quality Of Chest Compressions Research Articles

Effectiveness of a Novel Tablet Application in Reducing Guideline Deviations During Pediatric Cardiac Arrest

Deviations from international resuscitation guidelines during the management of pediatric cardiac arrest are frequent and affect clinical outcomes. An interactive tablet application (app), PediAppRREST, was developed to reduce guideline deviations during pediatric cardiac arrest. To assess the effectiveness of PediAppRREST in improving the management of simulated in-hospital pediatric cardiac arrest. This multicenter 3-group simulation-based randomized clinical trial was conducted from September 2020 to December 2021 at 4 Italian university hospitals (Padua, Florence, Rome, Novara). Participants included residents in pediatrics, emergency medicine, and anesthesiology. Analyses were conducted as intention-to-treat. Data were analyzed from January to June 2022. Teams were randomized to 1 of 3 study groups: an intervention group that used the PediAppRREST app; a control group that used a paper-based cognitive aid, the Pediatric Advanced Life Support (PALS) pocket card; and a control group that used no cognitive aids. All the teams managed the same standardized simulated scenario of nonshockable pediatric cardiac arrest. The primary outcome was the number of deviations from guidelines, measured by a 15-item checklist based on guideline recommendations. The main secondary outcomes were quality of chest compressions, team clinical performance (measured by the Clinical Performance Tool), and perceived team leader's workload. Study outcomes were assessed via video reviews of the scenarios. Overall 100 teams of 300 participants (mean [SD] age, 29.0 [2.2] years; 195 [65%] female) were analyzed by intention-to-treat, including 32 teams randomized to the PediAppRREST group, 35 teams randomized to the PALS control group, and 33 teams randomized to the null control group. Participant characteristics (210 pediatric residents [70%]; 48 anesthesiology residents [16%]; 42 emergency medicine residents [14%]) were not statistically different among the study groups. The number of deviations from guidelines was significantly lower in the PediAppRREST group than in the control groups (mean difference vs PALS control, -3.0; 95% CI, -4.0 to -1.9; P < .001; mean difference vs null control, -2.6; 95% CI, -3.6 to -1.5; P < .001). Clinical Performance Tool scores were significantly higher in the PediAppRREST group than control groups (mean difference vs PALS control, 1.4; 95% CI, 0.4 to 2.3; P = .002; mean difference vs null control, 1.1; 95% CI, 0.2 to 2.1; P = .01). The other secondary outcomes did not significantly differ among the study groups. In this randomized clinical trial, the use of the PediAppRREST app resulted in fewer deviations from guidelines and a better team clinical performance during the management of pediatric cardiac arrest. ClinicalTrials.gov Identifier: NCT04619498.

Dispatcher-assisted BLS for lay bystanders: A pilot study comparing video streaming via smart glasses and telephone instructions

ObjectiveTo determine whether dispatcher assistance via smart glasses improves bystander basic life support (BLS) performance compared with standard telephone assistance in a simulated out-of-hospital cardiac arrest (OHCA) scenario. MethodsPilot study in which 28 lay people randomly assigned to a smart glasses-video assistance (SG-VA) intervention group or a smartphone-audio assistance (SP-AA) control group received dispatcher guidance from a dispatcher to provide BLS in an OHCA simulation. SG-VA rescuers received assistance via a video call with smart glasses (Vuzix, Blade) connected to a wireless network, while SP-AA rescuers received instructions over a smartphone with the speaker function activated. BLS protocol steps, quality of chest compressions, and performance times were compared. ResultsNine of the 14 SG-VA rescuers correctly completed the BLS protocol compared with none of the SP-AA rescuers (p = 0.01). A significantly higher number of SG-VA rescuers successfully opened the airway (13 vs. 5, p = 0.002), checked breathing (13 vs. 8, p = 0.03), correctly positioned the automatic external defibrillator pads (14 vs.6, p = 0.001), and warned bystanders to stay clear before delivering the shock (12 vs. 0, p < 0.001). No significant differences were observed for performance times or chest compression quality. The mean compression rate was 104 compressions per minute in the SG-VA group and 98 compressions per minute in the SP-AA group (p = 0.46); mean depth of compression was 4.5 cm and 4.4 cm (p = 0.49), respectively. ConclusionsSmart glasses could significantly improve dispatcher-assisted bystander performance in an OHCA event. Their potential in real-life situations should be evaluated.

Quality of chest compressions performed by anaesthetic trainees with and without audiovisual feedback

Introduction: The use of audiovisual feedback devices on chest compression (CC) metrics such as the rate and depth has been proven to improve resuscitation quality. This study compared the quality of CC performed by anaesthetic trainees on manikins with audiovisual feedback and subsequent skill retention without the feedback. Methods: CC metrics measured were the compression rate and depth recorded and reviewed by RescueNet® Code Review software, which recorded compressions in target. Fifty participants performed 2 minutes of CC without audiovisual feedback (CC1), followed by another 2 minutes of CC with audiovisual feedback (CC2), separated by 5 minutes of rest. Those who achieved at least 70% of compressions in target during CC2 performed another 2 minutes of CC without audiovisual feedback at 30 minutes (CC3) and 5–7 days (CC4) later. Results: The baseline compressions in target during CC1 was 14.43 ± 20.18%, improving significantly to 81.80 ± 7.61% (p &lt; 0.001) with audiovisual feedback (CC2). Forty-five (90%) participants achieved compressions in target of at least 70% during CC2. However, without the feedback, compressions in target decreased significantly to 56.33 ± 27.02% (p &lt; 0.001) and 49.32 ± 33.86% (p &lt; 0.001) at 30 minutes (CC3) and 5–7 days (CC4) later, respectively. The overall effect size for the compressions in target was 0.625. Conclusion: Audiovisual feedback device usage significantly improves CC performance, but improved skills were not fully retained when CC was performed without the device afterwards. Therefore, real-time audiovisual feedback may ensure better CC, a component of cardiopulmonary resuscitation.

Surviving the storm: manual vs. mechanical chest compressions onboard a lifeboat during bad weather conditions

ObjectiveIt is challenging for rescuers to perform cardiopulmonary resuscitation (CPR) onboard lifeboats, particularly during rough weather. A mechanical chest compression device (MCD) may provide better quality chest compressions. The aim of this study was to compare the quality of chest compressions performed by lifeboat-crewmembers with those of a MCD during rough-sea conditions.MethodsLifeboat-crewmembers were scheduled to provide compression-only CPR on a resuscitation-mannequin during two sets of five 6-min epochs on a lifeboat at sea in two different weather-conditions. Simultaneously a MCD was used for compression-only CPR on another mannequin onboard the lifeboat. On a third occasion compressions by MCD only were measured due to COVID-19 restrictions. The primary outcome variable was the quality of chest compression, evaluated using published variables and standards (mean compression depth and compression frequency, percentage correct compression depth, percentage of not leaning on the thorax, percentage of correct hand placement on the thorax, hands-off-time).ResultsSix male lifeboat-crewmembers (mean age 35 years) performed CPR during two different weather conditions. In weather-conditions one (wind ~6–7 Beaufort/wave-height: 100–150 cm) quality of manual compressions was significantly worse than mechanical compressions for mean compression depth (p &amp;lt; 0.05) and compression frequency (p &amp;lt; 0.05), percentage correct compression depth (p &amp;lt; 0.05), percentage of not leaning on the thorax (p &amp;lt; 0.05), and hands off time (p &amp;lt; 0.05). Crewmembers could only perform CPR for a limited time-period (sea-conditions/seasickness) and after one set of five epochs measurements were halted. In weather-condition two (wind ~9 Beaufort/wave-height ~200 cm) similar results were found during two epochs, after which measurements were halted (sea-conditions/seasickness). In weather-condition three (wind ~7 Beaufort/wave-height ~300–400 cm) MCD compressions were according to resuscitation-guidelines except for three epochs during which the MCD was displaced.ConclusionCrewmembers were only able to perform chest-compressions for a limited time because of the weather-conditions. The MCD was able to provide good quality chest compressions during all but three epochs during the study period. More research is needed to determine whether MCD-use in real-life circumstances improves outcome. Inclusion of data on use of a MCD on lifeboats should be considered in future revisions of the USFD and resuscitation guidelines.

The effect of standalone audio-visual feedback devices on the quality of chest compressions during laypersons' cardiopulmonary resuscitation training: a systematic review and meta-analysis.

Individual studies that investigated the effect of standalone audio-visual feedback (AVF) devices during laypersons' cardiopulmonary resuscitation (CPR) training have yielded conflicting results. This review aimed to evaluate the effect of standalone AVF devices on the quality of chest compressions during laypersons' CPR training. Randomized controlled trials of simulation studies recruiting participants without actual patient CPR experience were included. The intervention evaluated was the quality of chest compressions with standalone AVF devices vs. without AVF devices. Databases, such as PubMed, Cochrane Central, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science, and PsycINFO, were searched from January 2010 to January 2022. The risk of bias was assessed using the Cochrane risk of bias tool. A meta-analysis alongside a narrative synthesis was used for examining the effect of standalone AVF devices.Sixteen studies were selected for this systematic review. A meta-analysis revealed an increased compression depth of 2.22 mm [95% CI (Confidence Interval), 0.88-3.55, P = 0.001] when participants performed CPR using the feedback devices. Besides, AVF devices enabled laypersons to deliver compression rates closer to the recommended range of 100-120 per min. No improvement was noted in chest recoil and hand positioning when participants used standalone AVF devices. The quality of the included studies was variable, and different standalone AVF devices were used. Standalone AVF devices were instrumental in guiding laypersons to deliver deeper compressions without compromising the quality of compression rates. However, the devices did not improve the quality of chest recoil and placement of the hands. PROSPERO: CRD42020205754.

Partial detachment of the aorta: a fatal complication of CPR chest compressions

BackgroundPartial aorta detachment is a rare and fatal complication of mechanical chest compression.Case presentationThe paper describes a patient in cardiac arrest who died despite receiving CPR using mechanical chest compression. After death, an autopsy showed the presence of a partial rupture of the aortic wall in the intra-pericardial section.DiscussionIn the discussion, for this case, we propose to deepen our knowledge of post-resuscitation complications, which may help to understand the need to maintain the recommended parameters of chest compressions, respond more confidently to changes in the patient's condition during CPR, to interpret the results of bedside examinations better, and to understand the autopsy results better. In our opinion, the best method of diagnosing internal injuries, which we provide with Point-of-Care (POCUS) ultrasound, allows for therapeutic interventions that maximize the chances of spontaneous circulation. Education and skill development are also indispensable aspects of CPR. Particular attention should be paid to the same quality of chest compressions performed.ConclusionsAs conclusions drawn from the analysis of this case, we propose paying particular attention to the difficulty of explaining changes in the patient's condition during CPR, the widespread use of POCUS, and considering the use of compressions performed by staff in situations where it is possible and safe.

Potential to enhance telephone cardiopulmonary resuscitation with improved instructions - findings from a simulation-based manikin study with lay rescuers

BackgroundTelephone-Cardiopulmonary Resuscitation (T-CPR) significantly increases rate of bystander resuscitation and improves patient outcomes after out-of-hospital cardiac arrest (OHCA). Nevertheless, securing correct execution of instructions remains a difficulty. ERC Guidelines 2021 recommend standardised instructions with continuous evaluation. Yet, there are no explicit recommendations on a standardised wording of T-CPR in the German language. We investigated, whether a modified wording regarding check for breathing in a German T-CPR protocol improved performance of T-CPR. MethodsA simulation study with 48 OHCA scenarios was conducted. In a non-randomised trial study lay rescuers were instructed using the real-life-CPR protocol of the regional dispatch centre and as the intervention a modified T-CPR protocol, including specific check for breathing (head tilt-chin lift instructions). Resuscitation parameters were assessed with a manikin and video recordings.ResultsCheck for breathing was performed by 64.3% (n = 14) of the lay rescuers with original wording and by 92.6% (n = 27) in the group with modified wording (p = 0.035). In the original wording group the head tilt-chin manoeuvre was executed by 0.0% of the lay rescuers compared to 70.3% in the group with modified wording (p < 0.001). The average duration of check for breathing was 1 ± 1 s in the original wording group and 4 ± 2 s in the group with modified wording (p < 0.001). Other instructions (e.g. check for consciousness and removal of clothing) were well performed and did not differ significantly between groups. Quality of chest compression did not differ significantly between groups, with the exception of mean chest compression depth, which was slightly deeper in the modified wording group.ConclusionCorrect check for breathing seems to be a problem for lay rescuers, which can be decreased by describing the assessment in more detail. Hence, T-CPR protocols should provide standardised explicit instructions on how to perform airway assessment. Each protocol should be evaluated for practicability.

Conhecimento sobre primeiros socorros de servidores de instituições de ensino infanto- juvenil

First aid consists of the first assistance to an accident or sudden illness victim, outside the hospital environment, with or without risk of death. The present study aims to assess the competences and skills related to first aid training with educational workers. This is a pre and post-test experimental research of an educational intervention action carried out by nurses with 31 teachers and 53 employees from three public educational institutions in the city of Ponta Grossa, Parana State, Brazil. The technological application ‘QCPR Learner’ was used to assess practical skills and an instrument for assessing theoretical knowledge, applied before and after the intervention. It was found that 35.7% were successful in the theoretical test and 58% in the practical test before training and that there was a significant improvement in the correct answers in the post-test, when compared to the pre-test, in the themes: cardiorespiratory arrest, external chest compression, bleeding and tooth avulsion (p = 0.000). Regarding the quality of chest compressions before and after the educational intervention, there was a significant improvement in the variables: correct depth, correct frequency and effectiveness of the compressions (p

Transesophageal Echocardiography in Patients in Cardiac Arrest: The Heart and Beyond.

Point of care ultrasound involves different ultrasound modalities and is useful to assist management in emergent clinical situations such as cardiac arrest. The use of point of care ultrasound in cardiac arrest has mainly been described using transthoracic echocardiography as a diagnostic and as a prognostic tool. However, cardiac evaluation using transthoracic echocardiography might be challenging because of patient-related or technical factors. Furthermore, its use during pulse check pauses has been associated with delays in chest compression resumption. Transesophageal echocardiography (TEE) overcomes these limitations by providing reliable and continuous imaging of the heart without interfering with cardiopulmonary resuscitation. In this narrative review we describe the role of TEE during cardiopulmonary resuscitation in 4 different applications: (1) chest compression quality feedback; (2) rhythm characterization; (3) diagnosis of reversible causes; and (4) procedural guidance. Considering its limitations, we propose an algorithm for the integration of TEE in patients with cardiac arrest with a focus on these 4 applications and extend its use to extracardiac applications.

Under pressure: What individual characteristics lead to performance of high-quality chest compressions during CPR practice sessions?

AimDespite well-established protocols for cardiopulmonary resuscitation training, performance during real-life cardiac arrests can be suboptimal. Understanding personal characteristics which could influenceperformance of high-quality chest compressions could provide insight into the practice-performance gap. This study examined chest compressionperformance, while employing feedback and introducing code team sounds as an anxiety-inducing factor in registered nurses using a cardiopulmonary resuscitation training manikin. MethodsParticipants included 120 registered nurses with basic life support certification randomized to one of the following groups: no feedback and no code team sounds, feedback without code team sounds, or feedback with code team sounds. Chest compression sessions occurred at baseline, 30-days and 60-days. Demographic variables and anxiety level were also collected. The primary outcome was chest compression performance, defined as average percent of time with correct rate and percent with correct depth as captured by the defibrillator. Statistical analysis included linear mixed effects analysis. ResultsThe effect of feedback on chest compression performance depended on the value of other parameters. The benefit of feedback on the primary outcome depended on: age, with feedback less beneficial among older participants (p = 0.0413); and time, with feedback more beneficial with repetition (p = 0.011). These interactions also affected the outcome percent of time with correct compression depth. Increased anxiety was associated with decreased percent correct compression depth (p < 0.001). ConclusionFeedback emerged as important in determining chest compression performance. Chest compression quality was limited by the performer’s age and anxiety level. Future research should focus on identifying factors related to individual characteristics which may influence chest compression performance.

In-hospital cardiac arrest and basic life support

Survival of in-hospital cardiac arrests is still as low as 15-35%. Healthcare workers should closely monitor patients' vital signs, notice any deterioration, and initiate the necessary actions to prevent cardiac arrest. The introduction of early warning sign protocols (including the monitoring of respiratory rate, oxygen saturation, pulse, blood pressure, consciousness, etc.) can improve the recognition of periarrest patients during hospital stay. However, when a cardiac arrest occurs, healthcare workers should also be able to work in team and follow the relevant protocols delivering good quality chest compressions and early defibrillation. To achieve this goal, regular trainings, appropriate infrastructure and system-wide teamwork are needed. In this paper, we discuss the challenges of the first phase of in-hospital resuscitation and its integration into the hospital-wide medical emergency response system. Orv Hetil. 2023; 164(12): 449-453.

Pediatric Chest Compression Improvement Via Augmented Reality Cardiopulmonary Resuscitation Feedback in Community General Emergency Departments: A Mixed-Methods Simulation-Based Pilot Study

BackgroundYearly, more than 20,000 children experience a cardiac arrest. High-quality pediatric cardiopulmonary resuscitation (CPR) is generally challenging for community hospital teams, where pediatric cardiac arrest is infrequent. Current feedback systems are insufficient. Therefore, we developed an augmented reality (AR) CPR feedback system for use in many settings. ObjectiveWe aimed to evaluate whether AR-CPR improves chest compression (CC) performance in non–pediatric-specialized community emergency departments (EDs). MethodsWe performed an unblinded, randomized, crossover simulation-based study. A convenience sample of community ED nonpediatric nurses and technicians were included. Each participant performed three 2-min cycles of CC during a simulated pediatric cardiac arrest. Participants were randomized to use AR-CPR in one of three CC cycles. Afterward, participants participated in a qualitative interview to inquire about their experience with AR-CPR. ResultsOf 36 participants, 18 were randomized to AR-CPR in cycle 2 (group A) and 18 were randomized to AR-CPR in cycle 3 (group B). When using AR-CPR, 87–90% (SD 12–13%) of all CCs were in goal range, analyzed as 1-min intervals, compared with 18–21% (SD 30–33%) without feedback (p < 0.001). Analysis of qualitative themes revealed that AR-CPR may be usable without a device orientation, be effective at cognitive offloading, and reduce anxiety around and enhance confidence in the CC delivered. ConclusionsThe novel CPR feedback system, AR-CPR, significantly changed the CC performance in community hospital non–pediatric-specialized general EDs from 18–21% to 87–90% of CC epochs at goal. This study offers preliminary evidence suggesting AR-CPR improves CC quality in community hospital settings.

CPR quality with rotation of every 1 versus 2 minutes as characteristics of rescuers: A randomized crossover simulation study.

Fatigue and rotation time are key factors affecting the quality of cardiopulmonary resuscitation (CPR). This study aimed to investigate the effects of rotation time on CPR duration, and sex on chest compression quality. In this randomized crossover simulation study, we enrolled 100 paramedic students stratified by sex and randomly grouped into 28 male and 22 female pairs. In the 2- and 1-minute scenarios, 2 participants performed CPR for 20 minutes with a rotation cycle of 2 minutes and 1 minute, respectively. After taking a break, they changed over and performed CPR again for 20 minutes. The switching of roles was performed with the students positioned on opposite sides of the mannequin. For chest compression quality, a set was defined as CPR performed by 1 pair in a 2-minute scenario for 4 minutes. The quality of CPR in each set was compared between the 2 groups. The 1-minute group showed significantly higher chest compression depth than the 2-minute group (54.0 [51.5-57.0] vs 52.5 [48.5-56.5] mm, P = .001, respectively). The female 2-minute group showed decreased chest compression depth over time, and the 1-minute group showed significantly increased chest compression depth during all sets except the 2nd set (54.0 [51.9-55.1] vs 50.5 [48.5-53.8] mm [P = .030], 52.3 [49.4-54.5] vs 50.8 [47.0-53.1] mm [P = .080], 52.8 [49.8-54.5] vs 48.8 [45.4-51.6] mm [P = .002], 51.5 [48.5-53.3] vs 48.3 [44.5-50.6] mm [P = .004], and 50.8 [48.9-54.1] vs 47.5 [44.6-50.1] mm [P = .001], respectively). The fatigue scores in the 2-minute group were significantly higher during sets 4 and 5 than those in the 1-minute group. When rescuer fatigue increases during prolonged CPR owing to their physical strength and skill levels, the rotation of rescuers every minute would be helpful in maintaining high-quality CPR.

Cost-effective cardiopulmonary resuscitation practice device for maintaining chest compression quality: a semi-randomized controlled clinical trial

Objective Continued chest compression after the completion of a basic life support (BLS) course is effective for maintaining the skills acquired during the course. Using low-cost tennis balls for BLS practice, we examined the effects on the long-term continued quality of chest compression. Methods This semi-randomized controlled clinical trial included 153 participants who completed BLS courses from August 2018 to December 2019 and were randomly divided into 5 groups: ball with rhythm (n=33), ball without rhythm (n=32), manikin (Little Anne) with rhythm (n=16), manikin without rhythm (n=23), and no-practice (n=49). Immediately after training and at 3, 6, and 12 months following training, chest compression quality (rate, depth, recoil, and pressure point) was measured, and intergroup comparisons were statistically analyzed. Results The no-practice group demonstrated a decline in chest compression quality at 3 months after BLS course completion. However, no participant in the ball with rhythm group demonstrated a decline in quality on any evaluated items even at 12 months. The tennis ball group (n=65) and the manikin group (n=39) did not demonstrate any significant differences in chest compression quality. Conclusion Weekly BLS practice with low-cost tennis balls can maintain the quality of chest compression for 12 months. Tennis balls are spherical, give only on perpendicular downward compression, and roll away on removing hands, which facilitates the acquisition of proper chest compression posture. Weekly practice is important for skill maintenance following the completion of the BLS course. Keywords: Chest, Survival, Randomized controlled trial, Tennis

Using real-time device-based visual feedback in CPR recertification programs: A prospective randomised controlled study

BackgroundReceiving regular training to maintain CPR skills is critical for in-service health-care professionals, especially because motor skills diminish over time. ObjectivesTo compare the effects of real-time device-based visual feedback and conventional instructor-based feedback on the chest compression skills and self-efficacy of nurses receiving a CPR recertification program. DesignA prospective randomised controlled study with repeated measurements was conducted according to the CONSORT 2010 guidelines. MethodsA total of 109 nurses were recruited, and 98 nurses were eligible for random allocation. The control group (CG, n = 49) was advised by instructors for skill correction, and the experimental group (EG, n = 49) adjusted their skills according to on-screen real-time feedback data. The study outcomes were CPR performance metrics and self-efficacy that were assessed immediately after the training session (T1) and retested after 12 weeks (T2). ResultsIn the EG, the percentage of the appropriate rate, depth, and chest recoil at T1 significantly improved by 24.47 % (P < .001), 19.63 % (P < .001), and 11.52 % (P = .001), respectively. The EG exhibited significantly higher chest compression total scores at T1, and the difference remained significant at T2 (P < 0.001). Moreover, the self-efficacy in the EG significantly improved at T1 (2.76; P < .001) and T2 (2.58; P < .001). ConclusionCompared with instructor-based feedback, real-time device-based visual feedback improved chest compression quality and CPR self-efficacy.

The effect of hand position on chest compression quality during CPR in young children: Findings from the Videography in Pediatric Resuscitation (VIPER) collaborative

ObjectiveTo determine the effect of hand position on chest compression (CC) quality during CPR in young children. MethodsProspective observational exploratory study. Patients < 8 years receiving CC for > 2 minutes were enrolled. Data was collected from video review and CC monitor device and analyzed in ‘CC segments’ (periods of CC by individual providers). Four techniques were compared: two thumbs (2 T), hands encircling the chest; two fingers (2F) on the sternum; one hand on sternum (1H); two hands on sternum (2H). Univariate analysis of CC rate and depth between hand positions was performed through nonparametric testing, stratified by age category. Results47 patients received 824 minutes of CC. Among 270 CC segments in infants < 1 yo, 2 T was used in 27%; 2F 3%; 1H 18%; 2H 26%. Among 189 CC segments in children aged 1 to 8 yo, 1H was used in 26%; 2H 74%. Across all segments, median CC rate was 117 cpm (IQR 110–125). Median depth was 2.92 cm (IQR 2.44 – 4.04) in infants < 1 yo, 3.56 cm (IQR 2.92 – 4.14) in children 1 to 8 yo. 1H achieved greater depth than 2 T in infants (p < 0.01), and 2H achieved greater depth than 1H in children > 1 (p < 0.001). ConclusionsIn infants, 1H resulted in greater CC depth than 2 T. In children 1 to 8 yo, 2H resulted in greater depth than 1H.. These data suggest that different hand position during CPR in young children from what is currently recommended may result in better CPR quality.

Impact of Personal Protective Equipment on the Quality of Chest Compressions in Prehospital Care: A Prospective Randomized Crossover Study.

The use of personal protective equipment (PPE) in prehospital emergency care has significantly increased since the onset of the coronavirus disease 2019 (COVID-19) pandemic. Several studies investigating the potential effects of PPE use by Emergency Medical Service providers on the quality of chest compressions during resuscitation have been inconclusive. This study aimed to determine whether the use of PPE affects the quality of chest compressions or influences select physiological biomarkers that are associated with stress. This was a prospective randomized, quasi-experimental crossover study with 35 Emergency Medical Service providers who performed 20 minutes of chest compressions on a manikin. Two iterations were completed in a randomized order: (1) without PPE and (2) with PPE consisting of Tyvek, goggles, KN95 mask, and nitrile gloves. The rate and depth of chest compressions were measured. Salivary cortisol, lactate, end-tidal carbon dioxide (EtCO2), and body temperature were measured before and after each set of chest compressions. There were no differences in the quality of chest compressions (rate and depth) between the two groups (P >.05). After performing chest compressions, the group with PPE did not have elevated levels of cortisol, lactate, or EtCO2 when compared to the group without PPE, but did have a higher body temperature (P <.001). The use of PPE during resuscitation did not lower the quality of chest compressions, nor did it lead to higher stress-associated biomarker levels, with the exception of body temperature.

Efficacy of distance training program for cardiopulmonary resuscitation utilizing smartphone application and home delivery system

Aim of the studyCommunity cardiopulmonary resuscitation (CPR) education is important for laypersons. However, during the COVID-19 pandemic, with social distancing, conventional face-to-face CPR training was unavailable. We developed a distance learning CPR training course (HEROS-Remote) using a smartphone application that monitors real-time chest compression quality and a home delivery collection system for mannikins. This study aimed to evaluate the efficacy of the HEROS-Remote course by comparing chest compression quality with that of conventional CPR training. MethodsWe applied layperson CPR education with HEROS-Remote and conventional education in Seoul during the COVID-19 pandemic. Both groups underwent a 2-min post-training chest compression test, and we tested non-inferiority. Chest compression depth, rate, complete recoil, and composite chest compression score was measured. Trainees completed a satisfaction survey on CPR education and delivery. The primary outcome was the mean chest compression depth. ResultsA total of 180 trainees were enrolled, with 90 assigned to each training group. Chest compression depth of HEROS-Remote training showed non-inferiority to that of conventional training (67.4 vs. 67.8, p = 0.78), as well as composite chest compression score (92.7 vs. 95.5, p = 0.16). The proportions of adequate chest compression depth, chest compression rate, and chest compressions with complete chest recoil were similar in both training sessions. In the HEROS-Remote training, 90% of the trainees were satisfied with CPR training, and 96% were satisfied with the delivery and found it convenient. ConclusionHEROS-Remote training was non-inferior to conventional CPR training in terms of chest compression quality. Distance learning CPR training using a smartphone application and mannikin delivery had high user satisfaction and was logistically feasible.

An Evaluation of the Quality of CPR Chest Compressions Performed on Football-Equipped and Obese Simulation Manikins

Objective Protective athletic equipment may hamper the delivery of effective chest compressions. Unfortunately, an algorithm for managing cardiac arrest emergencies with equipment-laden athletes has yet to be established by national CPR certifying agencies. Further, athletes classified as being overweight or obese carry adipose in the thoracic region, which has been reported to inhibit the ability of rescuers to provide quality chest compressions. Thus, the purpose of this study was two-fold. The first purpose was to assess the ability of emergency responders to perform CPR chest compressions on an obese manikin. The second purpose was to analyze the effect of American football protective equipment on the performance of chest compressions by emergency responders. Methods Fifty emergency responders completed four 2-minute bouts of compression-only CPR. The scenarios included performing chest compressions on both traditional and obese CPR manikins, and performing chest compressions over a set of shoulder pads/chest protector that is used in the sport of American football on both traditional and obese manikins. Results The most notable outcomes in this study were related to chest compression depth, which fell well below the minimum recommended depth published by the American Heart Association in all conditions. Mean compression depth was significantly lower when performed on the obese manikin (avg over pads = 32.8, SD = 9.2 mm; avg no pads = 38.2, SD = 9.1 mm) compared to the traditional manikin (avg over pads = 40.0, SD = 10.9 mm; avg no pads = 40.8, SD = 14.8 mm), with statistical analyses revealing a significant effect due to both manikin size (p < 0.001) and the presence of equipment (p = 0.003), and a statistically significant interaction effect (p = 0.035). Chest recoil data revealed a statistically significant effect due to both manikin size (p = 0.017) and the presence of chest/shoulder safety pads (p = 0.003). Conclusion Within this sample of emergency responders, chest compressions were adversely affected both by the equipment and obesity. Additionally, the traditional manikin received comparable chest compressions regardless of the presence or absence of football protective equipment, albeit both conditions resulted in poor depth performance.

The association of chest compressor&amp;apos;s physical activity level with the quality of continuous chest compressions during a stimulated cardiac arrest in an education center

Background: Cardiopulmonary resuscitation (CPR) is a lifesaving procedure performed by qualified rescuers. The quality of CPR depends on effective chest compression (CC) characteristics: rate, depth, hand position, and chest recoil. Besides CC, previous research has proven that physical activity level (PAL) varies among rescuers and affects CPR quality. This study aims to assess the association between PAL and the quality of continuous chest compressions-cardiopulmonary resuscitation (CCC-CPR) for 5 minutes by qualified rescuers at the National Guard Hospital in Jeddah (NGHA-J). Methods: This is a cross-sectional study. The global physical activity questionnaire was used to measure the participants&amp;apos; PALs, and the SimMan 3G mannequin was used to measure the four CC characteristics. The recommended sample size is 45 of the rescuers at NGHA-J. Results: A total of 45 members were involved in the study, and most participants were 27 (60%) males. Most participants are classified as having high PAL 21(46.67%). The study indicates that there is no significant effect among the PALs and the CCC-CPR effectiveness according to (p 0.65) which is determined by the non-parametric Kruskal Wallis test. The optimal effective CCs between the three groups of PALs were achieved by the moderate PAL participants with a median of 47.5 (IQR 35). Conclusion: The study findings deny any relationship between the quality of the CCC-CPR and the PAL of the rescuers.