Quality Of Cardiopulmonary Resuscitation Research Articles

Quality of Cardiopulmonary Resuscitation in Avalanche Victims with a Single Rescuer: A Prospective, Crossover, Manikin Pilot Study.

Tanaka, Shota, Koshi Nakagawa, Yosuke Kanagawa, Takashi Katsurahara, Kazuki Kozakai, Ken Tsuhako, Fumitaka Yoshikawa, Soh Gotoh, Kensuke Osanai, Madoka Sono, Hironori Inoue, Shuji Sakanashi, Hiroyuki Takahashi, and Hideharu Tanaka. Quality of cardiopulmonary resuscitation in avalanche victims with a single rescuer: a prospective, crossover, manikin pilot study. High Alt Med Biol. 25:60-67, 2024. Background: Winter outdoor recreational activities such as off-piste skiing have gained popularity and, as a result, the number of avalanche-related deaths has increased. However, the quality of cardiopulmonary resuscitation (CPR) at avalanche sites remains unclear. Our study compared the quality of CPR performed in a simulated avalanche burial on a snowy mountain with that performed indoors. Methods: Ten prehospital health care providers participated in the crossover pilot study. Various methods, including over-the-head CPR (OTH-CPR) and standard CPR, were used to perform avalanche resuscitation, with five rescue breaths, followed by 30 chest compressions and two breaths. The quality CPR was judged by four variables of chest compression and ventilation. Results: The OTH-CPR performed indoors was better in quality: 5.33% [95% confidence interval (CI) -14.2 to 3.5] higher in adequate compression depth (94.3 ± 10.6% on the snow vs. 99.3 ± 1.1% indoors), 3.4% [95% CI -16.1 to 22.9] higher in adequate compression rate (70.4 ± 38.0% vs. 76.1 ± 35.7%), and 2.3% [95% CI -6.4 to 1.72] higher in adequate recoil (96.9 ± 4.8% vs. 99.2 ± 1.6%) than OTH-CPR on the snow. In terms of ventilation quality, OTH-CPR performed indoors had a 50% higher ventilation score [95% CI -73.0 to -27.0] than OTH-CPR on the snow (1.4 ± 4.3% vs. 45.9 ± 32.6%, Cohen's d = -1.81). Conclusions: Chest compression quality was slightly impaired in the avalanche scenarios on the snow than in indoor settings. Asphyxiation is the main cause of avalanche-related deaths; however, low ventilation quality was observed on snow compared with the indoor setting.

The effect of pocket mask training on the self-efficacy and willingness to perform artificial respiration in cardiac arrest patients: A randomized control trial

Background: Out-of-hospital cardiac arrest due to hypoxia, it is necessary to provide adequate oxygen for correction of the cause. So, the purpose of this study was to compare the overall quality of CPR, willingness to perform ventilation using ventilation aids, and self-efficacy compared to the enlisted ventilation method (MMV) by educating the general public on pocket masks (MPV), which are respiratory aids. Methods: This study was a randomized controlled comparative study, in which 110 study subjects were listed with numbered names in the order in which they applied for training, and random numbers were named A (MMV method) and B (MPV method) in that order. Randomization generated a random number order using the SAS program, and the generated random numbers A and B were arranged from 1 to 110 in the order in which they applied for training, through this, they were classified into A groups (N = 57) and B groups (N = 53). The study subjects classified into Group A received CPR training including enlistment ventilation on April 22, 2023, and the trainees in Group B received CPR training using a ventilator on April 29, 2023. Results: The primary outcome is that the result of the comparison of ventilation quality is the mean Tidal Volume (TV) before training for MPV is 1076 ± 422, whereas the mean TV for MMV is 1015 ± 510 (p < 0.05). After training, the mean tidal volume (TV) for MPV is 876ml ± 422, whereas the mean TV for MMV is 1001 ± 516, indicating that MMV resulted in a significantly higher tidal volume than the ILCO guidelines. After training, comparing the time per ventilation cycle, the MPV group showed 0.923sec ± 0.432, while the MMV group showed 1.021sec ± 0.535 (p < 0.05). After completing two ventilations, it is evident that there is a delay in starting the next chest compression in the MMV group compared to the MPV group (MMV: 10.21 ± 4.112 vs. MPV: 9.88 ± 2.831, p < 0.05). Conclusion: As a result of this study, the researcher recommends adding training on pocket masks when educating artificial respiration in CPR training conducted in Korea, given that the performance accuracy of pocket masks is high and the efficient ventilation rate is high.

Effectiveness of Feedback with Mobile Devices for Quality Measure of CPR Training: A Systematic Review

Cardiopulmonary resuscitation (CPR) is a life-saving skill that can significantly increase survival rates in an emergency. Medical professionals, health students, and trained lay people must all perform high-quality CPR. As an outcome, effective CPR training using instruments that support the achievement of high-quality CPR is essential. Objective: This systematic review aimed to evaluate the effectiveness of feedback provided via mobile devices in measuring the quality of CPR training. Method: Design used systematic review with reference to the PRISMA Statement Guidelines 2020. Search results through database of ScienceDirect (778 articles), Wiley Online Library (765 articles), PubMed (55 articles), and ResearchGate (73 articles). The research designs of articles analyzed was randomized controlled trial which published from 2013 to 2023 with the keywords cardiopulmonary resuscitation, CPR training, mobile devices. The sample in this study was taken from five articles that match the inclusion criteria. JBI's critical assessment tool for assessing bias risk in randomly controlled 2023 checklist tests is used to critically evaluate the instruments used for the selected article. Results: The primary results that five publications were based on CPR quality metrics such as chest compression depth and speed, as well as the proportion of acceptable chest compression depth. Conclusions: This review discovered evidence that mobile devices have an effect on the effectiveness of real-time feedback on CPR quality in CPR training. CPR trainees received effective instant guidance from a variety of mobile devices, including smartphones and smart watches equipped with sensors.

Effectiveness of a dispatcher-assisted CPR using an animated image: Simulation study

IntroductionConsidering the few studies evaluating bystander cardiopulmonary resuscitation (CPR) performance, we sought to analyze differences in bystander CPR performance with and without the use of our self-developed animated GIFs based on dispatcher-assisted CPR simulation. MethodsA total of 80 adults who had not received CPR training over the past two years participated in the study. Among them, 40 people were classified into the auditory group (receiving CPR instructions only over the phone), and the other 40 people were classified into the audiovisual group (receiving CPR instructions over the phone after receiving images on a smartphone). All participants were asked to perform adult and infant CPR for 2 min. CPR performance was recorded using two video cameras (front and side) and analyzed by two emergency physicians, whereas CPR quality was measured using Resusci Anne & Baby QCPR Mk II (Laerdal). ResultsIn the adult CPR study, the audiovisual group had higher performance scores for adequacy of “knee position,” “hand posture,” “elbow extension,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). No significant difference in CPR quality was observed between the two groups. In the infant CPR study, audiovisual group had higher performance scores in adequacy of “compression site,” “finger posture,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). Regarding CPR quality, the audiovisual group had higher scores for “adequate compression rate ratio” (p = 0.047). ConclusionAudiovisual guidance using animated GIFs more effectively improved CPR Standard Posture Completeness and Instruction Performance than did traditional auditory guidance.

PENGETAHUAN PERAWAT MEMBERIKAN HIGH QUALITY CPR DAN KESIAPSIAGAAN DALAM MANAJEMEN BENCANA DI INSATALASI GAWAT DARURAT DI 4 RUMAH SAKIT DAERAH DI KAB. SEMARANG

Blockage of coronary arteries causes problems in the heart's electrical system, one of them is cardiac arrest occurs suddenly at any time and at anyone. The heart failure caused the supply of food to organs to decrease. As health workers, knowledge of High-QualityPR must be maintained by nurses in dealing with cardiac arrest, and as part of preparedness, nurses carry out their duties when disaster occurs. Objective: This research aims to determine nurses' knowledge of improving High-Quality CPR capabilities in practice settings and in disaster activities. Research method: this research used qualitative descriptive design using the Convenience Sampling Technique, namely sampling taken based on the wishes of the researcher based on convenience, adequacy, and cooperation. Research solution: nurses in carrying out their duties in health services and disaster preparedness must know High-Quality CPR and carry out activities to reduce disasters in patients who experience cardiac arrest problems. Conclusion: This research is expected to confirm in provision High Quality CPR services. Keywords: Cardiac Arrest, High-Quality CPR, Knowledge

CPR Quality Officer role to improve CPR quality: A multi-centred international simulation randomised control trial

BackgroundAn out-of-hospital cardiac arrest requires early recognition, prompt and quality clinical interventions, and coordination between different clinicians to improve outcomes. Clinical team leaders and clinical teams have high levels of cognitive burden. We aimed to investigate the effect of a dedicated Cardio-Pulmonary Resuscitation (CPR) Quality Officer role on team performance. MethodsThis multi-centre randomised control trial used simulation in universities from the UK, Poland, and Norway. Student Paramedics participated in out-of-hospital cardiac arrest scenarios before randomisation to either traditional roles or assigning one member as the CPR Quality Officer. The quality of CPR was measured using QCPR® and Advanced Life Support (ALS) elements were evaluated. ResultsIn total, 36 teams (108 individuals) participated. CPR quality from the first attempt (72.45%, 95% confidence interval [CI] 64.94 to 79.97) significantly increased after addition of the CPR Quality role (81.14%, 95% CI 74.20 to 88.07, p = 0.045). Improvement was not seen in the control group. The time to first defibrillation had no significant difference in the intervention group between the first attempt (53.77, 95% CI 36.57–70.98) and the second attempt (48.68, 95% CI 31.31–66.05, p = 0.84). The time to manage an obstructive airway in the intervention group showed significant difference (p = 0.006) in the first attempt (168.95, 95% CI 110.54–227.37) compared with the second attempt (136.95, 95% CI 87.03–186.88, p = 0.1). ConclusionA dedicated CPR Quality Officer in simulated scenarios improved the quality of CPR compressions without a negative impact on time to first defibrillation, managing the airway, or adherence to local ALS protocols.

Quality of Cardiopulmonary Resuscitation in Children With Cardiac and Noncardiac Disease: Comparing Apples and Oranges?

Quality of Cardiopulmonary Resuscitation in Children With Cardiac and Noncardiac Disease: Comparing Apples and Oranges?

Interdisciplinary training program for pediatric cardiorespiratory arrest using rapid cycle deliberate practice: A descriptive cross-sectional study.

cardiorespiratory arrest (CRA) is a severe public health concern, and clinical simulation has proven to be a beneficial educational strategy for training on this topic. To describe the implementation of a program for pediatric cardiac arrest care using rapid-cycle deliberate practice (RCDP), the quality of the technique employed, and participants' opinions on the methodology. This descriptive cross-sectional study of pre- and post-performance training in cardiopul monary resuscitation (CPR) techniques and reaction evaluation was conducted in a hospital in São Paulo. Multidisciplinary groups performed pediatric resuscitation in a simulated scenario with RCDP mediated by a facilitator. The study sample included professionals working in patient care. During the simulation, the participants were evaluated for their compliance with the CRA care algorithm. Further, their execution of chest compressions was assessed pre- and post-intervention. In total, 302 professionals were trained in this study. The overall quality of CPR measured pre-intervention was inadequate, and only 26% had adequate technique proficiency, whereas it was 91% (P < 0.01) post-intervention. Of the participants, 95.7% responded to the final evaluation and provided positive comments on the method and their satisfaction with the novel simulation. Of these, 88% considered that repetition of the technique used was more effective than traditional simulation. The RCDP is effective for training multidisciplinary teams in pediatric CPR, with an emphasis on the quality of chest compressions. However, further studies are necessary to explore whether this trend translates to differential performances in practical settings.

Considerations for Medical Students' and Residents' Response to an In-Flight Call for Help.

INTRODUCTION: High quality cardiopulmonary resuscitation and medical care in an emergency can save lives, especially when resources are limited, as when in flight on a commercial airplane. A medical student or resident may be the most qualified person to offer assistance during an in-flight cardiac arrest; however, he/she may not yet have experience acting as a sole provider on the ground. Moreover, physicians-in-training may feel an ethical obligation to help a fellow passenger in need, but later worry that their help is subject to questions of tort liability action. This commentary will discuss who should volunteer to help in flight, considering the capability, ethics, and legal consequences of medical students and residents providing medical assistance on an airplane. It will also discuss how changes in medical curriculum due to the COVID-19 pandemic may aid medical trainees' ability to help during an in-flight emergency as well as propose further opportunities for training.Edelson J, Ruskin K. Considerations for medical students' and residents' response to an in-flight call for help. Aerosp Med Hum Perform. 2024; 95(1):59-60.

A new method to evaluate carotid blood flow by continuous Doppler monitoring during cardiopulmonary resuscitation in a porcine model of cardiac arrest

AimWe used a wearable carotid Doppler patch to study carotid blood flow patterns in a porcine model of cardiac arrest to identify return of spontaneous circulation (ROSC) and hemodynamics associated with different arrhythmias and the quality of compressions. MethodsTwenty Landrace pigs were used as models of cardiac arrest following a standard protocol. Carotid blood flow was monitored continuously using noninvasive ultrasound. Carotid spectral waveforms were captured during various arrhythmias and CPR. Typical carotid blood flow waveforms were recorded at the time of ROSC, and hemodynamic changes were compared with carotid blood flow parameters. ResultsThe results showed that the carotid blood flow waveforms varied with ventricular arrhythmia type. During CPR, compression depth correlated significantly with carotid maximal velocity (Vmax) (Spearman correlation coefficient (r) = 0.682, P < 0.001) and velocity–time integral (VTI) (r = 0.794, P < 0.001). Vmax and VTI demonstrated moderate predictive value for survival. The regular carotid blood flow pattern towards the brain was observed during ROSC, concurrent with compression waveforms. After ROSC, VTI and carotid pulse volume (cPV) showed similar trends as stroke volume (SV). The carotid minute volume (cMV) exhibited a similar trend as cardiac output (CO). ConclusionsCarotid blood flow monitoring could provide valuable information about different arrhythmias as well as the quality of CPR. Carotid flow monitoring allows for timely and effective identification of ROSC. In addition, it may provide valuable hemodynamic information after ROSC.

A novel CPR-assist device vs. established chest compression techniques in infant CPR: A manikin study

IntroductionGuidelines for infant CPR recommend the two-thumb encircling hands technique (TTT) and the two-finger technique (TFT) for chest compression. Some devices have been designed to assist with infant CPR, but are often not readily available. Syringe plungers may serve as an alternative infant CPR assist device given their availability in most hospitals. In this study, we aimed to determine whether CPR using a syringe plunger could improve CPR quality measurements on the Resusci-Baby manikin compared with traditional methods of infant CPR. MethodsCompression area with a diameter of 1 to 2 cm is recommended in previous infant CPR device researches. In this is a randomized crossover manikin study, we examined the efficacy of the Syringe Plunger Technique (SPT) which uses the plunger of the 20 ml syringe with a 2 cm diameter flat piston, commonly available in hospital, for infant External Chest Compressions (ECC). Participants performed TTT, TFT and SPT ECC on Resusci® Baby QCPR® according to 2020 BLS guidelines. ResultsSixty healthcare providers participated in this project. The median (IQR) ECC depths in the TTT, TFT and SPT in the first minute were 41 mm (40–42), 40 mm (38–41) and 40 mm (39–41), respectively, with p < 0.001. The median (IQR) ECC recoil in the TTT, TFT and SPT groups in the first minute was 15% (1–93), 64% (18–96) and 53% (8–95), respectively, with p = 0.003. The result in the second minute had similar findings. The SPT had the best QCPR score and less fatigue. ConclusionThe performance of chest compression depth and re-rebound ratio was statistically different among the three groups. TTT has good ECC depth and depth accuracy but poor recoil. TFT is the complete opposite. SPT can achieve a depth close to TTT and has a good recoil performance as TFT. Regarding comprehensive performance, SPT obtains the highest QCPR score, and SPT is also less fatigued. SPT may be an effective alternative technique for infant CPR.

Impact of Personal Protective Equipment on Cardiopulmonary Resuscitation and Rescuer Safety

Background. High-quality cardiopulmonary resuscitation (CPR) is a key element in the rescue of cardiac arrest patients but is difficult to achieve in circumstances involving aerosol transmission, such as the COVID-19 pandemic. Methods. This prospective randomized crossover trial included 30 experienced health care providers to evaluate the impact of personal protective equipment (PPE) on CPR quality and rescuer safety. Participants were asked to perform continuous CPR for 5 minutes on a manikin with three types of PPE: level D-PPE, level C-PPE, and PAPR. The primary outcome was effective chest compression per minute. Secondary outcomes were the fit factor by PortaCount, vital signs and fatigue scores before and after CPR, and perceptions related to wearing PPE. Repeated-measures ANOVA was used, and a two-tailed test value of 0.05 was considered statistically significant. Results. The rates of effective chest compressions for 5 minutes with level D-PPE, level C-PPE, and PAPRs were 82.0 ± 0.2%, 78.4 ± 0.2%, and 78.0 ± 0.2%, respectively ( p = 0.584 ). The fit-factor test values of level C-PPE and PAPRs were 182.9 ± 39.9 vs. 198.9 ± 9.2 ( p &lt; 0.001 ). The differences in vital signs before and after CPR were not significantly different among the groups. In addition, the fatigue and total perception scores of wearing PPE were significantly higher for level C-PPE than PAPRs: 3.8 ± 1.6 vs. 3.0 ± 1.6 ( p &lt; 0.001 ) and 27.9 ± 5.4 vs. 26.0 ± 5.3 ( p &lt; 0.001 ), respectively. Conclusion. PAPRs are recommended when performing CPR in situations where aerosol transmission is suspected. When PAPRs are in short supply, individual fit-tested N95 masks are an alternative. This trial is registered with NCT04802109.

Chest compression quality comparing 1-min vs 2-min rotation of rescuers wearing N95 masks

BackgroundDuring the COVID-19 pandemic, cardiopulmonary resuscitation (CPR) performed by rescuers wearing well-sealed respirators such as N95 masks, was associated with significant reduction in the chest compression rate and depth. This was attributed to fatigue during the standard 2-min rescuer rotations. We hypothesized that in such situations, rotating rescuers every one minute, instead of the standard two minutes would improve CPR quality. AimTo compare the quality of chest compressions when rescuers wearing N95 masks are rotated every one minute, instead of the standard practice of two-minute rotations. MethodsA randomized, controlled, crossover trial was conducted, with the approval of the institutional Ethics Committee. Medical students who volunteered as rescuers were trained to perform high-quality chest compressions on a manikin, and then randomly allocated into pairs. Each pair was randomized to one of two trial groups viz. one-minute rotations crossed-over to two-minute rotations; and vice versa. Thus, each pair performed CPR with one-minute rotations, as well as two-minute rotations Each CPR session included chest compressions for a duration of 12 min. The outcome parameters included CPR quality, compression depth, compression rate, and chest compression fraction. Rescuer fatigue was measured before and after each study session using the modified Borg scale. ResultsFifty-six participants completed the study. The overall CPR quality was statistically similar in the study arms (median 88% vs. 81%, p = 0.09). However, the minute-to-minute inter-arm comparison revealed significantly lower CPR quality in the 2-min rotation arm, at the end of minutes 4, 6, 8, 10 and 12 (respective p-values 0.03, 0.001, 0.008, 0.02, 0.002). A similar trend was observed in compression depth also. Rescuer fatigue score was significantly less with 1-min rotations compared to 2-min rotations (p < 0.001). Rescuer vital signs and cardiorespiratory parameters were not different with the two types of rotations. ConclusionDuring CPR performed by rescuers wearing N95 masks, the quality of CPR appears to be superior with rescuers rotating at 1-min instead of 2-min intervals. More frequent rotation was also associated with less rescuer fatigue.

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&amp;lt;&amp;lt;0.001) and release velocity (p&amp;lt;0.05) with the modified metronome. Percentage of compressions within the optimal range was significantly higher for compression depth (p&amp;lt;0.05) and significantly lower for compression rate (p&amp;lt;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

Abstract 104: Photoplethysmogram Signal Characteristics as a Non-Invasive Surrogate of Diastolic Blood Pressure During Cardiopulmonary Resuscitation

Background: During cardiopulmonary resuscitation (CPR), diastolic blood pressure (DBP) is a key driver of coronary perfusion pressure and thereby, blood flow during CPR. Although resuscitation guidelines advise measuring DBP as an indicator of CPR quality, the need for an invasive arterial catheter to measure DBP limits scope of patients for whom a BP-directed CPR strategy can be implemented. Aims and Hypothesis: We aimed to study the photoplethysmogram (PPG) signal acquired from pulse oximetry monitoring as a non-invasive indicator of CPR quality. We hypothesized that a machine learning algorithm using dynamic PPG features would accurately classify CPR segments according to whether they met established pediatric DBP thresholds associated with improved outcomes (≥25mmHg in infants and ≥30 mmHg in older children). Methods/Approach: This was an NHLBI-funded ancillary study of the ICU-RESUScitation clinical trial (NCT02837497). This initial pilot study included 12 children who received CPR for an IHCA and had both arterial BP and pulse oximetry monitoring in place. Physiologic data were summarized into five-second epochs and DBP for each epoch was dichotomized by whether it met age-based DBP thresholds. Time-domain features ( k =25) were systematically engineered from the PPG signal, and a Support Vector Machine (SVM) model with a Gaussian kernel was trained to classify the CPR quality samples. Results: The analysis yielded n= 268 five-second CPR epochs, of which 147 (55.9%) met DBP thresholds. In the testing set of 134 previously unseen samples (50% of n , n low =59, n high =75), the SVM model achieved a classification accuracy of 91% with 100% precision and specificity, 79.7% sensitivity, and a negative predictive value of 86.2% only influenced by false negatives. Throughout development, six features describing the dicrotic notch characteristics reflected in the PPG waveform were empirically observed as significant CPR quality indicators. Conclusion: In this multicenter pilot investigation, the PPG waveform derived from pulse oximetry readings showed promise as a non-invasive surrogate of invasively measured DBP during pediatric CPR. This has the potential to greatly broaden the population for whom physiologic monitoring during CPR is possible.

Abstract 306: Evaluating Layperson CPR Performance Supported by a Just-in-Time Video Compared to a Standard Training Course

Background: Just-in-time (JIT) video training has been proposed as an alternative to in-person CPR courses, with associated time and cost savings. Research Question: Does a JIT training video improve layperson performance of CPR? Aim: Measure CPR performance using a JIT video compared to the American Heart Association (AHA) HeartSaver® CPR AED Training course. Methods: A convenience sample of laypeople was randomized to perform CPR in a simulated scenario a) after participating in an AHA HeartSaver® course led by experienced instructors, b) with access to a JIT training video, or c) control, with no assistance or training. CPR quality was assessed by trained evaluators and objective performance assessed using Laerdal QCPR-enabled simulators. The primary outcome was performance of correct CPR. Results: Of 230 eligible subjects, 226 were randomized with no significant differences in baseline characteristics across groups. Prevalence of correct CPR was low, though significantly higher in the AHA group (AHA: 40%, 95%CI 28-51; JIT: 15%, 95%CI 8-26; control 10%, 95%CI 4-19). Overall, 94% of participants performed compressions within 1 minute, with no difference between groups. An AED was called for more frequently in the AHA group (47%) than the JIT (15%) or control (10%) groups. Flow fraction was significantly better in the AHA group (89%, IQR 77-99) compared to the JIT (75%, IQR 47-90) or control (49%, IQR 22-74) groups and compression rates of 100-120 were more frequent in the AHA (51%) and JIT groups (47%) compared to controls (27%). Conclusions: While correct performance of specific CPR skills varied in this sample, laypersons using a JIT training video performed as well as those taking an AHA HeartSaver® course on several key measures such as rapid chest compression and compression rate. JIT video training may be a viable option for supporting untrained bystander CPR performance, though further evaluation is needed to identify optimal strategies for implementation.

Abstract 222: Real Time Feedback of Chest Compressions by Hands-Free Carotid Doppler in a Porcine Model

Background: Real-time hemodynamic feedback devices provide information on cardiopulmonary resuscitation (CPR) quality. This can improve hand positioning and technique, thereby maximizing blood flow and potentially improve survival. Hypothesis: We hypothesize that a newly developed hands-free Doppler for carotid blood flow velocity (RescueDoppler, RD), can identify optimal vs. suboptimal chest compression sites during CPR. Aim: To assess the potential of the RD device to continuously monitor the effect of each compression by ultrasound metrics and waveforms in a porcine model. Methods: Ventricular fibrillation was induced in 5 pigs using an ICD. Manual CPR (blinded for hemodynamic data) was performed for 10 seconds at 3 different compression sites in random order (Fig.), and repeated 6 times. We analyzed ultrasound waveforms with Time Average Velocity (TAV) in a linear mixed model with site as fixed effect, and animal and site within animal as random effects. We further compared TAV to invasive systolic blood pressure (SBP) from the contralateral carotid artery. Results: Data from 5 pigs (mean weight 31.2 kg) and 29 of 30 sequences were included. Overall, blood flow velocity was highest at compression site 2 (TAV 33 cm/s, P&lt;0.01), but there was significant variability (P&lt;0.01) in animals (SD= 3.7) and at sites within animal (SD= 7). A compression site yielding the highest TAV (range 19 to 48 cm/s) or lowest TAV (6-25 cm/s) was successfully identified in all animals with corresponding SBPs 50-81 mmHg, and 46-64 mmHg, respectively. The correlation between TAV and SBP was 0.62-0.90 within animals. Conclusions In this animal study, a newly developed hands-free Doppler enabled assessment of blood flow velocity during CPR and detected significant variation according to chest compression site. RD identified the sites with both high and low blood flow velocities and is thus a promising device for effectively identifying the optimal and suboptimal chest compression sites during CPR.

Nurses' Perceptions Towards Resuscitated Patients: A Qualitative Study.

Nurses' perceptions of resuscitated patients may affect their care, and this has not been investigated in previous literature. The aim of this study was to explore nurses' perceptions towards resuscitated patients. In this descriptive-qualitative study seventeen clinical nurses participated using purposive sampling. In-depth, semi-structured interviews were conducted and data were analyzed by conventional content analysis. Four main categories emerged: Injured, undervalued, problematic, and destroyer of resources. Participants considered resuscitated patients to have multiple physical injuries, which are an important source of legal problems and workplace violence, and they believed that these patients will eventually die. Resuscitated patients are considered forgotten and educational cases. Iranian nurses have a strong negative perception towards resuscitated patients. Improving the quality of cardiopulmonary resuscitation, improving the knowledge and skills of personnel in performing resuscitation, and supporting managers and doctors to nurses in the post-resuscitation period can change the attitude of nurses and improve post-resuscitation care.

Abstract 185: Regional Oxygen Saturation and Capnography Monitoring During Resuscitation After Cardiac Arrest in a Swine Pediatric ARDS Model

Introduction: Survival and outcomes after cardiac arrest (CA) depend largely on the effectiveness of cardiopulmonary resuscitation (CPR). Traditional invasive methods of monitoring CPR can be challenging out-of-hospital and are lacking in more than 50% of in-hospital pediatric CA. Regional oxygen saturation (rSO 2 ) monitoring with Near Infrared Spectroscopy (NIRS) and volumetric capnography offers a noninvasive approach that could potentially overcome these challenges. Aim: To determine the feasibility and effectiveness of NIRS and volumetric capnography monitoring in a swine model of pediatric hypoxia induced CA. Approach: Juvenile pigs were sedated and mechanically ventilated. Mild to moderate Acute Respiratory Distress Syndrome (ARDS) was induced by continuous oleic acid infusion. Respiratory and hemodynamic variables were monitored using invasive and noninvasive (NIRS and capnography) monitoring to assess efficacy of CPR. Animals were randomized into one of the two groups: High-quality CPR (hqCPR) to achieve coronary perfusion pressure of 25-30 mmHg and low-quality CPR (lqCPR) to achieve coronary perfusion pressure of 10-15 mmHg. Trajectories over time were analyzed using regression analyses. The discriminatory ability to distinguish between groups based on trajectories were analyzed using receiver operating characteristics curve (ROC) analysis. Results: 39 animals (23±3 kg) were included in our study. In the hqCPR group, there are generally higher values for cerebral and renal rSO 2 , ETCO 2 , volume of CO 2 elimination (VCO 2 ), and carotid blood flow, compared to the lqCPR group (p&lt;0.0001). Cerebral and renal rSO 2 values increase over time, while ETCO 2 , VCO 2 , and carotid flow values decrease in the hqCPR group. Cerebral rSO2 had a ROC AUC of 0.76 (95% CI: 0.58-0.94), whereas renal rSO2 had a ROC AUC of 0.54 (95% CI: 0.22-0.87) representing nearly no discrimination ability. ETCO 2 had a ROC AUC of 0.66 (95% CI: 0.49-0.84), whereas VCO 2 had a ROC AUC of 0.62 (95% CI: 0.38-0.85). Conclusions: Higher mean cerebral rSO2 values during CPR might be used to assess quality of CPR effectiveness and provide real-time adjustments as needed. This could guide healthcare providers in optimizing CPR quality and improving outcomes for cardiac arrest patients.

Abstract 309: The Hiccup Method for BLS HPCPR for Pediatric Cardiac Arrest: Description of Technique and Quality Metrics in Simulated Pediatric Out of Hospital Cardiac Arrest (OHCA)

Key principles of high-performance CPR (HPCPR) include optimizing rate and depth of chest compressions, and minimizing pauses. Maryland EMS sought compromise to translate existing adult HPCPR protocol to accommodate AHA 15:2 compression: ventilation ratio pediatric recommendations. The resulting “Maryland Hiccup” method of HPCPR delivers 1 ventilation on each upstrokes after compressions 14 and 15, resulting in nearly continuous compressions. We sought to determine how the Maryland Hiccup (MH) style of CPR compares to the standard AHA 15:2 (AHA) style in simulated pediatric CPR performed by EMS clinicians. Methods: Teams of 2-person EMS providers utilized a child -size medium fidelity manikin to perform four-minute cycles of HPCPR. Teams were randomly assigned 2 cycles in either MH or AHA style, then crossed over to the other style. HPCPR performance metrics were compared: compression fraction, no flow time, rate, depth, and ventilation rate and volume using student’s t-test. Results: Thirty-eight clinicians (22 BLS, 16 ALS) participated. Both compression fraction (80% with AHA vs 98% with MH, p &lt; .001) and no flow time (2.79 seconds with AHA vs 0.16 seconds with MH, p&lt;.001) were improved with MH technique. Overall compressions were deeper than the recommended 2 inches or 5 cm, with AHA than MH (63mm vs 60mm respectively, p=0.01, Table 1). No differences were noted in compression rate, ventilation rate or ventilation volume. Conclusions: The Maryland Hiccup style of HPCPR with synchronized ventilations interspersed with chest compressions significantly improves CPR quality metrics in simulated pediatric CPR by EMS clinicians. While the CCF was superior with the MH method (98%), the chest compression depth was shallower than the AHA method by 3mm. How this translates to changes in actual patient outcomes has yet to be determined. Further study is warranted to explore physiologic benefits and patient outcome.