Quality Of Chest Compressions Research Articles

Assessing the quality of chest compressions with a DIY low-cost manikin (LoCoMan) versus a standard manikin: a quasi-experimental study in primary education.

Extending the access to cardiopulmonary resuscitation (CPR) training to a wider public is an important step in increasing survivability of out-of-hospital cardiac arrest. However, often price and maintenance of CPR manikins are barriers that prevent training at schools. This study aims to evaluate the learning of hands-only (HO) CPR by practicing with a low-cost manikin (LoCoMan) with visual qualitative feedback and to compare the results with the skills acquired by practice on a conventional manikin. A quasi-experimental study with 193 schoolchildren (10 to 12years old) who were allocated to two groups: the LoCoMan group was taught via an integrative approach (science combined with physical education (PE)) and practiced on a handmade manikin, and a control group practiced in a traditional setting with a commercial manikin (Resusci Junior, Laerdal, Norway). All participants practiced for 1 hands-on skill session before performing a post-test on an instrumented CPR manikin. The outcomes including HO-CPR performance variables were compared between groups. The LoCoMan and control groups both achieved acceptable percentage of HO-CPR quality (57% and 71%, p = 0.004). Among 6th-graders, there were no significant differences in HO-CPR quality between LoCoMan 68% and control 71%, p = 0.66. The control group achieved better chest compression depth while the LoCoMan group showed more compressions with adequate chest recoil. Conclusion: Schoolchildren are able to build and use a low-cost manikin with visual feedback. The integrative learning approach used in this study may be a feasible alternative methodology for training and learning HO-CPR in schools when commercial manikins are not available. What is Known: • Access to CPR training should be universal and independent of age, location, financial means, or access to qualified instructors. • Scientific societies promote the implementation of CPR in schools, so that teachers and schoolchildren can play a multiplier role in their environment, but the gap in CPR learning is related to cultural, economic factors or access to resources and materials. What is New: • LoCoMan may be a useful device for teaching and learning CPR in schoolchildren from the age of 10 and upwards. • LOCOMAN shows that it is feasible and possible to build a low-cost manikin (about €5 in the European Region) and to integrate it into an integrative educational project, and outlines how this could be done. this approach can be an incentive for teachers to attempt teaching CPR, but also for education outside the formal environment.

The association of recent simulation training and clinical experience of team leaders with cardiopulmonary resuscitation quality during in-hospital cardiac arrest

ObjectiveWe aimed to investigate the association of recent team leader simulation training (<6 months) and years of clinical experience (≥4 years) with chest compression quality during in-hospital cardiac arrest (IHCA). MethodsThis cohort study of IHCA in four Danish hospitals included cases with data on chest compression quality and team leader characteristics. We assessed the impact of recent simulation training and experienced team leaders on longest chest compression pause duration (primary outcome), chest compression fraction (CCF), and chest compression rates within guideline recommendations using mixed effects models. ResultsOf 157 included resuscitation attempts, 45% had a team leader who recently participated in simulation training and 66% had an experienced team leader. The median team leader experience was 7 years [Q1; Q3: 4; 11]. The median duration of the longest chest compression pause was 16 s [10; 30]. Having a team leader with recent simulation training was associated with significantly shorter longest pause durations (difference: −7.11 s (95%-CI: −12.0; −2.2), p = 0.004), a higher CCF (difference: 3% (95%-CI: 2.0; 4.0%), p < 0.001) and with less guideline compliant chest compression rates (odds ratio: 0.4 (95%-CI: 0.19; 0.84), p = 0.02). Having an experienced team leader was not associated with longest pause duration (difference: −1.57 s (95%-CI: −5.34; 2.21), p = 0.42), CCF (difference: 0.7% (95%-CI: −0.3; 1.7), p = 0.17) or chest compression rates within guideline recommendations (odds ratio: 1.55 (95%-CI: 0.91; 2.66), p = 0.11). ConclusionRecent simulation training of team leaders, but not years of team leader experience, was associated with shorter chest compression pauses during IHCA.

A smartwatch-based CPR feedback device improves chest compression quality among health care professionals and lay rescuers

A smartwatch-based CPR feedback device improves chest compression quality among health care professionals and lay rescuers

Resuscitation Update - What's New?

Perfect, uninterrupted basic life support (BLS) is the key for successful cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA). Time plays an important role in the treatment of OHCA. This applies both to the time until the start of BLS and the reduction of all pauses during resuscitation, especially chest compressions. In 2022, the rate of bystander-CPR showed an absolute increase of 4% compared to previous years. The bystander-CPR rate is currently above 50%. Compared to OHCA in adults, cardiac arrest in children is rare in Germany. In the period from 2007 to 2021, the incidence was 3.08 per 100000 children. In addition, the etiology in children varies depending on the age group. While hypoxia is often the cause of circulatory arrest in younger children, trauma and drowning accidents are the main causes in school-age children. Different additional diagnostic and therapeutic strategies have been evaluated over the last years. Point-of-care ultrasound during resuscitation should only be performed by experienced users. Interrupting chest compressions and thus prolonging the no-flow phases must be avoided. Double sequential external defibrillation after the third shock can successfully terminate refractory ventricular fibrillation. While further studies are needed, emergency medical systems should train their teams to avoid complications. In refractory OHCA, extracorporeal CPR should be considered. In the case of in-hospital cannulation, immediate transport should be weighed against impaired chest compression quality. Therefore, transportation under CPR is only beneficial if there is an indication for further treatment.

Comparison of the effects of using feedback devices for training or simulated cardiopulmonary arrest

BackgroundHigh-quality chest compression is essential for successful cardiac arrest resuscitation. High-quality cardiopulmonary resuscitation (CPR) can effectively improve the survival rate of patients with cardiopulmonary arrest. However, bystanders untrained in cardiopulmonary resuscitation may provide inadequate chest compressions. Previous studies have shown that the use of feedback devices in training alone or in simulated cardiopulmonary arrest alone can improve cardiopulmonary resuscitation. This study aims to determine whether using an audiovisual feedback (AVF) device during CPR training or a simulated cardiopulmonary arrest (CA) scenario would be more effective in improving the quality of chest compressions (CC).MethodsWe use a prospective, randomized, 2 × 2 factorial design trial. A total of 160 participants from Wuhan University and senior clinical medicine undergraduates who had not participated in any CPR training before and had no actual CPR experience are recruited. Each participant is randomized to 1 of 4 permutations, including AVF device vs. no AVF device during CPR training and AVF device vs. no AVF device during simulated CA. Main outcomes and measures are the depth, the percentage of CCs with correct depth (5–6 cm), the rate of CCs, and the percentage of CCs with the correct rate (100–120 cpm).ResultsThe use of the AVF device during simulated CA resulted in improved CC quality. In CA without AVF device, the average compression depth and the percentage of adequate depth with AVF device are 5.1 cm, 5.0 cm and 55.5%, 56.3%, respectively, which are higher than those without AVF device (4.5 cm, 4.7 cm and 32.8%, 33.6%). (p = 0.011, p = 0.000, both < 0.05).Compared with CA without AVF device, the average compression rate and the percentage of adequate rate with AVF device are 112.3 cpm, 111.2 cpm and 79.4%, 83.1%, respectively. The average compression rate and the percentage of adequate rate without using the AVF device are 112.4 cpm, 110.3 cpm and 71.5%, 68.5%, respectively. (p = 0.567 > 0.05, p = 0.017 < 0.05)Although the average compression rate in group D is slightly lower than that in group C, the percentage of suitable frequency with the feedback device is still higher than that without AVF device.ConclusionUsing a feedback device during simulated cardiopulmonary arrest is more effective in improving cardiopulmonary resuscitation than during training.

User Needs and Factors Associated With the Acceptability of Audiovisual Feedback Devices for Chest Compression Monitoring in Cardiopulmonary Resuscitation.

The use of audiovisual feedback devices to guide the quality of chest compressions during cardiopulmonary resuscitation has increased in recent years. Audiovisual feedback devices can be classified as integrated (eg, Zoll AED Plus defibrillator) or standalone (eg, CPRmeter). This study aimed to explore users' needs and factors affecting the acceptability of audiovisual feedback devices. Semistructured interviews were conducted with healthcare professionals involved in lifesaving activities. The Unified Theory of Acceptance and Use of Technology was used as a theoretical framework for the study. The Unified Theory of Acceptance and Use of Technology model has four constructs: performance expectancy, effort expectancy, social influence, and facilitating factors. Ten themes were identified under the four constructs. The performance expectancy constructs include three themes: perceived usefulness, outcome expectation, and applicability in diverse situations. The effort expectancy construct encompasses two themes: user-friendliness and complexity. The social influence construct has two themes: social and organizational factors. Lastly, the facilitating factors construct includes three themes: staff competence, perceived cost, and compatibility of devices. Exploring the needs and factors influencing the acceptability of audiovisual feedback devices used during cardiopulmonary resuscitation will inform healthcare providers, managers, manufacturers, and procurers on how to improve the efficiency and use of these devices.

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.

Wearable Inertial and Pressure Sensors-Based Chest Compression Quality Assessment to Improve Accuracy and Robustness

Wearable Inertial and Pressure Sensors-Based Chest Compression Quality Assessment to Improve Accuracy and Robustness

Improving the effectiveness of CPR during interventional procedures.

The number of interventional procedures, such as transcatheter aortic valve replacements or thoracic endovascular aortic repairs, is on the rise. Intraprocedural cardiac arrest is a rare occurrence during high-risk procedures. Modern hybrid-operating tables may adversely affect chest compression quality due to their flexibility. To investigate this relationship, we analyzed the blood pressure generated during chest compressions at different degrees of table extension and assessed the effect of an additional stabilization bar to secure the table. A CPR manikin was connected to online blood pressure monitoring on a hybrid operating table. Chest compressions were administered using a mechanical device (at 100bpm and 80bpm). Hemodynamic effects were evaluated at various degrees of table extension (0%, 50%, 100% table extension) and with the addition of a stabilization bar. A greater degree of table extension was associated with lower diastolic blood pressure. The addition of a stabilization bar alleviated this drop in diastolic blood pressure and enabled the generation of higher mean arterial pressures at 50% and 100% table extension during chest compressions. The flexibility of a hybrid operating table adversely impacts the hemodynamic effect of chest compressions. This effect may be mitigated by using a stabilization bar. These results may be relevant for providing further recommendations for CPR guidelines in hybrid OR settings.

A user-centered evaluation of automated chest compression devices for prehospital cardiac arrest care

Objective: This study aimed to compare the various factors of LUCAS and AutoPulse devices used for patients struggling with cardiac arrest. Methods: A randomized crossover study with 24 emergency medical service (EMS) providers were recruited for this research. Such studies performed CPR with both devices on a manikin in a simulated ambulance. Results: The results showed that the AutoPulse device provides a faster response and is easy to apply with less user interaction than LUCAS. Moreover, the AutoPulse device also resulted in minimized workload, higher satisfaction, and maximum situation awareness compared with LUCAS. However, proper information must be presented between the two devices according to the chest compression quality, hemodynamic parameters, and ventilation quality. Conclusion: AutoPulse had gained a clear advantage over LUCAS regarding workload, user performance, situation awareness, and satisfaction of the EMS providers.

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.

Chest compression quality and patient outcomes with the use of a CPR feedback device: A retrospective study

Feedback devices were developed to guide resuscitations as targets recommended by various guidelines are difficult to achieve. Yet, there is limited evidence to support their use for in-hospital cardiac arrests (IHCA), and they did not correlate with patient outcomes. Therefore, this study has investigated the compression quality and patient outcomes in IHCA with the use of a feedback device via a retrospective study of inpatient code blue activations in a Singapore hospital over one year. The primary outcome was compression quality and secondary outcomes were survival, downtime and neurological status. 64 of 110 (58.2%) cases were included. Most resuscitations (71.9%) met the recommended chest compression fraction (CCF, defined as the proportion of time spent on compressions during resuscitation) despite overall quality being suboptimal. Greater survival to discharge and better neurological status in resuscitated patients respectively correlated with higher median CCF (p = 0.040 and 0.026 respectively) and shorter downtime (p < 0.001 and 0.001 respectively); independently, a higher CCF correlated with a shorter downtime (p = 0.014). Overall, this study demonstrated that reducing interruptions is crucial for good outcomes in IHCA. However, compression quality remained suboptimal despite feedback device implementation, possibly requiring further simulation training and coaching. Future multicentre studies incorporating these measures should be explored.

Abstract 382: The Effect of Stepstool Use on Chest Compression Quality During CPR in Young Children: Findings From the Videography in Pediatric Emergency Research (VIPER) Collaborative

Background: Delivering chest compressions (CC) of adequate depth and rate during pediatric cardiopulmonary resuscitation (CPR) has known beneficial hemodynamic consequences; however, chest compression quality in this population is often suboptimal. While common, the benefit of stepstool use during pediatric CPR has not been studied. Objective: To analyze the effect of step stool use on chest compression quality (depth, rate) in a pediatric emergency department (ED). Methods: We conducted a prospective observational cohort study involving patients &lt;8 years of age receiving chest compressions in an ED for &gt;2 minutes. Data was collecting via structured video review and from a CC monitoring device. Analysis was by compressor segment. We compared CC rate and depth by step stool use in each of 3 age groups: &lt; 1 year, 1-8 years, 9-18 years. We also examined step stool and CC quality by compressor hand position: 1) two thumbs, hands encircling chest (2T), 2) two fingers, 2 nd and 3 rd digits, pressing on anterior sternum (2F), 3) one hand (1H), and4) two hands (2H). Results: 46 patients received 390 CC segments (565 total minutes of CC). In patient &lt;1 year and 1-8years of age, the majority of compressors utilized a step stool (73% &lt;1 year; 83.3% 1-8 years). For &lt;1year, there was no difference in mean CC rate or depth with or without step stool use. In children &gt;1year of age, a step stool was associated with deeper chest compressions [3.63cm (IQR 3.07 - 4.17)versus 2.74 cm (IQR 2.39 - 3.24) without, p=0.000] and a mean CC rate more consistent with AHA guidelines [115 compressions per minute (IQR 115 - 128) versus 125 (IQR 110 - 121) without p=0.0037]. Stratified by hand placement technique, 1H compressions with a step stool achieved greater depth in children &gt;1 years (p&lt;0.01); 2H compressions with a step stool achieved a more compliant CC rate in children &gt;1 years (p&lt;0.05). Conclusions: CPR depth failed to reliably meet AHA guidelines regardless of stepstool use across all age categories. However, in children between 1 - 8 years of age, step stool use was significantly associated with higher quality chest compressions. Our findings of better CC depth and rate with one and two hand compressions should prompt further investigation and evaluation of CC technique in the pediatric population.

Abstract 383: Effect of Audiovisual Feedback Device Type on Prehospital Chest Compression Quality During Prehospital Resuscitation

Background: Real-time audiovisual feedback devices have been implemented to optimize cardiopulmonary resuscitation (CPR) performance during out-of-hospital cardiac arrest (OHCA). Emergency medical service (EMS) personnel perceive different levels of usability regarding feedback device type. The study aimed to evaluate the effect of type of audiovisual feedback device used during prehospital CPR on chest compression quality during prehospital resuscitation. Method: Adult OHCA patients who received CPR by EMS personnel utilizing feedback device in Seoul between April 2020 and December 2021 were included. Cases that utilized mechanical chest compression devices were excluded. Feedback devices were classified into two types: sticker-type (S-type) and puck-type (P-type). The quality of chest compressions during prehospital resuscitation was compared based on the feedback device type. The primary outcome assessed was chest compression depth. Subgroup analysis was conducted for cases in which EMS personnel had experience using both types of devices. Results: In total, 2,896 OHCA cases were included. 1,596 cases utilized S-type devices and 1,300 cases utilized P-type devices. The median chest compression depth was significantly higher in cases that utilized the S-type device (Median: 5.2, interquartile range (IQR): 4.5-5.8) compared to those that used the P-type device (Median: 4.3, IQR: 3.7-5.0) (P&lt;0.001). In addition, proportion of chest compressions with adequate depth (5-6 cm) was significantly higher in the S-type group, while average chest compression rate and chest compression fraction were higher in the P-type group. Similar findings were observed in the subgroup analysis. Conclusion: Difference in chest compression quality parameters were observed during prehospital resuscitation according to type of audiovisual feedback device utilized. Chest compression quality regarding chest compression depth was superior when S-type feedback device was used.

New communication tool for basic life support training: smart glasses. A quasi-experimental study

AimTo analyze the effectiveness of a teaching-learning methodology for teletraining in basic life support (BLS) based on communication through smart glasses. DesignPilot quasi-experimental non-inferiority study. ParticipantsSixty college students. InterventionsRandomization of the participants in: tele-training through smart glasses (SG) and traditional training (C) groups. Both training sessions were very brief (less than 8 min) and included the same BLS content. In SG, the instructor trained through a video call with smart glasses. Main variables of interestThe BLS protocol, the use of AED, the quality of resuscitation and the response times were evaluated. ResultsIn most of the BLS protocol variables, the resuscitation quality and performance times, there were no statistically significant differences between groups. There were significant differences (in favor of the SG) in the assessment of breathing (SG: 100%, C: 81%; p = 0.013), the not-to-touch warning before applying the shock (SG: 79%, C: 52%; p = 0.025) and compressions with correct recoil (SG: 85%, C: 32%; p = 0.008). ConclusionsLaypeople BLS-AED brief tele-training through smart glasses could potentially be, at least, as effective as traditional training methods. In addition, smart glasses could be more advantageous than traditional teaching for certain points of the BLS protocol and chest compressions quality, probably due to the capability of real-time visualization of images which supports the BLS sequence. Augmented reality supported teaching should be considered for BLS training, although caution is required in extrapolating findings, and further in-depth studies are needed to confirm its potential role depending on concrete target populations and environments.

296 Quality of chest compressions in school children trained by their teachers

296 Quality of chest compressions in school children trained by their teachers

Nueva herramienta de comunicación para el entrenamiento de soporte vital básico: smart glasses. Un diseño cuasiexperimental

AimTo analyze the effectiveness of a teaching-learning methodology for teletraining in basic life support (BLS) based on communication through smart glasses. DesignPilot quasi-experimental non-inferiority study. ParticipantsSixty college students. InterventionsRandomization of the participants in: tele-training through smart glasses (SG) and traditional training (C) groups. Both training sessions were very brief (less than 8 minutes) and included the same BLS content. In SG, the instructor trained through a video call with smart glasses. Main variables of interestThe BLS protocol, the use of AED, the quality of resuscitation and the response times were evaluated. ResultsIn most of the BLS protocol variables, the resuscitation quality and performance times, there were no statistically significant differences between groups. There were significant differences (in favor of the SG) in the assessment of breathing (SG: 100%, CG: 81%; p=0.013), the not-to-touch warning before applying the shock (SG: 79%, CG: 52%; p=0.025) and compressions with correct recoil (SG: 85%, CG: 32%; p=0.008). ConclusionsLaypeople BLS-AED brief tele-training through smart glasses could potentially be, at least, as effective as traditional training methods. In addition, smart glasses could be more advantageous than traditional teaching for certain points of the BLS protocol and chest compressions quality, probably due to the capability of real-time visualization of images which supports the BLS sequence. Augmented reality supported teaching should be considered for BLS training, although caution is required in extrapolating findings, and further in-depth studies are needed to confirm its potential role depending on concrete target populations and environments.

Investigation of the Effect of Using a Metronome or Song on the Lay Rescuers' Quality of Chest Compressions

Introduction: This study aimed to determine the quality of chest compressions performed by lay rescuers assisted by a healthcare worker over the telephone and investigate the effect of metronome use or the Stayin’ Alive song on the quality of these chest compressions.&#x0D; Material and Method: This study was conducted prospectively at the emergency department of a tertiary hospital. The lay rescuers were assisted by an emergency medicine specialist over the telephone to perform chest compressions using the CPR Lilly PRO+ simulator. Three groups were formed, and the same participants performed three cycles of chest compressions over the telephone for two minutes first without any external stimulus (Group 1), then using a metronome as an external stimulus (Group 2), and finally by listening to the Stayin’ Alive song as another external stimulus (Group 3). The obtained data were analyzed with IBM SPSS v. 23.0.&#x0D; Results: There was no statistically significant difference between the three groups in terms of the target number of chest compressions (p=0.404). However, the compression depth and chest compression fraction statistically significantly differed between the groups (p

Manual vs Mechanical Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest on a Ski Slope: A Pilot Study.

The quality of cardiopulmonary resuscitation (CPR) is critical in increasing the probability of survival with a good neurologic outcome after out-of-hospital cardiac arrest. In an austere environment with a potentially salvageable patient, bystanders or first responders may need to provide chest compressions for a prolonged duration or during physically challenging transportation scenarios. Consequently, they may be at risk of fatigue or injury, and chest compression quality may deteriorate. The study sought to assess whether or not access to and utilization of a mechanical compression device (Lund University Cardiopulmonary Assist System) was feasible and not inferior to manual compressions while extricating and transporting a patient from a ski slope. Variable 3-person ski patrol teams responded to a simulated patient with out-of-hospital cardiac arrest in a nonshockable rhythm. Using a mannequin and CPR quality monitor, performance during manual CPR was compared with that of a mechanical compression device. This is a prospective, crossover analysis of CPR quality during extrication from a ski slope. Across 8 total runs, chest compression fraction, which is the proportion of time without spontaneous circulation during which compressions occurred, and high-quality CPR, as measured by appropriate rate and depth, were compared between the 2 groups. Extrication times between the 2 groups were also measured. There was no difference in compression fraction between the manual (91.4%; 95% CI [86.8-96.1]) and mechanical arms (92.8%; 95% CI [88.8-96.8]) (P=0.67). There was an increase in the time performing high-quality CPR in the mechanical group (58.5%; 95% CI [45.8-71.2]) vs that in the manual group (25.6%; 95% CI [13.5-37.8]) (P<0.001). There was a statistically significant difference in the extrication times between the 2 groups, 7.6 ± 0.5 min in the manual group vs 8.6 ± 0.4 min in the mechanical group (P=0.014). Mechanical CPR devices are noninferior for use in ski areas during initial resuscitation and transportation. Compared with manual CPR, mechanical CPR would likely improve the fraction of time performing high-quality CPR.

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

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