Quality Of External Chest Compression Research Articles

Are three minutes of CPR a great effort for the layperson?

The CPR Guidelines recommended that the rescuer is replaced every minute. However, it is difficult in the first moments to carry out the relays with such cadence and, therefore, it may be necessary to prolong the CPR time of each rescuer. Physical fatigue has a significant effect on the quality of external chest compressions (ECC), which can decrease after as few as 1–5 min of CPR. Percentage or maximal heart rate (%RMHR) and effort perception (EP) were parameters usually analysed to evaluate the effort of the rescuer during CPR. The aims of this study were to analyse college students while they performed CPR on a manikin for three minutes, the following: (1) the optimal cut-off points of arms muscle strength to perform adequate ECC, (2) physiological response (%RMHR), and (3) the PE.

Lifeline ARM is more effective than manual cardiopulmonary resuscitation during ambulance transport: A prospective randomized crossover manikin trial

Purpose: According to the 2015 European Resuscitation Council guidelines, the quality of external chest compressions (CCs) is a key element improving the outcome in cardiopulmonary resuscitation (CPR). However, as indicated in many studies, the performance of CPR is highly variable [ 1 Kurowski A. Szarpak Ł. Bogdański Ł. Zaśko P. Czyżewski Ł. Comparison of the effectiveness of cardiopulmonary resuscitation with standard manual chest compressions and the use of TrueCPR and PocketCPR feedback devices. Kardiol Pol. 2015; 73(10): 924-930https://doi.org/10.5603/KP.a2015.0084 Crossref Scopus (30) Google Scholar , 2 Abelairas-Gómez C. Barcala-Furelos R. Szarpak Ł. García-García Ó. Paz-Domínguez Á. López-García S. et al. The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation. Kardiol Pol. 2017; 75(1): 21-27https://doi.org/10.5603/KP.a2016.0165 Crossref Scopus (25) Google Scholar ]. Our aim was to examine if CCs were more effective with the use of newly developed mechanical CC device, Lifeline ARM (ARM) as compared with standard manual CCs.

The effects of up-down hand position switch on the quality of external chest compression and fatigue during cardiopulmonary resuscitation

Objective To investigate the effects of up-down hand position switch on the quality of external chest compression and the fatigue of rescuers during cardiopulmonary resuscitation (CPR). Methods Two methods of external chest compression were compared in the experiment. One method was a chest compression by alternating two oberlapped hans up-and-down compressing directly on the chest wall, and the other was the chest compression without alternating hand positions. A total of 177 medical students trained by standard basic life support course were randomly assigned to the sequences of those two methods by drawing lots. Two different methods of chest compression were separately performed at 7 days interval. Each time, 10 cycles of standard adult CPR were made on the manikin. The data including CPR quality, physiological variables and subjective fatigue feeling of the rescuers before and after CPR were recorded. The results were expressed as mean±SD. The t test was used to compare the means of two groups, and χ2 test was used to compare the frequency between groups. The probability of event-free(no fatigue appearance) was estimated by Kaplan-Meier. The statistical significance was defined as P<0.05. Results Among the rescuers, those used the dominant hand in contact with the sternum firstly, there were no significant differences in chest compression quality (P>0.05), Borg scores after CPR(13.17±1.62 vs.13.41±2.11, P=0.437), or cycle number of fatigue appearance (P=0.127) between the alternating compressing hand position group and the conventional compressing without alternating hand position group. While among the rescuers, those used the non-dominant hand in contact with the sternum firstly, compression depth was deeper [（39±10)mm vs.（38±9)mm,P=0.015], Borg score after CPR was lower(12.67±2.03 vs.13.33±1.95, P=0.011), and the appearance of fatigue appeared later(P=0.041) in the compression with alternating hand positions group, compared with the conventional compression without alternating hand positions group. Conclusion The up-down hand position alternate during CPR may delay the fatiguewhich appeared earlier in non-dominant hand position rescuers and improve the quality of external chest compressions. Key words: Cardiopulmonary resuscitation; External chest compression; Compressing hand; Fatigue; Quality

Up-down hand position switch may delay the fatigue of non-dominant hand position rescuers and improve chest compression quality during cardiopulmonary resuscitation: a randomized crossover manikin study.

Previous studies have shown improved external chest compression (ECC) quality and delayed rescuer fatigue when the dominant hand (DH) was in contact with the sternum. However, many rescuers prefer placing the non-dominant hand (NH) in contact with the sternum during ECC. We aimed to investigate the effects of up-down hand position switch on the quality of ECC and the fatigue of rescuers during cardiopulmonary resuscitation (CPR). After completion of a review of the standard adult basic life support (BLS) course, every candidate performed 10 cycles of single adult CPR twice on an adult manikin with either a constant hand position (CH) or a switched hand position (SH) in random order at 7-day intervals. The rescuers’ general characteristics, hand positions, physiological signs, fatigue appearance and ECC qualities were recorded. Our results showed no significant differences in chest compression quality for the DH position rescuers between the CH and SH sessions (p>0.05, resp.). And also no significant differences were found for Borg score (p = 0.437) or cycle number (p = 0.127) of fatigue appearance after chest compressions between the two sessions. However, for NH position rescuers, the appearance of fatigue was delayed (p = 0.046), with a lower Borg score in the SH session (12.67 ± 2.03) compared to the CH session (13.33 ± 1.95) (p = 0.011). Moreover, the compression depth was significantly greater in the SH session (39.3 ± 7.2 mm) compared to the CH session (36.3 ± 8.1 mm) (p = 0.015). Our data suggest that the up-down hand position switch during CPR may delay the fatigue of non-dominant hand position rescuers and improve the quality of chest compressions.

Dominant Hand Position Improves the Quality of External Chest Compression: A Manikin Study Based on 2010 CPR Guidelines

BackgroundThe 2010 cardiopulmonary resuscitation (CPR) guidelines increased the importance of external chest compression. However, the best hand position to be the compressing one has not been identified. ObjectivesTo investigate the effects of dominant or nondominant external chest compression hand position during CPR. MethodsMedical students performed five cycles of conventional CPR and completed one questionnaire. The CPR performances were manually evaluated, and detailed aspects of the external chest compression quality were assessed via the SimMan® Essential system (Laerdal China Ltd., Hangzhou, China). ResultsOne hundred fifty-seven students participated in the nondominant hand (NH) group, and 68 students participated in the dominant hand (DH) group. The manual evaluations revealed no differences between the two groups. The proportion of chest compressions “above 100 cpm [compressions per minute]” was higher in the DH group than in the NH group (97% vs. 92%, respectively, p = 0.002). The frequency distributions of the chest compression rates were also significantly different between the two groups (p < 0.0001). The distribution of the NH group was concentrated within “130–139” cpm, whereas this distribution was concentrated within “140–149” cpm in the DH group. The chest compression depth of the DH group was deeper than that of the NH group (p = 0.001). The depth of the fifth cycle was significantly decreased compared with those of cycles 1, 2, and 3 in the NH group. A greater number of full chest recoils were observed in the NH group (p = 0.02). ConclusionThe dominant hand position during CPR was associated with a higher chest compression rate, a greater chest compression depth, and delayed fatigue.

Role of Dominant Hand Position during Chest Compression by Novice Rescuers: An Observational Simulation Study

Introduction The aim of this study was to determine the effect of hand positioning on the quality of external chest compression (ECC) by novice rescuers. Methods This observational simulation study was conducted for 117 included participants. After completion of an adult cardiopulmonary resuscitation (CPR) training program for 3-h, the participants selected which of their hands would be in contact with the mannequin during ECC and performed 5 cycles of single rescuer CPR on a recording mannequin. The participants were assigned to 2 groups: the dominant hand group (DH; n=40) and the non-dominant hand group (NH; n=29). The depth and rate of ECC were analysed to compare the effectiveness of ECC between 2 groups. Results The rate of ECC was significantly faster in the DH group (mean, 117.3 ±11.4/min) than in the NH group (mean, 110.9±12.2/min) (p=0.028). However, the depth of ECC in the dominant hand group (mean, 52.4±5.9 mm) was not significantly different from that in the non-dominant hand group (mean, 50.8±6.0 mm) (p=0.287). Similarly, the portion of ECC with inadequate depth in the dominant hand group (mean, 1.8±4.3%) was not significantly different from that in the non-dominant hand group (mean, 5.3±15.6%) (p=0.252). Conclusions ECC can be performed with an acceptably higher rate of compressions when the dominant hand of the novice rescuer is placed in contact with the sternum. However, the position of the dominant hand does not affect the depth of ECC. (Hong Kong j.emerg.med. 2014;21:382-386)

Quality of external chest compressions, time or body mass index and fitness

Quality of external chest compressions, time or body mass index and fitness

An investigation into fatigue of witness and quality of external chest compression in the resuscitation Manikin

Objective To investigate the effect of fatigue of witness and quality of external chest compression according to the requirement of 2010 guidelines for cardiopulmonary resuscitation.Methods A total of 96 volunteer participants in basic life support training course were recruited from the College of Automation in the Guangdong University of Technology.All volunteers were randomly (random number) divided into two groups:2010 guidelines group and 2005 guidelines group.The instructors explained the procedures of external chest compression as required as per different guidelines and then guided the trainees to practice CPR as they learned.Trainees,who completed entire training course and passed the examination,were eligible into the study.In the final investigation,trainees of two groups were asked to perform 8-min continuous external chest compression of CPR.The demographics of trainees such as age,gender,tallness,body weight,heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP),blood lactate and rating of perceived exertion (RPE) were recorded before and immediately after CPR.Results Of them,42 and 39 subjects were finally enrolled into 2010 group and 2005 group,respectively.There was no statistically significant difference in basic status of trainees between two groups.After 8-min external chest compression,trainees in 2010 guidelines group brought about greater compression depth and rate than those in 2005 guidelines group (P ＜0.05).On the contrary,HR,SBP and lactate were also higher in 2010 guidelines group than those in 2005 guidelines group (P ＜ 0.05).Furthermore,the quality of external chest compression declined to a sub-optimal pattern [(47.63 ±7.87) mm vs.(40.26 ±5.93) mm,P ＝0.000] even though RPE value still indicated a status of relative easiness [(11.35 ± 1.29) vs.(10.54 ± 1.74),P =0.000].Conclusions When the recommendation of 2010 guidelines for cardiopulmonary resuscitation was followed,trainees in current study could perform optimal compression depth and rate even in the occurrence of increased fatigue.Therefore,study on this manikin showed it had better to conduct rescuer-exchange in every minute so as to get high quality of external chest compression. Key words: 2010 guideline for cardiopulmonary resuscitation; Quality of chest compression; Degree of fatigue; Manikin

DO CLINICAL EXAMINATION GLOVES PROVIDE ADEQUATE ELECTRICAL INSULATION FOR SAFE HANDS-ON DEFIBRILLATION?Status: PendingCategory: Defibrillation

Introduction: The quality of external chest compression during a resuscitation attempt is crucial to successful defibrillation and return of spontaneous circulation. Interruptions to chest compressions are often related to defibrillation as the rescuer stands clear for the rhythm check and subsequent shock delivery. The ability to continue chest compressions during defibrillation (hands-on defibrillation) would contribute significantly to minimising no flow time and improving the overall effectiveness of chest compressions. Several studies have suggested that clinical examination gloves provide adequate electrical insulation to enable hands-on defibrillation to be safely undertaken. Glove integrity however is often compromised during clinical procedures. We examined clinical examination gloves used for CPR to ascertain whether they offer sufficient protection to limit current to below the safe threshold of 1 mA.

Chest compressions performed by ED staff: a randomized cross-over simulation study on the floor and on a stretcher

BackgroundMultiple factors may contribute to the observed survival variability following in-hospital cardiopulmonary resuscitation (CPR). While in-hospital CPR is most often performed on patients lying on a bed or stretcher, CPR training uses primarily manikins placed on the floor. We analyzed the quality of external chest compressions (ECC) in simulated cardiac arrest scenarios occurring both on a stretcher and on the floor. MethodsProspective cross-over simulation study enrolling ED nurses and nurse's aides as part of an annual evaluation. Simulated CPR was performed in the 2 rescuer-mode for 2 min, both kneeling on the floor, and standing beside a knee high stretcher. The order of position was randomized. ECC parameters were compared. ResultsED nurses (n=48) and nurse's aides (n=26) performed 128 scenarios. Mean ECC depth was 32±13 mm on the floor and 27±11 mm on a stretcher (∆: 5 mm, 95%CI [3-7], P<.001). Participants last trained within a year (n=17) developed deeper ECCs than their colleagues (n=47) in both positions (floor: 39±12 mm vs stretcher: 34±11 mm (p=0.016) for those trained within the year, and floor: 29±12 mm vs stretcher: 24±10 mm (P<.001) for those trained over a year ago). ConclusionsThe quality of chest compressions performed by ED staff was below 2005 guideline standards, with decreased ECC depth during CPR on a stretcher. Annual refresher courses should be implemented in the ED, with a focus on obtaining required ECC depth while standing next to a stretcher.

Evaluation of a newly developed media-supported 4-step approach for basic life support training

ObjectiveThe quality of external chest compressions (ECC) is of primary importance within basic life support (BLS). Recent guidelines delineate the so-called 4“-step approach” for teaching practical skills within resuscitation training guided by a certified instructor. The objective of this study was to evaluate whether a “media-supported 4-step approach” for BLS training leads to equal practical performance compared to the standard 4-step approach.Materials and methodsAfter baseline testing, 220 laypersons were either trained using the widely accepted method for resuscitation training (4-step approach) or using a newly created “media-supported 4-step approach”, both of equal duration. In this approach, steps 1 and 2 were ensured via a standardised self-produced podcast, which included all of the information regarding the BLS algorithm and resuscitation skills. Participants were tested on manikins in the same mock cardiac arrest single-rescuer scenario prior to intervention, after one week and after six months with respect to ECC-performance, and participants were surveyed about the approach.ResultsParticipants (age 23 ± 11, 69% female) reached comparable practical ECC performances in both groups, with no statistical difference. Even after six months, there was no difference detected in the quality of the initial assessment algorithm or delay concerning initiation of CPR. Overall, at least 99% of the intervention group (n = 99; mean 1.5 ± 0.8; 6-point Likert scale: 1 = completely agree, 6 = completely disagree) agreed that the video provided an adequate introduction to BLS skills.ConclusionsThe “media-supported 4-step approach” leads to comparable practical ECC-performance compared to standard teaching, even with respect to retention of skills. Therefore, this approach could be useful in special educational settings where, for example, instructors’ resources are sparse or large-group sessions have to be prepared.

Impact of physical fitness and biometric data on the quality of external chest compression: a randomised, crossover trial

BackgroundDuring circulatory arrest, effective external chest compression (ECC) is a key element for patient survival. In 2005, international emergency medical organisations changed their recommended compression-ventilation ratio (CVR) from 15:2 to 30:2 to acknowledge the vital importance of ECC. We hypothesised that physical fitness, biometric data and gender can influence the quality of ECC. Furthermore, we aimed to determine objective parameters of physical fitness that can reliably predict the quality of ECC.MethodsThe physical fitness of 30 male and 10 female healthcare professionals was assessed by cycling and rowing ergometry (focussing on lower and upper body, respectively). During ergometry, continuous breath-by-breath ergospirometric measurements and heart rate (HR) were recorded. All participants performed two nine-minute sequences of ECC on a manikin using CVRs of 30:2 and 15:2. We measured the compression and decompression depths, compression rates and assessed the participants' perception of exhaustion and comfort. The median body mass index (BMI; male 25.4 kg/m2 and female 20.4 kg/m2) was used as the threshold for subgroup analyses of participants with higher and lower BMI.ResultsHR during rowing ergometry at 75 watts (HR75) correlated best with the quality of ECC (r = -0.57, p < 0.05). Participants with a higher BMI and better physical fitness performed better and showed less fatigue during ECC. These results are valid for the entire cohort, as well as for the gender-based subgroups. The compressions of female participants were too shallow and more rapid (mean compression depth was 32 mm and rate was 117/min with a CVR of 30:2). For participants with a lower BMI and higher HR75, the compression depth decreased over time, beginning after four minutes for the 15:2 CVR and after three minutes for the 30:2 CVR. Although found to be more exhausting, a CVR of 30:2 was rated as being more comfortable.ConclusionThe quality of the ECC and fatigue can both be predicted by BMI and physical fitness. An evaluation focussing on the upper body may be a more valid predictor of ECC quality than cycling based tests. Our data strongly support the recommendation to relieve ECC providers after two minutes.

Do mechanical CPR feedback devices improve the quality of chest compressions on simulated patients in a hospital bed

Aim: The aim of this study was to determine if mechanical CPR feedback devices improve the quality of external chest compressions during simulated basic life support on a hospital bed.Methodology: Twenty-one (n = 21) staff from a general hospital were recruited to take part in this randomised crossover trial of three commercial CPR devices, manufactured by, CPREzy, Zoll and Leardal. All participants were BLS certified within the previous 24months. Staffs were asked to deliver 150 chest compressions with each device to a simulated patient over a 2 min period in a random order. A 2 min recovery period was allowed between each device.Results: The use of a device over no adjunct did not improve the compression depth (38–51 mm). This difference was not statistically significant (p = 0.134).One device was found to consistently deliver low compressions compared to all other devices. This difference was statistically significant (p = 0.001).There was no statistical significant difference (p = 0.258) found between the four devices when determining compression effectiveness (defined as compression depth vs. incomplete release vs. incorrect hand placement).There was no statistical significant difference between the device used and the operators ability to deliver at a rate of 150 compressions in 2 min (p = 0.134).Preference ranking of devices by candidates did show significant differences (p = 0.000) with no device being preferred to each of the commercial units.Conclusions: This study appears to demonstrate that Healthcare professionals who hold current BLS certification perform as efficiently without a device as with any of the commercial adjuncts tested. The question that needs to be asked is “has the industry engineered a product to solve a problem that does not exist?”The results from this study conflict with other studies and will require further research to provide definitive outcomes. Aim: The aim of this study was to determine if mechanical CPR feedback devices improve the quality of external chest compressions during simulated basic life support on a hospital bed. Methodology: Twenty-one (n = 21) staff from a general hospital were recruited to take part in this randomised crossover trial of three commercial CPR devices, manufactured by, CPREzy, Zoll and Leardal. All participants were BLS certified within the previous 24months. Staffs were asked to deliver 150 chest compressions with each device to a simulated patient over a 2 min period in a random order. A 2 min recovery period was allowed between each device. Results: The use of a device over no adjunct did not improve the compression depth (38–51 mm). This difference was not statistically significant (p = 0.134). One device was found to consistently deliver low compressions compared to all other devices. This difference was statistically significant (p = 0.001). There was no statistical significant difference (p = 0.258) found between the four devices when determining compression effectiveness (defined as compression depth vs. incomplete release vs. incorrect hand placement). There was no statistical significant difference between the device used and the operators ability to deliver at a rate of 150 compressions in 2 min (p = 0.134). Preference ranking of devices by candidates did show significant differences (p = 0.000) with no device being preferred to each of the commercial units. Conclusions: This study appears to demonstrate that Healthcare professionals who hold current BLS certification perform as efficiently without a device as with any of the commercial adjuncts tested. The question that needs to be asked is “has the industry engineered a product to solve a problem that does not exist?” The results from this study conflict with other studies and will require further research to provide definitive outcomes.

New visual feedback device improves performance of chest compressions by professionals in simulated cardiac arrest

Introduction Quality of external chest compression (ECC) is a key component of Basic Life Support. Different approaches to improve rescuers’ performance have been evaluated, but few attempts have been made to invent simple devices to improve performance. This study evaluates a new visual feedback system for ECC for healthcare professionals. Methods Ninety-three healthcare professionals volunteered (14 emergency medical technicians, 45 paramedics, 34 physicians; age 32 ± 7.2 (range 21–61); 72% male) in this randomized cross-over study. All subjects were tested on a manikin (Skillreporter ResusciAnne ®, Laerdal, Stavanger, Norway) in identical mock cardiac arrest scenario and asked to perform 2 min of continuous ECC (secured airway): Group A ( n = 46): ECC with device first, followed by ECC without device a minimum of 45 min later; group B ( n = 47): vice versa. Primary endpoints: mean compression rate 90–120 min −1; mean compression depth 38–51 mm. Data were analyzed using repeated measure logistic regression model for binary categorized endpoints and repeated measure ANOVA test for continuous endpoints. Results Correct compression depth was achieved by 45.2% of subjects (95%-CI: 30.5–64.9 mm) without vs. 73.1% (95%-CI: 40.3–57.4 mm) with device ( p < 0.001); correct compression rate was achieved by 62.4% (95%-CI: 78–147.8 min −1) without vs. 94.6% (95%-CI: 87.3–126.6 min −1) with device ( p < 0.001). Overall, 85% of the subjects thought the feedback system was helpful and 80.6% would use it if available. Conclusions The new visual feedback device significantly improved ECC performance (compression rate and depth) by healthcare professionals in simulated cardiac arrest. Most participants found the device easy to use.

Role of dominant versus non-dominant hand position during uninterrupted chest compression CPR by novice rescuers: A randomized double-blind crossover study

Previous research has suggested improved quality of chest compressions when the dominant hand was in contact with the sternum. However, the study was in health care professionals and during conventional chest compression-ventilation CPR. The aim of this study was to test the hypothesis, in null form, that the quality of external chest compressions (ECC) in novice rescuers during 5min of uninterrupted chest compression CPR (UCC-CPR) is independent of the hand in contact with the sternum. Confirmation of the hypothesis would allow the use of either hand by the novice rescuers during UCC-CPR. Fifty-nine first year public heath students participated in this randomised double-blind crossover study. After completion of a standard adult BLS course, they performed single rescuer adult UCC-CPR for 5 min on a recording Resusci Anne. One week later they changed the hand of contact with the sternum while performing ECC. The quality of ECC was recorded by the skill meter for the dominant and non-dominant hand during 5 min ECC. The total number of correct chest compressions in the dominant hand group (DH), mean 183+/-152, was not statistically different from the non-dominant hand group (NH), mean 152+/-135 (P=0.09). The number of ECC with inadequate depth in the DH group, mean 197+/-174 and NH group, mean 196+/-173 were comparable (P=0.1). The incidence of ECC exceeding the recommended depth in the DH group, mean 51+/-110 and NH group, mean 32+/-75 were comparable (P=0.1). Although there is a trend to increased incidence of correct chest compressions with positioning the dominant hand in contact with the sternum, it does not reach statistical significance during UCC-CPR by the novice rescuers for 5 min.

Increasing compression depth during manikin CPR using a simple backboard

The quality of external chest compressions (ECC) is influenced by the surface supporting the patient. The aim of this study was to compare chest compression depth with and without a rigid backboard. The authors hypothesized that the presence of a backboard would result in an increased depth of chest compressions. A randomized, double-blinded, cross-over trial. We simulated in-hospital cardiac arrest using a resuscitation manikin placed in a standard hospital bed. In total, 23 hospital orderlies were randomly assigned to perform ECC for 2 min on two identical ResusciAnne manikins, under one of which a rigid backboard had been placed. Data were recorded using the Laerdal PC-Skill Reporting System. Mean chest compression depth increased from 43 to 48 mm (P < 0.0001) when a backboard was present (mean difference 5 mm, 95% CI 3.6-7.5 mm, SD 4.6). There was a significant increase in mean proportion of compressions >40 mm when using a backboard Mean 92% vs. 69%, P= 0.0007). No difference was found between the two groups in the following variables: duty cycle, compression rate, mean proportion of compressions of correct depth (40-50 mm) or proportion of compressions with incomplete release. Applying a backboard significantly increases depth of chest compressions during cardiopulmonary resuscitation when performed on a manikin model.