Resusci Anne SkillReporter Research Articles

Educational Effect of Practical Examination on Basic Cardiopulmonary Resuscitation Self-Learning

Simplification of basic cardiopulmonary resuscitation (CPR) enables easy production of videos for training, and non-face-to-face training can be provided via internet. The participants of this study were 89 university students who took basic CPR class in 2020. We utilized teaching materials that is a 50-minute teaching material for standard adult CPR, comprised of a 25-minute power point slide show and a 25-minute video. All participants completed self-learning via Google Classroom (Alphabet Inc., Mountain View, USA). The participants took compression-only (C-O) practical examination consisting of 180 chest compressions after 5-minute C-O CPR using Resusci Anne SkillReporter (Laerdal Medical, Stavanger, Norway). The collected data were analyzed at an ⍺=.05 using the SPSS 20.0 for Windows (IBM Inc, New York, USA). Changes in willingness, knowledge, performance, and attitude toward CPR before and after the practical exam were analyzed using t-tests. Willingness to perform CPR increased from 1.78 to 2.02, showing a statistically significant change (p=.040). The knowledge score increased from 3.12 to 3.56 and performance score increased from 2.87 to 3.36. The attitude score increased from 3.39 to 3.69, and all these changes were statistically significant (p<.001; p<.001; p<.001). The practical exam on self-learning of basic CPR was effective on improving willingness, knowledge, performance, and attitudes of non-healthcare providers.

Comparison of Adult Manikin Chest Compression between Music and Metronome Practice after Video Self-Instruction

The study was conducted to improve chest compression training by analyzing manikin-assessed scores on chest compression and self-assessed scores on cardiopulmonary resuscitation (CPR) based on music and metronome training after video self-instruction (VSI). The 64 participants had undertaken 50 min of VSI and practiced 25 min of compression-only (C-O) CPR. Thirty-two participants of the music (the Bee Gees’ Stayin’ Alive) training group practiced C-O CPR 103 times a min, while 32 participants of the metronome training group practiced C-O CPR at 100 times a min. Immediately after the training, participants performed 150 chest compressions on Resusci Anne SkillReporter; researchers collected 64 printouts, and 128 self-assessed scores on willingness, knowledge, performance, and attitude through pre and post-training questionnaires. There was no difference in the manikin-assessed scores between the music and metronome training groups. The two training methods were consistent with or similar to the compression guidelines. Therefore, C–O CPR training can be imparted by utilizing music as well as the existing metronome training method; however, supplementary research on how to maintain compression depth is needed, and ventilation training should be provided using other feedback devices.

Quantitative Analysis of Bystander Cardiopulmonary Resuscitation Quality

PURPOSE The purpose of this research was to investigate the effects of gender and number of rescuers on the quality of cardiopulmonary resuscitation (CPR). METHODS Fifty-five university students (23 males vs. 32 females) participated in this study voluntarily. Each subjects performed one rescuer CPR and two rescuer CPR for 5-cycles in random order. The quality of CPR was recorded using a Resusci Anne Skillreporter manikin. RESULTS Male participants presented higher compression depth and correct compression than females. Two rescuer CPR had higher compression depth and correct compression than one rescuer CPR, but the two rescuer CPR had lower hands off time and compression fatigue. There was a significant gender by number of rescuers interaction for a compression rate. The two rescuer CPR had higher numbers of ventilation, but lower ventilation fatigue compared with the one rescuer CPR. There was a significant correlation between compression fatigue and compression depth of female subjects. CONCLUSIONS These results suggest that laypersons are taught to perform two rescuer CPR to provide high quality CPR. To increase the number of people trained in CPR, CPR educational program should be included in an undergraduate curriculum. 색인어: 1인 구조자 ì‹¬íì†Œìƒìˆ , 2인 구조자 ì‹¬íì†Œìƒìˆ , 구조자 피로도, 가슴압박 깊이, 가슴압박 속도 Keywords: One rescuer CPR, Two rescuer CPR, Rescuer fatigue, Compression depth, Compression rate

Basic Life Support, Defibrillation and Quality CPR (QCPR) programme for medical students: Preliminary results

Integration of Quality CPR feedback (Q-FB) during Basic life support (BLS) training demonstrated to improve learning outcomes compared to instructor feedback only (I-FB). In collaboration with University of Bologna, we trained students of the first year of medical school with the aim of investigating the role of Q-FB and I-FB in BLS and AED teaching. Between March and June 2018, 60 students were enrolled (50% Female, BMI 21.6 ± 2.2). We used the Resusci Anne (RA) Skill Reporter with Q-CPR software (Laerdal, Norway) to give feedback (FB) and to record CPR performance. The programme had several steps: 1.Initial Q-CPR: students performed 2 minutes of BLS with pocket mask without any previous training or instruction, at first without and, immediately after, with Q-FB; 2.BLS course: after lesson and demonstration, students performed: CPR1 - 2 minutes of CPR with Q-FB and without I-FB; CPR2 - 2 minutes of CPR with both Q-CPR and I-FB; AED1 - 2 minutes of CPR and AED, lone rescuer with Q-FB; AED2 - 2 minutes of CPR and AED, two rescuers with Q-FB; 3.post-course Q-CPR: 2 minutes of BLS without and with Q-FB.

P116: A randomized cross-over trial of conventional bimanual versus single elbow (Koch) chest compression quality in a height-restricted aeromedical helicopter

Introduction: Aeromedical helicopters and fixed wing aircraft are used across Canada to transfer patients to definitive care. Given height limitation in aeromedical transport, CPR performance can be affected. An adapted manual compression technique has been proposed by H. Koch (pron. Cook) that uses the elbow to compress the sternum rather than the conventional hand. This preliminary study evaluated the quality of Koch compressions versus conventional bimanual compressions. Methods: Paramedics (5), registered nurses (3) and a physician (1) were recruited. Each participant performed a 2 minute cycle of each technique, were randomized to determine which technique was performed first, and rested 5 minutes between compression cycles. A Resusci Anne SkillReporter manikin atop a stretcher in a BK117 helicopter was used. The compressors performed without feedback or prompting. Outcomes include compression rate, depth, recoil, and fatigue. Results: The mean conventional compression rate was (bpm) 118 +/− 13 versus 111 +/− 10 in the Koch scenario (p=0.02) (target 100 to 120). Mean conventional compression depth (mm) was 44 +/− 9 versus 49 +/− 7 in the Koch scenario (p=0.01) (target 50 to 60). The mean percentage of compressions with complete release in the conventional scenario was 86 +/− 20 versus 84 +/− 22 in the Koch scenario (p=0.9) (target 100%). Using a Modified Borg Scale of 1 to 10, mean provider fatigue after conventional CPR was 7 (+/− 1.6) versus 3 (+/− 1.2) using Koch technique (p<0.001). On average, Koch technique improved the percentage of compressions at target rate by 26%, the percentage at correct depth by 9%, overall compression quality score by 13% and were more less fatiguing. Conclusion: Using an elbow in a height-restricted environment improved compression depth and reduced provider fatigue. From our limited data, Koch compressions appear to improve compression quality. Further study and external validation are required.

Cardiopulmonary Resuscitation Performance may Improve with Consideration of Performer’s Characteristics

Background: In basic life support, chest compressions are a very important and basic skill. Acquiring the ability to perform chest compressions is affected by individual characteristics such as physique and physical strength, although all persons can learn to Perform Cardiopulmonary Resuscitation (CPR), including chest compressions. The aim of this study was to examine differences in physique between males and females and Basic Life Support (BLS) skill using a portable manikin with automated corrective feedback.Methods: Participants were 120 fourth-year preclinical dental school students (87 males, 33 females). For skill assessment, students performed chest compressions and single rescuer CPR using a Laerdal Resusci Anne Skill Reporter TM manikin for 2 minutes each before and after CPR. Outcome measures were (1) compression depth (mm), (2) compression rate (number of compressions per minute), (3) compression release depth (recoil, mm), and (4) hand position before and after the BLS course.Results: After the BLS course, compression depth and rate improved significantly. Both before and after the BLS course, male students performed deeper chest compressions than female students. In females, the duration of acceptable chest compressions was significantly shorter than in males.Conclusion: CPR performance was significantly different between males and females, probably due to differences in physique. Therefore, it is necessary for individualized instruction adapted to the learner’s characteristics.

Are chest compression depths measured by the Resusci Anne SkillReporter and CPRmeter the same?

Objective. We investigated whether data collected using the Resusci Anne Skill-Reporter were comparable with those collected using the CPRmeter (cardiopul-monary resuscitation meter -an acceler-ometer feedback device used to provide high-quality chest compressions). Materials and Methods. Fifty continu-ous chest compressions were performed using a Resusci Anne SkillReporter and a CPRmeter under two conditions (Ex-periment 1: complete chest wall recoil; Experiment 2: incomplete chest wall re-coil). The conditions were defined accord-ing to visual feedback signals provided by the CPRmeter. A single healthcare worker performed 20 repetitions under each ex-perimental condition alternately. Chest compression data were collected and ana-lyzed using the Laerdal PC SkillReporting System and QCPR Review software. Results. The mean difference in chest com-pression depth between the Resusci Anne SkillReporter and CPRmeter was 6.7 ± 1.2 mm in Experiment 1 (95% CI: 6.1~7.3) and was significantly higher in Experiment 2 (17.3 ± 1.9 mm; 95% CI: 16.4~18.2; p < 0.001).Conclusions. The chest compression depth measured by the Resusci Anne Skill-Reporter was significantly different from that of the CPRmeter. Cardiopulmonary resuscitation instructors, trainees, and re-searchers should be aware of this difference to ensure the most accurate interpretation of their training or experimental results.

Relationship between chest compression depth and novice rescuer body weight during cardiopulmonary resuscitation

This study determined if rescuer body weight is a major determinant of chest compression depth (CCD) among novice rescuers by analyzing the results of cardiopulmonary resuscitation (CPR) skill tests among medical students and determined the body weight threshold for those unable to achieve adequate CCD. Retrospective analysis of CPR test results was performed. A total of 107 medical students completed the tests, which included 5 cycles of CPR. Data were collected using a ResusciAnne SkillReporter. Anthropometric data including participant body weight, body mass index, and height were also collected. The relationships between CCD and anthropometric data were evaluated by Pearson correlation coefficient. In addition, univariate linear regression analysis was used to assess the association between body weight and CCD. The highest positive correlation was found between CCD and body weight (r = 0.636, P < .001). Body weight correlated with CCD by as much as 40.5% (R2 = 40.5, P < .001). Using a regression model, we described the association between body weight and CCD as follows: expected CCD (mm) = 0.46 × body weight + 17.59. The regression equation shows that rescuers weighing more than 70.5 kg could achieve a CCD of 50 mm. Rescuer body weight is a major determinant of CCD in novice rescuers. Based on these findings, if 2 or more rescuers are available to perform CPR, chest compression should preferentially be performed by rescuers of healthy weight or overweight.

Does the Bed Frame Deflection Occur along with Mattress Deflection during In‐Hospital Cardiopulmonary Resuscitation? an Experiment Using Mechanical Devices

ObjectivesWhen we perform chest compression on a patient on a bed, the mattress and bed frame can be depressed together with the patient's chest. This study was conducted to assess whether bed frame deflection occurred during chest compressions.MethodsWe designed a firm bed (“bed like the ground,” BLG) to assess the bed frame deflection in the Stryker Trauma Stretcher (STS) and the ER stretcher cart (ER‐SC). The STS included a soft mattress and the ER‐SC a hard mattress. We performed 50 continuous chest compressions on the Resusci Anne Skill Reporter with CPRmeter in each experiment. The experiments were done in four settings. Test 1 included the BLG; test 2 included a mattress and backboard on each bed; test 3 included the mattress of each bed and a backboard on the BLG; and test 4 included the mattress of each bed on the BLG. We calculated the mattress and bed frame deflections using the gaps of compression depths between the values measured by Resusci Anne and CPRmeter.ResultsThe mattress deflections of the STS and ER‐SC mattress were determined to be 11.2 and 0.67 mm, respectively. The bed frame deflection for the STS and ER‐SC were 0.95 and 5.17 mm, respectively.ConclusionThe study confirms that bed frame deflection will occur when we perform chest compressions on the manikin lying on a bed. Additionally, the bed frame deflections differ depending on the type of bed. (Hong Kong j.emerg.med. 2016;23:35‐41)

Evaluation of an alternative chest compression technique: a manikin study.

The 2010 American Heart Association Guidelines for Resuscitation emphasize the importance of high-quality chest compression as a key determinant of successful cardiopulmonary resuscitation.1 To maximize the effect of chest compression by rescuers who have difficulty laying one hand over the other due to disabilities such as arthritis, the American Heart Association Basic Life Support healthcare provider course recommends an alternative chest compression technique that involves chest compression with one hand, and the other hand gripping the wrist of the lower hand for additional power. In theory, two approaches with this alternative technique are possible: left hand chest compression with the right hand gripping the left wrist, or the opposite. As no clinical trial or simulation study has compared this technique with the conventional method, or examined differences in the two possible approaches, we investigated these aspects by simulation with a manikin. This study was approved by the Research Ethics Committee of our institution. We recruited 22 right-handed male doctors (mean age, 30.7 ± 4.2 years; mean height, 172.1 ± 5.6 cm; mean weight, 69.2 ± 4.5 kg) who occasionally (but not routinely) perform cardiopulmonary resuscitation. The Resusci Anne SkillReporter manikin (Laerdal, Stavanger, Norway) was used to measure chest compression depth.2 Participants were instructed to carry out the following four trials: conventional chest compression with left hand lower (Con-L, Fig. 1A) or right hand lower (Con-R, Fig. 1B); and alternative chest compression technique with left hand lower (Alt-L, Fig. 1C) or right hand lower (Alt-R, Fig. 1D). Four chest compression patterns. Conventional method with left hand lower (A) and right hand lower (B). Alternative technique with left hand lower (C) and right hand lower (D). Participants carried out 30 chest compressions vertical to the manikin's chest on the floor. To minimize learning effects, the order of the four trials was randomized. Compression depth and rate were measured for each trial, and chest compression depth was compared using one-way repeated measures anova. Data are presented as mean ± SD. P < 0.05 was considered statistically significant. Chest compression depth did not significantly differ by technique (Con-L, 5.4 ± 0.5 cm; Con-R, 5.3 ± 0.4 cm; Alt-L, 5.4 ± 0.5 cm; Alt-R, 5.3 ± 0.4 cm). Incomplete recoil (>10 mm) of the thorax between compressions was not observed in any of the trials. Chest compression rate was significantly slower with the alternative technique compared to the conventional method (Con-L, 110.2 ± 5.6 times/min; Con-R, 112.5 ± 6.5 times/min; Alt-L, 101.4 ± 5.5 times/min; Alt-R, 102.3 ± 5.4 times/min; P < 0.05). There were no bilateral differences in compression depth or rate. In conclusion, the alternative chest compression technique did not reduce compression depth, but did decrease compression rate relative to the conventional method in healthy male rescuers. Rescuers performing the alternative chest compression technique should be mindful of this and aim to maintain a high compression rate in healthy male rescuers. None.

Abstract 261: Correction for Body Displacement for Accurate Delivery of Chest Compressions: Accuracy of the Truecpr Device on a Soft Mattress

Objective: Accelerometer based chest compression feedback devices overestimate compression depth by not accounting for a soft surface below the victim. TrueCPR, a new real-time feedback device, provides visual feedback on compression depth, based on measured changes in magnetic field strength between a backpad and a chestpad. We determined accuracy of that method on a calibrated test bench and on a manikin on a soft surface. Methods: First, we used a calibrated, computerized drill press compressing a Laerdal Resusci Anne SkillReporter manikin on a firm surface to verify calibration of its compression depth measurement, and to measure accuracy of the TrueCPR device. Then, we compared measurements of two feedback devices (TrueCPR and a sternum-only accelerometer) on a standard inflatable hospital mattress. Thirty manual chest compressions were given with feedback of TrueCPR or the accelerometer, to achieve the recommended depth of 50-60 mm and compared with the compression depth measured by the manikin. Results: Compared to the drill press, the manikin measured compression depth with error &lt;1 mm for depths below 55 mm and with 1-2 mm underestimation above 55mm. TrueCPR showed a systematic underestimation of 3-4 mm on a hard surface. On the mattress, TrueCPR showed an underestimation of 2-4 mm, where the accelerometer showed an overestimation of 17-23 mm (figure). A compression depth in the recommended range was achieved with TrueCPR in 23 of 30 compressions and with the accelerometer in 2 of 30 compressions. Conclusion: TrueCPR measures depth independent of the stiffness of the surface upon which the CPR is being performed with a constant underestimation of &lt;4 mm. A sternum-only accelerometer substantially overestimates depth when performing CPR on a soft surface. Correction for body displacement on a soft surface is essential for accurate delivery of chest compressions within the recommended depth range.

A Randomized Trial of Cardiopulmonary Resuscitation Training for Medical Students

Current European Resuscitation Guidelines 2010 recommend the use of prompt/feedback devices when training for cardiopulmonary resuscitation (CPR). We aimed to assess the quality of CPR training among second-year medical students with a voice advisory mannequin (VAM) compared to guidance provided by an instructor. Forty-three students received a theoretical reminder about CPR followed by a 2-minute pretest on CPR (compressions/ventilations cycle) with Resusci Anne SkillReporter (Laerdal Medical). They were then randomized into a control group (n = 22), trained by an instructor for 4 minutes per student, and an intervention group (n = 21) trained individually with VAM CPR mannequin for 4 minutes. After training, the students performed a 2-minute posttest, with the same method as the pretest. Participants in the intervention group (VAM) performed more correct hand position (73% vs. 37%; P = 0.014) and tended to display better compression rate (124 min vs. 135 min; P = 0.089). In a stratified analyses by sex we found that only among women trained with VAM was there a significant improvement in compression depth before and after training (36 mm vs. 46 mm, P = 0.018) and in the percentage of insufficient compressions before and after training (56% vs. 15%; P = 0.021). In comparison to the traditional training method involving an instructor, training medical students in CPR with VAM improves the quality of chest compressions in hand position and in compression rate applied to mannequins. Only among women was VAM shown to be superior in compression depth training. This technology reduces costs in 14% in our setup and might potentially release instructors' time for other activities.

A stabilization device to improve the quality of cardiopulmonary resuscitation during ambulance transportation: A randomized crossover trial

The quality of cardiopulmonary resuscitation (CPR) during ambulance transportation is suboptimal, and therefore measures that can improve the quality are desirable. To evaluate whether the use of a stabilization device can improve the quality of CPR during ambulance transportation. This randomized controlled crossover trial enrolled 22 experienced ambulance officers. Each participant performed CPR in an ambulance under three conditions with 72 h apart, each condition for 10 min: non-moving (NM), moving without device (MND), and moving with device (MD). The sequences of conditions were randomized. The primary outcomes were effective chest compressions recorded by the Laerdal Resusci-Anne Skill-reporter manikin. The secondary outcomes included the severity of back pain scored using the Brief Pain Inventory short-form, the physiology parameter before and after CPR, and the changes in postural stability which was represented by the sway index (SI) of lower back measured using a goniometer. The overall effective compressions in 10 min were 87.0±17% for NM, 59.0±19% for MND, and 69.0±23% for MD (p<0.001). Compared to MND, MD had a lower no-flow fraction while driving on curved sections (0.04 vs. 0.29, p<0.001). Whereas the pain severity and social interference scores were similar under all conditions, MND had a higher SI than MD and NM. The use of a stabilization device can improve the quality of CPR and posture stability during ambulance transportation, although the effects on the severity of back pain were not significant.

Factors influencing quality of chest compression depth in nursing students

The purpose of the study was to identify factors influencing quality of chest compression depth in nursing students. A convenience sample of 102 female nursing students enrolled in a cardiopulmonary resuscitation skills training session. Each student performed 3 min of chest compression skills on a Resusci Anne SkillReporter manikin for measurements of both depth and rate. Nursing students with correct compression depth (50-60 mm) had higher body weight (t = -2.02, P = 0.046) and body mass index (t = -2.19, P = 0.031) compared with students in the incorrect depth group. Mean chest compression depth was shallower in underweight nursing students compared with normal weight or overweight students (F = 8.89, P < 0.001). Body weight was a significant factor influencing quality of chest compression depth (F = 4.25, P = 0.003). Educational intervention targeting underweight nursing students might need to enhance the quality of chest compression skills.

Backboard insertion in the operating table increases chest compression depth: a manikin study

The quality of chest compression (CC) is influenced by the surface supporting the patient. The present study compared chest compression depth with and without a rigid backboard on an operating table with a pressure-distributing mattress. We hypothesized that the presence of a backboard would result in an increased depth of chest compression on the operating table with a pressure-distributing mattress. In a randomized crossover trial, we simulated in-hospital cardiac arrest in a Resusci Anne SkillReporter model placed on a standard operating table with a 6-cm-thick pressure-distributing mattress. A total of 25 male doctors performed CC 30 times, with or without the rigid backboard. Mean chest compression depth increased from 4.9±0.4 to 5.4±0.3mm (P<0.0001) when a backboard was present. Mean proportion of compressions >50mm increased significantly with the presence of a backboard (53.6%±32.3%-81.8%±15.0%, P<0.0001). Applying a backboard significantly increased CC depth during cardiopulmonary resuscitation of a manikin model on an operating table with a pressure-distributing mattress.

Rescuer fatigue and cardiopulmonary resuscitation positions: A randomized controlled crossover trial

During cardiopulmonary resuscitation (CPR), it is recommended to alternate rescuers every 2 min when two or more rescuers are available, regardless of the rescuer's position. It is unclear, however, whether rescuer fatigue depends on the rescuer's position. To compare rescuer fatigue by doing CPR in different positions. This randomized controlled crossover trial studied 24 experienced health-care providers from a teaching hospital in southern Taiwan. Each participant performed CPR for 10 min on days 1, 8, and 15 of the study in three different positions: kneeling, standing on a taboret, and standing on the floor. Effective compression was recorded using the Laerdal Resusci-Anne Skillreporter manikin. The range of motion (ROM) of the elbows and lower back were detected using a flexible goniometer, and the severity of back pain was scored using the Brief Pain Inventory short-form. Rescuers maintained adequate effective compressions for 2 min while kneeling and standing on a taboret, but only for 1 min while standing on the floor. The ROM for elbows and lower back during CPR while kneeling were significantly lower than for standing on the floor. Moreover, the total pain (p<0.001) and social interference (p=0.004) scores 24h after CPR were significantly lower for the kneeling position. CPR is best performed in a kneeling position. In order to minimize rescuer fatigue, we recommend alternating rescuers every 2 min while kneeling or standing on a taboret, and every 1 min while standing on the floor.

Instructions to “push as hard as you can” improve average chest compression depth in dispatcher-assisted cardiopulmonary resuscitation

Cardiopulmonary resuscitation (CPR) with adequate chest compression depth appears to improve first shock success in cardiac arrest. We evaluate the effect of simplification of chest compression instructions on compression depth in dispatcher-assisted CPR protocol. Data from two randomized, double-blinded, controlled trials with identical methodology were combined to obtain 332 records for this analysis. Subjects were randomized to either modified Medical Priority Dispatch System (MPDS) v11.2 protocol or a new simplified protocol. The main difference between the protocols was the instruction to "push as hard as you can" in the simplified protocol, compared to "push down firmly 2in. (5cm)" in MPDS. Data were recorded via a Laerdal ResusciAnne SkillReporter manikin. Primary outcome measures included: chest compression depth, proportion of compressions without error, with adequate depth and with total release. Instructions to "push as hard as you can", compared to "push down firmly 2in. (5cm)", resulted in improved chest compression depth (36.4 mm vs. 29.7 mm, p<0.0001), and improved median proportion of chest compressions done to the correct depth (32% vs. <1%, p<0.0001). No significant difference in median proportion of compressions with total release (100% for both) and average compression rate (99.7 min(-1) vs. 97.5 min(-1), p<0.56) was found. Modifying dispatcher-assisted CPR instructions by changing "push down firmly 2in. (5cm)" to "push as hard as you can" achieved improvement in chest compression depth at no cost to total release or average chest compression rate.

The effectiveness of cardiopulmonary resuscitation instruction: Animation versus dispatcher through a cellular phone

We developed a cardiopulmonary resuscitation (CPR) instruction programme using motion capture animation integrated into cellular phones. We compared the effectiveness of animation-assisted CPR instruction with dispatcher-assisted instruction in participants with no previous CPR training. This study was a single blind cluster randomized trial. Participants were allocated to either animation-assisted CPR (AA-CPR; 8 clusters, 44 participants) group or dispatcher-assisted CPR (DA-CPR; 8 clusters, 41 participants). The overall performance and time of each step of CPR cycle were recorded on a checklist by 3 assessors. The objective performances were evaluated using the Resusci Anne SkillReporter Manikin. Differences between the groups were compared using an independent t-test adjusted for the effect of clustering. The AA-CPR group had a significantly better checklist score (p<0.001) and time to completion of 1 CPR cycle (p<0.001) than the DA-CPR group. In an objective assessment of psychomotor skill, the AA-CPR group demonstrated more accurate hand positioning (68.8+/-3.6%, p=0.033) and compression rate (72.4+/-3.7%, p=0.015) than DA-CPR group. However, the accuracy of compression depth (p=0.400), ventilation volume (p=0.977) and flow rate (p=0.627) were below 30% in both groups. Audiovisual animated CPR instruction through a cellular phone resulted in better scores in checklist assessment and time interval compliance in participants without CPR skill compared to those who received CPR instructions from a dispatcher; however, the accuracy of important psychomotor skill measures was unsatisfactory in both groups.

Instructions to “put the phone down” do not improve the quality of bystander initiated dispatcher-assisted cardiopulmonary resuscitation

The quality of early bystander CPR appears important in maximizing survival. This trial tests whether explicit instructions to "put the phone down" improve the quality of bystander initiated dispatch-assisted CPR. In a randomized, double-blinded, controlled trial, subjects were randomized to a modified version of the Medical Priority Dispatch System (MPDS) version 11.2 protocol or a simplified protocol, each with or without instruction to "put the phone down" during CPR. Data were recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions. Primary outcome measures included chest compression rate, depth, and the proportion of compressions without error, with correct hand position, adequate depth, and total release. Time was measured in two distinct ways: time required for initiation of CPR and total amount of time hands were off the chest during CPR. Proportions were analyzed by Wilcoxon rank sum tests and time variables with ANOVA. All tests used a two-sided alpha-level of 0.05. Two hundred and fifteen subjects were randomized-107 in the "put the phone down" instruction group and 108 in the group without "put the phone down" instructions. The groups were comparable across demographic and experiential variables. The additional instruction to "put the phone down" had no effect on the proportion of compressions administered without error, with the correct depth, and with the correct hand position. Likewise, "put the phone down" did not affect the average compression depth, the average compression rate, the total hands-off-chest time, or the time to initiate chest compressions. A statistically significant, yet trivial, effect was found in the proportion of compressions with total release of the chest wall. Instructions to "put the phone down" had no effect on the quality of bystander initiated dispatcher-assisted CPR in this trial.

Simplified dispatch-assisted CPR instructions outperform standard protocol

Dispatch-assisted chest compressions only CPR (CC-CPR) has gained widespread acceptance, and recent research suggests that increasing the proportion of compression time during CPR may increase survival from out-of-hospital cardiac arrest. We created a simplified CC-CPR protocol to reduce time to start chest compressions and to increase the proportion of time spent delivering chest compressions. This simplified protocol was compared to a published protocol, Medical Priority Dispatch System (MPDS) Version 11.2, recommended by the National Academies of Emergency Dispatch. Subjects were randomized to the MPDS v11.2 protocol or a simplified protocol. Data was recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions for both protocols. Outcomes included chest compression rate, depth, hand position, full release, overall proportion of compressions without error, time to start of CPR and total hands-off chest time. Proportions were analyzed by Wilcoxon's Rank Sum tests and time variables with Welch ANOVA and Wilcoxon's Rank Sum test. All tests used a two-sided alpha-level of 0.05. One hundred and seventeen subjects were randomized prospectively, 58 to the standard protocol and 59 to the simplified protocol. The average age of subjects in both groups was 25 years old. For both groups, the compression rate was equivalent (104 simplified versus 94 MPDS, p = 0.13), as was the proportion with total release (1.0 simplified versus 1.0 MPDS, p = 0.09). The proportion to the correct depth was greater in the simplified protocol (0.31 versus 0.03, p < 0.01), as was the proportion of compressions done without error (0.05 versus 0.0, p = 0.16). Time to start of chest compressions and total hands-off chest time were better in the simplified protocol (start time 60.9s versus 78.6s, p < 0.0001; hands-off chest time 69 s versus 95 s, p < 0.0001). The proportion with correct hand position, however, was worse in the simplified protocol (0.35 versus 0.84, p < 0.01). The simplified protocol was as good as, or better than the MPDS v11.2 protocol in every aspect studied except hand position, and the simplified protocol resulted in significant time savings. The protocol may need modification to ensure correct hand position. Time savings and improved quality of CPR achieved by the new set of instructions could be important in strengthening critical links in the cardiac chain of survival.