Uninterrupted Chest Compressions Research Articles

The resuscitation blanket: A useful tool for “hands-on” defibrillation

Aim of study We investigated the safety, feasibility and efficacy of a resuscitation blanket designed with the intent to protecting the rescuer from the risk of receiving electrical current during defibrillation which, would allow for uninterrupted chest compressions. Methods Fifteen pigs weighing between 22 and 40 kg were investigated with an established model of cardiac arrest and CPR. CPR was performed with the interposition of the blanket between the rescuer's hands and the chest of the animal. Defibrillation voltage and current over the blanket were measured. Hemodynamics, including coronary perfusion pressure (CPP), end-tidal CO 2 (EtCO 2) and 50% successful defibrillation threshold (DFT50) were measured and compared during CPR with and without the blanket. Results Leakage through the blanket was nominal. Voltages of 42.0, 56.6 and 105 V and mean leakage currents of 1.1, 1.4 and 3.3 μA were measured above the blanket for 150, 200 and 360 J defibrillation shocks. CPP and EtCO 2 in the animals during chest compression with the resuscitation blanket were not significantly different compared to those measured without the blanket. However, when the blanket was not utilized, CPP decreased ( P < 0.05) during the 15-s hands-off interruption prior to defibrillation. Defibrillation threshold was significantly lower when the blanket was used. Conclusion The resuscitation blanket is a safe and useful tool which protects the rescuer from hands-on defibrillation shocks, allowing for uninterrupted chest compressions, and therefore improving defibrillation success.

2009 Dickinson W. Richards Memorial Lecture—Improving Survival From Out-of-Hospital Cardiac Arrest

A renewed understanding of resuscitation physiology has led to several bold new approaches to basic life support (BLS) and advanced cardiovascular life support (ACLS), as well as a recognition that aggressive postresuscitation care can have a major impact on long-term outcome. Concepts initially tested in basic and translational resuscitation research laboratories have within the past several years been piloted in a number of rural and urban communities. Several of these newer approaches to BLS, ACLS, and postresuscitation care have dramatically increased historical survival rates around the world. These include the following: Hands-only BLS CPR . The survival rate for witnessed ventricular fibrillation in Tokyo increased from 11% to 19% when lay bystander rescuers performed chest compression– only or “hands-only” BLS as compared with chest compressions and mouth-to-mouth breathing. The American Heart Association endorsed “hands-only” BLS for encouraging more bystander CPR in March 2008. New ACLS algorithm emphasizing uninterrupted chest compressions . The initial report of the use of this newly revised ACLS approach came from rural Wisconsin. The rate of 1-year survival from witnessed ventricular fibrillation cardiac arrest tripled, from 15% to 48%. A follow-up report 3 years later showed a persistent benefit, with a 3-year survival rate of 40%. In Phoenix, Arizona, introduction of this revised ALCS algorithm increased the rate of survival to hospital discharge with ventricular fibrillation cardiac arrest from 12% to 28%. Postresuscitation care . Postresucitation care is the next great opportunity to improve long-term outcome among victims of out-of-hospital cardiac arrest. In Norway, the rate of 1-year survival among those resuscitated from out-of-hospital cardiac arrest increased from 26% to 56% after formalization of the postresuscitation care, with emphasis on providing mild therapeutic hypothermia and early catheterization and percutaneous coronary intervention where indicated. Case series reported in the literature suggest this approach can produce long-term survival rates of 70% among those initially resuscitated, with 80% of such long-term survivors being neurologically intact. The near future holds more real promise for improving the outcome of those suffering cardiac arrest than ever before. Now is the time to move forward and provide improved care to all victims of sudden cardiac death.

Resuscitation, Prolonged Cardiac Arrest, and an Automated Chest Compression Device

The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest. To describe how the circumstances of out-of-hospital cardiac arrest can impede the performance of CPR, and how this situation can be overcome. The presentation of two cases of prolonged CPR (48 min and 120 min, respectively) with an automated chest compression device, the AutoPulse, under difficult circumstances. Both patients survived without neurological sequelae. Prolonged chest compressions may be necessary in some cardiac arrests. These cases suggest that automated chest compression devices may increase the chance of a favorable outcome in these rare situations.

Miniaturization of a Chest Compressor for Cardiopulmonary Resuscitation

A miniaturized chest compressor (MCC®) for cardiopulmonary resuscitation (CPR) was designed to serve as a compact portable device to overcome limitations of manual chest compression and of currently marketed mechanical devices. We sought to especially address constraints of size and weight of current devices, together with the need for ease of application and consistent compressions with appropriate force and depth. We further intended that the device allows for ease of evacuation and transport through small spaces. These objectives are responsive to the increasingly recognized requirements for uninterrupted chest compression including that which results from operator fatigue during manual compressions. Utilizing a garment applied to the torso, the device incorporated a telescopic piston for chest compression. The compressor was pneumatically powered so as to avoid the added weight and potential electrical adversity of power delivered by batteries. Pneumatic power was supplied by the same compressed air or oxygen tank, which is routinely carried by professional emergency medical rescuers. The MCC® was tested on a porcine model during cardiac arrest and resuscitation with comparisons to the current industry standard, the Michigan Thumper®. Arterial, carotid, and coronary perfusion pressures, together with end-tidal carbon dioxide as a surrogate for cardiac output, were measured. The MCC® threshold levels of pressure, flow, and end-tidal PCO2 are achieved, which were predictive of successful defibrillation with restoration of spontaneous circulation. We conclude that the MCC® is as effective as that of the established industry standard, the Michigan Thumper®, with the potential advantage of portability and facile application, especially for out-of-hospital resuscitation.

Letter by Sullivan Regarding Article, “Hands-On Defibrillation: An Analysis of Electrical Current Flow Through Rescuers in Direct Contact With Patients During Biphasic External Defibrillation”

To the Editor: As an engineer and scientist for a leading manufacturer of external defibrillators, I feel compelled to comment on the recent report by Lloyd et al, “Hands-On Defibrillation: An Analysis of Electrical Current Flow Through Rescuers in Direct Contact With Patients During Biphasic External Defibrillation.”1 The authors of this study have the laudable goal of improving patient care by eliminating the hands-off period during a shock. However, although their results are interesting, their study has insufficient power to conclude that “uninterrupted manual chest compressions during shock delivery are feasible” (p 2513). This study demonstrates the fact …

Electrocardiographic analysis during uninterrupted cardiopulmonary resuscitation

Prior studies have shown that interruptions of chest compressions could result in high failure rates of resuscitation. Chest compression artifacts force the interruption of compressions before electrocardiographic rhythm analysis. It was the goal of this study to evaluate the accuracy of an automated electrocardiographic rhythm analysis algorithm designed to attenuate compression-induced artifact and minimize uninterrupted chest compressions. Retrospective diagnostic analysis. Out-of-hospital cardiopulmonary resuscitation. Eight hundred thirty-two patients. Patients were treated with defibrillation and cardiopulmonary resuscitation. Continuous data were recorded using automated external defibrillators with concurrent measurement of electrocardiographic and sternal motion during chest compressions. Human electrocardiographics recorded by automated external defibrillators were annotated and randomly selected to build distinct training and testing databases. The artifact reduction and tolerant filter was applied to the electrocardiographic signal. The algorithm was optimized with the training database (sensitivity, 93.9%; specificity, 91.2%) and tested with the testing database (sensitivity, 92.1%; specificity, 90.5%). Average attenuation of compression-induced artifact was more than 35 dB. Shockable ventricular arrhythmias can be differentiated from electrocardiographic rhythms not requiring defibrillation in the presence of chest compression-induced artifact with sensitivity and specificity above 90%. With the artifact reduction and tolerant filter, it is possible to effectively eliminate pre- and postshock compression pauses.

Abstract P167: Pentax-AWS is More Useful Than Macintosh Laryngoscope and Airtraq to Establish Tracheal Intubation while Uninterrupted Chest Compression: a Comparative Study with Manikin

Purpose. In resuscitation, chest compression is essential, and it should be performed appropriately and uninterruptedly to obtain the return of spontaneous circulation and breathing. However, attempt of tracheal intubation with the Macintosh laryngoscope (Mac) occasionally needs a temporary pause of chest compression and delays its resuming. Consequently, we studied the efficacy of the new video-laryngoscopes, PENTAX-AWS (AWS) and Airtraq (ATQ) as device used for tracheal intubation while nonstop chest compression. Materials and Methods. Twenty seven participants including 11 non-anesthetic doctors, 1 paramedic, 11 nurses and 4 medical students enrolled in this study. At first, Participants and supplementary assistant who concentrated on chest compression simulated CPR with the use of Resusci Anne Simulator manikin (Laerdal) placed on medical emergency bed as 30:2 protocol proposed in 2005 AHA Guidelines. Strength and rhythm of the compression were monitored in real-time by PC skill-reporting system. After the chest compressions became constant, participants were requested to intubate with using Mac, AWS and ATQ in both situations without chest compression and while the compression. Results. Tracheal intubation was successfully achieved within 3 attempts by 92.6% participants in Mac and 100% in AWS and ATQ without chest compression, and 66.7% in Mac, 100% in AWS and 81.5% in ATQ while chest compression. Rate of success in the 1st attempt was 55.6% in Mac, 96.3% in AWS and 51.9% in ATQ while compression. Time to intubate while compression with AWS was 14.6s, which was significantly shorter than 26.1s with ATQ in the successful attempts. Conclusions. With using AWS, high success rate of tracheal intubation was achieved even in chest compression situation in comparison with the other two devices. Macintosh laryngoscope is the most inconvenient among these devices when tracheal intubation is attempted while chest compression. ATQ showed significant decrease of success rate in compression situation despite it achieved 100% success without compression. PENTAX-AWS is expected to be more useful than Macintosh laryngoscope and Airtraq to establish tracheal intubation while uninterrupted chest compression in clinical use.

Abstract P200: Optimal Phase Relationship Between Defibrillation and Manual Chest Compression Improves Shock Success

Introduction A newly developed blanket provides the protection for rescuer from shock during cardiopulmonary resuscitation (CPR) and allow for uninterrupted chest compression. We examined relationships between the phase of manual compression and the timing of defibrillation based on measurement of the 50% defibrillation threshold (DFT50). Methods Ventricular fibrillation (VF) was electrically induced and untreated for 10 seconds in 8 domestic male pigs weighing between 22–31 kg. The depth and frequency of manual chest compression utilizing the isolated blanket initiated and continued for 25 seconds guided by a CPR prompter (iCPR, ZOLL Medical Corporation, Chelmsford, MA). A biphasic electrical shock of variable energies ranging from 30~150J was delivered at 5 phases of the compression period as shown in Figure 1–A . A group in which defibrillation was attempted at a constant 2 seconds following discontinued of chest compression served as a control. Results No difference between coronary perfusion pressures (CPP) prior to delivering of the shock were observed between the 6 groups. The calculated energy required for defibrillation, however, was significantly lower during the latter half of decompression as represented by group C and D (Figure 1–B ). Conclusion Defibrillation efficacy is maximal when an electrical shock is delivered during the latter phase of decompression.

87: Impact of New CPR/Advanced Cardiac Life Support Guidelines on Outcome from Out-of-Hospital Cardiac Arrest

We implemented policies calling for 2 minutes of CPR by first responders prior to use of an AED; emphasis on continuous, uninterrupted chest compressions; provision of a minimum of 20 minutes of advanced life support efforts on scene prior to transport; avoidance of hyperventilation; and minimizing transport of patients who failed to achieve return of spontaneous circulation (ROSC). We sought to determine the impact of these new guidelines on the rate of ROSC and termination of resuscitation (TOR) in the field.

Hands-On Defibrillation

Brief interruptions in chest compressions reduce the efficacy of resuscitation from cardiac arrest. Interruptions of this type are inevitable during hands-off periods for shock delivery to treat ventricular tachyarrhythmias. The safety of a rescuer remaining in contact with a patient being shocked with modern defibrillation equipment has not been investigated. This study measured the leakage voltage and current through mock rescuers while they were compressing the chests of 43 patients receiving external biphasic shocks. During the shock, the rescuer's gloved hand was pressed onto the skin of the patient's anterior chest. To simulate the worst case of an inadvertent return current pathway, a skin electrode on the rescuers thigh was connected to an electrode on the patient's shoulder. In no cases were shocks perceptible to the rescuer. Peak potential differences between the rescuer's wrist and thigh ranged from 0.28 to 14 V (mean 5.8+/-5.8 V). The average leakage current flowing through the rescuer's body for each phase of the shock waveform was 283+/-140 microA (range 18.9 to 907 microA). This was below several recommended safety standards for leakage current. Rescuers performing chest compressions during biphasic external defibrillation are exposed to low levels of leakage current. The present findings support the feasibility of uninterrupted chest compressions during shock delivery, which may enhance the efficacy of defibrillation and cardiocerebral resuscitation.

Minimally Interrupted Cardiac Resuscitation by Emergency Medical Services for Out-of-Hospital Cardiac Arrest

Out-of-hospital cardiac arrest is a major public health problem. To investigate whether the survival of patients with out-of-hospital cardiac arrest would improve with minimally interrupted cardiac resuscitation (MICR), an alternate emergency medical services (EMS) protocol. A prospective study of survival-to-hospital discharge between January 1, 2005, and November 22, 2007. Patients with out-of-hospital cardiac arrests in 2 metropolitan cities in Arizona before and after MICR training of fire department emergency medical personnel were assessed. In a second analysis of protocol compliance, patients from the 2 metropolitan cities and 60 additional fire departments in Arizona who actually received MICR were compared with patients who did not receive MICR but received standard advanced life support. Instruction for EMS personnel in MICR, an approach that includes an initial series of 200 uninterrupted chest compressions, rhythm analysis with a single shock, 200 immediate postshock chest compressions before pulse check or rhythm reanalysis, early administration of epinephrine, and delayed endotracheal intubation. Survival-to-hospital discharge. Among the 886 patients in the 2 metropolitan cities, survival-to-hospital discharge increased from 1.8% (4/218) before MICR training to 5.4% (36/668) after MICR training (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.1-8.9). In the subgroup of 174 patients with witnessed cardiac arrest and ventricular fibrillation, survival increased from 4.7% (2/43) before MICR training to 17.6% (23/131) after MICR training (OR, 8.6; 95% CI, 1.8-42.0). In the analysis of MICR protocol compliance involving 2460 patients with cardiac arrest, survival was significantly better among patients who received MICR than those who did not (9.1% [60/661] vs 3.8% [69/1799]; OR, 2.7; 95% CI, 1.9-4.1), as well as patients with witnessed ventricular fibrillation (28.4% [40/141] vs 11.9% [46/387]; OR, 3.4; 95% CI, 2.0-5.8). Survival-to-hospital discharge of patients with out-of-hospital cardiac arrest increased after implementation of MICR as an alternate EMS protocol. These results need to be confirmed in a randomized trial.

Minimizing Stomach Inflation Versus Optimizing Chest Compressions

In a bench model, we evaluated a bag-valve device (Smart Bag MO) with limited maximum inspiratory gas flow developed to reduce the risk of stomach inflation in an unprotected airway. During simulated cardiopulmonary resuscitation with uninterrupted chest compressions, ventilation with the "disabled" Smart Bag MO or an adult self-inflating bag-valve device provided only adequate tidal volumes if inspiratory time was 0.5 s. Ventilation with the "enabled" Smart Bag MO, even in ventilation windows of 0.5 s, provided inadequate tidal volumes during simulated cardiopulmonary resuscitation and would result in hypoventilation in a patient.

Cardiopulmonary Resuscitation in Small Animal Medicine: An Update

In December 2005, the American Heart Association published new guidelines for cardiopulmonary cerebral resuscitation (CPCR) in humans for the 1st time in 5 years. Many of the recommendations are based on research conducted in animal species and may be applicable to small animal veterinary patients. One important change that may impact how CPCR is performed in veterinary medicine is the recommendation to avoid administration of excessive ventilatory rates because this maneuver severely decreases myocardial and cerebral perfusion, decreasing the chance of survival. The new guidelines also emphasize the importance of providing well-executed, continuous, uninterrupted chest compressions. Interruption of chest compressions should be avoided and, if necessary, should be minimized to <10 seconds. During defibrillation, immediate resumption of chest compressions for 2 minutes after a single shock, before reassessment of the rhythm by ECG, is recommended. This recommendation replaces previous recommendations for the delivery of 3 defibrillatory shocks in rapid succession. Allowing permissive hypothermia postresuscitation has been found to be beneficial and may increase success rate. Medications utilized in cardiopulmonary resuscitation, including amiodarone, atropine, epinephrine, lidocaine, and vasopressin, along with the indications, effects, routes of administration, and dosages, are discussed. The application of the new guidelines to veterinary medicine as well as a review of cardiopulmonary resuscitation in small animals is provided.

Identifying potentially shockable rhythms without interrupting cardiopulmonary resuscitation*

Current versions of automated external defibrillators (AEDs) mandate interruptions of chest compression for rhythm analyses because of artifacts produced by chest compressions. Interruption of chest compressions reduces likelihood of successful resuscitation by as much as 50%. We sought a method to identify a shockable rhythm without interrupting chest compressions during cardiopulmonary resuscitation (CPR). Experimental study. Weil Institute of Critical Care Medicine, Rancho Mirage, CA. None. Electrocardiographs (ECGs) were recorded in conjunction with AEDs during CPR in human victims. A shockable rhythm was defined as disorganized rhythm with an amplitude > 0.1 mV or, if organized, at a rate of > or = 180 beats/min. Wavelet-based transformation and shape-based morphology detection were used for rhythm classification. Morphologic consistencies of waveform representing QRS components were analyzed to differentiate between disorganized and organized rhythms. For disorganized rhythms, the amplitude spectrum area was computed in the frequency domain to distinguish between shockable ventricular fibrillation and nonshockable asystole. For organized rhythms, in victims in whom the absence of a heartbeat was independently confirmed, the heart rate was estimated for further classification. To derive the algorithm, we used 29 recordings on 29 patients from the Creighton University ventricular tachyarrhythmia database. For validation, the algorithm was tested on an independent population of 229 victims, including recordings of both ECG and depth of chest compressions obtained during suspected out-of-hospital sudden death. The recordings included 111 instances in which the ECG was corrupted during chest compressions. A shockable rhythm was identified with a sensitivity of 93% and a specificity of 89%, yielding a positive predictive value of 91%. A nonshockable rhythm was identified with a sensitivity of 89%, a specificity of 93%, and a positive predictive value of 91% during uninterrupted chest compression. The algorithm fulfilled the potential lifesaving advantages of allowing for uninterrupted chest compression, avoiding pauses for automated rhythm analyses before prompting delivery of an electrical shock.

Abstract 63: Hands-On Defibrillation: An Analysis of Current Flow Through Rescuers In Contact With Patients During Biphasic External Defibrillation

Background: During cardiopulmonary resuscitation, the need for rescuers to stand clear before a shock is delivered invariably interrupts chest compressions. Brief interruptions like these reduce the efficacy of defibrillation in animal models. Current flow through a rescuer in contact with a patient being shocked with modern biphasic waveforms and adhesive patch electrodes has not been investigated. We hypothesized that leakage current is low through a rescuer performing chest compressions at the time of shock delivery. Methods: During 18 elective cardioversions using truncated exponential biphasic waveforms (median energy 200 joules, range 100 –360 joules), an investigator serving as the rescuer placed a gloved hand on the patient’s anterior chest immediately adjacent to the defibrillating patch with approximately 20lbs of pressure to simulate chest compressions. Skin electrodes were used to connect the rescuer’s thigh to the patient’s posterior shoulder, simulating a worst-case return current pathway. During shock delivery, voltage and current through the rescuer (hand to thigh) were recorded using a digital storage oscilloscope during the shock delivery. Results: In no cases were shocks perceptible to the rescuer. Mean patient transthoracic impedance was 57 +/− 14 ohms (range 36 –79 ohms). Potential differences in volts (V) between the rescuer’s wrist and thigh ranged from 1.7 to 14 V (mean 6.7 +/− 2.7 V). Calculated impedances through rescuers ranged from 8,190 to 100,400 ohms (mean 30,100 +/− 20,400 ohms). The average leakage current flowing through the rescuer’s body for each phase of the shock waveform was 273 +/−191 microamperes (range 1 to 910 microamperes). All measured values in our series were well below 2,500 microamperes, an accepted safety standard for earth-leakage current in medical devices. Conclusions: Even in a simulated worst-case scenario, a rescuer performing chest compressions during biphasic external defibrillation is exposed to low levels of leakage current. Our findings demonstrate the safety and feasibility of uninterrupted chest compressions during shock delivery, which may enhance the efficacy of defibrillation and cardiocerebral perfusion.

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.

Miniaturized mechanical chest compressor: A new option for cardiopulmonary resuscitation

After cardiac arrest, uninterrupted chest compressions with restoration of myocardial blood flow facilitates restoration of spontaneous circulation. We recognized that this may best be accomplished with a mechanical device and especially so during transport. We therefore sought to develop a lightweight, portable chest compressor which may be carried on the belt or attached to the oxygen tank typically carried on the back of the first response rescuer. A miniaturized pneumatic chest compressor (MCC) weighing less than 2 kg was developed and compared with a currently marketed "Michigan Thumper", which weighed 19 kg. We hypothesized that the 2 kg, low profile, portable device will be as effective as the standard pneumatic Thumper for restoring circulation during CPR. Ventricular fibrillation was electrically induced in 10 domestic male pigs weighing 39+/-2 kg, and untreated for 5 min. Animals were then randomized to receive chest compressions with either the MCC or the Thumper. After 5 min of mechanical chest compression, defibrillation was attempted with a 150 J biphasic shock. Coronary perfusion pressure (CPP) and end tidal PCO(2) (EtPCO(2)) were measured by conventional techniques together with right carotid artery blood flow (CBF). Four of five animals compressed with the Thumper and each animal compressed with the MCC were successfully resuscitated. No significant differences in CPP, EtPCO(2), CBF and post-resuscitation myocardial function were observed between groups. Resuscitated animals survived for more than 72 h without neurological impairment. The low profile, 2 kg miniaturized chest compressor is as effective as the conventional Thumper in an experimental model of CPR.

CCR Triples Survivals: Uninterrupted chest compressions show stunning early results

CCR Triples Survivals: Uninterrupted chest compressions show stunning early results

The physiological effect on rescuers of doing 2 min of uninterrupted chest compressions

To analyse how rescuers tolerate the effort derived of giving uninterrupted chest compressions during 2min. Twenty-three healthy volunteers, nurses and doctors of the Intensive Care Unit (ICU), members of the hospital cardiac arrest team, were enrolled in the study. Using a training manikin, participants were asked to perform chest compressions during 2min at a rate of 100min(-1). The oxygen saturation and cardiac rate of the subjects were monitored using pulse oximetry before and after one and 2min performing chest compressions. The percentage of the maximal heart rate of the rescuer over the theoretical maximum allowed in a conventional stress test was calculated, taking into account age and body mass index (BMI) of the subjects. Fatigue was measured using a visual analogical scale (VAS). The means (+/-S.D.) of chest compressions in the first and second minutes were 103+/-12, and 104+/-11, respectively. The mean percent of the maximum heart rate observed was 61+/-8%. None of the subjects had difficulties to complete the test. All subjects recovered their basal values in less than 2min, and the mean value recorded in the VAS was 3+/-2. The practice of uninterrupted chest compressions during 2min by the same rescuer is well tolerated by health professionals trained in cardiopulmonary resuscitation (CPR).

Should bystander resuscitation education be compulsory to everybody?

Purpose of the study: To assess current knowledge of suggested modifications of various aspects of basic life support (BLS) by lay people (LP) and health care professionals (HC). Materials and methods: Thirty-one male and 108 female HC and 47 LP completed a self-administered anonymous questionnaire. The questionnaire contained multiple-choice questions regarding BLS innovations. Results: Most responders, either LP or HC, did not know whether modifications or new recommendations – such as those for applying the same guidelines to children as to adults, those emphasizing uninterrupted chest compressions or that automate external defibrillators should promptly applied in adults if available – for improvement of BLS are been published (62.8% versus 48.3%) or simply reject such a possibility (7% versus 20%).