A study of chest compression rates during cardiopulmonary resuscitation in humans. The importance of rate-directed chest compressions

1992 ◽  
Vol 152 (1) ◽  
pp. 145-149 ◽  
Author(s):  
K. B. Kern
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Chest Compressions

Chest compression efficacy of child resuscitators

2021 ◽  
Vol 13 (11) ◽  
pp. 448-455
Author(s):  
Tiffany Wai Shan Lau ◽  
Anthony Robert Lim ◽  
Kyra Anne Len ◽  
Loren Gene Yamamoto
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Minimum Weight ◽  
Success Rates ◽  
Compression Force ◽  
Chest Compressions ◽  
Traditional Methods ◽  
Video Review ◽  
Brief Training

Background: Chest compression efficacy determines blood flow in cardiopulmonary resuscitation (CPR) and relies on body mechanics, so resuscitator weight matters. Individuals of insufficient weight are incapable of generating a sufficient downward chest compression force using traditional methods. Aims: This study investigated how a resuscitator's weight affects chest compression efficacy, determined the minimum weight required to perform chest compressions and, for children and adults below this minimum weight, examine alternate means to perform chest compressions. Methods: Volunteers aged 8 years and above were enrolled to perform video-recorded, music-facilitated, compression-only CPR on an audible click-confirming manikin for 2 minutes, following brief training. Subjects who failed this proceeded to alternate modalities: chest compressions by jumping on the lower sternum; and squat-bouncing (bouncing the buttocks on the chest). These methods were assessed via video review. Findings: There were 57 subjects. The 30 subjects above 40kg were all able to complete nearly 200 compressions in 2 minutes. Success rates declined in those who weighed less than 40kg. Below 30 kg, only one subject (29.9 kg weight) out of 14 could achieve 200 effective compressions. Nearly all of the 23 subjects who could not perform conventional chest compressions were able to achieve effective chest compressions using alternate methods. Conclusion: A weight below 40kg resulted in a declining ability to perform standard chest compressions effectively. For small resuscitators, the jumping and squat-bouncing methods resulted in sufficient compressions most of the time; however, chest recoil and injuries are concerns.

Abstract 20: Peripheral Intravenous Analysis Detects Return of Spontaneous Circulation Without Interruption of Chest Compressions in a Rat Model of Cardiopulmonary Resuscitation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Claudius Balzer ◽  
Franz J Baudenbacher ◽  
Antonio Hernandez ◽  
Michele M Salzman ◽  
Matthias L Riess ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Venous Pressure ◽  
Fold Increase ◽  
Spontaneous Circulation ◽  
Arterial Line ◽  
Chest Compressions ◽  
Waveform Data ◽  
Return Of Spontaneous Circulation

Introduction: A higher chest compression fraction (CCF) or percentage of time providing chest compressions is associated with improved survival after cardiac arrest (CA). Pauses in chest compression duration during cardiopulmonary resuscitation (CPR) to palpate a pulse can reduce the CCF. Peripheral Intravenous Analysis (PIVA) is a novel method for determining cardiac and volume status using waveforms from a standard peripheral intravenous (IV) line. We hypothesize that PIVA will demonstrate the onset of return of spontaneous circulation (ROSC) without interruption of CPR. Methods: Eight Zucker Diabetic Fatty (ZDF) rats (4 lean, 4 diabetic) were intubated, ventilated, and cannulated with a 24g IV in the tail vein and a 22g IV in the femoral artery, each connected to a TruWave pressure transducer. Mechanical ventilation was discontinued to achieve CA. After 8 minutes, CPR began with mechanical ventilation, IV epinephrine, and chest compressions using 1.5 cm at 200 times per minute until mean arterial pressure (MAP) increased to 120 mmHg per arterial line. All waveforms were recorded and analyzed in LabChart. PIVA was measured using a Fourier transform of the peripheral venous waveform. Data are mean ± SD. Statistics: Unpaired student’s t-test (two-tailed), α = 05. Results: CA and ROSC were achieved in all 8 rats. Within 1 minute of CPR, there was a 70 ± 35 fold increase/decrease in PIVA during CPR that was temporally associated with ROSC. Within 8 ± 13 seconds of a reduction in PIVA, there was a rapid increase in end-tidal CO 2 . In all rats, ROSC occurred within 38 ± 9 seconds of the maximum PIVA value. Peripheral venous pressure decreased by 1.2 ± 0.9 mmHg during resuscitation and ROSC, which was not significant different at p=0.05. Conclusion: In this pilot study, PIVA detected ROSC without interrupting CPR. Use of PIVA may obviate the need pause CPR for pulse checks, and may result in a higher CCF and survival. Future studies will focus on PIVA and CPR efficacy.

scholarly journals An alternative method of chest compression from over-the-head during cardiopulmonary resuscitation

2019 ◽  
Author(s):  
Michał Ćwiertnia ◽  
Marek Kawecki ◽  
Tomasz Ilczak ◽  
Monika Mikulska ◽  
Mieczyslaw Dutka ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Artificial Respiration ◽  
Hand Position ◽  
Chest Compressions ◽  
Confined Spaces ◽  
Medical Response ◽  
Emergency Interventions ◽  
The Subject

Abstract Background Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial respiration using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient’s side, with compression carried out from behind the patient’s head. Methods The subject of the study were two methods of CPR – ‘standard’ (STD) and ‘over-the-head’ (OTH). The STD method consisted of 30 chest compressions from the patient’s side, and two attempts at artificial respiration after moving round to behind the patient’s head. In the OTH method, both compression and respiration were conducted from behind the patient’s head. Results Both CPR methods were conducted by 38 paramedics working in medical response teams. The average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p<0.001); the depth of compression 50–60 mm (STD 50.65%, OTH 60.22%, p<0.001); the rate of compression 100–120/min. (STD 46.39%, OTH 53.78%, p<0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p<0.001); correct hand position (STD 99.32%, OTH method 99.66%, p<0.001). The remaining parameters showed no significant differences in comparison to reference values. Conclusions The demonstrated higher quality of CPR in the simulated research using the OTH method conducted by one person justifies the use of this method in a wider range of emergency interventions than only for CPR conducted in confined spaces.

scholarly journals USING CHEST COMPRESSIONS WITH ASYNCHRONOUS VENTILATION AT VARIOUS CHEST COMPRESSION RATES (90, 100, 120/MIN) – A RANDOMIZED CONTROLLED ANIMAL TRIAL

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e27-e28
Author(s):  
Sparsh Patel ◽  
Po-Yin Cheung ◽  
Tze-Fun Lee ◽  
Matteo Pasquin ◽  
Megan O’Reilly ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Porcine Model ◽  
Life Support ◽  
Neonatal Resuscitation ◽  
Chest Compressions ◽  
Neonatal Asphyxia ◽  
Significant Difference ◽  
Post Test ◽  
The Mean

Abstract BACKGROUND The current Pediatric Advanced Life Support guidelines recommends that newborns who require cardiopulmonary resuscitation (CPR) in settings (e.g., prehospital, Emergency department, or paediatric intensive care unit, etc.) should receive continuous chest compressions with asynchronous ventilations (CCaV) if an advanced airway is in place. However, this has never been examined in a newborn model of neonatal asphyxia. OBJECTIVES To determine if CCaV at rates of 90/min or 120/min compared to current standard of 100/min will reduce the time to return of spontaneous circulation (ROSC) in a porcine model of neonatal resuscitation. DESIGN/METHODS Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia, which was achieved by clamping the endotracheal tube until asystole. Piglets were randomized into 3 CCaV groups: chest compression (CC) at a rate of 90/min (CCaV 90,n=7), of 100/min (CCaV 100,n=7), of 120/min (CCaV 120,n=7), or sham-operated group. A two-step randomization process with sequentially numbered, sealed brown envelope was used to reduce selection bias. After surgical instrumentation and stabilization an envelope containing the allocation “sham” or “intervention” was opened (step one). The sham-operated group had the same surgical protocol, stabilization, and equivalent experimental periods without hypoxia and asphyxia. Only piglets randomized to “intervention” underwent hypoxia and asphyxia. Once the criteria for CPR were met, a second envelope containing the group allocations was opened (step two). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. RESULTS The mean (±SD) duration of asphyxia was similar between the groups with 260 (±133)sec, 336 (±217)sec, and 231 (±174)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). The mean (SD) time to ROSC was also similar between groups 342 (±345)sec, 312 (±316)sec, and 309 (±287)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). Overall, 5/7 in the CCaV 90, 5/7 in CCaV 100, and 5/7 in the CCaV 120 survived. CONCLUSION There was no significant difference in time to ROSC for either chest compression technique during cardiopulmonary resuscitation in a porcine model of neonatal asphyxia.

scholarly journals Chest Compressions in the Delivery Room

Children ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. 4 ◽  
Author(s):  
Catalina Garcia-Hidalgo ◽  
Georg M. Schmölzer
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Mode Of Action ◽  
Poor Prognosis ◽  
Delivery Room ◽  
Chest Compressions ◽  
Optimal Depth ◽  
The Poor ◽  
Sustained Inflation ◽  
High Incidence

Annually, an estimated 13–26 million newborns need respiratory support and 2–3 million newborns need extensive resuscitation, defined as chest compression and 100% oxygen with or without epinephrine in the delivery room. Despite such care, there is a high incidence of mortality and neurologic morbidity. The poor prognosis associated with receiving chest compression alone or with medications in the delivery room raises questions as to whether improved cardiopulmonary resuscitation methods specifically tailored to the newborn could improve outcomes. This review discusses the current recommendations, mode of action, different compression to ventilation ratios, continuous chest compression with asynchronous ventilations, chest compression and sustained inflation optimal depth, and oxygen concentration during cardiopulmonary resuscitation.

scholarly journals Comparison of standard and over-the-head method of chest compressions during cardiopulmonary resuscitation - a simulation study

2019 ◽  
Author(s):  
Michał Ćwiertnia ◽  
Marek Kawecki ◽  
Tomasz Ilczak ◽  
Monika Mikulska ◽  
Mieczysław Dutka ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Artificial Ventilation ◽  
Hand Position ◽  
Chest Compressions ◽  
Confined Spaces ◽  
Medical Response ◽  
Significant Difference ◽  
Emergency Interventions

Abstract Background: Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial ventilation using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient’s side with compression conducted from the ‘over-the-head’ position. Methods: The subject of the study were two methods of CPR – ‘standard’ (STD) and ‘over-the-head’ (OTH). The STD method consisted of cycles of 30 chest compressions from the patient’s side, and two attempts at artificial ventilation after moving round to behind the patient’s head. In the OTH method, both compression and ventilation were conducted from behind the patient’s head. Results: Both CPR methods were conducted by 38 paramedics working in medical response teams. Statistical analysis was conducted on the data collected, giving the following results: the average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p < 0.001); the depth of compression 50–60 mm (STD 50.65%, OTH 60.22%, p < 0.001); the rate of compression 100–120/min. (STD 46.39%, OTH 53.78%, p < 0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p < 0.001); correct hand position (STD 99.32%, OTH method 99.66%, p < 0.001). A statistically significant difference was demonstrated in the results to the benefit of the OTH method in the above parameters. The remaining parameters showed no significant differences in comparison to reference values. Conclusions: The demonstrated higher quality of CPR in the simulated research using the OTH method conducted by one person justifies the use of this method in a wider range of emergency interventions than only for CPR conducted in confined spaces.

scholarly journals Can the British Heart Foundation PocketCPR application improve the performance of chest compressions during bystander resuscitation: A randomised crossover manikin study

2016 ◽  
Vol 24 (1) ◽  
pp. 14-23 ◽  
Author(s):  
Georgette Eaton ◽  
John Renshaw ◽  
Pete Gregory ◽  
Tim Kilner
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
British Heart Foundation ◽  
Chest Compressions ◽  
Manikin Study ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Heart Foundation

This study aims to determine whether the British Heart Foundation PocketCPR training application can improve the depth and rate of chest compression and therefore be confidently recommended for bystander use. A total of 118 candidates were recruited into a randomised crossover manikin trial. Each candidate performed cardiopulmonary resuscitation for 2 min without instruction or performed chest compressions using the PocketCPR application. Candidates then performed a further 2 min of cardiopulmonary resuscitation within the opposite arm. The number of chest compressions performed improved when PocketCPR was used compared to chest compressions when it was not (44.28% vs 40.57%, p < 0.001). The number of chest compressions performed to the required depth was higher in the PocketCPR group (90.86 vs 66.26). The British Heart Foundation PocketCPR application improved the percentage of chest compressions that were performed to the required depth. Despite this, more work is required in order to develop a feedback device that can improve bystander cardiopulmonary resuscitation without creating delay.

scholarly journals Rhythm Analysis during Cardiopulmonary Resuscitation Using Convolutional Neural Networks

Entropy ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 595
Author(s):  
Iraia Isasi ◽  
Unai Irusta ◽  
Elisabete Aramendi ◽  
Trygve Eftestøl ◽  
Jo Kramer-Johansen ◽  
...  
Keyword(s):  
Neural Networks ◽  
Cardiopulmonary Resuscitation ◽  
Convolutional Neural Networks ◽  
Chest Compression ◽  
Compression Therapy ◽  
Recursive Least Squares ◽  
Chest Compressions ◽  
Baseline Model ◽  
Sensitivity Specificity ◽  
Fully Connected

Chest compressions during cardiopulmonary resuscitation (CPR) induce artifacts in the ECG that may provoque inaccurate rhythm classification by the algorithm of the defibrillator. The objective of this study was to design an algorithm to produce reliable shock/no-shock decisions during CPR using convolutional neural networks (CNN). A total of 3319 ECG segments of 9 s extracted during chest compressions were used, whereof 586 were shockable and 2733 nonshockable. Chest compression artifacts were removed using a Recursive Least Squares (RLS) filter, and the filtered ECG was fed to a CNN classifier with three convolutional blocks and two fully connected layers for the shock/no-shock classification. A 5-fold cross validation architecture was adopted to train/test the algorithm, and the proccess was repeated 100 times to statistically characterize the performance. The proposed architecture was compared to the most accurate algorithms that include handcrafted ECG features and a random forest classifier (baseline model). The median (90% confidence interval) sensitivity, specificity, accuracy and balanced accuracy of the method were 95.8% (94.6–96.8), 96.1% (95.8–96.5), 96.1% (95.7–96.4) and 96.0% (95.5–96.5), respectively. The proposed algorithm outperformed the baseline model by 0.6-points in accuracy. This new approach shows the potential of deep learning methods to provide reliable diagnosis of the cardiac rhythm without interrupting chest compression therapy.

scholarly journals Comparison of standard and over-the-head method of chest compressions during cardiopulmonary resuscitation - a simulation study

2019 ◽  
Author(s):  
Michał Ćwiertnia ◽  
Marek Kawecki ◽  
Tomasz Ilczak ◽  
Monika Mikulska ◽  
Mieczysław Dutka ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Artificial Ventilation ◽  
Hand Position ◽  
Chest Compressions ◽  
Medical Response ◽  
Single Person ◽  
Significant Difference ◽  
Emergency Interventions

Abstract Background: Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial ventilation using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient’s side with compression conducted from the ‘over-the-head’ position. Methods: The subject of the study were two methods of CPR – ‘standard’ (STD) and ‘over-the-head’ (OTH). The STD method consisted of cycles of 30 chest compressions from the patient’s side, and two attempts at artificial ventilation after moving round to behind the patient’s head. In the OTH method, both compressions and ventilations were conducted from behind the patient’s head. Results: Both CPR methods were conducted by 38 paramedics working in medical response teams. Statistical analysis was conducted on the data collected, giving the following results: the average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p < 0.001); the depth of compression 50–60 mm (STD 50.65%, OTH 60.22%, p < 0.001); the rate of compression 100–120/min. (STD 46.39%, OTH 53.78%, p < 0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p < 0.001); correct hand position (STD 99.32%, OTH method 99.66%, p < 0.001). A statistically significant difference was demonstrated in the results to the benefit of the OTH method in the above parameters. The remaining parameters showed no significant differences in comparison to reference values. Conclusions: The higher quality of CPR in the simulated research using the OTH method by a single person justifies the use of this method in a wider range of emergency interventions.

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