scholarly journals LO67: The impact of CPR quality during entire resuscitation episode on survival from cardiac arrest

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S51
Author(s):  
I. Drennan ◽  
A.K. Taher ◽  
S. Cheskes ◽  
C. Zhan ◽  
A. Byers ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Patient Survival ◽  
P Value ◽  
High Quality ◽  
Compression Depth ◽  
Entire Duration ◽  
Cpr Quality ◽  
The Impact

Introduction: High-quality cardiopulmonary resuscitation (CPR) is essential for patient survival. Typically, CPR quality is only measured during the first 10 minutes of resuscitation. There is limited research examining the quality of CPR over the entire duration of resuscitation.Objective: To examine the quality of CPR over the entire duration of resuscitation and correlate the quality of CPR to patient survival. Methods: This was a retrospective observational study using data from the Toronto RescuNET Epistry-Cardiac Arrest database. We included consecutive, adult (>18) OHCA treated by EMS between January 1, 2014 and September 30, 2015. High-quality CPR was defined, in accordance with 2015 AHA Guidelines, as a chest compression rate of 100-120/min, depth of 5.0-6.0 cm and chest compression fraction (ccf) of >0.80. We further categorized high-quality resuscitation as meeting benchmarks >80% of the time, moderate-quality between 50-80% and low-quality meeting benchmarks <50% of the resuscitation. We used multivariable logistic regression to determine association between variables of interest, including CPR quality metrics, and survival to hospital discharge. Results: A total of 5,208 OHCA met our inclusion criteria with a survival rate of 8%. The median (IQR) duration of resuscitation was 23.0 min (15.0,32.7). Overall CPR quality was considered high-quality for ccf in 81% of resuscitation episodes, 41% for rate, and 7% for depth. The percentage of resuscitations meeting the quality benchmarks differed between survivors and non-survivors for both depth (15% vs 6%) and ccf (61% vs 83%) (P value <0.001). After controlling for Utstein variables maintaining a chest compression depth within recommendations for >80% showed a trend towards improved survival (OR 1.68, 95% CI 0.96, 2.92). Other variables associated with survival were public location, initial CPR by EMS providers or bystanders, witnessed cardiac arrest (EMS or bystander), and initial shockable rhythm. Increasing age and longer duration of resuscitation were associated with decreased survival. Conclusion: Overall, EMS providers were not able to maintain rate or depth within guideline recommendations for the majority of the duration of resuscitation. Maintaining chest compression depth for greater than 80% of the resuscitation showed a trend towards increased survival from OHCA.

scholarly journals Effect of the Use of Metronome Feedback on the Quality of Pediatric Cardiopulmonary Resuscitation

2021 ◽  
Vol 18 (15) ◽  
pp. 8087
Author(s):  
Dongjun Yang ◽  
Wongyu Lee ◽  
Jehyeok Oh
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Healthcare Providers ◽  
Compression Rate ◽  
Audio Feedback ◽  
Simple Method ◽  
Compression Depth ◽  
Pediatric Resuscitation ◽  
Cpr Quality

Although the use of audio feedback with devices such as metronomes during cardiopulmonary resuscitation (CPR) is a simple method for improving CPR quality, its effect on the quality of pediatric CPR has not been adequately evaluated. In this study, 64 healthcare providers performed CPR (with one- and two-handed chest compression (OHCC and THCC, respectively)) on a pediatric resuscitation manikin (Resusci Junior QCPR), with and without audio feedback using a metronome (110 beats/min). CPR was performed on the floor, with a compression-to-ventilation ratio of 30:2. For both OHCC and THCC, the rate of achievement of an adequate compression rate during CPR was significantly higher when performed with metronome feedback than that without metronome feedback (CPR with vs. without feedback: 100.0% (99.0, 100.0) vs. 94.0% (69.0, 99.0), p < 0.001, for OHCC, and 100.0% (98.5, 100.0) vs. 91.0% (34.5, 98.5), p < 0.001, for THCC). However, the rate of achievement of adequate compression depth during the CPR performed was significantly higher without metronome feedback than that with metronome feedback (CPR with vs. without feedback: 95.0% (23.5, 99.5) vs. 98.5% (77.5, 100.0), p = 0.004, for OHCC, and 99.0% (95.5, 100.0) vs. 100.0% (99.0, 100.0), p = 0.003, for THCC). Although metronome feedback during pediatric CPR could increase the rate of achievement of adequate compression rates, it could cause decreased compression depth.

scholarly journals Effect of Acute Exposure to Altitude on the Quality of Chest Compression‐Only Cardiopulmonary Resuscitation in Helicopter Emergency Medical Services Personnel: A Randomized, Controlled, Single‐Blind Crossover Trial

2021 ◽  
Author(s):  
Anna Vögele ◽  
Michiel Jan van Veelen ◽  
Tomas Dal Cappello ◽  
Marika Falla ◽  
Giada Nicoletto ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Chest Compression ◽  
Acute Exposure ◽  
Medical Services ◽  
Compression Depth ◽  
Helicopter Emergency Medical Services ◽  
Emergency Medical ◽  
Emergency Medical Services Personnel ◽  
Cpr Quality

Background Helicopter emergency medical services personnel operating in mountainous terrain are frequently exposed to rapid ascents and provide cardiopulmonary resuscitation (CPR) in the field. The aim of the present trial was to investigate the quality of chest compression only (CCO)‐CPR after acute exposure to altitude under repeatable and standardized conditions. Methods and Results Forty‐eight helicopter emergency medical services personnel were divided into 12 groups of 4 participants; each group was assigned to perform 5 minutes of CCO‐CPR on manikins at 2 of 3 altitudes in a randomized controlled single‐blind crossover design (200, 3000, and 5000 m) in a hypobaric chamber. Physiological parameters were continuously monitored; participants rated their performance and effort on visual analog scales. Generalized estimating equations were performed for variables of CPR quality (depth, rate, recoil, and effective chest compressions) and effects of time, altitude, carryover, altitude sequence, sex, qualification, weight, preacclimatization, and interactions were analyzed. Our trial showed a time‐dependent decrease in chest compression depth ( P =0.036) after 20 minutes at altitude; chest compression depth was below the recommended minimum of 50 mm after 60 to 90 seconds (49 [95% CI, 46–52] mm) of CCO‐CPR. Conclusions This trial showed a time‐dependent decrease in CCO‐CPR quality provided by helicopter emergency medical services personnel during acute exposure to altitude, which was not perceived by the providers. Our findings suggest a reevaluation of the CPR guidelines for providers practicing at altitudes of 3000 m and higher. Mechanical CPR devices could be of help in overcoming CCO‐CPR quality decrease in helicopter emergency medical services missions. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04138446.

scholarly journals The Impact of CPR Position (Kneeling, Footstool and Standing Beside Bed) on Cardiopulmonary Resuscitation Quality: A Literature Review

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Ristina Mirwanti
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Literature Review ◽  
Standing Position ◽  
The Body ◽  
Essential Point ◽  
Elbow Movement ◽  
Cpr Quality ◽  
The Impact

Background: Cardiopulmonary Resuscitation (CPR) is one of the measures to deal with emergency cardiac arrest (cardiac arrest) where the heart organ loses its function suddenly. Hence it is unable to pump blood throughout the body. CPR consists of aid in circulation (compression) and breathing (ventilation). AHA has determined guidelines for implementing CPR, especially an essential point in CPR, namely chest compression. The standing position is fundamental in the implementation of CPR, but kneeling and footstool positions can be carried out during CPR implementation. This paper aims to show the impact of standing, kneeling, and footstool positions on CPR quality.Method: The method used is by searching journals in Science Direct, PubMed, and Google Scholar. The keywords used are CPR, Kneeling Position, Footstool, standing beside the bed Obtained eight selected journals according to the topic, then analyzed.Results: Based on the search result, eight articles meet the criteria. The literature review results showed three positions that can be chosen when conducting CPR: standing, kneeling, and footstool. Those positions could give impact toward helper: pain level and exhaustion degree, and quality of CPR: compression strength, depth of compression, amount of compression, chest recoil, elbow movement, and movement in the lower back.Conclusion: Three CPR positions can be done, including standing beside the bed, kneeling, and standing on stepstool footing. Each position gives impacts both to helper condition and CPR quality. Researchers recommend standing on stepstool footing due to it provides the best effect on CPR quality.

Abstract 109: Pediatric CPR in the Emergency Department: Initial Findings From the Videography in Pediatric Emergency Research Collaborative

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Karen J O’Connell ◽  
Benjamin T Kerrey ◽  
Sage R Myers ◽  
Alexis B Sandler ◽  
Richard Hanna ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Pediatric Emergency ◽  
Ventilation Rate ◽  
Older Children ◽  
High Quality ◽  
Video Review ◽  
Cpr Quality ◽  
The Impact ◽  
Monitor Device

Introduction: Cardiopulmonary resuscitation (CPR) is frequently performed in a manner inconsistent with American Heart Association (AHA) guidelines. Published studies on CPR quality during pediatric cardiac arrest using chest compression (CC) monitor devices have reported data in aggregate form from entire CPR events. The addition of video review allows precise measurement of CPR quality at the level of individual providers. Hypothesis: To measure individual healthcare providers’ (HCP) CPR quality during pediatric cardiac arrest events in actual patients in the emergency department (PED) and describe adherence to AHA guidelines. Methods: A report from the Videography in Pediatric Emergency Resuscitation (VIPER) Collaborative, a prospective observational database from three tertiary PEDs. All study sites videorecord and review resuscitations and use a pressure sensor/monitor device during CPR. All events where chest compressions (CC) were performed under videorecorded conditions with the monitor device in use were eligible for inclusion. Data on CPR performance was collected by a combination of video review and monitor device; CC rate and depth and ventilation rate were extracted in time periods corresponding to individual CPR providers. CPR segments were defined as ‘high-quality’ if all AHA guidelines were achieved (CC rate 100-120 cpm; CC depth >= 1.5 inches for infants or >= 2 inches for children; ventilation rate 8-12 bpm, no pauses > 10 seconds). Results: Between August 2016 and April 2018, complete data was available for 31 events (infants: n=5; older children: n=6). 279 compression segments were analyzed. Median CC rate was 119 cpm (IQR 110 – 129); median depth was 1.0 inches in infants (IQR 0.85 – 1.2) and 2.1 inches in older children (IQR 1.4 – 2.4). Median ventilation rate was 15 bpm (IQR 10 - 30). 22/279 (8%) compression segments met all criteria for high-quality CPR. Conclusions: PED HCPs infrequently met AHA guidelines for CPR quality. Future studies using video review and CC monitor data collection should examine the impact of specific training strategies on provider-level CPR performance during pediatric cardiac arrest.

scholarly journals Evaluation of the quality of cardiopulmonary resuscitation according to vehicle driving pattern, using a virtual reality ambulance driving system: a prospective, cross-over, randomised study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023784 ◽  
Author(s):  
Jin Ho Beom ◽  
Min Joung Kim ◽  
Je Sung You ◽  
Hye Sun Lee ◽  
Ji Hoon Kim ◽  
...  
Keyword(s):  
Chest Compression ◽  
Fire Service ◽  
Quality Parameters ◽  
Hand Position ◽  
Sudden Stop ◽  
Compression Depth ◽  
Randomised Study ◽  
Cpr Quality ◽  
Service Academy

ObjectivesTo analyse changes in the quality of cardiopulmonary resuscitation (CPR) according to driving patterns encountered during ambulance transport, using a virtual reality simulator.DesignProspective, cross-over, randomised study.SettingThis study was conducted at the National Fire Service Academy, Cheonan-si, Korea.ParticipantsEmergency medical technicians (39 men and 9 women) attending the National Fire Service Academy for clinical training with ≥6 months field experience or having performed ≥10 CPR. Individuals who withdrew consent were excluded.Outcome measuresCPR quality parameters (eg, chest compression depth and its variability).ResultsChest compressions were performed for 8 min each in a stationary and driving state. The mean chest compression depths were 54.8 mm and 55.3 mm during these two states, respectively (p=0.41). The SD of the chest compression depth was significantly higher while in the driving (7.6 mm) than in the stationary state (6.5 mm; p=0.04). The compression depths in the speed bump and sudden stop sections were 51.5 mm and 50.6 mm, respectively, which was shallower than those in all other sections (p<0.001). The correct hand position rate was low in the speed bump, sudden stop and right-hand cornering sections (65.4%, 71.5% and 72.5%, respectively; p=0.001)ConclusionsAlthough we found no differences in chest compression quality parameters between the stationary and driving states, the variability in the chest compression depth increased in the driving state. When comparing CPR quality parameters according to driving patterns, we noted a shallower compression depth, increased variability and decreased correct hand position rate in the speed bump, sudden stop and right-hand cornering sections. The clinical significance of these changes in CPR quality during ambulance transport remains to be determined. Future studies on how to reduce changes in the quality of CPR (including research on equipment development) are needed.

Assessing the quality of CPR performed by a single lifeguard, two lifeguards and a lifeguard with a bystander after water rescue: a quasi-experimental trial

2020 ◽  
pp. emermed-2018-207939 ◽  
Author(s):  
Shuang Li ◽  
Ting Kan ◽  
Zijian Guo ◽  
Chulin Chen ◽  
Li Gui
Keyword(s):  
Lower Percentage ◽  
Baseline Measurement ◽  
Compression Depth ◽  
Quasi Experimental ◽  
Water Rescue ◽  
Cpr Quality ◽  
Repeated Analysis ◽  
Cpr Training ◽  
The Impact

BackgroundHigh-quality cardiopulmonary resuscitation (CPR) could improve survival of drowning victims. The purpose of the study is to assess the impact of fatigue caused by water rescue on subsequent CPR quality and the influence of a bystander’s participation on CPR quality in a lifeguard rescue.MethodsThis was a simulated quasi-experimental study with a sample of 14 lifeguards and 13 laypersons. Each lifeguard performed 2 min single-rescuer CPR as baseline measurement. In three separate trials, a single lifeguard swam 50 m to perform a water rescue in a pool and returned with the manikin another 50 m. After each rescue, 10 min of CPR was performed by a single lifeguard, two lifeguards or a lifeguard with a layperson with no CPR training. Paired t-test and repeated analysis of variance were used to analyse CPR quality variables.ResultsBaseline CPR quality was adequate for most measures except compression depth and re-expansion. After water rescue, the single lifeguard trial showed no significant differences compared with baseline. CPR score and ventilation score of the single-lifeguard trial was higher than that of the lifeguard-bystander trial (p=0.027, p<0.001). Both the two-lifeguard trial (p=0.025), and lifeguard-bystander trial (p=0.010) had a lower percentage of breaths with correct ventilation volume and higher percentage of breaths with excessive ventilation volume (p=0.007, p=0.011, respectively) than the single-lifeguard trial. No-flow time of the lifeguard-bystander trial was longer than other trials (p<0.001).ConclusionsAlthough CPR given by the lifeguard was not optimal, fatigue generated by a water rescue has no impact on the quality of subsequent CPR performed by a trained lifeguard for 10 min. Untrained bystanders assisting in CPR in a drowning event is unlikely to be helpful.

scholarly journals Smartphone apps to support laypersons in bystander CPR are of ambivalent benefit: a controlled trial using medical simulation

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Camilla Metelmann ◽  
Bibiana Metelmann ◽  
Louisa Schuffert ◽  
Klaus Hahnenkamp ◽  
Marcus Vollmer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Real Time ◽  
Chest Compression ◽  
Controlled Trial ◽  
Control Group ◽  
Smartphone Apps ◽  
Resuscitation Training ◽  
The Impact ◽  
Off Time

Abstract Background Bystander-initiated resuscitation is essential for surviving out-of-hospital cardiac arrest. Smartphone apps can provide real-time guidance for medical laypersons in these situations. Are these apps a beneficial addition to traditional resuscitation training? Methods In this controlled trial, we assessed the impact of app use on the quality of resuscitation (hands-off time, assessment of the patient’s condition, quality of chest compression, body and arm positioning). Pupils who have previously undergone a standardised resuscitation training, encountered a simulated cardiac arrest either (i) without an app (control group); (ii) with facultative app usage; or (iii) with mandatory app usage. Measurements were compared using generalised linear regression. Results 200 pupils attended this study with 74 pupils in control group, 65 in facultative group and 61 in mandatory group. Participants who had to use the app significantly delayed the check for breathing, call for help, and first compression, leading to longer total hands-off time. Hands-off time during chest compression did not differ significantly. The percentage of correct compression rate and correct compression depth was significantly higher when app use was mandatory. Assessment of the patient’s condition, and body and arm positioning did not differ. Conclusions Smartphone apps offering real-time guidance in resuscitation can improve the quality of chest compression but may also delay the start of resuscitation. Provided that the app gives easy-to-implement, guideline-compliant instructions and that the user is familiar with its operation, we recommend smartphone-guidance as an additional tool to hands-on CPR-training to increase the prevalence and quality of bystander-initiated CPR.

Abstract 1806: End-tidal Carbon Dioxide as a Measure of Cardiopulmonary Resuscitation Efficacy during Human Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Joshua L Wallbrecht ◽  
Dana P Edelson ◽  
Barbara Litzinger ◽  
Deborah Walsh ◽  
Terry L Vanden Hoek ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Arrest ◽  
Chest Compression ◽  
Compression Rate ◽  
Medical Systems ◽  
Compression Depth ◽  
Mean Values ◽  
End Tidal Carbon Dioxide ◽  
Cpr Quality ◽  
End Tidal

Background: End-tidal carbon dioxide (EtCO 2 ) is a physiologic measure that has potential to serve as an indicator of chest compression efficacy, with higher EtCO 2 values during CPR correlating with improved hemodynamics during prior laboratory studies. EtCO 2 measurement could therefore guide resuscitation efforts and help optimize CPR performance. Objective: To test the hypothesis that EtCO 2 levels positively correlate with improved chest compression rate and depth during human cardiac arrest. Methods: A prospective, observational study was conducted using a commercially available monitor/defibrillator with CPR quality and EtCO 2 sensing capabilities (MRx-QCPR, Philips Medical Systems) during in-hospital cardiac arrests at one hospital from 4/2006 until 8/2006. Resuscitation transcripts were divided into 30-second segments and mean values of chest compression rate and depth and EtCO 2 were derived for each segment. Regression analysis, with cluster-adjustment for individual patients, was used to correlate compression rate and depth with EtCO 2 . Results: Data were collected and analyzed from 281 30-second segments with a median of 12 (interquartile range: 8–33) segments per arrest from 13 consecutive patients for whom EtCO 2 and chest compression data were simultaneously available. Mean EtCO 2 was 19±7 mmHg. After adjusting for compression rate and clustering, there was a positive correlation between compression depth and EtCO 2 (regression coefficient 0.20; 95%CI [−0.01 – 0.42]). There was no significant correlation between compression rate and EtCO 2 after adjusting for compression depth and cluster, nor between survival and EtCO 2 levels. Conclusion: We found that deeper chest compressions correlated with higher EtCO 2 levels. Based on this relationship, changes in EtCO 2 during the actual resuscitation event may be reflective of the CPR quality being delivered. This work also suggests the feasibility of continuous monitoring of physiology during CPR to ensure resuscitation quality.

scholarly journals LO01: Analysis of bystander CPR quality during out-of-hospital cardiac arrest using data derived from automated external defibrillators

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S6-S6
Author(s):  
S. M. Fernando ◽  
C. Vaillancourt ◽  
S. Morrow ◽  
I. G. Stiell
Keyword(s):  
Cardiac Arrest ◽  
Compression Rate ◽  
High Quality ◽  
Shock Delivery ◽  
Automated External Defibrillators ◽  
Resuscitation Guidelines ◽  
Bystander Cpr ◽  
Cpr Quality ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality, and CPR quality is one of the few modifiable factors associated with improved outcomes. Particularly, bystander CPR has been shown to improve survival and neurological outcomes in OHCA. However, the quality of CPR performed by bystanders in OHCA is unknown. We evaluated bystander CPR quality during OHCA, utilizing data stored within Automated External Defibrillators (AEDs), and matched with cases enrolled in the Resuscitation Outcomes Consortium (ROC) database. Methods: This cohort study included adult OHCA cases from the Ottawa ROC site between 2011-2016, which were of presumed cardiac etiology, not witnessed by EMS, and where an AED was utilized by a bystander with > 1 minute of CPR process data available. AED data from Ottawa Paramedic Services was matched to each case identified by the ROC database. AED data was analyzed using manufacturer software to determine overall measures of bystander CPR quality, changes in bystander CPR quality over time, and bystander adherence to existing 2010 Resuscitation Guidelines. Results: 100 cases met all inclusion criteria. 75.0% of patients were male, with a mean age of 62.3 years. 58.0% of arrests occurred in the home setting, and 24.0% were witnessed arrests. Initial rhythm was ventricular fibrillation/ventricular tachycardia in 36.0% of cases. Overall survival rate was 42.0%, with a modified Rankin Score of 3.7 (95% CI: 2.9-4.5). Bystanders demonstrated high-quality CPR over the course of resuscitation, with a chest compression fraction (CCF) of 75.9% (73.6-78.1), a compression depth of 5.26 cm (5.03-5.49), and a compression rate of 111.2/min (107.7-114.7). Mean peri-shock pause was 26.8 seconds (24.6-29.1). Adherence rates to 2010 Resuscitation Guidelines for compression rate and depth were 66.0% (60.9-71.1) and 54.9% (48.6-61.3), respectively. CPR quality was lowest in the first minute of resuscitation, during which rhythm analysis took place (mean 40.5 sec). In cases involving a shockable rhythm, overall latency from initiation of AED to shock delivery was 59.2 sec (45.5-72.8). Conclusion: We found that bystanders perform high-quality CPR, with strong adherence rates to existing Resuscitation Guidelines. Our findings provide evidence of the quality of bystander CPR performed during OHCA.

scholarly journals How Different Fermentation Type Affects Volatile Composition of Plum Jerkums

2021 ◽  
Vol 11 (10) ◽  
pp. 4658
Author(s):  
Magdalena Januszek ◽  
Paweł Satora
Keyword(s):  
Volatile Compounds ◽  
Current Paper ◽  
Higher Alcohols ◽  
High Quality ◽  
Volatile Composition ◽  
Spontaneous Fermentation ◽  
Fermentation Efficiency ◽  
Yeast Strains ◽  
The Impact

Quality of plum jerkum is significantly associated to the profile of volatile compounds. Therefore, we decided to assess the impact of various fermentation types on selected properties of plum jerkums, especially compounds which contribute to the aroma of the finished product. We used the following yeast strains: S. cerevisiae S1, H. uvarum H2, and Ethanol RED (S. cerevisiae). Moreover, we considered spontaneous fermentation. S. cerevisiae and H. uvarum strains were isolated during the fermentation of Čačanska Lepotica or Węgierka Dąbrowicka (plum cultivars), respectively. As for fermentation type, spontaneous fermentation of H. uvarum H2 provided the best results. It could be associated to the fact that plum juices fermented with H. uvarum H2 presented the highest concentration of terpenoids, esters, or some higher alcohols. In the current paper, application of indigenous strains of yeasts resulted in the required oenological characteristics, e.g., highest fermentation efficiency and concentration of ethanol was determined in juices fermented with Ethanol RED (S. cerevisiae) and also with S. cerevisiae S1. Our results suggested that indigenous strains of yeasts present in plums demonstrate great potential for the production of plum jerkums of high quality.

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