The effect of automatic external defibrillator with a real-time feedback on quality of bystander cardiopulmonary resuscitation: A before-and-after simulation study

2019 ◽  
Vol 27 (5) ◽  
pp. e744-e751
Author(s):  
Chu Hyun Kim ◽  
Tae Han Kim ◽  
Sang Do Shin ◽  
Kyoung Jun Song ◽  
Young Sun Ro ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Real Time ◽  
Simulation Study ◽  
Automatic External Defibrillator ◽  
Before And After ◽  
Bystander Cardiopulmonary Resuscitation ◽  
External Defibrillator

Abstract 275: Automated External Defibrillator with Real-Time Audiovisual Feedback System Improves the Quality of Cardiopulmonary Resuscitation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kenji Hayashi ◽  
Hiroaki Ushikoshi ◽  
Naoki Matsumaru ◽  
Sho Nachi ◽  
Hikaru Nachi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Medical Students ◽  
Cardiopulmonary Resuscitation ◽  
Real Time ◽  
Healthcare Professionals ◽  
Feedback System ◽  
Automated External Defibrillator ◽  
Feedback Systems ◽  
External Defibrillator

Background: Public access defibrillation (PAD) with automated external defibrillator (AED) is a widely available and beneficial intervention for cardiac arrest. The quality of chest compressions (CC) is an important determinant of the outcome of cardiopulmonary resuscitation (CPR). In Japan, AED with real-time audiovisual feedback is being implemented, and has been available to bystanders since 2011. However, the benefit of CC feedback systems for laypersons remains unclear. In this study, we sought to determine the effects of audiovisual feedback system on the quality of CC in bystanders with different medical backgrounds. Methods: A total of 478 individuals (151 healthcare professionals [mean age, 31.3 years], 76 medical students [mean age, 23.6 years], and 251 non-healthcare professionals [mean age, 40.1 years]) participated in a CPR quality improvement challenge. Participants performed two 2-min trials of CC on a training manikin equipped with an accelerometer-based system for measuring both rate and depth of CC. Real-time audiovisual feedback was disabled during first trial, but activated during the second trial. The quality of CC was evaluated by counting the number of compressions with the appropriate depth (5.0-10 cm) and rate (100-120 cpm) in each trial. Results: Among all participants, mean depth of CC was higher (6.35 vs. 5.87 cm), and mean rate was lower (102.4 vs. 112.2 cpm) when the feedback system was activated than when it was disabled (p < 0.05). When real-time feedback was activated, non-healthcare professional participants performed CC of greater depth (6.41 vs. 5.63 cm) than healthcare professionals (6.25 vs. 6.09 cm) and medical students (6.34 vs. 6.19 cm) (p < 0.05). The quality index of CC, which the percentage of adequate depth and rate, was also significantly improved regardless medical backgrounds (p < 0.05). Conclusions: The use of real-time CPR feedback systems improves the quality of CC performed by individuals of all backgrounds, especially non-healthcare personnel. PAD with AED providing CPR feedback technologies may elevate the survival rate of out-of-hospital cardiac arrest and increase the likelihood of favorable outcomes.

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

2014 ◽  
Vol 21 (6) ◽  
pp. 382-386 ◽  
Author(s):  
Ch Jo ◽  
Jh Ahn ◽  
Yd Shon ◽  
Gc Cho
Keyword(s):  
Hong Kong ◽  
Cardiopulmonary Resuscitation ◽  
Training Program ◽  
Chest Compression ◽  
Simulation Study ◽  
Hand Position ◽  
Dominant Hand ◽  
Cpr Training

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

Abstract 2688: Automated Rhythm Analysis To Reduce Pauses During Cardiopulmonary Resuscitation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Joseph L Sullivan ◽  
Robert G Walker ◽  
Isabelle L Banville ◽  
Thomas D Rea ◽  
Fred W Chapman
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Current Approach ◽  
Adjacent Segment ◽  
Automatic External Defibrillator ◽  
Predictive Values ◽  
Rhythm Analysis ◽  
External Defibrillator

Background : Pauses in cardiopulmonary resuscitation (CPR) for Automatic External Defibrillator (AED) ECG analysis may adversely affect cardiac arrest resuscitation. Thus, approaches that analyze the ECG rhythm during CPR may improve outcomes. We developed and tested an Analysis During CPR (ADC) algorithm to determine if it would meet the American Heart Association recommended 90% sensitivity for coarse (>0.2 mV peak-peak) ventricular fibrillation (VF) and 95% specificity for non-shockable rhythms. Methods : Defibrillator ECG and impedance recordings from 162 patients were retrospectively gathered from 3 EMS systems. 1047 15-second CPR-artifacted segments (274 coarse VF + 773 non-shockable) were identified for analysis; their artifact and rhythm distributions reflect those found in the 162 patients. Each CPR artifacted segment was paired with an adjacent segment free of CPR artifact for reference. Independent reviewers manually annotated and verified Shock/No-Shock rhythm designations blinded to the ADC determination. The ADC algorithm automatically classified each segment into categories of Shock/No Shock/Pause CPR For Clean Analysis, where the last category is segments recognized by the ADC as too noisy for accurate Shock/No Shock determination. In those situations the device would revert to the current approach of a CPR pause for AED rhythm analysis. Results : Of the 1047 CPR-artifacted segments, the ADC recommended to “Pause CPR For Clean Analysis” in 10% (n=109), including 4.4% of VF segments (12/274) and 12% (97/773) of non-shockable segments. Of the 938 remaining segments, the ADC correctly identified VF in 97% (sensitivity: 255/262) and correctly identified nonshockable rhythms in 96% (specificity: 650/676). Corresponding positive and negative predictive values were 91% and 99% respectively. Conclusions : The ADC is the first algorithm for automated ECG rhythm analysis during ongoing CPR that has been demonstrated to meet the existing AHA sensitivity and specificity recommendations designed for traditional rhythm analysis during hands-off pauses. Incorporation of this algorithm into an AED may eliminate about 90% of analysis pauses without compromising analysis accuracy and in turn may improve the likelihood of resuscitation.

Abstract 2019: Untrained Volunteers Perform High Quality CPR When using an Automatic External Defibrillator with a CPR Voice Prompting Algorithm

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Benjamin S Abella ◽  
Salem Kim ◽  
Alexandra Colombus ◽  
Cheryl L Shea ◽  
Lance B Becker
Keyword(s):  
Real Time ◽  
Patient Outcomes ◽  
Chest Compression ◽  
Automatic External Defibrillator ◽  
Chest Compressions ◽  
High Quality ◽  
Cpr Training ◽  
Adult Volunteers ◽  
Improve Patient ◽  
External Defibrillator

Background: Recent investigations have demonstrated that CPR performance among trained providers can be improved by audiovisual prompting and real-time feedback, and higher quality CPR before defibrillation can improve shock success and has the potential to improve patient outcomes. Objective: We hypothesized that simplified voice prompts incorporated into an automatic external defibrillator (AED) can lead to improvements in CPR performance by untrained lay rescuers. Methods: Adult volunteers with no prior CPR training were assessed in their use of an AED with chest compression voice instructions and metronome prompts on a CPR-recording manikin. Volunteers were given minimal instructions regarding use of the device and were given no instructions regarding CPR performance. The AED was designed to prompt five cycles of 30 chest compressions between defibrillatory attempts. Chest compression rates and depths were measured via review of videotape and manikin recording data, respectively. Results: A total of 60 adults were assessed in their use of the AED, with a mean age of 33.6±12.8; 36/63 (57%) were female. Mean chest compression rate was 103±12 and mean depth was 37±14 mm. Furthermore, minimal decay in chest compression rates occurred over 5 cycles of chest compressions, with mean rate of 101±19 during the first cycle and 104±10 during the 5 th cycle. No volunteers were unable to use the AED or complete 5 cycles of chest compressions. Conclusions: Our work demonstrates that with appropriate real-time prompts delivered even in the absence of training or human coaching, laypersons can perform CPR that has a quality often similar to trained providers. This finding has important implications for AED design especially in light of the renewed importance of both CPR and the interaction of quality chest compressions and defibrillatory success.

Abstract 250: Effect of Coaching on Dispatch-assisted Cardiopulmonary Resuscitation: A Randomized Simulation Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Hidetada Fukushima ◽  
Keisuke Takano ◽  
Hideki Asai
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Simulation Study ◽  
Average Rate ◽  
Sudden Cardiac Arrest ◽  
Video Camera ◽  
Guideline Recommendation ◽  
Compression Depth ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Cpr Training ◽  
Study Participants

Introduction: Immediate bystander cardiopulmonary resuscitation (CPR) is essential for the good outcome of sudden cardiac arrest victims. Current guidelines recommend dispatch-assisted CPR (DACPR). Its quality, however, varies from case to case. The aim of this study was todetermine the effectiveness of dispatch coaching on the quality of CPR by lay rescuers. Methods: We conducted a DACPR simulation study. Participants with no prior CPR training within 1 year were assigned randomly to one of two DACPR simulations (No Coaching Group: callers were told to perform CPR and the dispatcher sometimes confirmed if the caller was performing CPR or Coaching Group: the dispatcher coached, encouraged, and counted out loud with a metronome). The study participants performed CPR for 2 minutes under the study dispatcher. All performances were recorded by video camera and Resusci Anne® QCPR (Laerdal, Norway). Results: Forty-nine participants aged 20s to 50s were recruited, and 48 completed the simulation (Coaching Group, 27, 9 males and No Coaching Group, 21, 16 males). The average rate of chest compressions was 102.5/min in Coaching Group and 109.3/min in No Coaching group (p=0.270). The average compression depth was slightly deeper in Coaching group (43.0mm vs 41.5mm, p=0.695). When compared the average depth of the first 10 compressions to the total average in each group, the depth significantly improved in Coaching group while that decreased in No Coaching Groups (38.4mm to 43.0mm; p=0.020, 42.3mm to 41.5mm; p=0.431, respectively). The chest compression fraction was also high in Coaching Group (99.4% vs 93.0%, p=0.005). Conclusions: Participants in Coaching Group performed better CPR compared to No Coaching Group in terms of high flow fraction. Although the average compression depth was below the guideline recommendation in both groups, it significantly improved in Coaching group. This study indicates that dispatch coaching can optimize the performance of bystander CPR.

scholarly journals Effect of real-time feedback during cardiopulmonary resuscitation training on quality of performances: A prospective cluster-randomized trial

2019 ◽  
Vol 27 (4) ◽  
pp. 187-196
Author(s):  
So Yeon Joyce Kong ◽  
Kyoung Jun Song ◽  
Sang Do Shin ◽  
Young Sun Ro ◽  
Helge Myklebust ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Randomized Trial ◽  
Real Time ◽  
Cluster Randomized Trial ◽  
Group Model ◽  
Feedback Group ◽  
Resuscitation Training ◽  
Objective Feedback ◽  
Cluster Randomized

Background: The evidence supporting delivery of quality cardiopulmonary resuscitation is growing and significant attention has been focused on improving bystander cardiopulmonary resuscitation education for laypeople. The aim of this randomized trial was to assess the effectiveness of instructor’s real-time objective feedback during cardiopulmonary resuscitation training compared to conventional feedback in terms of trainee’s cardiopulmonary resuscitation quality. Methods: We performed a cluster-randomized trial of community cardiopulmonary resuscitation training classes at Nowon District Health Community Center in Seoul. Cardiopulmonary resuscitation training classes were randomized into either intervention (instructor’s objective real-time feedback based on the QCPR Classroom device) or control (conventional, instructor’s judgment-based feedback) group. The primary outcome was total cardiopulmonary resuscitation score, which is an overall measure of chest compression quality. Secondary outcomes were individual cardiopulmonary resuscitation performance parameters, including compression rate, depth, and release. Generalized linear mixed models were used to analyze the outcome data, accounting for both random and fixed effects. Results: A total of 149 training sessions (2613 trainees) were randomized into 70 intervention (1262 trainees) and 79 control (1351 trainees) groups. Trainees in the QCPR feedback group significantly increased overall cardiopulmonary resuscitation score performance compared with those in the conventional feedback group (model-based mean Δ increment from baseline to session 5: 11.2 (95% confidence interval 9.2–13.2) and 8.0 (6.0–9.9), respectively; p = 0.02). Individual parameters of compression depth and release also showed higher improvement among trainees in QCPR group with positive trends (p < 0.08 for both). Conclusion: This randomized trial suggests beneficial effect of instructor’s real-time objective feedback on the quality of layperson’s cardiopulmonary resuscitation performance.

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