Efficacy of and Satisfaction with an In-house Developed Natural Rubber Cardiopulmonary Resuscitation Manikin

Introduction: A barrier to cardiopulmonary resuscitation (CPR) training in low-income countries is limited resources. Our goal was to build a CPR training model of simple design that would provide a good feedback system. Methods: We developed a low-cost, Basic Life Support training manikin made entirely of natural rubber. Our in-house manikin provides feedback when performing correct chest compression and rescue breathing. The properties of the manikin were tested using simulated chest compression in a laboratory and compared with a commercial manikin. Forty healthy nurse volunteers with CPR experience performed CPR in both types of manikins and responded to questionnaires. Results: A tensile test in a laboratory demonstrated that both types of manikins had acceptable ranges of properties for real-situation CPR in cardiac arrest patients. There were no differences in aesthetic properties, and the manikins felt to the volunteers like a real patient when they were performing chest compression. The feedback response was clear when chest compressions and rescue breathing were performed correctly, and the overall satisfaction with the manikin was good. In addition, the mean scores in terms of the manikin feeling like a real patient when performing rescue breathing and the positive feedback from the rubber manikin were statistically higher than those for the commercial manikin (p=0.001 vs. p=0.023). Conclusion: The in-house developed CPR manikin employing real-time feedback by simple mechanics is effective compared with a commercial manikin. The advantage of our manikin is that it is easy to build and costs substantially less than a commercial manikin. The use of an in-house developed manikin could make effective CPR training more available in limited-resource areas.

Abstract 214: Basic Life Support Instructors Overestimate Their Own Ability to Perform Cardiopulmonary Resuscitation

Introduction: High-quality cardiopulmonary resuscitation (CPR) increases survival from cardiac arrest. Laypeople attend basic life support (BLS) courses to learn CPR, but unfortunately, skill quality and retention are often poor. BLS instructors teach by demonstrating CPR skills. However, BLS instructors’ ability to correctly demonstrate CPR remains to be investigated. Aim: To determine BLS instructors’ competence in demonstrating CPR skills. Methods: Certified BLS instructors were asked to demonstrate CPR on a resuscitation manikin (AMBU ® Man, AMBU) in a simulated teaching setting but without verbal explanations. Data on CPR quality was collected from the manikin and the first three cycles of CPR were analyzed. Correct CPR was defined according to the European Resuscitation Council 2015 Guidelines: chest compression (CC) depth of 50-60 mm, CC rate of 100-120 min -1 , and rescue breath volume of 500-600 mL. Instructors were asked to rate their own ability to perform CPR on a 5-point Likert scale before the demonstration and after receiving a performance report thereof. Results: Data from 125 certified instructors were analyzed. Median instructor age was 45 years (Q1;Q3: 30;56), 72% were male, and instructor experience was 8 years (3;14) with a median of 14 courses/year (6;44)). Mean CC depth was 64 mm (SD: 7.3). In total, 22% of chest compressions were performed within guideline recommendations (72% were too deep and 5% were too shallow). Mean CC rate was 115 min -1 (10.8). Full recoil was achieved in 86% of CCs. Of all attempted rescue breaths, 94% resulted in any amount of air registered (mean volume: 499 mL (291)). Only 11% of rescue breaths were within guideline recommendations (52% were too shallow and 37% were excessive). Instructors rated their ability to perform CCs lower after receiving a performance report (p=0.02). Similarly, ratings of rescue breathing ability were lower after receiving a performance report (p=0.01). Conclusion: Certified and experienced BLS instructors performed CC with excessive depth, but with acceptable CC rate and recoil. Instructors were unable to correctly demonstrate rescue breathing. Instructors overrated their ability to demonstrate correct CPR even when provided with their own CPR performance report.

CPR with Chest Compression Alone or with Rescue Breathing

The benefit of rescue breathing performed by the layperson during cardiopulmonary resuscitation (CPR) is uncertain. The study article by Rea et al. compared the outcomes of 1941 patients randomly assigned to a compression-only CPR approach versus the traditional compression and rescue breath CPR performed by laypeople. The authors found no significant difference in the percentage of patients who survived until hospital discharge or in the proportion who survived with a favorable neurologic outcome. However, there was a trend toward improved outcomes in patients with shockable rhythms and cardiac causes of arrest in the compression only group. The results support a strategy compression-only CPR when performed by laypersons versus the traditional compression and rescue breath CPR.

On-Scene Rescue Breathing Resulting in Gastric Perforation and Massive Pneumoperitoneum

Rescue breathing performed too vigorously or by untrained individuals may cause gastric distension and perforation. A 26-year-old woman is presented who developed acute abdominal pain and distension after receiving rescue breathing following a heroin overdose. Massive pneumoperitoneum was seen on chest x-ray, and on subsequent laparotomy, a 4cm laceration was found in the lesser curvature of the stomach. Review of the literature suggests that the lesser curvature is particularly susceptible to perforation following over-distension. Emergency personnel should be aware of this rare, but serious, complication. Expansion of community and first responder naloxone use in the proper clinical setting may further diminish utilization of rescue breathing.ButterfieldM, PeredyT. On-scene rescue breathing resulting in gastric perforation and massive pneumoperitoneum. Prehosp Disaster Med. 2017;32(6):682–683.