Performance of cardiopulmonary resuscitation during prolonged basic life support in military medical university students: A manikin study

BACKGROUND: The quality of chest compressions can be significantly improved after training of rescuers according to the latest national guidelines of China. However, rescuers may be unable to maintain adequate compression or ventilation throughout a response of average emergency medical services because of increased rescuer fatigue. In the present study, we evaluated the performance of cardiopulmonary resuscitation(CPR) in training of military medical university students during a prolonged basic life support(BLS).METHODS: A 3-hour BLS training was given to 120 military medical university students. Six months after the training, 115 students performed single rescuer BLS on a manikin for 8 minutes. The qualities of chest compressions as well as ventilations were assessed.RESULTS: The average compression depth and rate were 53.7±5.3 mm and 135.1±15.7 compressions per minute respectively. The proportion of chest compressions with appropriate depth was 71.7%±28.4%. The average ventilation volume was 847.2±260.4 m L and the proportion of students with adequate ventilation was 63.5%. Compared with male students, significantly lower compression depth(46.7±4.8 vs. 54.6±4.8 mm, P0.001) and adequate compression rate(35.5%±26.5% vs. 76.1%±25.1%, P0.001) were observed in female students.CONCLUSIONS: CPR was found to be related to gender, body weight, and body mass index of students in this study. The quality of chest compressions was well maintained in male students during 8 minutes of conventional CPR but declined rapidly in female students after 2 minutes according to the latest national guidelines. Physical fitness and rescuer fatigue did not affect the quality of ventilation.     

Cardiopulmonary resuscitation using the cardio vent device in a resuscitation model

To compare the “Bellows on Sternum Resuscitation” (BSR) device that permits simultaneous compression and ventilation by one rescuer with two person cardiopulmonary resuscitation (CPR) with bag-valve-mask (BVM) ventilation in a single blind crossover study performed in the laboratory setting. Tidal volume and compression depth were recorded continuously during 12-min CPR sessions with the BSR device and two person CPR. Six CPR instructors performed a total of 1,894 ventilations and 10,532 compressions in 3 separate 12-min sessions. Mean tidal volume (MTV) and compression rate (CR) with the BSR device differed significantly from CPR with the BVM group (1242 mL vs. 1065 mL, respectively, p = 0.0018 and 63.2 compressions per minute (cpm) vs. 81.3 cpm, respectively, p = 0.0076). Error in compression depth (ECD) rate of 9.78% was observed with the BSR device compared to 8.49% with BMV CPR (p = 0.1815). Error rate was significantly greater during the second half of CPR sessions for both BSR and BVM groups. It is concluded that one-person CPR with the BSR device is equivalent to two-person CPR with BVM in all measured parameters except for CR. Both groups exhibited greater error rate in CPR performance in the latter half of 12-min CPR sessions.     

Push-fast recommendation on performing CPR causes excessive chest compression rates,a manikin model

BackgroundIncreasing chest compression rate during cardiopulmonary resuscitation can affect the workload and, ultimately, the quality of chest compression. This study examines the effects of compression at the rate of as-fast-as-you-can on cardiopulmonary resuscitation (CPR) performance.MethodsA crossover, randomized-to-order design was used. Each participant performed chest compressions without ventilation on a manikin with 2 compression rates: 100 per minute (100-cpm) and “push as-fast-as you-can” (PF). The participants performed chest compressions at a rate of either 100-cpm or PF and subsequently switched to the other after a 50-minute rest.ResultsForty-two CPR-qualified nonprofessionals voluntarily participated in the study. During the PF session, the rescuers performed CPR with higher compression rates (156.8 vs 101.6 cpm), more compressions (787.2 vs 510.8 per 5 minutes), and more duty cycles (51.0% vs 41.7%), but a lower percentage of effective compressions (47.7% vs 57.9%) and a lower compression depth (35.6 vs 38.0 mm) than they did during the 100-cpm session. The CPR quality deteriorated in numbers and percentile of effective compression since the third minute in the PF session and the fourth minute in the 100-cpm session. The percentile of compressions with adequate depth in the 100-cpm sessions was higher than that in the PF sessions during the second, third, and fourth minutes of CPR.ConclusionPush-fast technique showed a significant decrease in the percentile of effective chest compression compared with the 100-cpm technique during the 5-minute hand-only CPR. The PF technique exhibited a trend toward increased fatigue in the rescuers, which can result in early decay of CPR quality.     

An analysis of the efficacy of bag-valve-mask ventilation and chest compression during different compression-ventilation ratios in manikin-simulated paediatric resuscitation

The ideal chest compression and ventilation ratio for children during performance of cardiopulmonary resuscitation (CPR) has not been determined. The efficacy of chest compression and ventilation during compression ventilation ratios of 5:1, 10:2 and 15:2 was examined. Eighteen nurses, working in pairs, were instructed to provide chest compression and bag-valve-mask ventilation for 1 min with each ratio in random on a child-sized manikin. The subjects had been previously taught paediatric CPR within the last 3 or 5 months. The efficacy of ventilation was assessed by measurement of the expired tidal volume and the number of breaths provided. The rate of chest compression was guided by a metronome set at 100/min. The efficacy of chest compressions was assessed by measurement of the rate and depth of compression. There was no significant difference in the mean tidal volume or the percentage of effective chest compressions delivered for each compression-ventilation ratio. The number of breaths delivered was greatest with the ratio of 5:1. The percentage of effective chest compressions was equal with all three methods but the number of effective chest compressions was greatest with a ratio of 5:1. This study supports the use of a compression-ventilation ratio of 5:1 during two-rescuer paediatric cardiopulmonary resuscitation.     

Quality of chest compressions during compression-only CPR: a comparative analysis following the 2005 and 2010 American Heart Association guidelines

Objective

The latest guidelines both increased the requirements of chest compression rate and depth during cardiopulmonary resuscitation (CPR), which may make it more difficult for the rescuer to provide high-quality chest compression. In this study, we investigated the quality of chest compressions during compression-only CPR under the latest 2010 American Heart Association (AHA) guidelines (AHA 2010) and its effect on rescuer fatigue.

Methods

Eighty-six undergraduate volunteers were randomly assigned to perform CPR according to the 2005 AHA guidelines (AHA 2005) or AHA 2010. After the training course and theoretical examination of basic life support, eight min of compression-only CPR performance was assessed. The quality of chest compressions including rate and depth of compression was analyzed. The rescuer fatigue was evaluated by the changes of heart rate and blood lactate, and rating of perceived exertion.

Results

Thirty-nine participants in the AHA 2005 group and 42 participants in the AHA 2010 group completed the study. Significantly greater mean chest compression depth and compression rate were both achieved in the AHA 2010 group than in the AHA 2005 group. And significantly greater rescuer fatigue was observed in the AHA 2010 group. In addition, the female in the AHA 2010 group could perform the compression rate required by the guidelines, however, significantly shallower compression depth and greater rescuer fatigue were observed when compared to the male.

Conclusions

The quality of chest compressions was significantly improved following the 2010 AHA guidelines, however, it’s more difficult for the rescuer to meet the guidelines due to the increased fatigue of rescuer.     

The effect of the APLS-course on self-efficacy and its relationship to behavioural decisions in paediatric resuscitation

AimsSelf-efficacy may predict performance following life-support training but may be negatively influenced by experiences during training. To investigate both this and the use of self-efficacy in self-assessment we investigated the relationship between self-efficacy and measured performance during a simulated resuscitation, and the effect of death of a simulated patient on self-efficacy.Materials and methodsConsultant and trainee paediatricians and anaesthesiologists scored their self-efficacy for paediatric resuscitation skills before taking an unannounced simulated resuscitation test and objective structured clinical examination (OSCE)-tests of chest compressions and bag- and mask-ventilation. Performance in the simulation was scored by three independent expert observers and the OSCE's using a modified Berden and ventilation penalty scores.ResultsSelf-efficacy for the relevant skill was significantly higher in doctors choosing to give chest compressions, to intubate or insert an intraosseous device and in those who decided to intubate early. Self-efficacy correlated moderately with the quality of global performance on the simulation but not with the OSCE scores, nor was quality of individual skills during the simulation related to self-efficacy. Self-efficacy was higher in doctors who had taken the Advanced Paediatric Life Support (APLS)-course. Death of the simulated patient had a negative effect on self-efficacy.ConclusionSelf-efficacy seems to be predictive of certain actions during a simulated resuscitation but does not correlate with quality of performance of resuscitation skills. Self-efficacy might therefore be useful as a predictor of the application of learning, but cannot be recommended for self-assessment. There is evidence to support the unwritten rule during simulation training the patient should not be allowed to die.     

Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins

AimsThe adequate chest compression rate during CPR is associated with improved haemodynamics and primary survival. To explore whether the use of a metronome would affect also chest compression depth beside the rate, we evaluated CPR quality using a metronome in a simulated CPR scenario.MethodsForty-four experienced intensive care unit nurses participated in two-rescuer basic life support given to manikins in 10 min scenarios. The target chest compression to ventilation ratio was 30:2 performed with bag and mask ventilation. The rescuer performing the compressions was changed every 2 min. CPR was performed first without and then with a metronome that beeped 100 times per minute. The quality of CPR was analysed with manikin software. The effect of rescuer fatigue on CPR quality was analysed separately.ResultsThe mean compression rate between ventilation pauses was 137 ± 18 compressions per minute (cpm) without and 98 ± 2 cpm with metronome guidance (p < 0.001). The mean number of chest compressions actually performed was 104 ± 12 cpm without and 79 ± 3 cpm with the metronome (p < 0.001). The mean compression depth during the scenario was 46.9 ± 7.7 mm without and 43.2 ± 6.3 mm with metronome guidance (p = 0.09). The total number of chest compressions performed was 1022 without metronome guidance, 42% at the correct depth; and 780 with metronome guidance, 61% at the correct depth (p = 0.09 for difference for percentage of compression with correct depth).ConclusionsMetronome guidance corrected chest compression rates for each compression cycle to within guideline recommendations, but did not affect chest compression quality or rescuer fatigue.     

Single-rescuer cardiopulmonary resuscitation: 'two quick breaths'--an oxymoron

The Guidelines 2000 for CPR and ECC recommend for single lay-rescuers performing basic life support, "two quick breaths followed by 15 chest compressions", repeated until professional help arrives. It is uncertain that this can actually be accomplished by the majority of lay rescuers. We evaluated 53 first-year medical students after completing BLS CPR training to determine if they could deliver the goal of 80 compressions per minute when following this AHA BLS recommendation. Alternatively, a simplified technique of uninterrupted chest compression (UCC) BLS CPR was also taught and compared with standard BLS CPR (STD). The mean number of chest compressions/minute delivered with AHA BLS CPR was only 43 +/- 1 immediately after initial training and 49 +/- 2 when tested 6 months later. Uninterrupted chest compression BLS resulted in 113 +/- 2 compressions/min delivered immediately after training and 91 +/- 4 six months later (STD versus UCC; P < 0.0001). The mean length of time needed to provide the two breaths during STD-CPR was 14 +/- 1 and 12 +/- 1s (immediately after first training and six months after training). For STD-CPR, the mean minute ventilation was poor immediately after initial training (3.3 +/- 0.3 l/min) and further declined (1.9 +/- 0.4 l/min) at 6 months (P = 0.003). For single rescuer basic cardiopulmonary resuscitation, motivated BLS CPR-trained medical students take nearly as long as previously reported for middle-aged lay individuals to deliver these "two quick breaths". The "Guidelines 2000" recommendation for "two quick breaths" is an oxymoron, as it averages more than 13s. New recommendations for single-rescuer CPR should be considered that emphasize uninterrupted chest compressions.     

Standard Versus Over-the-Head Cardiopulmonary Resuscitation During Simulated Advanced Life Support

Background. Limited space can make rescuer position changes difficult during cardiopulmonary resuscitation (CPR). Over-the-head (OTH) CPR enables one rescuer to deliver chest compressions andventilations without changing position. The aim of the present study was to evaluate quality of OTH versus standard CPR with bag-valve-mask (BVM) ventilation in a manikin model during advanced life support (ALS). Method. In a randomised double-crossover trial, eight paramedic students performed ALS using both OTH andstandard CPR with BVM. Initial rhythm was asystole, converting to ventricular fibrillation after atropine, adrenaline, andCPR. Data collection was stopped after atropine andepinephrine had been given. Data are presented as means ± SD or median with 25% and75% percentile. Results. There were no significant differences in ventilation or compression variables or any time factors with median total hands off times of 50% versus 52% for OTH andstandard CPR respectively. Conclusion. OTH CPR is an alternative method during CPR.     

A different rescuer changing strategy between 30:2 cardiopulmonary resuscitation and hands-only cardiopulmonary resuscitation that considers rescuer factors: a randomised cross-over simulation study with a time-dependent analysis

Aim

To compare the time-dependent changes in the quality of chest compressions in 30:2 cardiopulmonary resuscitation (CPR) and hands-only cardiopulmonary resuscitation (HO-CPR) and to evaluate how individual rescuer factors affect the quality of chest compressions over time for both CPR techniques.

Methods

Total 1028 adult hospital and university workers participated in CPR training programs including sessions of 30:2 CPR and HO-CPR. Tests of both CPR methods were performed in a random order using a manikin with Skill-Reporter™. Data were collected from 863 subjects. The time-dependent changes in chest compressions quality and the effects of individual rescuer factors (age, gender, body mass index (BMI), prior CPR training and experience) were analysed using the general linear model for a repeated-measures procedure.

Results

In HO-CPR, the mean proportion of correct compressions depth (MPCD) decreased significantly throughout the time sectors following 20–40 s (74.4–50.4% in 100–120 s) compared to 30:2 CPR (83.4–76.3% in 100–120 s) (p < 0.0001). A significant decline of MPCD (MPCD < 70%) was initially observed at 40–60 s in HO-CPR, however, this pattern was not observed in 30:2 CPR. Individual rescuer factors minimally affected the time-dependent change in MPCD during 30:2 CPR. For HO-CPR, all rescuer factors except for male or obese/overweight (BMI ≥ 25) were associated with a significant declines of MPCD, and these decline were usually observed from 40 to 60 s.

Conclusion

Switching rescuers at an interval of 2-min is reasonable for 30:2 CPR. However, for HO-CPR switching rescuers every 1-min may be preferable except when rescuers are male or obese/overweight (BMI ≥ 25).     

Use of step stool during resuscitation improved the quality of chest compression in simulated resuscitation

Objectives: Resuscitation on a medical bed is difficult because of the need to match the height of the bed to the height of the rescuer, which is impossible on a fixed‐height medical bed. This study investigated the effect of using a step stool on chest compressions performed on a manikin in a fixed‐height medical bed. Methods: This prospective, observational study was performed using simulated resuscitation manikins and a fixed‐height (78 cm) medical bed. Chest compression–ventilation of more than five cycles was performed with and without a 20‐cm‐high step stool. A total of 74 medical students participated in this study. The quality of the chest compressions was examined using the Laerdal PC Skill Reporting System. The angle between the arm of the rescuer and the bed was measured. In addition, whether the heels of the rescuer reached the ground during the compressions was assessed using lateral‐view pictures. Results: Use of the step stool improved the quality of the chest compressions with regard to depth, proper compressions, insufficient compressions and incorrect hand position (P < 0.05). The angle between the rescuer's arm and bed during the chest compressions was closer to vertical with the use of the step stool than without it (average angle, 83.84 ± 4.16° and 73.41 ± 9.16°, respectively; P < 0.001). Conclusions: In‐hospital resuscitation was conducted on a fixed‐height medical bed by rescuers of different heights. The use of a step stool may improve the quality and effectiveness of chest compressions, particularly for short rescuers.     

Do manual chest compressions provide substantial ventilation during prehospital cardiopulmonary resuscitation?

IntroductionChest compressions have been suggested to provide passive ventilation during cardiopulmonary resuscitation. Measurements of this passive ventilatory mechanism have only been performed upon arrival of out-of-hospital cardiac arrest patients in the emergency department. Lung and thoracic characteristics rapidly change following cardiac arrest, possibly limiting the effectiveness of this mechanism after prolonged resuscitation efforts. Goal of this study was to quantify passive inspiratory tidal volumes generated by manual chest compression during prehospital cardiopulmonary resuscitation.Materials and methodsA flowsensor was used during adult out-of-hospital cardiac arrest cases attended by a prehospital medical team. Adult, endotracheally intubated, non-traumatic cardiac arrest patients were eligible for inclusion. Immediately following intubation, the sensor was connected to the endotracheal tube. The passive inspiratory tidal volumes generated by the first thirty manual chest compressions performed following intubation (without simultaneous manual ventilation) were calculated.Results10 patients (5 female) were included, median age was 64 years (IQR 56, 77 years). The median compression frequency was 111 compression per minute (IQR 107, 116 compressions per minute). The median compression depth was 5.6 cm (IQR 5.4 cm, 6.1 cm). The median inspiratory tidal volume generated by manual chest compressions was 20 mL (IQR 13, 28 mL).ConclusionUsing a flowsensor, passive inspiratory tidal volumes generated by manual chest compressions during prehospital cardiopulmonary resuscitation, were quantified. Chest compressions alone appear unable to provide adequate alveolar ventilation during prehospital treatment of cardiac arrest.     

心肺复苏不同循环周期按压质量分析

目的：通过对医务人员心肺复苏不同循环周期的按压质量变化分析,探讨5个循环周期交替按压是否合理。方法：2012-06-2013-10,选择参加培训的135名医务人员为研究对象,采用复苏反馈系统对不同循环周期胸外按压深度、频率和总体有效率进行分析。结果：随着按压周期的进行,胸外按压平均按压深度和平均按压频率逐渐降低,差异有统计学意义（P〈0.05）;平均按压有效率随着循环周期的进行不断下降,但差异无统计学意义（P〉0.05）。男、女性组平均深度比较,差异有统计学意义（P〈0.05）;而两组间平均频率比较,差异无统计学意义（P〉0.05）。结论：随着CPR循环周期的增加,按压质量逐渐下降。临床工作中,为得到更好的按压效果,在有条件情况下,可以考虑四个循环后交替按压。     

The Effect of Different Personal Protective Equipment Masks on Health Care Workers’ Cardiopulmonary Resuscitation Performance During the Covid-19 Pandemic

BackgroundPersonal protective equipment (PPE) is equipment that protects health care workers from harmful agents and organisms. The importance of this equipment was noticed again with the Coronavirus Disease 2019 (COVID-19) pandemic.ObjectivesIn this study, we investigated the effect of different masks used as PPE on resuscitation quality and rescuer fatigue.MethodsParticipants applied chest compression without a mask, with a surgical mask, a filtering face-piece respirator (FFR) mask, and a half-face mask with active P3 filter. A smart watch was worn on the left wrists of the participants during chest compression in each condition. They were requested to rate their fatigue on a visual analogue scale.ResultsStatistically higher average pulse rates were found in the FFR mask and half-face mask conditions. FFR mask and half-face mask resulted in statistically worse results than surgical mask and no-mask conditions in the number of compressions per minute, compression depth, and compression effectiveness. Further, half-face mask and FFR mask caused more fatigue in participants.ConclusionProtective masks other than surgical masks used as PPE increase rescuer fatigue in CPR and negatively affect the quality of chest compressions.     

A 10-s rest improves chest compression quality during hands-only cardiopulmonary resuscitation: A prospective,randomized crossover study using a manikin model

Objectives

This study was designed to assess changes in cardiopulmonary resuscitation (CPR) quality and rescuer fatigue when rescuers are provided with a break during continuous chest compression CPR (CCC-CPR).

Methods

The present prospective, randomized crossover study involved 63 emergency medical technician trainees. The subjects performed three different CCC-CPR methods on a manikin model. The first method was general CCC-CPR without a break (CCC), the second included a 10-s break after 200 chest compressions (10/200), and the third included a 10-s break after 100 chest compressions (10/100). All methods were performed for 10 min. We counted the total number of compressions and those with appropriate depth every 1 min during the 10 min and measured mean compression depth from the start of chest compressions to 10 min.

Results

The 10/100 method showed the deepest compression depth, followed by the 10/200 and CCC methods. The mean compression depth showed a significant difference after 5 min had elapsed. The percentage of adequate compressions per min was calculated as the proportion of compressions with appropriate depth among total chest compressions. The percentage of adequate compressions declined over time for all methods. The 10/100 method showed the highest percentage of adequate compressions, followed by the 10/200 and CCC methods.

Conclusion

When rescuers were provided a rest at a particular time during CCC-CPR, chest compression quality increased compared with CCC without rest. Therefore, we propose that a rescuer should be provided a rest during CCC-CPR, and specifically, we recommend a 10-s rest after 100 chest compressions.     

Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation

Over the last decade, the importance of delivering high-quality cardiopulmonary resuscitation (CPR) for cardiac arrest patients has become increasingly emphasized. Many experts are in agreement concerning the appropriate compression rate, depth, and amount of chest recoil necessary for high-quality CPR. In addition to these factors, there is a growing body of evidence supporting continuous or uninterrupted chest compressions as an equally important aspect of high-quality CPR. An innovative resuscitation protocol, called cardiocerebral resuscitation, emphasizes uninterrupted chest compressions and has been associated with superior rates of survival when compared with traditional CPR with standard advanced life support. Interruptions in chest compressions during CPR can negatively impact outcome in cardiac arrest; these interruptions occur for a range of reasons, including pulse determinations, cardiac rhythm analysis, electrical defibrillation, airway management, and vascular access. In addition to comparing cardiocerebral resuscitation to CPR, this review article also discusses possibilities to reduce interruptions in chest compressions without sacrificing the benefit of these interventions.     

The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest

IntroductionMost manikin and clinical studies have found decreased quality of CPR during transport to hospital. We wanted to study quality of CPR before and during transport for out-of-hospital cardiac arrest patients and also whether quality of CPR before initiation of transport was different from the quality in patients only receiving CPR on scene.Materials and methodsQuality of CPR was prospectively registered with a modified defibrillator for consecutive cases of out-of-hospital cardiac arrest in three ambulance services during 2002–2005. Ventilations were registered via changes in transthoracic impedance and chest compressions were measured with an extra chest compression pad placed on the patients’ sternum. Paired t-tests were used to analyse quality of CPR before vs. during transport with ongoing CPR. Unpaired t-tests were used to compare CPR quality prior to transport to CPR quality in patients with CPR terminated on site.ResultsQuality of CPR did not deteriorate during transport, but as previously reported overall quality of CPR was substandard. Quality of CPR performed on site was significantly better when transport was not initiated with ongoing CPR compared to episodes with initiation of transport during CPR: fraction of time without chest compressions was 0.45 and 0.53 (p < 0.001), compression depth 37 mm and 34 mm (p = 0.04), and number of chest compressions per minute 61 and 56 (p = 0.01), respectively.ConclusionCPR quality was sub-standard both before and during transport. Early decision to transport might have negatively affected CPR quality from the early stages of resuscitation.     

CPR PRO Device Reduces Rescuer Fatigue during Continuous Chest Compression Cardiopulmonary Resuscitation: A Randomized Crossover Trial Using a Manikin Model

Background

The performance of high-quality chest compressions with minimal interruptions is one of the most important elements of the “Chain of Survival.”

Objectives

To evaluate the impact of a novel CPR PRO^® (CPRO) device for manual chest compression on rescuer fatigue, pain, and cardiopulmonary resuscitation (CPR) quality.

Methods

Randomized crossover trial of 24 health care professionals performing continuous chest compression CPR for 10 min with a CPRO device and conventional manual CPR (MCPR). Data about chest compressions were recorded using a manikin. Rescuers' physiologic signs were recorded before and after each session, and heart rate (HR) data were tracked continuously. Fatigue was assessed with ratings of perceived exertion, and pain questionnaire.

Results

All subjects completed 10 min of CPR with both methods. Significantly more rest breaks were taken during MCPR sessions (1.7 ± 2 vs. 0.21 ± 0.72). Subjects' perceived exertion was higher after MCPR, as well as the average (120.7 ± 16.8 vs. 110.8 ± 17.6) and maximal HR (134.3 ± 18.5 vs. 123.42 ± 16.5) during testing. Subjects reported more pain in the hands, especially the wrist, after performing MCPR. Average depth of compressions was higher with the CPRO device (4.6 ± 7.0 vs. 4.3 ± 7.9) and declined more slowly over time. Other CPR quality parameters, such as the correct position and complete release of pressure, were also better for CPRO CPR.

Conclusions

CPRO device reduces rescuer fatigue and pain during continuous chest compression CPR, which results in a higher quality of CPR in a simulation setting.     

Quality of BLS decreases with increasing resuscitation complexity

OBJECTIVE: Multiple procedures performed in parallel may cause each procedure to be performed less effectively than if performed in isolation. BLS performed by prehospital providers potentially includes artificial ventilations, chest compressions, and application of an automated external defibrillator (AED). This study examines the effectiveness of artificial ventilation and chest compressions both with and without an AED. METHODS: Thirty-six prehospital providers participated in a prospective observational study. Tested in pairs (n=18), subjects randomly completed three, 6-min scenarios [apneic patient with a pulse (VENT), a pulseless patient (CPR), and a pulseless patient with an AED available (CPR+AED)]. A full-torso manikin capable of generating a carotid pulse was connected to a computer to record number of ventilations, tidal volume, flow rate, number of compressions, and compression depth. Data were analyzed by t-test, ANOVA, and Mann-Whitney U-test. RESULTS: Artificial ventilation performed in isolation provided more correct ventilations than during CPR or CPR+AED (25.7%, 14.2%, 13.7%, p=0.02). Fewer ventilations were delivered during CPR and CPR+AED (p=0.03). More compressions were delivered with CPR alone vs. CPR+AED (51.9, 35.7 min(-1), p=0.00). More correct compressions were delivered during CPR alone vs. CPR+AED (p=0.05). CONCLUSIONS: Both the quality and quantity of BLS decreases as the number of procedures performed simultaneously increases. Further decrements might occur when ALS skills enter into resuscitation. These results suggest a need to automate and/or prompt the performance of BLS to optimize resuscitation.     

Videographic assessment of cardiopulmonary resuscitation quality in the pediatric emergency department

ObjectiveTo describe the adherence to guidelines for CPR in a tertiary pediatric emergency department (ED) where resuscitations are reviewed by videorecording.MethodsResuscitations in a tertiary pediatric ED are videorecorded as part of a quality improvement project. Patients receiving CPR under videorecorded conditions were eligible for inclusion. CPR parameters were quantified by retrospective review. Data were described by 30-s epoch (compression rate, ventilation rate, compression:ventilation ratio), by segment (duration of single providers’ compressions) and by overall event (compression fraction). Duration of interruptions in compressions was measured; tasks completed during pauses were tabulated.Results33 children received CPR under videorecorded conditions. A total of 650 min of CPR were analyzed. Chest compressions were performed at <100/min in 90/714 (13%) of epochs; 100–120/min in 309/714 (43%); >120/min in 315/714 (44%). Ventilations were 6–12 breaths/min in 201/708 (23%) of epochs and >12/min in 489/708 (70%). During CPR without an artificial airway, compression:ventilation coordination (15:2) was done in 93/234 (40%) of epochs. 178 pauses in CPR occurred; 120 (67%) were <10 s in duration. Of 370 segments of compressions by individual providers, 282/370 (76%) were <2 min in duration. Median compression fraction was 91% (range 88–100%).ConclusionsCPR in a tertiary pediatric ED frequently met recommended parameters for compression rate, pause duration, and compression fraction. Hyperventilation and failure of C:V coordination were very common. Future studies should focus on the impact of training methods on CPR performance as documented by videorecording.