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.     

Rethinking bystander CPR for out-of-hospital cardiac arrest

Citation

SOS-KANTO study group: Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet 2007, 369:920–926 [1].

Background

Mouth-to-mouth ventilation is a barrier to bystanders doing cardiopulmonary resuscitation (CPR), but few clinical studies have investigated the efficacy of bystander resuscitation by chest compressions without mouth-to-mouth ventilation (cardiac-only resuscitation).

Methods

Objective

To compare the effect of bystander-provided cardiac-only resuscitation to conventional CPR in adults who had out-of-hospital cardiac arrest.

Design

Prospective multicenter observational study.

Setting

58 emergency hospitals and emergency medical service units in the Kanto region of Japan.

Subjects

Patients with witnessed out-of-hospital cardiac arrest who were subsequently transported by paramedics to participating emergency hospitals. Exclusion criteria were age <18 years, further cardiac arrest after the arrival of paramedics, documented terminal illness, presence of a do-not-resuscitate order, and bystander resuscitation without documented chest compressions.

Intervention

None. On arrival at the scene, paramedics assessed the technique of bystander resuscitation, recording it as conventional CPR (chest compressions with mouth-to-mouth ventilation), cardiac-only resuscitation (chest compressions alone), or no bystander CPR. Patients were followed and revaluated 30 days after the arrest to determine neurologic status.

Outcome

The primary endpoint was favorable neurological outcome 30 days after cardiac arrest using the Glasgow-Pittsburgh cerebral-performance scale, with favorable neurological outcome defined as a category 1 (good performance) or 2 (moderate disability) on a 5-point scale.

Results

4068 adult patients who had out-of-hospital cardiac arrest witnessed by bystanders were included; 439 (11%) received cardiac-only resuscitation from bystanders, 712 (18%) conventional CPR, and 2917 (72%) received no bystander CPR. Any resuscitation attempt was associated with a higher proportion having favorable neurological outcomes than no resuscitation (5.0%vs 2.2%, p < 0.0001). Cardiac-only resuscitation resulted in a higher proportion of patients with favorable neurological outcomes than conventional CPR in patients with apnea (6.2%vs 3.1%; p = 0.0195), with shockable rhythm (19.4%vs 11.2%, p = 0.041), and with resuscitation that started within 4 min of arrest (10.1%vs 5.1%, p = 0.0221). However, there was no evidence for any benefit from the addition of mouth-to-mouth ventilation in any subgroup. The adjusted odds ratio for a favorable neurological outcome after cardiac-only resuscitation was 2.2 (95% CI 1.2–4.2) in patients who received any resuscitation from bystanders.

Conclusion

Cardiac-only resuscitation by bystanders is the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest, especially those with apnea, shockable rhythm, or short periods of untreated arrest.     

The Specific Effect of Metronome Guidance on the Quality of One-person Cardiopulmonary Resuscitation and Rescuer Fatigue

Background

Metronome guidance is a simple and economic feedback method of guiding cardiopulmonary resuscitation (CPR). It has been proven for its usefulness in regulating the rate of chest compression and ventilation, but it is not yet clear how metronome use may affect compression depth or rescuer fatigue.

Study Objective

The aim of this study was to assess the specific effect that metronome guidance has on the quality of CPR and rescuer fatigue.

Methods

One-person CPRs were performed by senior medical students on Resusci Anne® manikins (Laerdal, Stavanger, Norway) with personal-computer skill-reporting systems. Half of the students performed CPR with metronome guidance and the other half without. CPR performance data, duration, and before–after trial differences in mean arterial pressure (MAP) and heart rate (HR) were compared between groups.

Results

Average compression depth (ACD) of the first five cycles, compression rate, no-flow fraction, and ventilation count were significantly lower in the metronome group (p = 0.028, < 0.001, 0.001, and 0.041, respectively). Total CPR duration, total work (ACD × total compression count), and the before–after trial differences of the MAP and HR did not differ between the two groups.

Conclusions

Metronome guidance is associated with lower chest compression depth of the first five cycles, while shortening the no-flow fraction and the ventilation count in a simulated one-person CPR model. Metronome guidance does not have an obvious effect of intensifying rescuer fatigue.     

Hemodynamic Effect of External Chest Compressions at the Lower End of the Sternum in Cardiac Arrest Patients

Background

Little is known about the hemodynamic effects of chest compression at different positions on the sternum during cardiopulmonary resuscitation (CPR).

Objectives

This study aimed to test whether external chest compression at the lower end of the sternum as an alternative position (alternative compression) results in superior hemodynamic effects compared to standard external chest compression (standard compression).

Methods

We enrolled 17 patients with non-traumatic cardiac arrest who failed to regain spontaneous circulation within 30 min after CPR initiation. Standard compression was begun when cardiac arrest was confirmed. Alternative compression was performed for 2 min if spontaneous circulation was not attained after 30 min of standard CPR. We compared hemodynamics and end-tidal CO₂ pressure during the last 2 min of standard compression and during alternative compression.

Results

Peak arterial pressure during compression systole (114 ± 51 vs. 95 ± 42 mm Hg, p < 0.001) and end-tidal CO₂ pressure (11.0 ± 6.7 vs. 9.6 ± 6.9 mm Hg, p < 0.05) were higher with alternative than standard compression, whereas arterial pressure during compression diastole, peak right atrial pressure, and coronary perfusion pressure did not differ between standard and alternative compression.

Conclusions

Compared to standard compression, alternative compression results in a higher peak arterial pressure and end-tidal CO₂ pressure, but no change in coronary perfusion pressure.     

2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival

Aim

Gaps exist in pediatric resuscitation knowledge due to limited data collected during cardiac arrest in real children. The objective of this study was to evaluate the relationship between the 2010 American Heart Association (AHA) recommended chest compression (CC) depth (≥51 mm) and survival following pediatric resuscitation attempts.

Methods

Single-center prospectively collected and retrospectively analyzed observational study of children (>1 year) who received CCs between October 2006 and September 2013 in the intensive care unit (ICU) or emergency department (ED) at a tertiary care children's hospital. Multivariate logistic regression models controlling for calendar year and known potential confounders were used to estimate the association between 2010 AHA depth compliance and survival outcomes. The primary outcome was 24-h survival. The primary predictor variable was event AHA depth compliance, prospectively defined as an event with ≥60% of 30-s epochs achieving an average CC depth ≥51 mm during the first 5 min of the resuscitation.

Results

There were 89 CC events, 87 with quantitative CPR data collected (23 AHA depth compliant). AHA depth compliant events were associated with improved 24-h survival on both univariate analysis (70% vs. 16%, p < 0.001) and after controlling for potential confounders (calendar year of arrest, gender, first documented rhythm; aOR 10.3; CI⁹⁵: 2.75–38.8; p < 0.001).

Conclusions

2010 AHA compliant chest compression depths (≥51 mm) are associated with higher 24-h survival compared to shallower chest compression depths, even after accounting for potentially confounding patient and event factors.     

Effective compression ratio—A new measurement of the quality of thorax compression during CPR

Purpose

Computer-based feedback systems for assessing the quality of cardiopulmonary resuscitation (CPR) are widely used these days. Recordings usually involve compression and ventilation dependent variables. Thorax compression depth, sufficient decompression and correct hand position are displayed but interpreted independently of one another. We aimed to generate a parameter, which represents all the combined relevant parameters of compression to provide a rapid assessment of the quality of chest compression—the effective compression ratio (ECR).

Methods

The following parameters were used to determine the ECR: compression depth, correct hand position, correct decompression and the proportion of time used for chest compressions compared to the total time spent on CPR. Based on the ERC guidelines, we calculated that guideline compliant CPR (30:2) has a minimum ECR of 0.79. To calculate the ECR, we expanded the previously described software solution. In order to demonstrate the usefulness of the new ECR-parameter, we first performed a PubMed search for studies that included correct compression and no-flow time, after which we calculated the new parameter, the ECR.

Results

The PubMed search revealed 9 trials. Calculated ECR values ranged between 0.03 (for basic life support [BLS] study, two helpers, no feedback) and 0.67 (BLS with feedback from the 6th minute).

Conclusion

ECR enables rapid, meaningful assessment of CPR and simplifies the comparability of studies as well as the individual performance of trainees. The structure of the software solution allows it to be easily adapted to any manikin, CPR feedback devices and different resuscitation guidelines (e.g. ILCOR, ERC).     

CPR feedback/prompt device improves the quality of hands-only CPR performed in manikin by laypersons following the 2015 AHA guidelines

Purpose

We investigated the effects of a cardiopulmonary resuscitation (CPR) feedback/prompt device on the quality of chest compression (CC) during hands-only CPR following the 2015 AHA guidelines.

Effects of BLS training on factors associated with attitude toward CPR in college students

Aim

In order to elucidate the factors for willingness to perform CPR, we evaluated the responses of college students to questionnaires before and after basic life support (BLS) training.

Methods

Before and after participating in a small group BLS course, 259 students completed questionnaires. A logistic regression model was used to elucidate independent factors for their willingness to attempt resuscitation.

Results

Factors associated with willingness to perform BLS for strangers were “anxiety for a bad outcome” (odds ratio (OR) 0.08) and “having knowledge of automated external defibrillator (AED)” (OR 4.5) before training. The proportion of students showing willingness to perform BLS increased from 13% to 77% after the training even when the collapsed person is a stranger. After training, “anxiety for being sued because of a bad outcome” (OR 0.3), and “anxiety for infection” (OR 3.8) were significant factors. Those who preferred to perform BLS without ventilation increased from 40% to 79% (p < 0.0001).

Conclusion

The proportion of students showing willingness to perform BLS increased after the training. Significant association between “anxiety for infection” and willingness to perform BLS might indicate that those who wish to perform BLS developed their awareness of risk of infection more than the counterparts. For future guidelines for resuscitation and the instruction consensus, the reluctance of bystanders to perform CPR due to the hesitation about mouth-to-mouth ventilation should be reconsidered with other recent reports indicating the advantage of compression-only CPR.     

Comparison of air-Q(®) and Soft Seal(®) laryngeal mask for airway management by novice doctors during infant chest compression: a manikin study

Background

Recent resuscitation guidelines for infant cardiopulmonary resuscitation (CPR) emphasise that rescuers should minimise the interruption of chest compressions. To that end, supraglottic devices such as laryngeal mask airways (LMAs) are suggested as a backup for airway management during infant CPR. We therefore compared the utility of the air-Q^® LMA (air-Q) with that of the Soft Seal^® LMA (Soft Seal) for infant CPR in an infant manikin.

Methods

Twenty-four novice doctors in the anaesthesia department performed insertion and ventilation with air-Q and Soft Seal on an infant manikin with or without chest compression.

Results

Two doctors failed to insert the Soft Seal without chest compression, while nine failed during chest compression (P < 0.05). However, only one doctor failed to insert the air-Q without chest compression, and two doctors failed during chest compression. Insertion time was not significantly increased with chest compression using either device. Insertion time during chest compression was significantly shorter for the air-Q than for the Soft Seal (P < 0.05). The visual analogue scale (VAS) was used to evaluate difficulty of use (0 mm (extremely easy) to 100 mm (extremely difficult)). VAS scores did not change significantly by the addition of chest compression with either device; however, VAS scores during chest compression were significantly higher with Soft Seal than with the air-Q device.

Conclusion

We conclude that novice doctors find the air-Q easier to use than Soft Seal for emergency airway management during chest compression in infants, in an infant manikin.     

Systematic review of the mechanisms driving effective blood flow during adult CPR

Background

High quality chest compressions is the most significant factor related to improved short-term and long-term outcome in cardiac arrest. However, considerable controversy exists over the mechanisms involved in driving blood flow.

Objectives

The aim of this systematic review is to elucidate major mechanisms involved in effective compression-mediated blood flow during adult cardiopulmonary resuscitation (CPR).

Design and setting

Systematic review of studies identified from the bibliographic databases of PubMed/Medline, Cochrane, and Scopus.

Selection criteria

All human and animal studies including information on the responsible mechanisms of compression-related blood flow. Data collection and analysis: Two reviewers (MG, TX) independently screened all potentially relevant titles and abstracts for eligibility, by using a standardized data-worksheet.

Main results

Forty seven studies met the inclusion criteria. Because of the heterogeneity in outcome measures, quantitative synthesis of evidence was not feasible. Evidence was critically synthesized in order to answer the review questions, taking into account study heterogeneity and validity. The number of included studies per category is as follows: blood flow during chest compression, nine studies; blood flow during chest decompression, six studies; effect of chest compression on cerebral blood flow, eight studies; active compression–decompression CPR, 14 studies; and effect of ventilation on compression-related blood flow, 13 studies.

Conclusion

The evidence so far is inconclusive regarding the major responsible mechanism in compression-related blood flow. Although both ‘cardiac pump’ and ‘thoracic pump’ have a key role, the effect of each mechanism is highly depended on other resuscitation parameters, such as positive pressure ventilation and compression depth.     

Performance of chest compressions by laypersons during the Public Access Defibrillation Trial

Background

Increasing evidence indicates that health professionals often may not achieve guideline standards for cardiopulmonary resuscitation (CPR). Little is known about layperson CPR performance.

Methods

The investigation was a retrospective cohort study of cardiac arrest patients treated by layperson CPR and one model of automated external defibrillator (AED) as part of the Public Access Defibrillation Trial (n = 26). CPR was measured using software that integrates the event log, ECG signal, and thoracic impedance signal. We assessed chest compression fraction (proportion of attempted resuscitation spent performing chest compressions), prompted compression fraction (proportion of attempted resuscitation spent performing compressions during AED-prompted periods), compression rate, and compressions per minute.

Results

Of the 26 cases, 13 presented with ventricular fibrillation and 13 with nonshockable rhythms. Overall, during the period when patients did not have spontaneous circulation, the median chest compression fraction was 34% (IQR 17-48%), median prompted chest compression fraction was 49% (IQR 30-66%), and the median chest compression rate was 96/min (IQR 90-110/min). Taken together, the median chest compression delivered per minute among all arrests was 29 (IQR 20-42). CPR characteristics differed according to initial rhythm: median chest compression per minute was 20 (IQR 13-29) among ventricular fibrillation and 42 (IQR 28-47) among nonshockable rhythms (p = 0.003).

Conclusions

In this study of trained laypersons, CPR varied substantially and often did not achieve guideline parameters. The findings suggest a need to improve CPR training, consider changes to CPR protocols, and/or improve the AED-rescuer interface.     

Medical students do not adversely affect the quality of cardiopulmonary resuscitation for ED patients

Objectives

To investigate the effect of medical student involvement on the quality of actual cardiopulmonary resuscitation (CPR).

Methods

A digital video-recording system was used to record and analyze CPR procedures for adult patients from March 2011 to September 2012.

Results

Twenty-six student-involved and 40 non–student-involved cases were studied. The chest compression rate in the student-involved group was significantly higher than that in the non–student-involved group (P < .001). The proportion of compressions at “above 110 cpm” was higher in the student-involved group (P = .021), whereas the proportion at “90-110 cpm” was lower in the student-involved group (P = .015). The ratio of hands-off time to total manual compression time was significantly lower in the student-involved group than in the non–student-involved group (P = .04). In contrast, the student-involved group delivered a higher ventilation rate compared with the non–student-involved group (P = .02). The observed time delay to first compression and first ventilation were very similar between the groups. There were no significant differences between the groups in either return of spontaneous circulation or time from survival to discharge.

Conclusion

Student-involved resuscitation teams were able to perform good CPR, with higher compression rates and fewer interruptions. However, the supervision from medical staff is still needed to ensure appropriate chest compression and ventilation rate in student-involved actual CPR in the emergency department.     

Real-time feedback can improve infant manikin cardiopulmonary resuscitation by up to 79%—A randomised controlled trial

Setting

European and Advanced Paediatric Life Support training courses.

Participants

Sixty-nine certified CPR providers.

Interventions

CPR providers were randomly allocated to a ‘no-feedback’ or ‘feedback’ group, performing two-thumb and two-finger chest compressions on a “physiological”, instrumented resuscitation manikin. Baseline data was recorded without feedback, before chest compressions were repeated with one group receiving feedback.

Main outcome measures

Indices were calculated that defined chest compression quality, based upon comparison of the chest wall displacement to the targets of four, internationally recommended parameters: chest compression depth, release force, chest compression rate and compression duty cycle.

Results

Baseline data were consistent with other studies, with <1% of chest compressions performed by providers simultaneously achieving the target of the four internationally recommended parameters. During the ‘experimental’ phase, 34 CPR providers benefitted from the provision of ‘real-time’ feedback which, on analysis, coincided with a statistical improvement in compression rate, depth and duty cycle quality across both compression techniques (all measures: p < 0.001). Feedback enabled providers to simultaneously achieve the four targets in 75% (two-finger) and 80% (two-thumb) of chest compressions.

Conclusions

Real-time feedback produced a dramatic increase in the quality of chest compression (i.e. from <1% to 75–80%). If these results transfer to a clinical scenario this technology could, for the first time, support providers in consistently performing accurate chest compressions during infant CPR and thus potentially improving clinical outcomes.     

3:1 Compression to ventilation ratio versus continuous chest compression with asynchronous ventilation in a porcine model of neonatal resuscitation

Objective

In contrast to the resuscitation guidelines of children and adults, guidelines on neonatal resuscitation recommend synchronized 90 chest compressions with 30 manual inflations (3:1) per minute in newborn infants. The study aimed to determine if chest compression with asynchronous ventilation improves the recovery of bradycardic asphyxiated newborn piglets compared to 3:1 Compression:Ventilation cardiopulmonary resuscitation (CPR).

Intervention and measurements

Term newborn piglets (n = 8/group) were anesthetized, intubated, instrumented and exposed to 45-min normocapnic hypoxia followed by asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Piglets were randomized to receive resuscitation with either 3:1 compressions to ventilations (3:1 C:V CPR group) or chest compressions with asynchronous ventilations (CCaV) or sham. Continuous respiratory parameters (Respironics NM3^®), cardiac output, mean systemic and pulmonary artery pressures, and regional blood flows were measured.

Main results

Piglets in 3:1 C:V CPR and CCaV CPR groups had similar time to return of spontaneous circulation, survival rates, hemodynamic and respiratory parameters during CPR. The systemic and regional hemodynamic recovery in the subsequent 4 h was similar in both groups and significantly lower compared to sham-operated piglets.

Conclusion

Newborn piglets resuscitated by CCaV had similar return of spontaneous circulation, survival, and hemodynamic recovery compared to those piglets resuscitated by 3:1 Compression:Ventilation ratio.     

Suppression of the cardiopulmonary resuscitation artefacts using the instantaneous chest compression rate extracted from the thoracic impedance

Aim

To demonstrate that the instantaneous chest compression rate can be accurately estimated from the transthoracic impedance (TTI), and that this estimated rate can be used in a method to suppress cardiopulmonary resuscitation (CPR) artefacts.

Methods

A database of 372 records, 87 shockable and 285 non-shockable, from out-of-hospital cardiac arrest episodes, corrupted by CPR artefacts, was analysed. Each record contained the ECG and TTI obtained from the defibrillation pads and the compression depth (CD) obtained from a sternal CPR pad. The chest compression rates estimated using TTI and CD were compared. The CPR artefacts were then filtered using the instantaneous chest compression rates estimated from the TTI or CD signals. The filtering results were assessed in terms of the sensitivity and specificity of the shock advice algorithm of a commercial automated external defibrillator.

Results

The correlation between the mean chest compression rates estimated using TTI or CD was r = 0.98 (95% confidence interval, 0.97–0.98). The sensitivity and specificity after filtering using CD were 95.4% (88.4–98.6%) and 87.0% (82.6–90.5%), respectively. The sensitivity and specificity after filtering using TTI were 95.4% (88.4–98.6%) and 86.3% (81.8–89.9%), respectively.

Conclusions

The instantaneous chest compression rate can be accurately estimated from TTI. The sensitivity and specificity after filtering are similar to those obtained using the CD signal. Our CPR suppression method based exclusively on signals acquired through the defibrillation pads is as accurate as methods based on signals obtained from CPR feedback devices.     

Usefulness of the compression-adjusted ventilation for adequate ventilation rate during cardiopulmonary resuscitation

Background

To perform high-quality cardiopulmonary resuscitation (CPR), high-quality chest compression and ventilation support should be performed. However, many providers still have not maintained an adequate ventilation rate but hyperventilated during CPR. Thus, this study was conducted to verify that the compression-adjusted ventilation (CAV) would be a more accurate ventilation method compared with the conventional ventilation (CV).

Methods

Volunteer medical students and emergency medical services personnel were recruited. They were randomly divided into either the CV group or the CAV group. In the CV group, participants performed ventilation with estimation of the rate of 8 to 10 per minute (1 ventilation/6-8 seconds). In the CAV group, the ventilation rate was adjusted in line with the compression rate (compression:ventilation, 12:1). In each group, 2-rescuer adult CPR was performed on a manikin, which was intubated with an endotracheal tube, during a period of 8 minutes. The compression rate and the ventilation rate were recorded during CPR.

Results

Data on 56 medical students and 41 emergency medical services personnel were analyzed. No significant difference was observed in compression rate (P = .817); however, median (interquartile range) ventilation rate differed significantly between the CV and CAV groups (8.79 [2.19] per minute vs 9.25 [1.07] per minute, P = .016). In addition, compared with the CV group, adequacy of ventilation rate was better in the CAV group (47.9% vs 85.7%, P < .001).

Conclusion

In comparison with the CV, the CAV is a more accurate method for maintenance of an adequate ventilation rate.     

Nationwide survey of resuscitation education in Finland

Aims

Good-quality cardiopulmonary resuscitation (CPR) is highlighted in the International Resuscitation Guidelines, but clinically the quality of CPR is often poor. Education of CPR has a major role in the primary skills imparted to students. Different methods can be used to teach CPR quality. We evaluated the current status of their usage in Finland institutes teaching students of emergency medicine at different levels.

Methods

The following institutes were included in an anonymous survey: medical schools (teaching future physicians), universities of applied sciences (paramedics), colleges (emergency medical technicians) and emergency services college (fire-fighters). Hours of teaching theory lessons of CPR and hours of small group training were evaluated. In particular, we focussed on the teaching methods for adequate chest compression rate and depth.

Results

Twenty-one of 30 institutes responded to the questionnaire. The median for hours of theory lessons of CPR was 8 h (range: 2–28 h). The median for hours of small group training was 10 (range: 3–40 h). The methods of teaching adequate chest compression rate were instructors’ visual estimation in 28.5% of the institutions, watch in 33.3%, metronome in 9.5% and manikins’ graphic in 28.5% of institutions. The methods of teaching adequate chest compression depth were instructors’ visual estimation in 33.3%, in manikins light indicators in 23.8% and manikins’ graphics in 52.3% of institutions.

Conclusion

The hours of theoretic lessons and small group training vary widely among different institutes. In one-third of institutions, the instructor's visual estimation was a sole method used to teach adequate chest compression rate and depth. Different technical methods were surprisingly seldom used.     

Chest compression quality management and return of spontaneous circulation: A matched-pair registry study

Aims

Investigating the effects of any intervention during cardiac arrest remains difficult. The ROSC after cardiac arrest score was introduced to facilitate comparison of rates of return of spontaneous circulation (ROSC) between different ambulance services. To study the influence of chest compression quality management (including training, real-time feedback devices, and debriefing) in comparison with conventional cardiopulmonary resuscitation (CPR), a matched-pair analysis was conducted using data from the German Resuscitation Registry, with the calculated ROSC after cardiac arrest score as the baseline.

Methods and results

Matching for independent ROSC after cardiac arrest score variables yielded 319 matched cases from the study period (January 2007–March 2011). The score predicted a 45% ROSC rate for the matched pairs. The observed ROSC increased significantly with chest compression quality management, to 52% (P = 0.013; 95% CI, 46–57%). No significant differences were seen in the conventional CPR group (47%; 95% CI, 42–53%). The difference between the observed ROSC rates was not statistically significant.

Conclusions

Chest compression quality management leads to significantly higher ROSC rates than those predicted by the prognostic score (ROSC after cardiac arrest score). Matched-pair analysis shows that with conventional CPR, the observed ROSC rate was not significantly different from the predicted rate. Analysis shows a trend toward a higher ROSC rate for chest compression quality management in comparison with conventional CPR. It is unclear whether a single aspect of chest compression quality management or the combination of training, real-time feedback, and debriefing contributed to this result.     

Teaching resuscitation in schools: annual tuition by trained teachers is effective starting at age 10. A four-year prospective cohort study

Aims

Evaluation of school pupils’ resuscitation performance after different types of training relative to the effects of training frequency (annually vs. biannually), starting age (10 vs. 13 years) and facilitator (emergency physician vs. teacher).

Methods

Prospective longitudinal study investigating 433 pupils in training and control groups. Outcome criteria were chest compression depth, compression frequency, ventilation volume, ventilation frequency, self-image and theoretical knowledge. In the training groups, 251 pupils received training annually or biannually either from emergency physicians or CPR-trained teachers. The control group without any training consisted of 182 pupils.

Results

Improvements in training vs. control groups were observed in chest compression depth (38 vs. 24 mm), compression frequency (74 vs. 42 min⁻¹), ventilation volume (734 ml vs. 21 ml) and ventilation frequency (9/min vs. 0/min). Numbers of correct answers in a written test improved by 20%, vs. 5% in the control group. Pupils starting at age 10 showed practical skills equivalent to those starting at age 13. Theoretical knowledge was better in older pupils. Self-confidence grew in the training groups. Neither more frequent training nor training by emergency physicians led to better performance among the pupils.

Conclusions

Pupils starting at age 10 are able to learn cardiopulmonary resuscitation with one annual training course only. After a 60-min CPR-training update, teachers are able to provide courses successfully. Early training reduces anxieties about making mistakes and markedly increases participants’ willingness to help. Courses almost doubled the confidence of pupils that what they had learned would enable them to save lives.