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Journal of Intensive Care and Emergency Medicine

Tag: cardiopulmonary resuscitation (Page 1 of 5)

Why should we switch chest compression providers every 2 minutes during cardiopulmonary resuscitation?

Abstract

Objective. This study was conducted to determine whether trained male rescuers could maintain adequate chest compression depth (CCD) for longer than the current recommended guidelines of 2 minutes.

Methods. Forty male medical doctors administered a 5-minute single rescuer cardiopulmonary resuscitation (CPR) to a manikin on the floor with conventional CPR or randomly administered continuous chest compressions (CCC). The ratio of compression to ventilation was set to 30:2 with mouth-to-mouth technique during conventional CPR. Chest compression data were recorded with an accelerometer device and divided into 1-minute segments for analysis.

Results. Although average CCD maintained the recommended depths throughout 5 minutes in conventional CPR, it decreased significantly with CCC (1 minute: 55.4 ± 4.5 mm; 2 minutes: 54.2 ± 5.4 mm; 3 minutes: 52.6 ± 5.6 mm; 4 minutes: 51.6 ± 5.5 mm; 5 minutes: 49.9 ± 5.8 mm, p < 0.001). The average chest compression numbers (ACCN) per minute were maintained over 80/min and have not been changed significantly within 5 minutes in the CCC. However, it didn’t reach to the 80/min and decreased significantly after 3minutes compared to the baseline ACCN during first 1-minute segment in the conventional CPR.

Conclusions. Despite the chest compression providers being limited to trained male medical doctors, the average CCD decreased significantly within 5minutes with CCC. Although maintaining adequate CCD, ACCN in each minute decreased significantly after 3minutes in the conventional CPR. Therefore, we should rotate chest compression providers every 2minutes regardless of the rescuer’s qualifications and CPR methods.

Key words: cardiopulmonary resuscitation, mouth-to-mouth resuscitation, cardiac arrest, healthcare provider

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Football referees as first responders in cardiac arrest. Assessment of a Basic Life Support training program.

Abstract

Aim. To assess football referees´ cardiopulmonary resuscitation (CPR) skills and automated external defibrillator (AED) use in a simulated sport incident scenario, after a brief training program.

Material and Methods. Quasi-experimental study with 35 amateur league football referees. A test – retest of related samples was carried out after the training program. Theoretical and hands-on session lasted 30 minutes, with 1/10 instructor/participant ratio. CPR skills were measured using Wireless Skill Report software and AED use by means of a specific check list.

Results. A third of sample knew what an AED is but only 8% knew how to use it. After training, all participants achieved 70% or higher CPR quality scores and were able to use AED properly (54.2% without any incidence). Mean time to discharge was shorter for participants who accomplished the quality goal (p=0.022).

Conclusions. After a very brief and simple training program, football referees were able to perform a potentially effective CPR and use an AED correctly in a simulated scenario. Basic life support training should be implemented in football referees´ formative curriculum.

Key words: automated external defibrillator, referees, cardiac arrest, cardiopulmonary resuscitation, basic life support, training, sport, football

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Development of a standardized in-hospital cardiopulmonary resuscitation set-up

Abstract

Objective. This study evaluated whether chest compression in a standardized in-hospital cardiopulmonary resuscitation (CPR) set-up can be performed as effectively as when the rescuer is kneeling beside the patient lying on the floor. Specifically, the in-hospital test was standardized according to the rescuers’ average knee height.

Methods. Experimental intervention (test 1) was a standardized, in-hospital CPR set-up: first, the bed height was fixed at 70 cm. Second, the height difference between the bed and a step stool was set to the average knee height of the CPR team members (45 cm). Control intervention (test 2) was kneeling on floor. Thirty-eight medical doctors on the CPR team each performed 2 minutes of chest compressions in test 1 and 2 in random order (cross-over trial). A Little Anne was used as a simulated patient who had experienced cardiac arrest. Chest compression parameters, such as average depth and rate, were measured using an accelerometer device.

Results. In all tests, the average depths were those recommended in the most recent CPR guidelines (50–60 mm); there were no significant differences between Tests 1 and 2 (53.1 ± 4.3 mm vs. 52.6 ± 4.8 mm, respectively; p = 0.398). The average rate in Test 2 (119.1 ± 12.4 numbers/min) was slightly faster than that in Test 1 (116.4 ± 10.2 numbers/min; p = 0.028). No differences were observed in any other parameters.

Conclusions. Chest compression quality in our standardized in-hospital CPR set-up was similar with that performed in a kneeling position on the floor.

Trial Registration: Clinical Research Information Service: KCT0001599

Key words: beds, cardiopulmonary resuscitation, posture

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Are chest compression depths measured by the Resusci Anne SkillReporter and CPRmeter the same?

Abstract

Objective. We investigated whether data collected using the Resusci Anne SkillReporter were comparable with those collected using the CPRmeter (cardiopulmonary resuscitation meter -an accelerometer feedback device used to provide high-quality chest compressions).

Materials and Methods. Fifty continuous chest compressions were performed using a Resusci Anne SkillReporter and a CPRmeter under two conditions (Experiment 1: complete chest wall recoil; Experiment 2: incomplete chest wall recoil). The conditions were defined according to visual feedback signals provided by the CPRmeter. A single healthcare worker performed 20 repetitions under each experimental condition alternately. Chest compression data were collected and analyzed using the Laerdal PC SkillReporting System and QCPR Review software.

Results. The mean difference in chest compression depth between the Resusci Anne SkillReporter and CPRmeter was 6.7 ± 1.2 mm in Experiment 1 (95% CI: 6.1~7.3) and was significantly higher in Experiment 2 (17.3 ± 1.9 mm; 95% CI: 16.4~18.2; p < 0.001).

Conclusions. The chest compression depth measured by the Resusci Anne SkillReporter was significantly different from that of the CPRmeter. Cardiopulmonary resuscitation instructors, trainees, and researchers should be aware of this difference to ensure the most accurate interpretation of their training or experimental results.

Key words: cardiopulmonary resuscitation, manikins, feedback, education, training

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Middle latency auditory evoked potential index for prediction of post-resuscitation survival in elderly populations with out-of-hospital cardiac arrest

Abstract

Background. Out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate in the elderly. Although most reports have investigated among elderly patients with OHCA until 1990s, non-invasive monitorings cannot presently predicted cerebral resuscitation during cardiopulmonary resuscitation (CPR). Findings of a previous study suggest that monitoring of middle latency auditory evoked potentials (MLAEP) during CPR could provide an indicator of effective post-resuscitation survival.

Objectives. We speculated that the MLAEP index (MLAEPi), measured in an emergency room, can predict post-resuscitation survival among elderly patients with OHCA.

Methods. This prospective study included 31 elderly patients aged ≥65 years with OHCA who received basic life support (BLS) and did not achieve restoration of spontaneous circulation (ROSC) until arrival at the emergency center between December 2010 and December 2011. All patients were administered advanced cardiac life support (ACLS) in the emergency room. Initial MLAEPi was measured using an MLAEP monitor (aepEX plus®, Audiomex, UK) during the first cycle of ACLS. Prediction of the post-resuscitation survival was investigated.

Results. Eight patients who achieved ROSC were admitted to our hospital and 23 did not achieve ROSC in the emergency room. Initial MLAEPi was significantly higher in patients with than without ROSC (median, 33 vs. 26, p = 0.02). Three survivors, among patients with ROSC, were discharged from our hospital (survivors) and 5 died during hospitalization (non-survivors). Initial MLAEPi was significantly higher in survivors than in non-survivors (median, 35 vs. 28, p = 0.03) or patients without ROSC (median, 35 vs. 26, p < 0.01).

Conclusions. MLAEPi satisfactorily denotes cerebral function and predicts post-resuscitation survival in elderly populations.

Key words: cardiopulmonary resuscitation, basic life support, advanced cardiac life support, age, monitoring, critical care

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