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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: cardiopulmonary resuscitation (Page 1 of 4)

Can tablets be used as a simulator for automated external defibrillation during cardiopulmonary resuscitation courses?

Abstract

Background. A novel, tablet-based automated external defibrillator (AED) simulator has been developed to facilitate AED training.

Objective. To evaluate if the tablet AED simulator (an AED simulator based on mobile technology (M-AED)) can be successfully used during cardiopulmonary resuscitation (CPR) courses. To test medical and dental students’ CPR attitudes, knowledge and skills, and evaluate the impact of a one day CPR course.

Methods. One hundred and twenty-four medical and dental students of University of Zagreb participated in a basic life support and automated external defibrillator (BLS/AED) course. All students filled out demographic, CPR attitudes and knowledge questionnaires before and after the course. Half of the students practised AED skills during the course on a conventional AED trainer (C-AED), and half on M-AED. All underwent assessment of CPR skills after the course with C-AED. Those that used M-AED during training, rated its use.

Results. All students successfully completed the assessment of skills after the course, with no significant difference in the number of those who had to be retested between C-AED and M-AED. A significant improvement in CPR attitudes and knowledge was noted after the course among all students, with no difference between C-AED and M-AED groups. M-AED as an AED trainer was highly rated.

Conclusions. Tablet based AED simulators can be effectively utilized during BLS/AED courses as a substitute for conventional AED trainers.

Key words: defibrillators, computer simulation, mobile applications, cardiopulmonary resuscitation, European Resuscitation Council Guidelines

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The effect of posture modification during continuous one-handed chest compression: A pilot study using in-hospital pediatric cardiac arrest simulation

Abstract

Background. We modified the posture of the one-handed chest compression (MOHCC) as follows: first, the axis of the rescuer’s compression hand was adjusted to the lower half of the patient’s sternum; second, the opposite hand was wrapped around the elbow joint of the rescuer’s compression arm. This study evaluated the effect of the MOHCC on the mean chest compression depth (MCD) over time.

Methods. Thirty medical doctors conducted 2 min of continuous MOHCC without ventilation using the in-hospital pediatric arrest model (70-cm-high bed, 25-cm-high stepstool, a pediatric manikin and a cardiopulmonary resuscitation (CPR) meter). The MCD and mean chest compression rate (MCR) were measured at 30 s intervals using the Q-CPR review software.

Results. The MCD changed significantly over time (0–30 s, 41.9–44.7 mm; 30–60 s, 40.4–43.6 mm; 60–90 s, 39.2–42.8 mm; 90–120 s, 38.6–42.3 mm; [95% CI], P=0.002). However, it did not decrease significantly between 60–90 s and 90–120 s (P=0.173). The total decrease in MCD was 2.9 mm over a 2 min period. The MCR did not change significantly over time (0–30 s, 108.6–118.9 /min; 30–60 s, 107.9–119.1 /min; 60–90 s, 107.7–119.3 /min; 90–120 s, 107.4–119.0 /min; P=0.800).

Conclusions. Although the MCD changed significantly over a 2 min period, it did not decrease significantly after 90 s during performance of MOHCC. The MOHCC might be considered when the one-handed chest compression (OHCC) is selected as a chest compression method for cardiac arrest in small children.

Key words: cardiopulmonary resuscitation, cardiac arrest, child, fatigue

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Effects of bed height on the performance of endotracheal intubation and bag mask ventilation

Abstract

Objectives. This study was performed to evaluate whether different bed heights affect the performance of airway procedures.

Methods. Thirty three medical doctors performed endotracheal intubation (EI) and bag mask ventilation (BMV) using three different bed heights; knee height, mid-thigh height, and anterior superior iliac spine (ASIS) height. For EI, performance was assessed based on intubation time, intubation success, and damage to teeth. For BMV, performance was assessed based on tidal volume, ventilation rate, peak pressure, minute ventilation, and airway opening. In addition, three numeric rating scales (NRS; 1 to 10) were used to assess the level of difficulty for each procedure and the doctors’ self-confidence. NRS scoring was based on posture (comfortable to uncomfortable), handling (easy to hard), and visual field (good to bad).

Results. No significant differences in performance were observed for EI or BMV at the three different bed heights. However, all of the NRS scores were significantly different among the different bed heights (P<0.001), and were poorest for the knee height beds: knee height (EI: posture 5.8~7.3, handling 4.3~5.7, visual field 3.9~5.5; BMV: posture 7.1~8.0, handling 5.9~7.2, 95% CI), mid-thigh height (EI: posture 2.9~4.0, handling 2.9~4.0, visual field 2.7~3.8; BMV: posture 2.4~3.2, handling 2.3~3.5) and ASIS height (EI: posture 2.2~3.5, handling 2.6~3.8, visual field 2.1~3.4; BMV: posture 2.9~4.4, handling 4.7~6.1).

Conclusions. Although the participants reported that the knee height beds were the least comfortable, hardest to handle, and made seeing the vocal cord difficult, these caveats did not affect their performance during airway procedures.

Key words: endotracheal intubation, positive pressure ventilation, bed, cardiopulmonary resuscitation

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Effect of population-based training programs on bystander willingness to perform cardiopulmonary resuscitation

Abstract

Objective. This study was performed to determine the factors related to unwillingness of bystanders to perform cardiopulmonary resuscitation (CPR), and improvement of willingness among the lay public after CPR training.

Design. Retrospective design

Methods. We collected questionnaires received from laypersons attending CPR training courses implemented by the CPR Improvement Program of Chang Gung Memorial Foundation. Pre- and post-training questionnaires were given to participants attending CPR training courses between September 2013 and January 2014.

Results. Among the 401 respondents at pre-training, higher educational level (odds ratio, 3.605; 95% confidence interval [CI], 3.055 – 8.284) and previous CPR training (odds ratio, 1.754; 95% CI, 1.049 – 2.932) were significantly associated with willingness to perform bystander CPR. Significant improvements in willingness to perform conventional CPR and hands-only CPR on a stranger were observed after training (P = 0.016 and P < 0.0001, respectively). Approximately half of the respondents claimed that fear of doing further harm was the primary reason for their lack of willingness to administer conventional CPR on a stranger.

Conclusions. We showed that CPR training significantly increased the rate of willingness to perform CPR on strangers as well as acquaintances among the lay public. This study also showed that fear of doing further harm was the most significant barrier after training. This concern should be addressed in future training programs.

Key words: cardiopulmonary resuscitation, cardiopulmonary resuscitation training, bystander willingness

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Effects of therapeutic hypothermia and kinetics of serum protein S100B after cardiopulmonary resuscitation

Abstract

Introduction. Post-resuscitation care is regulated by international guidelines. A milestone of these is the application of therapeutic hypothermia (TH). The aims of our study were: to determine the 30-day-mortality for our patients, to monitor the efficacy and effects of TH, and to investigate serum protein S100B – as an early prognostic marker.

Materials and Methods. In our study, 57 patients, treated after cardiopulmonary resuscitation (CPR) on a multidisciplinary intensive care unit, were included. Patients were divided into groups who received and who didn’t receive TH. 30-day-mortality was determined as an end-point. Effects of TH were monitored using statistical analysis according to clinical parameters and laboratory tests. Serum protein S100B levels were measured with ELISA technique on 20 randomised patients at admission and the 1st, 3rd and 5th day after CPR.

Results. Total 30-day-mortality was 74%. TH did not reduced the 30-day-mortality (73% vs. 74%, p>0.05). We found a significant correlation between TH and serum lactate concentration after admission (0h, p=0.006) and at 12 (p=0.045) and 36 (p=0.049) hours after CPR. On the 3rd (p=0.005) and 4th (p=0.043) day after CPR, as a result of TH, platelet count was significantly higher compared to normothermic samples. There was no significant difference in protein S100B levels between the normothermic and TH group and protein S100B levels did not correlate with 30-day-mortality.

Conclusion. Despite recommendations of international guidelines, we cannot prove the beneficial effect of TH, or a correlation of protein S100B levels with a positive outcome.

Key words: cardiac arrest, cardiopulmonary resuscitation, post-resuscitation care, therapeutic hypothermia, protein S100B

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