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When and where to promote cardiopulmonary resuscitation? A pilot study of association between circumstances and bystander CPR
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Poster Presentations / Resuscitation 83 (2012) e24–e123
Basic Life Support AP026 Assessing rescuer fatigue and resultant CPR performance under the new 2010 ERC guidelines Catherine McDonald 1,∗ , James Heggie 1 , Christopher Christopher Thorne 1 , Jonathan Hulme 2
Jones 1 ,
1
School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK 2 Sandwell & West Birmingham Hospitals, NHS Trust, Birmingham, UK Purpose of the study: Cardiopulmonary resuscitation (CPR) is crucial to survival following cardiac arrest, yet its effectiveness is significantly impaired by rescuer fatigue. The 2010 European Resuscitation Council (ERC) basic life support (BLS) guidelines increase the depth and narrow the accepted rate for chest compressions. This study sought to determine the extent to which these changes – which almost certainly require greater physical exertion – affect perceived and demonstrated effects of rescuer fatigue. Materials and methods: 62 participants were recruited to complete five minutes of conventional CPR following the ERC 2010 guidelines. Strict exclusion criteria were applied. A SkillReporterTM manikin was used to assess temporal change in determinants of CPR quality; chest compression rate and depth, and rescue breath volume were recorded and assessed for each minute of CPR delivery. Participants subjectively reported their end fatigue level, using a visual analogue scale, and the point at which they believed fatigue was affecting CPR delivery. Results: The proportion of chest compressions with adequate depth fell significantly between the first and fifth minute of CPR delivery, falling by 14% from 52% (95% CI: 50–53) to 38% (95% CI: 36–39); p = 0.012. Half of this decrease occurred between the first and second minutes of CPR delivery. Neither mean rescue breath volume nor chest compression rate differed over the assessed period. 49 (79%) participants reported that fatigue affected their CPR performance at an average of 167 s. End fatigue averaged 49.5 (range 0–95). Conclusions: This is the first study to investigate the effects of fatigue under the 2010 ERC guidelines. We have shown that fatigue impacts negatively on the quality of chest compression delivery after the first minute of CPR, in accordance with previous studies, and is poorly judged by rescuers. Rescuers should be advised to interchange after the second minute of CPR delivery, as per current guidance. http://dx.doi.org/10.1016/j.resuscitation.2012.08.085 AP027 An analysis of the introduction and efficacy of a novel training programme for ERC basic life support assessors Christopher Thorne 1,∗ , Christopher Jonathan Hulme 2 , Andrew Owen 3
Jones 1 , Philip
Harvey 2 ,
1
University of Birmingham, Birmingham, UK Sandwell & West Birmingham Hospitals, NHS Trust, Birmingham, UK 3 University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK 2
Purpose: Current ERC BLS/AED certification procedures permit BLS instructors to assess BLS/AED providers. Whilst there is some mention of assessment in the ERC instructor course it is unclear whether this is sufficient to prepare candidates for an assessment role. Recent studies have questioned the reliability of instructor-based assessment. This study sought to determine the
efficacy of instructor-based assessment and presents a simple training programme for BLS/AED Instructors aimed at standardising assessment decisions. Materials and methods: An Assessment Training Programme (ATP) which delivers supplementary, assessment-focused tuition for BLS instructors was integrated alongside an established BLS course. 18 ERC accredited Instructors participated in the study. Nine received standard ERC training (instructors); nine received additional training through the ATP (assessors). Formal assessment of 73 students’ BLS capabilities was performed by an assessor, with an ERC instructor and an ERC instructor trainer making a concurrent assessment. All participants individually completed an ERC assessment form. Pass/fail decisions for instructors and assessors were compared to the instructor trainers’ decisions as the gold-standard. Results: Instructors (49.3%) returned lower pass rates than assessors (64.4%) and instructor trainers (67.1%). There was a statistically significant difference between Instructors and Instructor Trainers (P = 0.035), and Instructors and Assessors (P = 0.015). There was not a significant difference between Assessors and Instructor Trainers (P = 0.824). Instructors were more prone to incorrectly failing candidates than Assessors (sensitivities of 80.5% and 63.8% respectively, P = 0.077). AED assessment was poor in both the Instructor (P = 0.007) and Assessor groups (P = 0.031). Conclusion: BLS Instructors have a tendency to fail candidates incorrectly for reasons that should not constitute a true assessment failure. The Assessment Training Programme described here is an effective intervention to standardise inter-assessor decision making and reduce-false failure rates. Consideration should be made to integrate such programmes into current BLS Instructor accreditation procedures. http://dx.doi.org/10.1016/j.resuscitation.2012.08.086 AP028 When and where to promote cardiopulmonary resuscitation? A pilot study of association between circumstances and bystander CPR Wei-Ting Chen 1,∗ , Shih-Hung Liu 1 , Nai-Chuan Chen 1 , HuangFu Ye 1 , Kuan-Chen Chin 1 , Eric Hao-Chang Chou 1 , Kah-Meng Chong 1 , Hui-Chih Wang 1 , Chih-Wei Yang 1 , Patrick Chow-In Ko 1 , Wen-Chu Chiang 1 , Matthew Huei-Ming Ma 1 , Mei-Shu Lai 2 , Allen Wen-Hsiang Chiu 4 , Chih-Hung Lin 4 , Guang-Hua Xiong 3 , YingWen Hsiao 3 1 Emergency Medicine Department, National Taiwan University Hospital, Taipei, Taiwan 2 Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan 3 Taipei City Fire Department, Taipei, Taiwan 4 Department of Health, Taipei City Government, Taipei, Taiwan
Introduction: Bystander cardiopulmonary resuscitation (CPR) is crucial to the survival of out-of-hospital cardiac arrest (OHCA). Although CPR was taught worldwide every day, the best time and region to promote these courses were not identified. We aimed to examine the association between circumstance factors and bystander CPR to identify the proper time and location to teach CPR. Methods: Data from Utstein registry of OHCAs in Taipei were used to test the correlation between bystander CPR rates and circumstance factors, including (1) the seasonal changes, (2) social economic status (SES) of the neighborhood surrounding the arrests, and (3) media events (i.e. OHCA of a celebrity). The seasonal changes were defined as the 3-month periods with temperature in rising (toward the annual peak of temperature) vs. in declining (toward
Poster Presentations / Resuscitation 83 (2012) e24–e123
the annual nadir of temperature). The average price of real property of the district was used as a surrogate for the SES. Celebrity arrests with more than five searchable reports from the largest News Archives in Taiwan were considered media events. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Stratified analyses by witness status or location of arrest were performed to examine the interactions. Results: From Jan. 1, 2008 to Dec. 30, 2009, 3573 adult nontraumatic OHCAs were included in analysis. Among them, only 617 (17.3%) cases received bystander CPR. Significantly higher bystander CPR rates were observed in months with rising temperatures, higher SES surroundings, and in the first 3 months of the media events, with ORs (95%CIs) 1.55 (1.21–1.97), 1.54 (1.21–1.96), and 1.23 (0.97–1.56), respectively. These effects were not confounded by witness status or location of arrest. Conclusions: The pilot study found certain circumstances were significantly associated with bystander CPR rate. These finding might have a potential to guide the time and region in need of CPR promotion. http://dx.doi.org/10.1016/j.resuscitation.2012.08.087 AP029 CPR performance is not dependent on rescuers’ side of approach: A randomised crossover trial Christopher Jones 1,∗ , Christopher Thorne 1 , Jonathan Hulme 2 1
School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK 2 Sandwell & West Birmingham Hospitals, NHS Trust, Birmingham, UK
Purpose of the study: Effective cardiopulmonary resuscitation (CPR) is crucial to improving outcome following sudden cardiac arrest (SCA). Performance of CPR is dependent on a number of variables, however. Although a rescuer’s side of approach is not thought to affect chest compression quality, little is known about the effect of rescuers’ sidedness preference on rescue breath delivery and conventional CPR performance. Materials and methods: Twenty-four first year healthcare students were recruited from the University of Birmingham, UK, during the 2011–2012 academic year following completion of a European Resuscitation Council (ERC) accredited BLS course. Demographic data was collected and participants asked to approach a casualty from a neutral position; the side approached was recorded as their preferred. Participants were subsequently randomised to approach a Skillmeter manikin from either their preferred or non-preferred side and asked to complete 120 s of conventional CPR, repeating from the contralateral side after a 120 s rest period. Determinants of chest compression and rescue breath quality were recorded. Results: 75% preferred to approach from the casualty’s right; preferred side of approach did not impact on CPR performance. The average number of rescue breaths and chest compressions did not differ between preferred (9.0 ± 0.9 breaths, 149 ± 11.2 compressions) and non-preferred (9.0 ± 1.1 breaths, 149 ± 12.4 compressions) sides of approach; neither did the number of ventilations delivered with no error (1.2 ± 1.7 and 1.1 ± 1.5 respectively). Similarly, no difference was seen in the average hands off time of rescuers approaching from their preferred (8.0 ± 1.1 s) and nonpreferred (8.0 ± 1.3) sides. No impact was seen from rescuers’ sidedness preference on chest compression duty cycle, rate, depth or hand position accuracy. Conclusions: Neither chest compression quality nor rescue breath performance is affected by rescuers’ side of approach to
e35
a casualty. We recommend that rescuers should be advised to approach from the quickest and most accessible side. http://dx.doi.org/10.1016/j.resuscitation.2012.08.088 AP030 Lay rescuers are unable to adhere to the narrower range for chest compression rate recommended by the 2010 ERC guidelines Christopher Jones 1,∗ , Andrew Jonathan Hulme 2
Owen 3 , Christopher
Thorne 1 ,
1
School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK 2 Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK 3 Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Purpose of the study: Updated guidelines for basic life support (BLS) were published by the European Resuscitation Council (ERC) in 2010. These recommend that rescuers perform chest compressions to a greater depth than previously advised (5–6 cm, increased from 4 to 5 cm) and at a more narrowly defined rate (100–120 compressions per minute (cpm), decreased from 80 to 120 cpm). We sought to determine the ability of lay rescuers to adhere to the changes outlined within these guidelines. Materials and methods: We conducted a retrospective analysis of assessment records for first year healthcare students trained and assessed using either the 2010 ERC BLS guidelines or their 2005 predecessor. All students were trained as lay rescuers within the University of Birmingham, UK, as part of a standardised ERC-accredited adult BLS course. Overall pass/fail results were compared, in addition to rescuers’ ability to perform defined skills. Results: We analysed the examination records of 1091 students, 561 of whom were trained using the 2005 ERC guidelines and 530 using the 2010 ERC guidelines. A significantly greater proportion of rescuers made at least one error when trained in accordance with the 2010 ERC guidelines (16.0%, compared with 11.1% of students trained using the 2005 ERC guidelines; p < 0.05), resulting from a significant increase in rescuers performing chest compressions at too fast a rate (6.04% vs. 2.67%; p < 0.05). No significant disparity existed in the ability of rescuers trained with either guideline set to perform any other aspect of the BLS guidelines. Conclusions: Lay rescuers are unable to meet the narrower rate recommended by the 2010 ERC guidelines and consequently deliver chest compressions at too fast a rate. BLS courses should place greater emphasis on ensuring that rescuers meet the narrower rate for chest compression delivery recommended by the 2010 ERC guidelines. http://dx.doi.org/10.1016/j.resuscitation.2012.08.089 AP031 Can pictograms improve the quality of bystander cardiopulmonary resuscitation? Marcus Ziegler 2,∗ , Konstantin Krychtiuk 2 , Karl Michael Hüpfl 1 , Bernhard Rössler 1
Schebesta 1 ,
1
Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, General Intensive Care and Pain Management, Medical University Vienna, Vienna, Austria 2 St. Johns Ambulance, Vienna, Austria Purpose: Since the introduction of the modern basic life support in the 1950, on-going efforts have been made to improve the qual-
Poster Presentations / Resuscitation 83 (2012) e24–e123
Basic Life Support AP026 Assessing rescuer fatigue and resultant CPR performance under the new 2010 ERC guidelines Catherine McDonald 1,∗ , James Heggie 1 , Christopher Christopher Thorne 1 , Jonathan Hulme 2
Jones 1 ,
1
School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK 2 Sandwell & West Birmingham Hospitals, NHS Trust, Birmingham, UK Purpose of the study: Cardiopulmonary resuscitation (CPR) is crucial to survival following cardiac arrest, yet its effectiveness is significantly impaired by rescuer fatigue. The 2010 European Resuscitation Council (ERC) basic life support (BLS) guidelines increase the depth and narrow the accepted rate for chest compressions. This study sought to determine the extent to which these changes – which almost certainly require greater physical exertion – affect perceived and demonstrated effects of rescuer fatigue. Materials and methods: 62 participants were recruited to complete five minutes of conventional CPR following the ERC 2010 guidelines. Strict exclusion criteria were applied. A SkillReporterTM manikin was used to assess temporal change in determinants of CPR quality; chest compression rate and depth, and rescue breath volume were recorded and assessed for each minute of CPR delivery. Participants subjectively reported their end fatigue level, using a visual analogue scale, and the point at which they believed fatigue was affecting CPR delivery. Results: The proportion of chest compressions with adequate depth fell significantly between the first and fifth minute of CPR delivery, falling by 14% from 52% (95% CI: 50–53) to 38% (95% CI: 36–39); p = 0.012. Half of this decrease occurred between the first and second minutes of CPR delivery. Neither mean rescue breath volume nor chest compression rate differed over the assessed period. 49 (79%) participants reported that fatigue affected their CPR performance at an average of 167 s. End fatigue averaged 49.5 (range 0–95). Conclusions: This is the first study to investigate the effects of fatigue under the 2010 ERC guidelines. We have shown that fatigue impacts negatively on the quality of chest compression delivery after the first minute of CPR, in accordance with previous studies, and is poorly judged by rescuers. Rescuers should be advised to interchange after the second minute of CPR delivery, as per current guidance. http://dx.doi.org/10.1016/j.resuscitation.2012.08.085 AP027 An analysis of the introduction and efficacy of a novel training programme for ERC basic life support assessors Christopher Thorne 1,∗ , Christopher Jonathan Hulme 2 , Andrew Owen 3
Jones 1 , Philip
Harvey 2 ,
1
University of Birmingham, Birmingham, UK Sandwell & West Birmingham Hospitals, NHS Trust, Birmingham, UK 3 University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK 2
Purpose: Current ERC BLS/AED certification procedures permit BLS instructors to assess BLS/AED providers. Whilst there is some mention of assessment in the ERC instructor course it is unclear whether this is sufficient to prepare candidates for an assessment role. Recent studies have questioned the reliability of instructor-based assessment. This study sought to determine the
efficacy of instructor-based assessment and presents a simple training programme for BLS/AED Instructors aimed at standardising assessment decisions. Materials and methods: An Assessment Training Programme (ATP) which delivers supplementary, assessment-focused tuition for BLS instructors was integrated alongside an established BLS course. 18 ERC accredited Instructors participated in the study. Nine received standard ERC training (instructors); nine received additional training through the ATP (assessors). Formal assessment of 73 students’ BLS capabilities was performed by an assessor, with an ERC instructor and an ERC instructor trainer making a concurrent assessment. All participants individually completed an ERC assessment form. Pass/fail decisions for instructors and assessors were compared to the instructor trainers’ decisions as the gold-standard. Results: Instructors (49.3%) returned lower pass rates than assessors (64.4%) and instructor trainers (67.1%). There was a statistically significant difference between Instructors and Instructor Trainers (P = 0.035), and Instructors and Assessors (P = 0.015). There was not a significant difference between Assessors and Instructor Trainers (P = 0.824). Instructors were more prone to incorrectly failing candidates than Assessors (sensitivities of 80.5% and 63.8% respectively, P = 0.077). AED assessment was poor in both the Instructor (P = 0.007) and Assessor groups (P = 0.031). Conclusion: BLS Instructors have a tendency to fail candidates incorrectly for reasons that should not constitute a true assessment failure. The Assessment Training Programme described here is an effective intervention to standardise inter-assessor decision making and reduce-false failure rates. Consideration should be made to integrate such programmes into current BLS Instructor accreditation procedures. http://dx.doi.org/10.1016/j.resuscitation.2012.08.086 AP028 When and where to promote cardiopulmonary resuscitation? A pilot study of association between circumstances and bystander CPR Wei-Ting Chen 1,∗ , Shih-Hung Liu 1 , Nai-Chuan Chen 1 , HuangFu Ye 1 , Kuan-Chen Chin 1 , Eric Hao-Chang Chou 1 , Kah-Meng Chong 1 , Hui-Chih Wang 1 , Chih-Wei Yang 1 , Patrick Chow-In Ko 1 , Wen-Chu Chiang 1 , Matthew Huei-Ming Ma 1 , Mei-Shu Lai 2 , Allen Wen-Hsiang Chiu 4 , Chih-Hung Lin 4 , Guang-Hua Xiong 3 , YingWen Hsiao 3 1 Emergency Medicine Department, National Taiwan University Hospital, Taipei, Taiwan 2 Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan 3 Taipei City Fire Department, Taipei, Taiwan 4 Department of Health, Taipei City Government, Taipei, Taiwan
Introduction: Bystander cardiopulmonary resuscitation (CPR) is crucial to the survival of out-of-hospital cardiac arrest (OHCA). Although CPR was taught worldwide every day, the best time and region to promote these courses were not identified. We aimed to examine the association between circumstance factors and bystander CPR to identify the proper time and location to teach CPR. Methods: Data from Utstein registry of OHCAs in Taipei were used to test the correlation between bystander CPR rates and circumstance factors, including (1) the seasonal changes, (2) social economic status (SES) of the neighborhood surrounding the arrests, and (3) media events (i.e. OHCA of a celebrity). The seasonal changes were defined as the 3-month periods with temperature in rising (toward the annual peak of temperature) vs. in declining (toward
Poster Presentations / Resuscitation 83 (2012) e24–e123
the annual nadir of temperature). The average price of real property of the district was used as a surrogate for the SES. Celebrity arrests with more than five searchable reports from the largest News Archives in Taiwan were considered media events. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Stratified analyses by witness status or location of arrest were performed to examine the interactions. Results: From Jan. 1, 2008 to Dec. 30, 2009, 3573 adult nontraumatic OHCAs were included in analysis. Among them, only 617 (17.3%) cases received bystander CPR. Significantly higher bystander CPR rates were observed in months with rising temperatures, higher SES surroundings, and in the first 3 months of the media events, with ORs (95%CIs) 1.55 (1.21–1.97), 1.54 (1.21–1.96), and 1.23 (0.97–1.56), respectively. These effects were not confounded by witness status or location of arrest. Conclusions: The pilot study found certain circumstances were significantly associated with bystander CPR rate. These finding might have a potential to guide the time and region in need of CPR promotion. http://dx.doi.org/10.1016/j.resuscitation.2012.08.087 AP029 CPR performance is not dependent on rescuers’ side of approach: A randomised crossover trial Christopher Jones 1,∗ , Christopher Thorne 1 , Jonathan Hulme 2 1
School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK 2 Sandwell & West Birmingham Hospitals, NHS Trust, Birmingham, UK
Purpose of the study: Effective cardiopulmonary resuscitation (CPR) is crucial to improving outcome following sudden cardiac arrest (SCA). Performance of CPR is dependent on a number of variables, however. Although a rescuer’s side of approach is not thought to affect chest compression quality, little is known about the effect of rescuers’ sidedness preference on rescue breath delivery and conventional CPR performance. Materials and methods: Twenty-four first year healthcare students were recruited from the University of Birmingham, UK, during the 2011–2012 academic year following completion of a European Resuscitation Council (ERC) accredited BLS course. Demographic data was collected and participants asked to approach a casualty from a neutral position; the side approached was recorded as their preferred. Participants were subsequently randomised to approach a Skillmeter manikin from either their preferred or non-preferred side and asked to complete 120 s of conventional CPR, repeating from the contralateral side after a 120 s rest period. Determinants of chest compression and rescue breath quality were recorded. Results: 75% preferred to approach from the casualty’s right; preferred side of approach did not impact on CPR performance. The average number of rescue breaths and chest compressions did not differ between preferred (9.0 ± 0.9 breaths, 149 ± 11.2 compressions) and non-preferred (9.0 ± 1.1 breaths, 149 ± 12.4 compressions) sides of approach; neither did the number of ventilations delivered with no error (1.2 ± 1.7 and 1.1 ± 1.5 respectively). Similarly, no difference was seen in the average hands off time of rescuers approaching from their preferred (8.0 ± 1.1 s) and nonpreferred (8.0 ± 1.3) sides. No impact was seen from rescuers’ sidedness preference on chest compression duty cycle, rate, depth or hand position accuracy. Conclusions: Neither chest compression quality nor rescue breath performance is affected by rescuers’ side of approach to
e35
a casualty. We recommend that rescuers should be advised to approach from the quickest and most accessible side. http://dx.doi.org/10.1016/j.resuscitation.2012.08.088 AP030 Lay rescuers are unable to adhere to the narrower range for chest compression rate recommended by the 2010 ERC guidelines Christopher Jones 1,∗ , Andrew Jonathan Hulme 2
Owen 3 , Christopher
Thorne 1 ,
1
School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK 2 Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK 3 Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Purpose of the study: Updated guidelines for basic life support (BLS) were published by the European Resuscitation Council (ERC) in 2010. These recommend that rescuers perform chest compressions to a greater depth than previously advised (5–6 cm, increased from 4 to 5 cm) and at a more narrowly defined rate (100–120 compressions per minute (cpm), decreased from 80 to 120 cpm). We sought to determine the ability of lay rescuers to adhere to the changes outlined within these guidelines. Materials and methods: We conducted a retrospective analysis of assessment records for first year healthcare students trained and assessed using either the 2010 ERC BLS guidelines or their 2005 predecessor. All students were trained as lay rescuers within the University of Birmingham, UK, as part of a standardised ERC-accredited adult BLS course. Overall pass/fail results were compared, in addition to rescuers’ ability to perform defined skills. Results: We analysed the examination records of 1091 students, 561 of whom were trained using the 2005 ERC guidelines and 530 using the 2010 ERC guidelines. A significantly greater proportion of rescuers made at least one error when trained in accordance with the 2010 ERC guidelines (16.0%, compared with 11.1% of students trained using the 2005 ERC guidelines; p < 0.05), resulting from a significant increase in rescuers performing chest compressions at too fast a rate (6.04% vs. 2.67%; p < 0.05). No significant disparity existed in the ability of rescuers trained with either guideline set to perform any other aspect of the BLS guidelines. Conclusions: Lay rescuers are unable to meet the narrower rate recommended by the 2010 ERC guidelines and consequently deliver chest compressions at too fast a rate. BLS courses should place greater emphasis on ensuring that rescuers meet the narrower rate for chest compression delivery recommended by the 2010 ERC guidelines. http://dx.doi.org/10.1016/j.resuscitation.2012.08.089 AP031 Can pictograms improve the quality of bystander cardiopulmonary resuscitation? Marcus Ziegler 2,∗ , Konstantin Krychtiuk 2 , Karl Michael Hüpfl 1 , Bernhard Rössler 1
Schebesta 1 ,
1
Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, General Intensive Care and Pain Management, Medical University Vienna, Vienna, Austria 2 St. Johns Ambulance, Vienna, Austria Purpose: Since the introduction of the modern basic life support in the 1950, on-going efforts have been made to improve the qual-