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AP015 Chest compression synchronized ventilation during CPR: Technical solution and flow-volume curves of a novel ventilator mode
Abstracts, Resuscitation 2011 – Implementation / Resuscitation 82S1 (2011) S1–S34
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AP015
AP017
Chest compression synchronized ventilation during CPR: Technical solution and flow-volume curves of a novel ventilator mode
Improvement of chest compression quality performed by first rescuers using a feedback device: Q-CPR® . Manikin prospective randomized crossover study
Florian Dietz 1 , Christian Neuhaus 3 , Wolfgang Dersch 2 , Pascal Wallot 2 , Oliver Hahn 2 , Stefan Schwarz 2 , Robert Mahling 2 , Hinnerk Wulf 2 , Clemens Kill 2
Clément Buleon 1 , Hélène Defacq 1 , Xavier Arrot 1 , Laurent Halbout 1 , Jean-Jacques Parienti 2 , Jean-Luc Hanouz 1
1
1
2
2
Weinmann Geräte für Medizin GmbH+Co.KG, Hamburg, Germany Dept. of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany 3 Institut für Automatisierungstechnik und Qualitätssicherung e.V., Heidelberg, Germany Objective: Mechanical ventilation with an automated ventilator is recommended during CPR with secured airway.1 We developed and investigated the novel ventilator mode Chest Compression Synchronized Ventilation (CCSV), a pressure controlled ventilation triggered by each chest compression. The new ventilator mode and trigger technology are described and the resulting flow-volume curves were investigated in a pig model. Methods: CCSV was programmed in a regular transport ventilator (MEDUMAT Transport) similar to ASB with an inverted trigger comprising three combined criteria: Airway pressure rises above 0.9–3.7 hPa, pressure slope crosses 25–375 hPa/s and expiration time exceeds 200–34 0 ms. The trigger is set to the most sensitive setting out of 15 without autotriggering. This novel trigger induces pressure controlled inspiration (decelerating flow) during each chest compression. After approval by local authorities 7 pigs were anaesthetized with endotracheal intubation, instrumented and VF was induced. After 3 min cardiac arrest 10 min continuous chest compressions (LUCAS device) with CCSV followed with a Pmax of 60 mbar, fixed inspiration time of 205 ms, and PEEP = 0 mbar. An external proximal flow and pressure sensor was used to acquire the ventilatory curves, tidal volumes were calculated for minute 4, 6, 8, 10 and 12, data are presented as median (25/75 percentiles). Results: CCSV was correctly triggered in 98.6% of the compressions achieving inspiratory pressures of 60 mbar, tidal volumes were 255 (227/287) ml, 243 (224/267) ml, 251 (222/291) ml, 232 (200/253) ml and 222 (191/254) ml. Conclusions: CCSV could be realized by an adapted trigger technology with an immediate ventilator response to each chest compression. Resulting ventilation volumes exceed the tidal volumes of passive ventilation as well as the respiratory dead space.2 References: 1. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, Perkins GD. European Resuscitation Council Guidelines for Resuscitation 2010 section 4. Adult advanced Life Support. Resuscitation 2010;81:1305–52. 2. Idris AH, Banner MJ, Wenzel V, Fuerst RS, Becker LB, Melker RJ. Resuscitation 1994;28:143–50.
AP016 Improvement of chest compression quality performed by witness rescuers using a feedback device: Q-CPR® . Manikin prospective randomized crossover study 1
1
1
1
Clément Buleon , Laurent Halbout , Xavier Arrot , Hélène De Facq , Jean-Jacques Parienti 2 , Jean-Luc Hanouz 1 1 2
Pôle Anesthésie-Réanimation-SAMU, CHU de Caen, Caen, France Unité de Biostatistiques et de Recherche Clinique, CHU de Caen, Caen, France
Background: Cardiac arrest is a major issue in public health. Five to 15 persons on 10 000 a year are concerned, with a low survival rate of 5% to 15% depending of studies.1 Patients’ survive depend on celerity and efficiency of life support action. Latest guidelines highlighted the chest compression quality. Feedback devices are developed to reduce hand off time and to improve the chest compression quality. We studied the impact of the Q-CPR® (Laerdal Medical) feedback device on resuscitation performed by witness rescuers without any skills in cardio-pulmonary resuscitation. Materials and Method: This is a prospective randomized crossover study on manikins (Resusci Anne® ). One hundred and forty four medical students without any skills in cardio-pulmonary resuscitation representing witness rescuers were included. Medical students were asked to perform 2 minutes of chest compression without interruption with (group A) or without (group B) feedback provided by the Q-CPR® device. There was 4 months between the 2 crossover phases to avoid resilience effect. Data are collected by the Q-CPR® device. Results: Good compression rate was significantly improved in the group A compared to group B (58% versus 20%, p<0.0001). Adequate depth rate (>40 mm) was significantly improved in the group A compared to group B (39% versus 01%, p<0.0001). Adequate rate of compression rate (90 to 120/min) was significantly improved in the group A compared to group B (80% versus 54%, p<0.0001). Conclusion: The use of the Q-CPR® significantly improved chest compression quality performed by medical students without any skills in cardio-pulmonary resuscitation representing witness rescuers. Because chest compression quality is a key point of the improvement in cardiac arrest survive and that witness rescuers are the first on site, such feedback device could play a major role in the future of basic life support in public places. Reference: 1. Resuscitation 2004 Oct;63(1):17–24.
Pôle Anesthésie-Réanimation-SAMU, CHU de Caen, Caen, France Unité de Biostatistiques et de Recherche Clinique, CHU de Caen, Caen, France
Background: Cardiac arrest is a major issue in public health. Five to 15 person on 10 000 a year are concerned, with a low survival rate of 5% to 15% depending of studies.1 Even if rescue network is well known and functional, patients’ survive depend of celerity and efficiency of life support action. The major point highlighted in the latest guidelines is the chest compression quality.2 . Feedback devices are developed to reduce hand off time and to improve the chest compression quality. We decided to study the impact of the Q-CPR® (Laerdal Medical) feedback device on resuscitation performed by first rescuers skilled in cardio-pulmonary resuscitation. Materials and method: This is a prospective randomized crossover study on manikins (Resusci Anne® ). Forty-eight first rescuers were included. Rescuers were asked to performed 2 minutes of chest compression without interruption with (group A, guide) or without (group B, not guide) feedback provide by the Q-CPR® device. There was 4 months between the 2 crossover phases to avoid resilience effect. Data are collected by the Q-CPR® device. Results: Good compressions rate was significantly improved in the group A compared to group B (59% versus 30%, p=0.001). Adequate depth rate (>40 mm) was significantly improved in the group A compared to group B (60% versus 38%, p=0.01). Adequate rate of compression rate (90 to 120/min) was significantly improved in the group A compared to group B (77% versus 57%, p=0.01). Conclusion: The use of the Q-CPR® feedback device significantly improved chest compression quality performed by first rescuers skilled in cardio-pulmonary resuscitation. Because chest compression quality is a key point of the improvement in cardiac arrest survival, such feedback device could play a major role in the future of basic and advanced life support. References: 1. Resuscitation 2004 Oct;63(1):17–24. 2. Resuscitation 2010 Oct;81(Suppl 1):e1–332.
AP018 Pediatric defibrillation doses in in-hospital cardiac arrest: does energy dose influence survival? Jimena Del Castillo 1 , Jesús López-Herce 1 , Antonio Rodriguez 2 , European and Latinoamerican Study Group of Cardiac European and Latinoamerican Study Group of Cardiac Arrest in Children (Red Iberoamericana de Estudio de la Parada Cardiorrespiratoria en la Infancia), Madrid, Spain 1
Pediatric Critical Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain 2 Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain Background: The objective of this study was to analyse the results of cardiopulmonary resuscitation (CPR) that included defibrillation in in-hospital CA in children and to examine the effectiveness of different defibrillation doses. Patients and Methods: Prospective, international, observational, multicentrical study was performed. 124 hospitals from european and latinamerican countries participated during 24 months. CA in children were analysed using the Utstein template. CA episodes presenting a rhythm which required defibrillation were analysed. Retourn of spontaneous circulation (ROSC) and survival after different initial shock doses were compared Results: 51 of 564 inhospital CA in children (9%) presented a shockable rhythm. Ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT) was the first documented ECG rhythm in 21 episodes (3.7%). In 30 CA (5.3%) a shockable rhythm developed during resuscitation. The first shock terminated VF or PVT in 11 patients (28.9%). 6 patients (11%) needed more than 3 shocks to solve VF or PVT. ROSC was achieved in 30 cases (58.8%) and sustained in 23 (45%). Only 15 (29.4%) survived to hospital discharge. Children with VF or PVT as first documented rhythm had better survival rates (52.4%) than children with subsequent VF or PVT (13.3%) (p=0.004). There were no significant differences in ROSC and survival rates when comparing different doses: 2 J/kg (54.4% and 18.2%), 3–4 J/kg (47.4% and 31.6%) or more than 4 J/kg (87.5% and 50%). When compared with lower energy doses, patients who received >4 J/kg achieved nonsignificant higher ROSC (87.5% vs 58%; p=0.11) and survival (50% vs 26.7%; p=0.23) rates. Conclusions: Termination of VF or PVT after the first defibrillation dose is achieved in a low percentage of cases. Higher initial shock doses achieved similar ROSC and survival rates than lower doses. The optimal pediatric defibrillation dose remains unknown.
S13
AP015
AP017
Chest compression synchronized ventilation during CPR: Technical solution and flow-volume curves of a novel ventilator mode
Improvement of chest compression quality performed by first rescuers using a feedback device: Q-CPR® . Manikin prospective randomized crossover study
Florian Dietz 1 , Christian Neuhaus 3 , Wolfgang Dersch 2 , Pascal Wallot 2 , Oliver Hahn 2 , Stefan Schwarz 2 , Robert Mahling 2 , Hinnerk Wulf 2 , Clemens Kill 2
Clément Buleon 1 , Hélène Defacq 1 , Xavier Arrot 1 , Laurent Halbout 1 , Jean-Jacques Parienti 2 , Jean-Luc Hanouz 1
1
1
2
2
Weinmann Geräte für Medizin GmbH+Co.KG, Hamburg, Germany Dept. of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany 3 Institut für Automatisierungstechnik und Qualitätssicherung e.V., Heidelberg, Germany Objective: Mechanical ventilation with an automated ventilator is recommended during CPR with secured airway.1 We developed and investigated the novel ventilator mode Chest Compression Synchronized Ventilation (CCSV), a pressure controlled ventilation triggered by each chest compression. The new ventilator mode and trigger technology are described and the resulting flow-volume curves were investigated in a pig model. Methods: CCSV was programmed in a regular transport ventilator (MEDUMAT Transport) similar to ASB with an inverted trigger comprising three combined criteria: Airway pressure rises above 0.9–3.7 hPa, pressure slope crosses 25–375 hPa/s and expiration time exceeds 200–34 0 ms. The trigger is set to the most sensitive setting out of 15 without autotriggering. This novel trigger induces pressure controlled inspiration (decelerating flow) during each chest compression. After approval by local authorities 7 pigs were anaesthetized with endotracheal intubation, instrumented and VF was induced. After 3 min cardiac arrest 10 min continuous chest compressions (LUCAS device) with CCSV followed with a Pmax of 60 mbar, fixed inspiration time of 205 ms, and PEEP = 0 mbar. An external proximal flow and pressure sensor was used to acquire the ventilatory curves, tidal volumes were calculated for minute 4, 6, 8, 10 and 12, data are presented as median (25/75 percentiles). Results: CCSV was correctly triggered in 98.6% of the compressions achieving inspiratory pressures of 60 mbar, tidal volumes were 255 (227/287) ml, 243 (224/267) ml, 251 (222/291) ml, 232 (200/253) ml and 222 (191/254) ml. Conclusions: CCSV could be realized by an adapted trigger technology with an immediate ventilator response to each chest compression. Resulting ventilation volumes exceed the tidal volumes of passive ventilation as well as the respiratory dead space.2 References: 1. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, Perkins GD. European Resuscitation Council Guidelines for Resuscitation 2010 section 4. Adult advanced Life Support. Resuscitation 2010;81:1305–52. 2. Idris AH, Banner MJ, Wenzel V, Fuerst RS, Becker LB, Melker RJ. Resuscitation 1994;28:143–50.
AP016 Improvement of chest compression quality performed by witness rescuers using a feedback device: Q-CPR® . Manikin prospective randomized crossover study 1
1
1
1
Clément Buleon , Laurent Halbout , Xavier Arrot , Hélène De Facq , Jean-Jacques Parienti 2 , Jean-Luc Hanouz 1 1 2
Pôle Anesthésie-Réanimation-SAMU, CHU de Caen, Caen, France Unité de Biostatistiques et de Recherche Clinique, CHU de Caen, Caen, France
Background: Cardiac arrest is a major issue in public health. Five to 15 persons on 10 000 a year are concerned, with a low survival rate of 5% to 15% depending of studies.1 Patients’ survive depend on celerity and efficiency of life support action. Latest guidelines highlighted the chest compression quality. Feedback devices are developed to reduce hand off time and to improve the chest compression quality. We studied the impact of the Q-CPR® (Laerdal Medical) feedback device on resuscitation performed by witness rescuers without any skills in cardio-pulmonary resuscitation. Materials and Method: This is a prospective randomized crossover study on manikins (Resusci Anne® ). One hundred and forty four medical students without any skills in cardio-pulmonary resuscitation representing witness rescuers were included. Medical students were asked to perform 2 minutes of chest compression without interruption with (group A) or without (group B) feedback provided by the Q-CPR® device. There was 4 months between the 2 crossover phases to avoid resilience effect. Data are collected by the Q-CPR® device. Results: Good compression rate was significantly improved in the group A compared to group B (58% versus 20%, p<0.0001). Adequate depth rate (>40 mm) was significantly improved in the group A compared to group B (39% versus 01%, p<0.0001). Adequate rate of compression rate (90 to 120/min) was significantly improved in the group A compared to group B (80% versus 54%, p<0.0001). Conclusion: The use of the Q-CPR® significantly improved chest compression quality performed by medical students without any skills in cardio-pulmonary resuscitation representing witness rescuers. Because chest compression quality is a key point of the improvement in cardiac arrest survive and that witness rescuers are the first on site, such feedback device could play a major role in the future of basic life support in public places. Reference: 1. Resuscitation 2004 Oct;63(1):17–24.
Pôle Anesthésie-Réanimation-SAMU, CHU de Caen, Caen, France Unité de Biostatistiques et de Recherche Clinique, CHU de Caen, Caen, France
Background: Cardiac arrest is a major issue in public health. Five to 15 person on 10 000 a year are concerned, with a low survival rate of 5% to 15% depending of studies.1 Even if rescue network is well known and functional, patients’ survive depend of celerity and efficiency of life support action. The major point highlighted in the latest guidelines is the chest compression quality.2 . Feedback devices are developed to reduce hand off time and to improve the chest compression quality. We decided to study the impact of the Q-CPR® (Laerdal Medical) feedback device on resuscitation performed by first rescuers skilled in cardio-pulmonary resuscitation. Materials and method: This is a prospective randomized crossover study on manikins (Resusci Anne® ). Forty-eight first rescuers were included. Rescuers were asked to performed 2 minutes of chest compression without interruption with (group A, guide) or without (group B, not guide) feedback provide by the Q-CPR® device. There was 4 months between the 2 crossover phases to avoid resilience effect. Data are collected by the Q-CPR® device. Results: Good compressions rate was significantly improved in the group A compared to group B (59% versus 30%, p=0.001). Adequate depth rate (>40 mm) was significantly improved in the group A compared to group B (60% versus 38%, p=0.01). Adequate rate of compression rate (90 to 120/min) was significantly improved in the group A compared to group B (77% versus 57%, p=0.01). Conclusion: The use of the Q-CPR® feedback device significantly improved chest compression quality performed by first rescuers skilled in cardio-pulmonary resuscitation. Because chest compression quality is a key point of the improvement in cardiac arrest survival, such feedback device could play a major role in the future of basic and advanced life support. References: 1. Resuscitation 2004 Oct;63(1):17–24. 2. Resuscitation 2010 Oct;81(Suppl 1):e1–332.
AP018 Pediatric defibrillation doses in in-hospital cardiac arrest: does energy dose influence survival? Jimena Del Castillo 1 , Jesús López-Herce 1 , Antonio Rodriguez 2 , European and Latinoamerican Study Group of Cardiac European and Latinoamerican Study Group of Cardiac Arrest in Children (Red Iberoamericana de Estudio de la Parada Cardiorrespiratoria en la Infancia), Madrid, Spain 1
Pediatric Critical Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain 2 Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain Background: The objective of this study was to analyse the results of cardiopulmonary resuscitation (CPR) that included defibrillation in in-hospital CA in children and to examine the effectiveness of different defibrillation doses. Patients and Methods: Prospective, international, observational, multicentrical study was performed. 124 hospitals from european and latinamerican countries participated during 24 months. CA in children were analysed using the Utstein template. CA episodes presenting a rhythm which required defibrillation were analysed. Retourn of spontaneous circulation (ROSC) and survival after different initial shock doses were compared Results: 51 of 564 inhospital CA in children (9%) presented a shockable rhythm. Ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT) was the first documented ECG rhythm in 21 episodes (3.7%). In 30 CA (5.3%) a shockable rhythm developed during resuscitation. The first shock terminated VF or PVT in 11 patients (28.9%). 6 patients (11%) needed more than 3 shocks to solve VF or PVT. ROSC was achieved in 30 cases (58.8%) and sustained in 23 (45%). Only 15 (29.4%) survived to hospital discharge. Children with VF or PVT as first documented rhythm had better survival rates (52.4%) than children with subsequent VF or PVT (13.3%) (p=0.004). There were no significant differences in ROSC and survival rates when comparing different doses: 2 J/kg (54.4% and 18.2%), 3–4 J/kg (47.4% and 31.6%) or more than 4 J/kg (87.5% and 50%). When compared with lower energy doses, patients who received >4 J/kg achieved nonsignificant higher ROSC (87.5% vs 58%; p=0.11) and survival (50% vs 26.7%; p=0.23) rates. Conclusions: Termination of VF or PVT after the first defibrillation dose is achieved in a low percentage of cases. Higher initial shock doses achieved similar ROSC and survival rates than lower doses. The optimal pediatric defibrillation dose remains unknown.