- Email: [email protected]
AP086 In-hospital evaluation of basic life support training programs: A randomized controlled trial
Abstracts, Resuscitation 2011 – Implementation / Resuscitation 82S1 (2011) S1–S34 ventilation and chest compression can prevent neonatal mortality. This study examined practical skills of NICU and operating room personnel’s in ventilation and chest compression on neonates and also the available instruments were evaluated. Method: Fifty six of staff candidates were tested. We also evaluated each candidate during performance of two rescuers CPR on a neonate manikin, using a checklist. Results: Findings show that 32% of the candidates under study worked in the neonates unit, 25% in NICU and 43% in the operation room. Availability of the main equipment related to ventilation and cardiac massage was moderate but accessible. Also, 44.6% of them had good capability, performing for ventilation in neonate with Ambo bag, and 50% of them had good capability of cardiac massage. The evaluation was conducted using check list by two examiners. Conclusions: In spite of good skill, 50% of the staffs were weak or moderate in giving cardiac massage and ventilation. For many of the staff conducting classes on neonate’s rehabilitation and process of ventilation and cardiac massage is necessary
S29
mmHg during the resuscitation, respectively. In compression-to-compression analysis, compression depths below 4 cm (n=691), 4–5 cm (n=1431), 5–6 cm (n=852) and >6 cm (n=1894) created SVP of 45±10, 42±13, 61±20 and 61±22 mmHg, respectively. Femoral arteriovenous pressure gradient in two patients were in systolic phase 23±10 and 55±11 mmHg, and in diastolic phase 8±5 and 4±8 mmHg. Conclusions: Surprisingly high extrathoracic venous pressures were induced by good quality CPR. Current compression technique creates high extrathoracic venous pressure and therefore can cause a harmful retrograde blood flow in venous circulation and decrease cardiac output during resuscitation.
AP088 Nurses feel inadequate despite successful in-hospital resuscitation: A qualitative pilot study Anne Mette Kristiansen, Jette Svanholm
AP086 In-hospital evaluation of basic life support training programs: A randomized controlled trial Naheed Akhtar 1 , Naheed Akhtar 2 , Robin Davies 1 , Michelle Davies 1 , Natalie Husselbee 1 , Richard Field 1 , Matthew Cooke 2 , Gavin Perkins 1 , Gavin Perkins 2 1 Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK 2 Warwick Medical School, University of Warwick, Coventry, UK
Background: Previous studies show that video facilitated training can replace instructor-led training and may be more cost effective. Using this principle we developed a Basic Life Support (BLS) video for training healthcare staff. The aim of this study was to determine the effectiveness of the new BLS video in supporting effective cardiopulmonary resuscitation (CPR) skill performance amongst healthcare professionals compared to conventional instructor-led BLS training. Materials and Methods: Healthcare staff were randomised to BLS-video training in absence of an instructor or BLS-video training facilitated by an instructor. At the end of the training session, CPR skill performance was measured on a Laerdal Resusci® Anne SkillReporter™ full body recording manikin. Participant perception of quality of CPR was quantified on a linear 10-point analogue scale. Results were considered significant if p value <0.05. Results: At initial evaluation CPR performance was inferior in the video group (16% correct chest compressions versus 34% Instructed group; p=0.006). This was largely due to insufficient chest compression depth in the video group, ((39 (13.9) mm versus Instructed group 49 (5.5) mm; p=0.01)). This prompted revision of the video to emphasise chest compression depth. The revised video led to improved chest compression depth ((45 (7.9) mm; p=0.01 compared to baseline)) and an overall increase in percentage of correct chest compressions, (36%; p=0.01). Participant perception of quality of CPR was no different between the two groups. Conclusion: The production of alternative training materials such as BLS video should be evaluated on a case by case basis to ensure effective learning outcomes. There remains scope to improve CPR performance in both video and instructor-led training.
AP087 High extrathoracic venous pressure during resuscitation attempts – Time to reanalyze the mechanisms of CPR? Marko Sainio 2 , Sanna Hoppu 2 , Heini Huhtala 3 , Klaus Olkkola 1 , Jyrki Tenhunen 2 1 Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku University Hospital, University of Turku, Turku, Finland 2 Critical Care Medicine Research Group, Department of Intensive Care, Tampere University Hospital, Tampere, Finland 3 School of Health Sciences, University of Tampere, Tampere, Finland
Background: Arteriovenous pressure gradient is a prerequisite to antegrade blood flow during resuscitation. High retrograde venous pressure waves could cause retrograde blood flow and decrease arteriovenous pressure gradient, diastolic heart filling and tissue perfusion. Currently it has been assumed that the intrathoracic retrograde blood pressure is not reflected disturbingly to extrathoracic vasculature. Materials and Methods: We are currently conducting a prospective study in out-of-hospital and in-hospital cardiac arrest patients. We have recorded the quality of CPR and invasive femoral arterial (per protocol) blood pressure using Philips HeartStart MRx defibrillator. During the demanding clinical conditions, we have unintentionally cannulated the femoral vein on several occasions. Herein we report the serendipitous venous pressure data from ten patients, two of whom had also arterial pressures measured simultaneously. Statistical analysis was performed using mixed model analysis with the patient as a random factor. Results: The episode length (mean ± SD) was 17±7 min. The access to femoral vessel (vein) was achieved within 15.5±8 min after collapse. Systolic (SVP), mean (MVP) and diastolic venous pressures (DVP) reached 53±17, 32±10 and 20±10
Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark Background: Cardiac arrest has a poor prognosis. Nurses are often first responders and expected to initiate cardiopulmonary resuscitation (CPR). Time plays a key role and nurses’ response may be crucial for a successful outcome. There is limited evidence about the experiences of nurses involved in CPR. Moreover, nurses often use CPR training sessions to debrief CPR experiences. This pilot study aims at gaining further knowledge of nurses’ experiences of participation in resuscitation to improve resuscitation performance, patient care and outcome. Materials and Methods: Semi-structured interviews conducted in March 2010 with four nurses from non-critical care wards were recorded and transcribed verbatim. A 3-step phenomenological hermeneutic approach was used to analyse data. Results: Five themes emerged: “On the edge of life and death”, “emotions”, “relation to the patient”, “chaotic resuscitation environment” and “debriefing”. Nurses experienced different emotions influencing their ability to function efficiently. Resuscitating one of the nurse’s own patients was stressful. The ambiguity of life was difficult to comprehend. The atmosphere was perceived as chaotic and too many participants resulted in less efficient actions being taken. In this critical and chaotic context the nurses need for debriefing seemed paramount. Still the debriefing carried out lacked structure and focus. Conclusion: These results indicated that resuscitation is challenging, stressful and creating emotions in a continuum from “panic to feeling happy”. The experience of uncertainty despite successful resuscitation is a key finding seemingly influencing the overall learning outcome and experience negatively. This piloty study stresses the need for debriefing after resuscitation to assist nurses and other health care professionals to cope with the experience and to reconstruct and understand reactions and feelings. Further investigations are needed to establish a structured debriefing tool to improve learning outcome, resuscitation performance, patient care and outcome.
AP089 Association between no-flow time and neurological outcome of out-of-hospital cardiac arrest patients Aki Nagase 1 , Hiroshi Kaneko 2 , Tetsuo Hatanaka 3, Hiroko Noguchi 4 , Seishiro Marukawa 5 1
Nagoya Ekisaikai Hospital, Nagoya, Japan Nagoya City Fire Department, Nagoya, Japan 3 Emergency Life-saving Technique Academy, Kitakyusyu, Japan 4 National Center of Neulorogy and Psychiatry, Kodaira, Japan 5 Iseikai Hospital, Osaka, Japan 2
Background: Rapid initiation of bystander CPR is the critical link of the chainof-survival for patients with witnessed cardiac arrest. Delay in CPR initiation either by bystanders or EMTs renders undue no-flow time and results in poor outcome. Using the national database of out-of-hospital cardiac arrest (OHCA), we examined the association between no-flow time and neurological outcome. Materials and Methods: A total of 217,006 witnessed OHCA patients from January 2005 through December 2009 was enrolled. All data were collected according to the Utstein-style guidelines. We excluded patients <18 years old, >99 years old, trauma- or malignancy-related cardiac arrest, patients who received defibrillation by layperson and patients for whom no-flow time exceeded 15 min. The primary outcome measure was favorable neurological outcome at 1 month post-arrest. Cox’s proportional hazards regression model was used to test the significance of no-flow time, adjusting for the gender, age, etiology, use of advanced airway device, prehospital epinephrine administration, EMS response time and time from CPR initiation to hospital arrival. Results: A total of 91,000 patients met inclusion criteria of which 17,778 patients presented with VF/VT, 31,819 with PEA and 41,403 with asystole. In all rhythms, neurological outcomes decreased almost linearly at a rate ∼5%/min of no-flow time, although the trend was not statistically significant over the initial few minutes. The trend did not appear to vary among rhythms.
S29
mmHg during the resuscitation, respectively. In compression-to-compression analysis, compression depths below 4 cm (n=691), 4–5 cm (n=1431), 5–6 cm (n=852) and >6 cm (n=1894) created SVP of 45±10, 42±13, 61±20 and 61±22 mmHg, respectively. Femoral arteriovenous pressure gradient in two patients were in systolic phase 23±10 and 55±11 mmHg, and in diastolic phase 8±5 and 4±8 mmHg. Conclusions: Surprisingly high extrathoracic venous pressures were induced by good quality CPR. Current compression technique creates high extrathoracic venous pressure and therefore can cause a harmful retrograde blood flow in venous circulation and decrease cardiac output during resuscitation.
AP088 Nurses feel inadequate despite successful in-hospital resuscitation: A qualitative pilot study Anne Mette Kristiansen, Jette Svanholm
AP086 In-hospital evaluation of basic life support training programs: A randomized controlled trial Naheed Akhtar 1 , Naheed Akhtar 2 , Robin Davies 1 , Michelle Davies 1 , Natalie Husselbee 1 , Richard Field 1 , Matthew Cooke 2 , Gavin Perkins 1 , Gavin Perkins 2 1 Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK 2 Warwick Medical School, University of Warwick, Coventry, UK
Background: Previous studies show that video facilitated training can replace instructor-led training and may be more cost effective. Using this principle we developed a Basic Life Support (BLS) video for training healthcare staff. The aim of this study was to determine the effectiveness of the new BLS video in supporting effective cardiopulmonary resuscitation (CPR) skill performance amongst healthcare professionals compared to conventional instructor-led BLS training. Materials and Methods: Healthcare staff were randomised to BLS-video training in absence of an instructor or BLS-video training facilitated by an instructor. At the end of the training session, CPR skill performance was measured on a Laerdal Resusci® Anne SkillReporter™ full body recording manikin. Participant perception of quality of CPR was quantified on a linear 10-point analogue scale. Results were considered significant if p value <0.05. Results: At initial evaluation CPR performance was inferior in the video group (16% correct chest compressions versus 34% Instructed group; p=0.006). This was largely due to insufficient chest compression depth in the video group, ((39 (13.9) mm versus Instructed group 49 (5.5) mm; p=0.01)). This prompted revision of the video to emphasise chest compression depth. The revised video led to improved chest compression depth ((45 (7.9) mm; p=0.01 compared to baseline)) and an overall increase in percentage of correct chest compressions, (36%; p=0.01). Participant perception of quality of CPR was no different between the two groups. Conclusion: The production of alternative training materials such as BLS video should be evaluated on a case by case basis to ensure effective learning outcomes. There remains scope to improve CPR performance in both video and instructor-led training.
AP087 High extrathoracic venous pressure during resuscitation attempts – Time to reanalyze the mechanisms of CPR? Marko Sainio 2 , Sanna Hoppu 2 , Heini Huhtala 3 , Klaus Olkkola 1 , Jyrki Tenhunen 2 1 Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku University Hospital, University of Turku, Turku, Finland 2 Critical Care Medicine Research Group, Department of Intensive Care, Tampere University Hospital, Tampere, Finland 3 School of Health Sciences, University of Tampere, Tampere, Finland
Background: Arteriovenous pressure gradient is a prerequisite to antegrade blood flow during resuscitation. High retrograde venous pressure waves could cause retrograde blood flow and decrease arteriovenous pressure gradient, diastolic heart filling and tissue perfusion. Currently it has been assumed that the intrathoracic retrograde blood pressure is not reflected disturbingly to extrathoracic vasculature. Materials and Methods: We are currently conducting a prospective study in out-of-hospital and in-hospital cardiac arrest patients. We have recorded the quality of CPR and invasive femoral arterial (per protocol) blood pressure using Philips HeartStart MRx defibrillator. During the demanding clinical conditions, we have unintentionally cannulated the femoral vein on several occasions. Herein we report the serendipitous venous pressure data from ten patients, two of whom had also arterial pressures measured simultaneously. Statistical analysis was performed using mixed model analysis with the patient as a random factor. Results: The episode length (mean ± SD) was 17±7 min. The access to femoral vessel (vein) was achieved within 15.5±8 min after collapse. Systolic (SVP), mean (MVP) and diastolic venous pressures (DVP) reached 53±17, 32±10 and 20±10
Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark Background: Cardiac arrest has a poor prognosis. Nurses are often first responders and expected to initiate cardiopulmonary resuscitation (CPR). Time plays a key role and nurses’ response may be crucial for a successful outcome. There is limited evidence about the experiences of nurses involved in CPR. Moreover, nurses often use CPR training sessions to debrief CPR experiences. This pilot study aims at gaining further knowledge of nurses’ experiences of participation in resuscitation to improve resuscitation performance, patient care and outcome. Materials and Methods: Semi-structured interviews conducted in March 2010 with four nurses from non-critical care wards were recorded and transcribed verbatim. A 3-step phenomenological hermeneutic approach was used to analyse data. Results: Five themes emerged: “On the edge of life and death”, “emotions”, “relation to the patient”, “chaotic resuscitation environment” and “debriefing”. Nurses experienced different emotions influencing their ability to function efficiently. Resuscitating one of the nurse’s own patients was stressful. The ambiguity of life was difficult to comprehend. The atmosphere was perceived as chaotic and too many participants resulted in less efficient actions being taken. In this critical and chaotic context the nurses need for debriefing seemed paramount. Still the debriefing carried out lacked structure and focus. Conclusion: These results indicated that resuscitation is challenging, stressful and creating emotions in a continuum from “panic to feeling happy”. The experience of uncertainty despite successful resuscitation is a key finding seemingly influencing the overall learning outcome and experience negatively. This piloty study stresses the need for debriefing after resuscitation to assist nurses and other health care professionals to cope with the experience and to reconstruct and understand reactions and feelings. Further investigations are needed to establish a structured debriefing tool to improve learning outcome, resuscitation performance, patient care and outcome.
AP089 Association between no-flow time and neurological outcome of out-of-hospital cardiac arrest patients Aki Nagase 1 , Hiroshi Kaneko 2 , Tetsuo Hatanaka 3, Hiroko Noguchi 4 , Seishiro Marukawa 5 1
Nagoya Ekisaikai Hospital, Nagoya, Japan Nagoya City Fire Department, Nagoya, Japan 3 Emergency Life-saving Technique Academy, Kitakyusyu, Japan 4 National Center of Neulorogy and Psychiatry, Kodaira, Japan 5 Iseikai Hospital, Osaka, Japan 2
Background: Rapid initiation of bystander CPR is the critical link of the chainof-survival for patients with witnessed cardiac arrest. Delay in CPR initiation either by bystanders or EMTs renders undue no-flow time and results in poor outcome. Using the national database of out-of-hospital cardiac arrest (OHCA), we examined the association between no-flow time and neurological outcome. Materials and Methods: A total of 217,006 witnessed OHCA patients from January 2005 through December 2009 was enrolled. All data were collected according to the Utstein-style guidelines. We excluded patients <18 years old, >99 years old, trauma- or malignancy-related cardiac arrest, patients who received defibrillation by layperson and patients for whom no-flow time exceeded 15 min. The primary outcome measure was favorable neurological outcome at 1 month post-arrest. Cox’s proportional hazards regression model was used to test the significance of no-flow time, adjusting for the gender, age, etiology, use of advanced airway device, prehospital epinephrine administration, EMS response time and time from CPR initiation to hospital arrival. Results: A total of 91,000 patients met inclusion criteria of which 17,778 patients presented with VF/VT, 31,819 with PEA and 41,403 with asystole. In all rhythms, neurological outcomes decreased almost linearly at a rate ∼5%/min of no-flow time, although the trend was not statistically significant over the initial few minutes. The trend did not appear to vary among rhythms.