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Compression-only CPR does not increase intracranial pressure compared to compression-ventilation CPR in pigs
Abstracts / Resuscitation 81S (2010) S1–S114 AP051 Personal preference and role of dominant hand position during external chest compression by novice rescuers Cho G.C. 1 , Kang G.H. 1 , Oh D.J. 2 , Rhee J.E. 3 , Song G.J. 4 1 Department
of Emergency Medicine,Hallym Medical Center, Seoul, Korea Department of cardiology,Hallym Medical Center, Seoul, Korea Department of emergency medicine, Seoul National University of Bundang Hospital, Gyeonggi-do, Korea 4 Department of emergency medicine, Samsung Medical Center, Seoul, Korea 2 3
Purpose: We conducted this study to identify the personal preference of dominant hand position during external chest compression (ECC) and the effect of hand positioning on the quality of ECC in novice rescuers. Methods: 383 Korea Railroad’s employees who had no cardiopulmonary resuscitation (CPR) training participated in this double-blind observational study. After completion of an adult CPR training program for 3 h, they selected the hand in contact with the manikin during ECC by oneself and performed 5 cycles of single rescuer CPR on a manikin. The quality of ECC was recorded by a recording Resusci Anne? in 72 participants. Results: Among 383 novice rescuers, 43.6% were women, and 98.7% were righthanded persons. 56.7% of them used the dominant hand in contact with the manikin during ECC, and men preferred positioning the dominant hand in contact with the manikin (P = 0.001). The rate of ECC was statistically faster in the dominant hand (DH) group, mean 117.3 ± 11.4 min−1 compared to the non-dominant hand (NH) group, mean 110.9 ± 12.2 min−1 (P = 0.028). However, the depth of ECC in the DH group, mean 52.4 ± 5.9 mm, was not statistically different from the NH group, mean 50.8 ± 6.0 mm (P = 0.287). Similarly, the portion of ECC with inadequate depth in the DH group, mean 1.8 ± 4.3%, was not statistically different from the NH group, mean 5.3 ± 15.6% (P = 0.252) Conclusions: Novice rescuers, especially men, prefer positioning the dominant hand in contact with the sternum during ECC. ECC is performed with a faster rate of compression when the dominant hand of the novice rescuer is placed in contact with the sternum. However, there is no statistical difference of the compression depth between the two groups during ECC.
S47
study was to assess ICP during different means of CPR (no-CPR vs. compression-only CPR vs. compression-ventilation CPR) in a porcine model of ventricular fibrillation (VF). We hypothesized that compression-only CPR would increase ICP compared to compressionventilation CPR if gasping was not present. Methods: Thirty-one anaesthetized domestic pigs (32 ± 2 kg) were included. ICP was measured via intraparenchymal probe MicroSensor Transducer (Codman, USA). Cerebral perfusion pressure was calculated according to the formula CPP = MAP − (ICP + CVP). VF was induced using intra-cardiac pacing lead. After 5 min of untreated VF, chest compressions were provided using an AutoPulse (Zoll, USA) simulating compression-only CPR for 5 min, followed with compression-ventilation CPR 30:2 for the next 5 min. Gasping was prevented using muscle relaxants. Data were analyzed using repeated measurements ANOVA and a Fisher’s protected LSD post hoc test. Results: Intracranial pressure (mean ± SD) during pre-arrest period, untreated VF, compression-only CPR, and compression-ventilation CPR was 9.7 ± 5.6, 14.6 ± 4.9, 11.2 ± 4.5, and 11.7 ± 4.5 mmHg respectively. Cerebral perfusion pressure measured in the same periods was 55.5 ± 12.3, −13.1 ± 5.2, 17.8 ± 5.1, and 19.0 ± 4.1 mmHg respectively. There were no statistical differences between periods of compression-only CPR and compression–ventilation CPR (P = 0.31 for ICP, and P = 0.53 for cerebral perfusion pressure). Conclusion: Withholding ventilation during compression-only CPR did not cause any changes to intracerebral and cerebral perfusion pressures compared to compression–ventilation CPR in this porcine model of VF. Supported by a grant IGA MH CZ NS10383-2/2009 and a research project MZO 00179906. References
AP052
1. Sayre MR, Berg RA, Cave DM, Page RL, Potts J, White RD. American Heart Association Emergency Cardiovascular Care Committee. Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. Circulation 2008;117:2162–7. 2. van Hulst RA, Hasan D, Lachmann B. Intracranial pressure, brain PCO2 , PO2 , and pH during hypo- and hyperventilation at constant mean airway pressure in pigs. Intens Care Med 2002;28:68–73. 3. Deakin CD, O’Neill JF, Tabor T. Does compression-only cardiopulmonary resuscitation generate adequate passive ventilation during cardiac arrest? Resuscitation 2007;75:53–9.
Cardiopulmonary resuscitation without ventilation
doi:10.1016/j.resuscitation.2010.09.198
doi:10.1016/j.resuscitation.2010.09.196
Pere R., Olivet J., Bertran C., Juvinya D., Carreras V.
AP054
Departament of Nursing, University of Girona, Catalonia, Spain Objectives: We propose to demonstrate that the simplification of CPR techniques, essentially the elimination of mouth-to-mouth resuscitation, increases the amount of time devoted to external chest compressions. We hope to determine, through the use of practice dummies, the exact amount of time devoted to chest compressions, and whether or not that time increases significantly when mouth-to-mouth resuscitation is not performed. Methodology: We conducted a controlled clinical test in which subjects were randomly split into two groups, with one group performing mouth-to-mouth resuscitation and external chest compressions (the control group), and the other only performing external chest compressions (the experimental group). Results: A total of 31 subjects performed CPR for 10-min periods. They were randomly split into two groups, with 14 performing conventional CPR and 17 doing uninterrupted chest compressions without mouth-to-mouth resuscitation. External chest compressions were not performed by the control group during 3 min and 10 s. Conclusions: The average time during which compressions are not performed on a patient with sudden cardiac arrest (SCA) when ventilations are also performed amounts to 42% of the total time. The average number of compressions that are not performed during a 10-min period when mouth-to-mouth resuscitation is performed is approximately 540. The data obtained from the study indicate that performing only compressions does not increase physical exhaustion. doi:10.1016/j.resuscitation.2010.09.197 AP053 Compression-only CPR does not increase intracranial pressure compared to compression-ventilation CPR in pigs Truhlar A. 1,2 , Turek Z. 1 , Parizkova R. 1 , Skulec R. 1,3 , Cerny V. 1,4 1 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic 2 Hradec Kralove Region Emergency Medical Service, Hradec Kralove, Czech Republic 3 Emergency Medical Service of the Central Bohemian Region, Beroun, Czech Republic 4 Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada
Introduction: Recent guidelines recommend compression-only CPR for bystander response to witnessed cardiac arrest although hypoventilation/apnoea may cause increase of intracranial pressure (ICP) affecting cerebral circulation.1,2 However, gasping respirations and chest compressions may generate some gas exchange.3 The aim of the
Stepping forward or shrinking back: Psychological factors in bystanders’ decisions to act (or not) Potts J., Lynch B. Emergency Cardiovascular Care, American Heart Association, United States Purpose: Bystander CPR is a strong predictor of survival from out-of-hospital cardiac arrest (OHCA), but the incidence of bystander CPR is low, even among those who have been trained. Until the mid-80s most of the research literature on bystander response in emergencies was not in the realm of OHCA; however, more recently, studies of OHCA have begun to generate significant observational data related to bystander response. This literature review incorporates both the cognitive and social psychological research and the research specific to OHCA, to elucidate the factors that appear to be at work in bystander intervention decisions. Materials and methods: The following criteria were developed for initial inclusion of research literature in the review: published in English between 1964 and 2010; keywords bystander, bystander intervention, bystander effect, helping behavior, bystander CPR, unresponsive bystander, and helping in an emergency. Databases included: MEDLINE, Psychological & Behavioral Sciences Collection, PsycINFO, Academic Search Complete, Health Source: Nursing/Academic Education and ERIC. Experimental, quasi-experimental, and observational studies were all included if they met the other criteria. The initial search produced 59 seed articles. The references of these articles were examined to secure additional relevant articles. Results: The extant research clearly shows that decisions about whether to act in an emergency is a complex process that can be mediated by many factors: characteristics of the rescuer and of the victim, knowledge and experience of the rescuer, dynamics of the social group and of the situation, and social and cultural norms that define and reinforce helping behavior. Conclusions: Public education efforts to increase the incidence of bystander CPR should address the problem at all of the identified levels. Suggestions for tailoring prospective educational programs, media messages and “just-in-time” training (such as dispatcher instructions or cell phone prompting) to improve the odds of bystander response will be presented. doi:10.1016/j.resuscitation.2010.09.199
of Emergency Medicine,Hallym Medical Center, Seoul, Korea Department of cardiology,Hallym Medical Center, Seoul, Korea Department of emergency medicine, Seoul National University of Bundang Hospital, Gyeonggi-do, Korea 4 Department of emergency medicine, Samsung Medical Center, Seoul, Korea 2 3
Purpose: We conducted this study to identify the personal preference of dominant hand position during external chest compression (ECC) and the effect of hand positioning on the quality of ECC in novice rescuers. Methods: 383 Korea Railroad’s employees who had no cardiopulmonary resuscitation (CPR) training participated in this double-blind observational study. After completion of an adult CPR training program for 3 h, they selected the hand in contact with the manikin during ECC by oneself and performed 5 cycles of single rescuer CPR on a manikin. The quality of ECC was recorded by a recording Resusci Anne? in 72 participants. Results: Among 383 novice rescuers, 43.6% were women, and 98.7% were righthanded persons. 56.7% of them used the dominant hand in contact with the manikin during ECC, and men preferred positioning the dominant hand in contact with the manikin (P = 0.001). The rate of ECC was statistically faster in the dominant hand (DH) group, mean 117.3 ± 11.4 min−1 compared to the non-dominant hand (NH) group, mean 110.9 ± 12.2 min−1 (P = 0.028). However, the depth of ECC in the DH group, mean 52.4 ± 5.9 mm, was not statistically different from the NH group, mean 50.8 ± 6.0 mm (P = 0.287). Similarly, the portion of ECC with inadequate depth in the DH group, mean 1.8 ± 4.3%, was not statistically different from the NH group, mean 5.3 ± 15.6% (P = 0.252) Conclusions: Novice rescuers, especially men, prefer positioning the dominant hand in contact with the sternum during ECC. ECC is performed with a faster rate of compression when the dominant hand of the novice rescuer is placed in contact with the sternum. However, there is no statistical difference of the compression depth between the two groups during ECC.
S47
study was to assess ICP during different means of CPR (no-CPR vs. compression-only CPR vs. compression-ventilation CPR) in a porcine model of ventricular fibrillation (VF). We hypothesized that compression-only CPR would increase ICP compared to compressionventilation CPR if gasping was not present. Methods: Thirty-one anaesthetized domestic pigs (32 ± 2 kg) were included. ICP was measured via intraparenchymal probe MicroSensor Transducer (Codman, USA). Cerebral perfusion pressure was calculated according to the formula CPP = MAP − (ICP + CVP). VF was induced using intra-cardiac pacing lead. After 5 min of untreated VF, chest compressions were provided using an AutoPulse (Zoll, USA) simulating compression-only CPR for 5 min, followed with compression-ventilation CPR 30:2 for the next 5 min. Gasping was prevented using muscle relaxants. Data were analyzed using repeated measurements ANOVA and a Fisher’s protected LSD post hoc test. Results: Intracranial pressure (mean ± SD) during pre-arrest period, untreated VF, compression-only CPR, and compression-ventilation CPR was 9.7 ± 5.6, 14.6 ± 4.9, 11.2 ± 4.5, and 11.7 ± 4.5 mmHg respectively. Cerebral perfusion pressure measured in the same periods was 55.5 ± 12.3, −13.1 ± 5.2, 17.8 ± 5.1, and 19.0 ± 4.1 mmHg respectively. There were no statistical differences between periods of compression-only CPR and compression–ventilation CPR (P = 0.31 for ICP, and P = 0.53 for cerebral perfusion pressure). Conclusion: Withholding ventilation during compression-only CPR did not cause any changes to intracerebral and cerebral perfusion pressures compared to compression–ventilation CPR in this porcine model of VF. Supported by a grant IGA MH CZ NS10383-2/2009 and a research project MZO 00179906. References
AP052
1. Sayre MR, Berg RA, Cave DM, Page RL, Potts J, White RD. American Heart Association Emergency Cardiovascular Care Committee. Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. Circulation 2008;117:2162–7. 2. van Hulst RA, Hasan D, Lachmann B. Intracranial pressure, brain PCO2 , PO2 , and pH during hypo- and hyperventilation at constant mean airway pressure in pigs. Intens Care Med 2002;28:68–73. 3. Deakin CD, O’Neill JF, Tabor T. Does compression-only cardiopulmonary resuscitation generate adequate passive ventilation during cardiac arrest? Resuscitation 2007;75:53–9.
Cardiopulmonary resuscitation without ventilation
doi:10.1016/j.resuscitation.2010.09.198
doi:10.1016/j.resuscitation.2010.09.196
Pere R., Olivet J., Bertran C., Juvinya D., Carreras V.
AP054
Departament of Nursing, University of Girona, Catalonia, Spain Objectives: We propose to demonstrate that the simplification of CPR techniques, essentially the elimination of mouth-to-mouth resuscitation, increases the amount of time devoted to external chest compressions. We hope to determine, through the use of practice dummies, the exact amount of time devoted to chest compressions, and whether or not that time increases significantly when mouth-to-mouth resuscitation is not performed. Methodology: We conducted a controlled clinical test in which subjects were randomly split into two groups, with one group performing mouth-to-mouth resuscitation and external chest compressions (the control group), and the other only performing external chest compressions (the experimental group). Results: A total of 31 subjects performed CPR for 10-min periods. They were randomly split into two groups, with 14 performing conventional CPR and 17 doing uninterrupted chest compressions without mouth-to-mouth resuscitation. External chest compressions were not performed by the control group during 3 min and 10 s. Conclusions: The average time during which compressions are not performed on a patient with sudden cardiac arrest (SCA) when ventilations are also performed amounts to 42% of the total time. The average number of compressions that are not performed during a 10-min period when mouth-to-mouth resuscitation is performed is approximately 540. The data obtained from the study indicate that performing only compressions does not increase physical exhaustion. doi:10.1016/j.resuscitation.2010.09.197 AP053 Compression-only CPR does not increase intracranial pressure compared to compression-ventilation CPR in pigs Truhlar A. 1,2 , Turek Z. 1 , Parizkova R. 1 , Skulec R. 1,3 , Cerny V. 1,4 1 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic 2 Hradec Kralove Region Emergency Medical Service, Hradec Kralove, Czech Republic 3 Emergency Medical Service of the Central Bohemian Region, Beroun, Czech Republic 4 Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada
Introduction: Recent guidelines recommend compression-only CPR for bystander response to witnessed cardiac arrest although hypoventilation/apnoea may cause increase of intracranial pressure (ICP) affecting cerebral circulation.1,2 However, gasping respirations and chest compressions may generate some gas exchange.3 The aim of the
Stepping forward or shrinking back: Psychological factors in bystanders’ decisions to act (or not) Potts J., Lynch B. Emergency Cardiovascular Care, American Heart Association, United States Purpose: Bystander CPR is a strong predictor of survival from out-of-hospital cardiac arrest (OHCA), but the incidence of bystander CPR is low, even among those who have been trained. Until the mid-80s most of the research literature on bystander response in emergencies was not in the realm of OHCA; however, more recently, studies of OHCA have begun to generate significant observational data related to bystander response. This literature review incorporates both the cognitive and social psychological research and the research specific to OHCA, to elucidate the factors that appear to be at work in bystander intervention decisions. Materials and methods: The following criteria were developed for initial inclusion of research literature in the review: published in English between 1964 and 2010; keywords bystander, bystander intervention, bystander effect, helping behavior, bystander CPR, unresponsive bystander, and helping in an emergency. Databases included: MEDLINE, Psychological & Behavioral Sciences Collection, PsycINFO, Academic Search Complete, Health Source: Nursing/Academic Education and ERIC. Experimental, quasi-experimental, and observational studies were all included if they met the other criteria. The initial search produced 59 seed articles. The references of these articles were examined to secure additional relevant articles. Results: The extant research clearly shows that decisions about whether to act in an emergency is a complex process that can be mediated by many factors: characteristics of the rescuer and of the victim, knowledge and experience of the rescuer, dynamics of the social group and of the situation, and social and cultural norms that define and reinforce helping behavior. Conclusions: Public education efforts to increase the incidence of bystander CPR should address the problem at all of the identified levels. Suggestions for tailoring prospective educational programs, media messages and “just-in-time” training (such as dispatcher instructions or cell phone prompting) to improve the odds of bystander response will be presented. doi:10.1016/j.resuscitation.2010.09.199