- Email: [email protected]
How we perform real CPR? Are we as good as we think when we train?
Abstracts / Resuscitation 85S (2014) S15–S121
Methods: Quasi-experimental study involving sixty three subjects, which were recruited from University of Castilla-La Mancha, Spain. We determined BMI, VO2 max and muscle strength. After previous training, participants performed CPR on a mannequin during 20 min. Results: The mean percentage of adequate ECC was higher on males (p < 0.05) in the eight analyzed minutes in CPR test. Those gender differences disappear when controlling for other variables such as age, BMI, cardiorespiratory and muscular fitness. The corresponding area under the receiver operating characteristic curves (ROC) to predicted adequate ECC for VO2 max and muscle strength were 0.868 and 0.872, with statistical significance (p ≤ 0.001). The best cut-off points for predicting successful ECC using ROC curves were 44.45 ml/kg/min for VO2 max, and 30.22 kg for muscular fitness. Conclusions: Anthropometric and physical fitness has a greater influence than the time on performing ECC on prolonged CPR. http://dx.doi.org/10.1016/j.resuscitation.2014.03.103
CPR Quality
S41
Conclusions: Feedback devices may help to improve hands-on time and CC rate but even with the help of a feedback device CC are not delivered at the 2010 Guidelines depth standards. http://dx.doi.org/10.1016/j.resuscitation.2014.03.104 AP056 A digital filter can effectively remove mechanical chest compression artifact Joseph Sullivan ∗ , Robert Walker, Alexander Esibov, Fred Chapman Physio-Control, Inc., Redmond, Washington, USA Purpose: Chest compression artifact interferes with ECG rhythm evaluation during cardiac arrest resuscitation. Previously proposed filters for manual compressions may not allow reliable rhythm interpretation. Because artifact is more consistent from LUCAS mechanical compressions than manual compressions, we tested if a simple digital filter would greatly attenuate artifact but preserve ECG quality.
AP055 How we perform real CPR? Are we as good as we think when we train? Pilar Palma-Padró 1,∗ , Alonso Mateos-Rodríguez 2 , Francesc Carmona-Jiménez 1 , José María Navalpotro-Pascual 2 , Xavier Escalada-Roig 1 , Navid Behzadi 2 1 2
Sistema d’Emergències Mèdiques, Barcelona, Spain SUMMA-112, Madrid, Spain
Objective: Feedback devices seem to improve CPR quality when used over mannequins for training use even when the firmness of a mannequin thorax is not comparable with a real human thorax, but usually real CPR quality is below the guidelines standards. The objective of this study is to describe the quality of real CPR performed by ALS teams with the assistance of the TrueCPR® feedback device. Methods: Crossover multicenter study from July to September 2013. 3 Advanced Life Support Units of SUMMA-112, the Emergency Medical Systems (EMS) of Madrid, and 3 of SEM-112, the EMS of Barcelona were equipped with the True CPR® device. Quality data was collected from the device. Percents were used to describe categorical variables and median and Intercuartil range for quantitative data because non-normal distribution of the variable values. Mann–Whitney U test was used to compare both EMS. Results: Sixteen cardiac arrests were assisted during the period of the study. 61.5% were male, the median age was 65 (IQR: 58.5–79.5), 100% presented non-shockable rhythms and 4 patients recovered spontaneous circulation. The median of the percent of hands-on time was 76.3% (IQR: 68.8–83.4%), the median of the medians of chest compressions (CC) depth was 3.8 cm (IQR: 3.3–4.3). A median of 94.9% (IQR: 79.5–98%) CC were too shallow for a median of 0.5% (IQR: 0–2.6%) too deep. The median percent of CC with complete recoil was 81.4% (IQR: 62.2–97.7%). The median of the medians of CC rate was 111.5 (IQR: 106–116.5) per minute (pm). The median of the percent of CC under 100pm was 5.6% (IQR: 3.7–8.7%) and over 120pm, 16.7% (IQR: 5.9–32.9%). No significant differences were found between both EMS in any of the studied variables.
Methods: Ten ECG segments were collected from asystolic cardiac arrest patients during LUCAS compressions. We created ten segments each of VF and QRS rhythms with challenging levels of LUCAS compression artifact by adding recordings of unartifacted VF and QRS rhythms to the artifacted asystolic segments with the artifact increased in amplitude by 4×. Artifacted segments were then filtered with a digital filter designed to remove LUCAS compression artifact. The signal quality of filtered VF and QRS segments was assessed by analysing the segments with an established VF detection algorithm. Results: Mean (±standard deviation) peak-peak amplitude of unfiltered asystole segments was 0.62 ± 0.29 mV (range: 0.28–1.1 mV). Filtered asystole segments were reduced to 0.085 ± 0.044 mV, (range: 0.034–0.164 mV). Sensitivity and specificity of automated rhythm analysis were 70% and 75% for unfiltered, and 100% and 100% for filtered signals. Conclusions: A simple digital filter reduced LUCAS artifact that might be interpreted as VF to a level below the 0.2 mV threshold used to define coarse VF. Signal quality of filtered VF/QRS segments was sufficient to allow correct automatic rhythm interpretation even with artifact 4× greater than that seen during LUCAS compressions. This approach should be evaluated in a larger dataset to assess if it would allow accurate automatic or manual rhythm interpretation during LUCAS chest compressions. http://dx.doi.org/10.1016/j.resuscitation.2014.03.105
Methods: Quasi-experimental study involving sixty three subjects, which were recruited from University of Castilla-La Mancha, Spain. We determined BMI, VO2 max and muscle strength. After previous training, participants performed CPR on a mannequin during 20 min. Results: The mean percentage of adequate ECC was higher on males (p < 0.05) in the eight analyzed minutes in CPR test. Those gender differences disappear when controlling for other variables such as age, BMI, cardiorespiratory and muscular fitness. The corresponding area under the receiver operating characteristic curves (ROC) to predicted adequate ECC for VO2 max and muscle strength were 0.868 and 0.872, with statistical significance (p ≤ 0.001). The best cut-off points for predicting successful ECC using ROC curves were 44.45 ml/kg/min for VO2 max, and 30.22 kg for muscular fitness. Conclusions: Anthropometric and physical fitness has a greater influence than the time on performing ECC on prolonged CPR. http://dx.doi.org/10.1016/j.resuscitation.2014.03.103
CPR Quality
S41
Conclusions: Feedback devices may help to improve hands-on time and CC rate but even with the help of a feedback device CC are not delivered at the 2010 Guidelines depth standards. http://dx.doi.org/10.1016/j.resuscitation.2014.03.104 AP056 A digital filter can effectively remove mechanical chest compression artifact Joseph Sullivan ∗ , Robert Walker, Alexander Esibov, Fred Chapman Physio-Control, Inc., Redmond, Washington, USA Purpose: Chest compression artifact interferes with ECG rhythm evaluation during cardiac arrest resuscitation. Previously proposed filters for manual compressions may not allow reliable rhythm interpretation. Because artifact is more consistent from LUCAS mechanical compressions than manual compressions, we tested if a simple digital filter would greatly attenuate artifact but preserve ECG quality.
AP055 How we perform real CPR? Are we as good as we think when we train? Pilar Palma-Padró 1,∗ , Alonso Mateos-Rodríguez 2 , Francesc Carmona-Jiménez 1 , José María Navalpotro-Pascual 2 , Xavier Escalada-Roig 1 , Navid Behzadi 2 1 2
Sistema d’Emergències Mèdiques, Barcelona, Spain SUMMA-112, Madrid, Spain
Objective: Feedback devices seem to improve CPR quality when used over mannequins for training use even when the firmness of a mannequin thorax is not comparable with a real human thorax, but usually real CPR quality is below the guidelines standards. The objective of this study is to describe the quality of real CPR performed by ALS teams with the assistance of the TrueCPR® feedback device. Methods: Crossover multicenter study from July to September 2013. 3 Advanced Life Support Units of SUMMA-112, the Emergency Medical Systems (EMS) of Madrid, and 3 of SEM-112, the EMS of Barcelona were equipped with the True CPR® device. Quality data was collected from the device. Percents were used to describe categorical variables and median and Intercuartil range for quantitative data because non-normal distribution of the variable values. Mann–Whitney U test was used to compare both EMS. Results: Sixteen cardiac arrests were assisted during the period of the study. 61.5% were male, the median age was 65 (IQR: 58.5–79.5), 100% presented non-shockable rhythms and 4 patients recovered spontaneous circulation. The median of the percent of hands-on time was 76.3% (IQR: 68.8–83.4%), the median of the medians of chest compressions (CC) depth was 3.8 cm (IQR: 3.3–4.3). A median of 94.9% (IQR: 79.5–98%) CC were too shallow for a median of 0.5% (IQR: 0–2.6%) too deep. The median percent of CC with complete recoil was 81.4% (IQR: 62.2–97.7%). The median of the medians of CC rate was 111.5 (IQR: 106–116.5) per minute (pm). The median of the percent of CC under 100pm was 5.6% (IQR: 3.7–8.7%) and over 120pm, 16.7% (IQR: 5.9–32.9%). No significant differences were found between both EMS in any of the studied variables.
Methods: Ten ECG segments were collected from asystolic cardiac arrest patients during LUCAS compressions. We created ten segments each of VF and QRS rhythms with challenging levels of LUCAS compression artifact by adding recordings of unartifacted VF and QRS rhythms to the artifacted asystolic segments with the artifact increased in amplitude by 4×. Artifacted segments were then filtered with a digital filter designed to remove LUCAS compression artifact. The signal quality of filtered VF and QRS segments was assessed by analysing the segments with an established VF detection algorithm. Results: Mean (±standard deviation) peak-peak amplitude of unfiltered asystole segments was 0.62 ± 0.29 mV (range: 0.28–1.1 mV). Filtered asystole segments were reduced to 0.085 ± 0.044 mV, (range: 0.034–0.164 mV). Sensitivity and specificity of automated rhythm analysis were 70% and 75% for unfiltered, and 100% and 100% for filtered signals. Conclusions: A simple digital filter reduced LUCAS artifact that might be interpreted as VF to a level below the 0.2 mV threshold used to define coarse VF. Signal quality of filtered VF/QRS segments was sufficient to allow correct automatic rhythm interpretation even with artifact 4× greater than that seen during LUCAS compressions. This approach should be evaluated in a larger dataset to assess if it would allow accurate automatic or manual rhythm interpretation during LUCAS chest compressions. http://dx.doi.org/10.1016/j.resuscitation.2014.03.105