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Implementation of CPR in Flemish secondary schools: Results of a self-training strategy without practice on a manikin
Abstracts / Resuscitation 85S (2014) S15–S121
p = 0.20), but there was a statistically significant difference in the third question answers (94.3% vs 72.1%, p < 0.01). Conclusions: Children’s retention of BLS knowledge after a year is good, but more emphasis needs to be made on the early activation of the emergency system. Compared to adults, children’s retention is better regarding the correct compression:ventilation ratio, despite the fact the course lasted only 1-hour.
S37
References 1. Cheskes S, Schmicker RH, Christenson J, et al. Perishock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest. Circulation 2011;124:58–66. 2. Valenzuela TD, Kern KB, Clark LL, et al. Interruptions of chest compressions during emergency medical systems resuscitation. Circulation 2005;112:1259–65.
http://dx.doi.org/10.1016/j.resuscitation.2014.03.094 http://dx.doi.org/10.1016/j.resuscitation.2014.03.093 AP045 A comparative study on feedback for BLS: Duration until first chest compression and absolute hands-off time Christoph Dibiasi 1,5,∗ , Christoph Schriefl 1,5 , Matthias Müller 1,5 , Katharina Skvarc 1,5 , Tanja Muschnig 1,5 , Dominik Stumpf 2,5 , Franz Josef Nierscher 3,5 , Robert Greif 4,5 1
Medical University Vienna, Vienna, Austria 2 Hospital of the Sisters of Charity Linz, Linz, Austria 3 Department of Anaesthesia, General Intensive Care and Pain Medicine, Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria 4 Department of Anaesthesiology and Pain Therapy, University Hospital Bern and University of Bern, Bern, Switzerland 5 Federal Ministry of the Interior, Vienna, Austria Purpose of study: Current ERC guidelines recommend feedback to improve CPR quality. We examined the duration until first chest compression and absolute hands off time, comparing an electronic feedback-device, structured human feedback, and standard BLS. This study was part of a research project on CPR feedback devices and other CPR feedback concepts. Methods: We randomized 326 medical students trained in BLS into three groups (Q-CPR® /MRx Defibrillator feedback, structured human feedback, standard BLS without feedback). Two-rescuer BLS was performed on an Ambu® ManC manikin for 8 min. Prior to the testing all students received video and hands-on training in their corresponding groups. Human feedback consisted of comments from the two-rescuers on hand position, compression rate and depth, correct decompression and hands-off time in regular intervals. All data are presented as mean and IQR. Results: The time until first chest compression was 8 (5–11) s for Q-CPR® , 2 (1–3) s for human feedback, and 3 (2–4) s for standard BLS (Q-CPR® vs. Standard BLS and vs. human feedback p < 0.001; standard BLS vs. human feedback p = 0.501). Absolute hands-off time was 57 (47–71) s for Q-CPR® , 63 (57–79) s for human feedback, and 61 (50–72) s for standard BLS (Standard BLS vs. Q-CPR® p = 0.947; standard BLS vs. human feedback p = 0.018; Q-CPR® vs. human feedback p = 0.003). Conclusions: Increased time until first chest compression was correlated to decreased patient outcome1 and we observed this time related problem with the feedback device. On the other hand, the use of this device led to the lowest absolute hands-off time, which is, in contrast, associated with better survival.2 In order to reduce the time until first chest compression manufacturers need to decrease the activation time for the initial setup of the feedback device. We recommend intensified hands-on training to lower the absolute hands-off time with human feedback or during standard BLS.
AP046 Implementation of CPR in Flemish secondary schools: Results of a self-training strategy without practice on a manikin Veerle Van Raemdonck 1,∗ , Veerle Van Raemdonck 2 , Koen Monsieurs 3 , Koen Monsieurs 4 , Koen Monsieurs 5 , Kristine De Martelaer 2 1
Erasmus University College, Brussels, Belgium Vrije Universiteit Brussel, Brussels, Belgium 3 Antwerp University Hospital, Antwerp, Belgium 4 University of Antwerp, Antwerp, Belgium 5 University of Ghent, Ghent, Belgium 2
Introduction: Basic Life Support (BLS) training is mandatory in Flemish schools. Because of limitations in time and training equipment, there is a need for alternative training strategies.1 De Vries suggested that laypeople could train themselves in BLS and Automated External Defibrillation (AED) by a web-based micro-simulation programme.2 This study measures BLS and AEDskills taught by an online simulation scenario without manikin training. Methods: School pupils (N = 41, 15–17 years) without previous BLS training were selected for an online self-training intervention consisting of a theoretical course, a cognitive test and an interactive video simulation (Kennisdesk® Doczero Academy, The Netherlands). In 50 min they learned how to use the platform. Six weeks later, skills were measured and recorded on video. An instructor certified by the European Resuscitation Council (ERC) evaluated the skills by the assessment form of the ERC BLS course. Each participant’s training time was measured online. Skillreporting software® (Laerdal, Norway) measured motor skills. Data were analysed by frequencies and cross tabulation with IBM® SPSS® Statistics version 21. Results: Mean training time was 43 min. Respectively 92% and 72% of the participants alerted the emergency services and assessed consciousness correctly. Assessment of breathing was ineffective: everyone failed in tilting the head of the victim backwards. Chin lift was performed by only 25%. Forty-four percent of the participants placed hands correctly for chest compressions. Mean compression depth was too low (35 mm, SD 13 mm). Mean compression rate (90/min, SD 21/min) scored close to the guidelines. Electrodes were placed correctly in 89% of the cases. Everyone used the AED. Conclusion: The learning platform needs to be improved to teach ventilation skills effectively. Ventilation and compression skills cannot be learned without manikin practice. The online learning tool may prepare pupils to learn how to use an AED before hands-on training.
References 1. Van Raemdonck V, Monsieurs K, Aerenhouts D, De Martelaer K. Low-cost training strategies for teaching motor skills of basic life support in secondary schools: a prospective randomised study. Eur J Emerg Med 2013 (in press) (accepted 18.07.13).
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Abstracts / Resuscitation 85S (2014) S15–S121
2. De Vries W, Schelvis M, Rustemeijer I, Bierens J. Self-training in the use of automated external defibrillators: the same results for less money? Resuscitation 2007;76:76–82.
AP048
http://dx.doi.org/10.1016/j.resuscitation.2014.03.095
Analysis of survival in patients with out-of-hospital cardiac arrest when using iCPR application
AP047
Sergi Mayol Barrera 1,∗ , Javier Berbel Castro 2
Impact of the newly implemented human feedback in contrast to Q-CPR® feedback and standard BLS on the “Effective Compression Ratio” outcome
1
Tanja Muschnig 1,∗ , Christoph Schriefl 1 , Matthias Müller 1 , Christoph Dibiasi 1 , Erich Pawelka 1 , Dominik Stumpf 2 , Franz Josef Nierscher 3 , Robert Greif 4 , Henrik Fischer 5 1
Medical University Vienna, Vienna, Austria Hospital of the Sisters of Charity Linz, Linz, Austria 3 Department of Anaesthesia, General Intensive Care and Pain Medicine, Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria 4 Department of Anaesthesiology and Pain Medicine, University Hospital Bern and University of Bern, Bern, Switzerland 5 Federal Ministry of the Interior, Vienna, Austria 2
Purpose of the study: Resuscitation feedback prompt devices are endorsed by the current ERC guidelines and should improve CPR quality. The aim of the study was to follow up on the question whether the mechanical feedback prompt devices are more effective for CPR quality than feedback from trained humans. This study was part of a research project on CPR feedback devices and other CPR feedback concepts. Materials and methods: 326 medical students were randomly assigned to one of three groups in this open, prospective RCT in order to compare the Effective Compression Ratio (ECR1, defined as effective compression2 multiplied by flow time; correctly performed BLS has an ECR of 0.79) between human feedback, audio-visual Q-CPR® /MRx Defibrillator feedback and standard BLS. Participants performed 2-rescuer BLS on an Ambu® ManC over 8 min. All of them were trained by video and hands-on training. Additionally, the human feedback group was instructed in giving verbal feedback regarding their partner’s performance considering compression rate and depth, correct pressure point, decompression and hands-off time. All data were presented as mean and IQR. Results: Standard BLS had an ECR of 0.27 (0.07–0.36). The QCPR® feedback device achieved 0.35 (0.21–0.45), and the human feedback group reached 0.33 (0.1–0.46). Standard BLS vs. Q-CPR® was significantly different (p = 0.004), whereas the others were not. Training time for the human feedback group was 50% longer [9:32 min (8:34–11:14)] than for the other two groups. Conclusion: In accordance with the current ERC guidelines, we demonstrated that the use of feedback prompt devices has a positive impact on the quality of BLS, but this requires additional investments. Interestingly, the human feedback with our rather short training time was not significantly different from the feedback device. Further studies should investigate whether extended human feedback training also improves CPR quality at comparable costs. http://dx.doi.org/10.1016/j.resuscitation.2014.03.096
Hospital Universitari Mútua de Terrassa, Terrassa, Spain 2 IVEMON, Ambulancias Egara, Terrassa, Spain Purpose of study: To analyse the correlation between using or no the iCPR, and its direct consequences on the Return of Spontaneous Circulation (ROSC) of the patients who suffered an out-of-hospital cardiac arrest. Materials and methods: The pilot test was experimental, retrospective and transversal within a period of nine months. The sample was made of 26 assisted patients with an out-of-hospital cardiac arrest on whom the iCPR application was applied or not. To get the information we used the healthcare assistance reports about these patients. Our variables were: demographic, development of the assistance and Utstein report. Results: We collected the information about 26 assistance reports out of which 13 (50%) iCPR were applied and 13(50%) were not. The average age was 69.3 (±10.7) years, 73.1% were men, in 76.9% the cardiac arrest was watched by witnesses, in 61.5% the aetiology was cardiologic, the average time to start CPR was 4.3 (±4.2) min, the average time to start CPR for healthcare professionals was 5.3 (±4.5) min and in 46.4% ROSC was achieved until the patient was transferred to hospital. In cases where the iCPR was used vs. not used we obtained ROSC [9 (69.2%) vs. 3 (31.8%); p < 0.05] and the mortality was [4 (30.7%) vs. 10 (69.3%); p < 0.05]. Conclusion: This pilot test concluded that the use of iCPR significantly improves the survival of patients who suffered an outof-hospital cardiac arrest until they are transferred to a hospital. In order for this pilot test to be conclusive it would be necessary to have a bigger sample size to have more accurate statistics. http://dx.doi.org/10.1016/j.resuscitation.2014.03.097 AP049 Influence of maximal oxygen uptake of university students in the ability to perform quality cardiopulmonary resuscitation Ángel López-González 1 , Mairena Sánchez-López 3 , Jaime López-Tendero 1 , Carlos Urkía-Mieres 4,∗ , Joseba Rabanales-Sotos 1 , Vicente Martínez-Vizacíno 2 1 School of Nursing, University of Castilla-La Mancha, Albacete, Spain 2 Social and Health Care Research Center, University of Castilla La-Mancha, Cuenca, Spain 3 School of Education, University of Castilla-La Mancha, Ciudad Real, Spain 4 Spanish Red Cross, Madrid, Spain
Background: It has been hypothesized that fitness and body mass index of the rescuers are predictors of the adequacy of external chest compressions. The aims of this study were to: (1) analyze by sex the evolution of effort indicator (percentage of maximum heart rate -%EMHR) reached in 8 min (1, 2, 3, 6, 9, 12, 15 and 20 min) on 20 min of cardiopulmonary resuscitation (CPR) and, (2) examine the influence of both body mass index (BMI) and maximal oxygen uptake (VO2 max) on predicting adequate chest compressions.
p = 0.20), but there was a statistically significant difference in the third question answers (94.3% vs 72.1%, p < 0.01). Conclusions: Children’s retention of BLS knowledge after a year is good, but more emphasis needs to be made on the early activation of the emergency system. Compared to adults, children’s retention is better regarding the correct compression:ventilation ratio, despite the fact the course lasted only 1-hour.
S37
References 1. Cheskes S, Schmicker RH, Christenson J, et al. Perishock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest. Circulation 2011;124:58–66. 2. Valenzuela TD, Kern KB, Clark LL, et al. Interruptions of chest compressions during emergency medical systems resuscitation. Circulation 2005;112:1259–65.
http://dx.doi.org/10.1016/j.resuscitation.2014.03.094 http://dx.doi.org/10.1016/j.resuscitation.2014.03.093 AP045 A comparative study on feedback for BLS: Duration until first chest compression and absolute hands-off time Christoph Dibiasi 1,5,∗ , Christoph Schriefl 1,5 , Matthias Müller 1,5 , Katharina Skvarc 1,5 , Tanja Muschnig 1,5 , Dominik Stumpf 2,5 , Franz Josef Nierscher 3,5 , Robert Greif 4,5 1
Medical University Vienna, Vienna, Austria 2 Hospital of the Sisters of Charity Linz, Linz, Austria 3 Department of Anaesthesia, General Intensive Care and Pain Medicine, Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria 4 Department of Anaesthesiology and Pain Therapy, University Hospital Bern and University of Bern, Bern, Switzerland 5 Federal Ministry of the Interior, Vienna, Austria Purpose of study: Current ERC guidelines recommend feedback to improve CPR quality. We examined the duration until first chest compression and absolute hands off time, comparing an electronic feedback-device, structured human feedback, and standard BLS. This study was part of a research project on CPR feedback devices and other CPR feedback concepts. Methods: We randomized 326 medical students trained in BLS into three groups (Q-CPR® /MRx Defibrillator feedback, structured human feedback, standard BLS without feedback). Two-rescuer BLS was performed on an Ambu® ManC manikin for 8 min. Prior to the testing all students received video and hands-on training in their corresponding groups. Human feedback consisted of comments from the two-rescuers on hand position, compression rate and depth, correct decompression and hands-off time in regular intervals. All data are presented as mean and IQR. Results: The time until first chest compression was 8 (5–11) s for Q-CPR® , 2 (1–3) s for human feedback, and 3 (2–4) s for standard BLS (Q-CPR® vs. Standard BLS and vs. human feedback p < 0.001; standard BLS vs. human feedback p = 0.501). Absolute hands-off time was 57 (47–71) s for Q-CPR® , 63 (57–79) s for human feedback, and 61 (50–72) s for standard BLS (Standard BLS vs. Q-CPR® p = 0.947; standard BLS vs. human feedback p = 0.018; Q-CPR® vs. human feedback p = 0.003). Conclusions: Increased time until first chest compression was correlated to decreased patient outcome1 and we observed this time related problem with the feedback device. On the other hand, the use of this device led to the lowest absolute hands-off time, which is, in contrast, associated with better survival.2 In order to reduce the time until first chest compression manufacturers need to decrease the activation time for the initial setup of the feedback device. We recommend intensified hands-on training to lower the absolute hands-off time with human feedback or during standard BLS.
AP046 Implementation of CPR in Flemish secondary schools: Results of a self-training strategy without practice on a manikin Veerle Van Raemdonck 1,∗ , Veerle Van Raemdonck 2 , Koen Monsieurs 3 , Koen Monsieurs 4 , Koen Monsieurs 5 , Kristine De Martelaer 2 1
Erasmus University College, Brussels, Belgium Vrije Universiteit Brussel, Brussels, Belgium 3 Antwerp University Hospital, Antwerp, Belgium 4 University of Antwerp, Antwerp, Belgium 5 University of Ghent, Ghent, Belgium 2
Introduction: Basic Life Support (BLS) training is mandatory in Flemish schools. Because of limitations in time and training equipment, there is a need for alternative training strategies.1 De Vries suggested that laypeople could train themselves in BLS and Automated External Defibrillation (AED) by a web-based micro-simulation programme.2 This study measures BLS and AEDskills taught by an online simulation scenario without manikin training. Methods: School pupils (N = 41, 15–17 years) without previous BLS training were selected for an online self-training intervention consisting of a theoretical course, a cognitive test and an interactive video simulation (Kennisdesk® Doczero Academy, The Netherlands). In 50 min they learned how to use the platform. Six weeks later, skills were measured and recorded on video. An instructor certified by the European Resuscitation Council (ERC) evaluated the skills by the assessment form of the ERC BLS course. Each participant’s training time was measured online. Skillreporting software® (Laerdal, Norway) measured motor skills. Data were analysed by frequencies and cross tabulation with IBM® SPSS® Statistics version 21. Results: Mean training time was 43 min. Respectively 92% and 72% of the participants alerted the emergency services and assessed consciousness correctly. Assessment of breathing was ineffective: everyone failed in tilting the head of the victim backwards. Chin lift was performed by only 25%. Forty-four percent of the participants placed hands correctly for chest compressions. Mean compression depth was too low (35 mm, SD 13 mm). Mean compression rate (90/min, SD 21/min) scored close to the guidelines. Electrodes were placed correctly in 89% of the cases. Everyone used the AED. Conclusion: The learning platform needs to be improved to teach ventilation skills effectively. Ventilation and compression skills cannot be learned without manikin practice. The online learning tool may prepare pupils to learn how to use an AED before hands-on training.
References 1. Van Raemdonck V, Monsieurs K, Aerenhouts D, De Martelaer K. Low-cost training strategies for teaching motor skills of basic life support in secondary schools: a prospective randomised study. Eur J Emerg Med 2013 (in press) (accepted 18.07.13).
S38
Abstracts / Resuscitation 85S (2014) S15–S121
2. De Vries W, Schelvis M, Rustemeijer I, Bierens J. Self-training in the use of automated external defibrillators: the same results for less money? Resuscitation 2007;76:76–82.
AP048
http://dx.doi.org/10.1016/j.resuscitation.2014.03.095
Analysis of survival in patients with out-of-hospital cardiac arrest when using iCPR application
AP047
Sergi Mayol Barrera 1,∗ , Javier Berbel Castro 2
Impact of the newly implemented human feedback in contrast to Q-CPR® feedback and standard BLS on the “Effective Compression Ratio” outcome
1
Tanja Muschnig 1,∗ , Christoph Schriefl 1 , Matthias Müller 1 , Christoph Dibiasi 1 , Erich Pawelka 1 , Dominik Stumpf 2 , Franz Josef Nierscher 3 , Robert Greif 4 , Henrik Fischer 5 1
Medical University Vienna, Vienna, Austria Hospital of the Sisters of Charity Linz, Linz, Austria 3 Department of Anaesthesia, General Intensive Care and Pain Medicine, Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria 4 Department of Anaesthesiology and Pain Medicine, University Hospital Bern and University of Bern, Bern, Switzerland 5 Federal Ministry of the Interior, Vienna, Austria 2
Purpose of the study: Resuscitation feedback prompt devices are endorsed by the current ERC guidelines and should improve CPR quality. The aim of the study was to follow up on the question whether the mechanical feedback prompt devices are more effective for CPR quality than feedback from trained humans. This study was part of a research project on CPR feedback devices and other CPR feedback concepts. Materials and methods: 326 medical students were randomly assigned to one of three groups in this open, prospective RCT in order to compare the Effective Compression Ratio (ECR1, defined as effective compression2 multiplied by flow time; correctly performed BLS has an ECR of 0.79) between human feedback, audio-visual Q-CPR® /MRx Defibrillator feedback and standard BLS. Participants performed 2-rescuer BLS on an Ambu® ManC over 8 min. All of them were trained by video and hands-on training. Additionally, the human feedback group was instructed in giving verbal feedback regarding their partner’s performance considering compression rate and depth, correct pressure point, decompression and hands-off time. All data were presented as mean and IQR. Results: Standard BLS had an ECR of 0.27 (0.07–0.36). The QCPR® feedback device achieved 0.35 (0.21–0.45), and the human feedback group reached 0.33 (0.1–0.46). Standard BLS vs. Q-CPR® was significantly different (p = 0.004), whereas the others were not. Training time for the human feedback group was 50% longer [9:32 min (8:34–11:14)] than for the other two groups. Conclusion: In accordance with the current ERC guidelines, we demonstrated that the use of feedback prompt devices has a positive impact on the quality of BLS, but this requires additional investments. Interestingly, the human feedback with our rather short training time was not significantly different from the feedback device. Further studies should investigate whether extended human feedback training also improves CPR quality at comparable costs. http://dx.doi.org/10.1016/j.resuscitation.2014.03.096
Hospital Universitari Mútua de Terrassa, Terrassa, Spain 2 IVEMON, Ambulancias Egara, Terrassa, Spain Purpose of study: To analyse the correlation between using or no the iCPR, and its direct consequences on the Return of Spontaneous Circulation (ROSC) of the patients who suffered an out-of-hospital cardiac arrest. Materials and methods: The pilot test was experimental, retrospective and transversal within a period of nine months. The sample was made of 26 assisted patients with an out-of-hospital cardiac arrest on whom the iCPR application was applied or not. To get the information we used the healthcare assistance reports about these patients. Our variables were: demographic, development of the assistance and Utstein report. Results: We collected the information about 26 assistance reports out of which 13 (50%) iCPR were applied and 13(50%) were not. The average age was 69.3 (±10.7) years, 73.1% were men, in 76.9% the cardiac arrest was watched by witnesses, in 61.5% the aetiology was cardiologic, the average time to start CPR was 4.3 (±4.2) min, the average time to start CPR for healthcare professionals was 5.3 (±4.5) min and in 46.4% ROSC was achieved until the patient was transferred to hospital. In cases where the iCPR was used vs. not used we obtained ROSC [9 (69.2%) vs. 3 (31.8%); p < 0.05] and the mortality was [4 (30.7%) vs. 10 (69.3%); p < 0.05]. Conclusion: This pilot test concluded that the use of iCPR significantly improves the survival of patients who suffered an outof-hospital cardiac arrest until they are transferred to a hospital. In order for this pilot test to be conclusive it would be necessary to have a bigger sample size to have more accurate statistics. http://dx.doi.org/10.1016/j.resuscitation.2014.03.097 AP049 Influence of maximal oxygen uptake of university students in the ability to perform quality cardiopulmonary resuscitation Ángel López-González 1 , Mairena Sánchez-López 3 , Jaime López-Tendero 1 , Carlos Urkía-Mieres 4,∗ , Joseba Rabanales-Sotos 1 , Vicente Martínez-Vizacíno 2 1 School of Nursing, University of Castilla-La Mancha, Albacete, Spain 2 Social and Health Care Research Center, University of Castilla La-Mancha, Cuenca, Spain 3 School of Education, University of Castilla-La Mancha, Ciudad Real, Spain 4 Spanish Red Cross, Madrid, Spain
Background: It has been hypothesized that fitness and body mass index of the rescuers are predictors of the adequacy of external chest compressions. The aims of this study were to: (1) analyze by sex the evolution of effort indicator (percentage of maximum heart rate -%EMHR) reached in 8 min (1, 2, 3, 6, 9, 12, 15 and 20 min) on 20 min of cardiopulmonary resuscitation (CPR) and, (2) examine the influence of both body mass index (BMI) and maximal oxygen uptake (VO2 max) on predicting adequate chest compressions.