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Injuries induced using an active compression–decompression device (Cardiopump®) during resuscitation for out-of-hospital cardiac arrest: Observational study
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Abstracts / Resuscitation 96S (2015) 43–157
AP052 Injuries induced using an active compression–decompression device (Cardiopump® ) during resuscitation for out-of-hospital cardiac arrest: Observational study Daniel Jost 1,∗ , Pascal Dang Minh 1 , Nicolas Genotelle 1 , Stéphane Travers 1 , Olga Maurin 1 , Florence Dumas 2 , Michel Bignand 1 , Jean-Pierre Tourtier 1 1 2
Fire Brigade of Paris, Paris, France Sudden Death Expertise Center, Paris, France
Purpose: Cardiopump® (CP) is a device used by professional rescuer teams to perform chest compression (CC) on out-of-hospital cardiac arrest (OHCA). It allows performing a compression followed by an active decompression, and has a gauge to assess the depth of the full compression and decompression. This study aimed to identify chest injuries induced by CC performed with CP. Materials and methods: Prospective observational study. Inclusion criteria: patients with non-traumatic OHCA > 15 years, for whom CP was used. Collected data: epidemiological (age, gender, location, bystander, CPR duration), clinical (skin lesions linked to CP, rib fracture caused by CC, subcutaneous emphysema) and prognosis (return of spontaneous circulation (ROSC), “beating-heart” on arrival at the hospital). We performed uni and multivariate statistical analysis (logistic regression). Results: A total of 3385 patients were included in 2013. Of these, 590 (17%) had chest skin lesions, 121 (4%) rib fractures, and 30 (0.89%) suffered subcutaneous emphysema. Mean age of injured patients was comparable to that of non-injured (66 ± 17 years vs 67 ± 19, p = 0.28), and so was their sex-ratio. Three logistic regression models were performed: 1. Skin lesions were linked to low-flow > 30 min (OR = 3.1 [1.6–5.8]) and regurgitation (OR = 2.1 [0.9–4.9]). 2. Rib fractures were linked to low-flow > 60 min (OR = 7.1 [1.3–30.1]) and less frequent in OHCA at home (OR = 0.38 [0.2–0.8]). 3. Subcutaneous emphysema was less frequent at home (OR = 0.09 [0.01–0.48]. None of the other variables was significantly linked to the occurrence of injury by CP. Conclusions: Chest injuries from CC performed with CP were frequent, and it was impossible to show their harmful effect on early patient outcome. A study should be conducted to compare the frequency and severity of lesions induced by CC performed by CP or no. http://dx.doi.org/10.1016/j.resuscitation.2015.09.149 AP053 Delivery of Basic Life Support in simulated cardiac arrest: An audit of skills and knowledge Katie Flower ∗ , Owain Leng, Chris Wells The University Hospital of North Tees, Stockton-on-Tees, UK Introduction: Basic Life Support (BLS) is mandatory for all clinical staff. The British Resuscitation Council recommends; ‘skills should be refreshed at least once a year, but preferably more often.’1 Currently, BLS skills are generally assessed through ILS courses, rather than as part of an integrated simulation scenario. This audit process provides opportunities to assess BLS skills efficiently and effectively, whilst also providing individual feedback and reflection on performance; a potentially powerful educational motivator.
Method: This was a snap-shot audit. Clinical staff were randomly selected individually from ward areas. The candidate then participated in a scenario which involved assessing an unresponsive patient (in the form of a pulseless resuscitation mannequin). During the simulation, data were collected on the adequacy of the patient assessment, the time taken to call for help, and an objective assessment of the quality of chest compressions using an advanced resuscitation mannequin. Following the simulation, participants were asked a series of questions aimed at assessing knowledge of the BLS algorithm. Structured and objective feedback on performance and knowledge was given at the end of the scenario. Results: 62 out of 63 selected staff participated in the audit. Interestingly, we found no correlation between knowledge and actual deliverance of chest compression rate and depth, specified in the BLS algorithm. All participants enjoyed the experience and found it highly beneficial as a quick refresher of skills. Discussion: The mismatch between abstract knowledge of BLS algorithm and the quality of chest compressions delivered, may have implications for the methods used to teach BLS, thus this is a potential area for further study. The unanimous appreciation of the participants, suggests that use of simulation and personalised feedback in real clinical areas may be a highly acceptable and valued educational intervention. Reference 1. The British Resuscitation Council; December 2010. Available from: https://www. resus.org.uk/pages/faqAED.htm#Q5 [updated November 2014].
http://dx.doi.org/10.1016/j.resuscitation.2015.09.150 AP054 The method to perform chest compressions with proper depth using an accelerometer-based feedback device on a hospital bed: A randomised simulation study Sanghyun Lee 1,∗ , Jaehoon Oh 1 , Hyunggoo Kang 1 , Taeho Lim 1 , Yeongtak Song 2 , Chiwon Ahn 1 , Hyunmin Cha 1 1
Hanyang University Hospital, Seoul, Republic of Korea 2 University of Ulsan, Ulsan, Republic of Korea Purpose of the study: Feedback devices are used to improve chest compression (CC) quality. In hospital CPR, some devices overestimate CC depth, because of compression of the mattress.1 We hypothesized that modulating target depths of feedback devices to 6 or 7 cm with consideration of a mattress compression depth (about 1.5 cm) could improve the proper CC depth (≥5 cm). We conducted this trial to find the proper target depth of feedback device using an accelerometer during CPR on a hospital bed. Materials and methods: In this prospective randomized crossover study, 19 emergency physicians performed CCs for 2 min continuously on a manikin in 2 different beds with three target depth of feedback devices (5, 6 and 7 cm). The primary outcome was CC depth. Results: Mean (SD) CC depths of target depths of feedback devices 5, 6, and 7 were 45.42 (5.79), 52.68 (4.18), and 58.47 (2.48) mm on one bed and 46.26 (4.49), 53.58 (3.15), and 58.74 (2.10) mm on the other bed (all p < 0.001), respectively. Conclusions: Targeting depths of feedback devices to 6 cm but not exceed 7 cm could be a proper method for optimal CC depth on a hospital bed.2
Abstracts / Resuscitation 96S (2015) 43–157
AP052 Injuries induced using an active compression–decompression device (Cardiopump® ) during resuscitation for out-of-hospital cardiac arrest: Observational study Daniel Jost 1,∗ , Pascal Dang Minh 1 , Nicolas Genotelle 1 , Stéphane Travers 1 , Olga Maurin 1 , Florence Dumas 2 , Michel Bignand 1 , Jean-Pierre Tourtier 1 1 2
Fire Brigade of Paris, Paris, France Sudden Death Expertise Center, Paris, France
Purpose: Cardiopump® (CP) is a device used by professional rescuer teams to perform chest compression (CC) on out-of-hospital cardiac arrest (OHCA). It allows performing a compression followed by an active decompression, and has a gauge to assess the depth of the full compression and decompression. This study aimed to identify chest injuries induced by CC performed with CP. Materials and methods: Prospective observational study. Inclusion criteria: patients with non-traumatic OHCA > 15 years, for whom CP was used. Collected data: epidemiological (age, gender, location, bystander, CPR duration), clinical (skin lesions linked to CP, rib fracture caused by CC, subcutaneous emphysema) and prognosis (return of spontaneous circulation (ROSC), “beating-heart” on arrival at the hospital). We performed uni and multivariate statistical analysis (logistic regression). Results: A total of 3385 patients were included in 2013. Of these, 590 (17%) had chest skin lesions, 121 (4%) rib fractures, and 30 (0.89%) suffered subcutaneous emphysema. Mean age of injured patients was comparable to that of non-injured (66 ± 17 years vs 67 ± 19, p = 0.28), and so was their sex-ratio. Three logistic regression models were performed: 1. Skin lesions were linked to low-flow > 30 min (OR = 3.1 [1.6–5.8]) and regurgitation (OR = 2.1 [0.9–4.9]). 2. Rib fractures were linked to low-flow > 60 min (OR = 7.1 [1.3–30.1]) and less frequent in OHCA at home (OR = 0.38 [0.2–0.8]). 3. Subcutaneous emphysema was less frequent at home (OR = 0.09 [0.01–0.48]. None of the other variables was significantly linked to the occurrence of injury by CP. Conclusions: Chest injuries from CC performed with CP were frequent, and it was impossible to show their harmful effect on early patient outcome. A study should be conducted to compare the frequency and severity of lesions induced by CC performed by CP or no. http://dx.doi.org/10.1016/j.resuscitation.2015.09.149 AP053 Delivery of Basic Life Support in simulated cardiac arrest: An audit of skills and knowledge Katie Flower ∗ , Owain Leng, Chris Wells The University Hospital of North Tees, Stockton-on-Tees, UK Introduction: Basic Life Support (BLS) is mandatory for all clinical staff. The British Resuscitation Council recommends; ‘skills should be refreshed at least once a year, but preferably more often.’1 Currently, BLS skills are generally assessed through ILS courses, rather than as part of an integrated simulation scenario. This audit process provides opportunities to assess BLS skills efficiently and effectively, whilst also providing individual feedback and reflection on performance; a potentially powerful educational motivator.
Method: This was a snap-shot audit. Clinical staff were randomly selected individually from ward areas. The candidate then participated in a scenario which involved assessing an unresponsive patient (in the form of a pulseless resuscitation mannequin). During the simulation, data were collected on the adequacy of the patient assessment, the time taken to call for help, and an objective assessment of the quality of chest compressions using an advanced resuscitation mannequin. Following the simulation, participants were asked a series of questions aimed at assessing knowledge of the BLS algorithm. Structured and objective feedback on performance and knowledge was given at the end of the scenario. Results: 62 out of 63 selected staff participated in the audit. Interestingly, we found no correlation between knowledge and actual deliverance of chest compression rate and depth, specified in the BLS algorithm. All participants enjoyed the experience and found it highly beneficial as a quick refresher of skills. Discussion: The mismatch between abstract knowledge of BLS algorithm and the quality of chest compressions delivered, may have implications for the methods used to teach BLS, thus this is a potential area for further study. The unanimous appreciation of the participants, suggests that use of simulation and personalised feedback in real clinical areas may be a highly acceptable and valued educational intervention. Reference 1. The British Resuscitation Council; December 2010. Available from: https://www. resus.org.uk/pages/faqAED.htm#Q5 [updated November 2014].
http://dx.doi.org/10.1016/j.resuscitation.2015.09.150 AP054 The method to perform chest compressions with proper depth using an accelerometer-based feedback device on a hospital bed: A randomised simulation study Sanghyun Lee 1,∗ , Jaehoon Oh 1 , Hyunggoo Kang 1 , Taeho Lim 1 , Yeongtak Song 2 , Chiwon Ahn 1 , Hyunmin Cha 1 1
Hanyang University Hospital, Seoul, Republic of Korea 2 University of Ulsan, Ulsan, Republic of Korea Purpose of the study: Feedback devices are used to improve chest compression (CC) quality. In hospital CPR, some devices overestimate CC depth, because of compression of the mattress.1 We hypothesized that modulating target depths of feedback devices to 6 or 7 cm with consideration of a mattress compression depth (about 1.5 cm) could improve the proper CC depth (≥5 cm). We conducted this trial to find the proper target depth of feedback device using an accelerometer during CPR on a hospital bed. Materials and methods: In this prospective randomized crossover study, 19 emergency physicians performed CCs for 2 min continuously on a manikin in 2 different beds with three target depth of feedback devices (5, 6 and 7 cm). The primary outcome was CC depth. Results: Mean (SD) CC depths of target depths of feedback devices 5, 6, and 7 were 45.42 (5.79), 52.68 (4.18), and 58.47 (2.48) mm on one bed and 46.26 (4.49), 53.58 (3.15), and 58.74 (2.10) mm on the other bed (all p < 0.001), respectively. Conclusions: Targeting depths of feedback devices to 6 cm but not exceed 7 cm could be a proper method for optimal CC depth on a hospital bed.2