Quality of external chest compressions, time or body mass index and fitness

Quality of external chest compressions, time or body mass index and fitness

S40 Abstracts / Resuscitation 85S (2014) S15–S121 AP052 AP053 Differences of verbal feedback between human feedback and an audio-visual feedback d...

183KB Sizes 7 Downloads 32 Views

S40

Abstracts / Resuscitation 85S (2014) S15–S121

AP052

AP053

Differences of verbal feedback between human feedback and an audio-visual feedback device during two-rescuer CPR

Achieving an out of hospital cardiac arrest survival rate of over 79%

Christoph Schriefl 1,∗ , Tanja Muschnig 1 , Christoph Dibiasi 1 , Erich Pawelka 1 , Katharina Skvarc 1 , Matthias Müller 1 , Franz Josef Nierscher 2 , Robert Greif 3 , Henrik Fischer 4 1

Medical University Vienna, Vienna, Austria Department of Anaesthesia, General Intensive Care and Pain Medicine, Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria 3 Department of Anaesthesiology and Pain Medicine, University Hospital Bern and University of Bern, Bern, Switzerland 4 Federal Ministry of the Interior, Vienna, Austria 2

Purpose of the study: ERC guidelines 2010 recommend feedback while performing CPR. A variety of audio-visual feedback devices are available but the evidence on whether they improve BLS quality is not solid.1 In a research project on CPR feedback devices we implemented a structured verbal feedback approach in two-rescuer CPR, which is described below. Materials and methods: For the open, prospective, randomised, controlled BLS trial, 326 trained medical students were randomized into three groups (human feedback, standard BLS without verbal feedback, audio-visual Q-CPR® /MRx Defibrillator feedback) to perform two-rescuer CPR for 8 min. We trained the study participants for about 10 min to provide structured verbal feedback in 5 categories: correct hand position/depth/decompression, compression rate and minimal hands-off time. The rescuer providing ventilation had to give verbal feedback on all 5 categories after the first 2 min of BLS. After that, the rescuer in the head position provided feedback either on each category or stated, “everything is all right” during each 2 min CPR slot. In contrast, the Q-CPR® gave feedback on 3 categories: depth, decompression and compression rate. All data are presented as mean and IQR. Results: The verbal feedback rate of the Q-CPR® was within the 8 min: 3 (1–5) for depth, 2 (1–4) for decompression and 1 (0–2) for rate. The human feedback revealed: 6 (3–7) for depth, 3 (2–6) for decompression, 6 (4–9) for rate (for all p < 0.001). The other human feedback frequency was: 5 (3–7) for correct hand position, 4 (4–5) for hands-off-time, and 3 (1–6) for general “OK”. Conclusions: Even short training in providing verbal feedback increased the amount of feedback substantially compared to a costly commercially available feedback prompt device. How the amount and quality of the verbal feedback improves the CPR quality needs to be investigated further. Reference 1. Zapletal B, Greif R, Stumpf D, et al. Comparing three CPR feedback devices and standard BLS in a single rescuer scenario: a randomised simulation study. Resuscitation 2013;November [Epub ahead of print].

http://dx.doi.org/10.1016/j.resuscitation.2014.03.101

Caleb Brown David Lloyd Leisure, Hertfordshire, UK Aim: The study reviewed out of hospital cardiac arrests that occurred within a Health & Fitness chain over a 3 year period form 1st January 2011 to 31st December 2013. All branches of the chain have an Automated External Defibrillator (AED), lay rescuers trained in CPR and the use of AEDs and a robust AED policy to ensure that the AED arrives at all incidents rapidly. Method: The study was undertaken by reviewing detailed incident reports that were compiled following each cardiac arrest, AED download data, Resuscitation Council UK event submissions and patient follow up notes. In all incidents casualties were attended to by at least two lay rescuers trained in CPR and AED and the AED electrodes were placed on the casualty’s chest rapidly. Results: During the 3 year period under review lay rescuers responded to 29 out of hospital cardiac arrests with 24 casualties surviving to hospital discharge generating an overall survival rate of over 79%. Survival rates peaked in 2012 with lay rescuers providing immediate assistance to 8 casualties in out of hospital cardiac arrest with 7 surviving to hospital discharge. Conclusion: The study demonstrates that lay rescuers can achieve exceptionally high out of hospital cardiac arrest survival rates, of at least 79%, by having a robust AED policy in place and a clear and focus training programme. http://dx.doi.org/10.1016/j.resuscitation.2014.03.102 AP054 Quality of external chest compressions, time or body mass index and fitness Ángel López-González 1,2 , Mairena Sánchez-López 3,2 , Jaime López-Tendero 1,2 , Carlos Urkía-Mieres 4,2,∗ , Elías Rovira-Gil 1,2 , Vicente Martínez-Vizcaíno 4,2 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: In sudden cardiac arrest the standard of care remains the prompt initiation of cardiopulmonary resuscitation (CPR), and even if the patient is not recovering, the unprofessional rescuer will only stop the CPR when their state of exhaustion prevents them to continue. Significant physical fatigue and shallow compressions are seen after already 1–5 min of CPR. However, in out-of-hospital cardiac arrest, properly administer CPR may by sustained continuously for prolonged periods. It has been hypothesized that fitness and body mass index (BMI) of the rescuers are predictors of the adequate external chest compressions (ECC) performance in prolonged CPR. The aims of this study were; (1) to analyze the differences within the mean percentage of adequate ECC and its components performed in 1, 2, 3, 5, 10 and 20 min by categories of weight status, cardiorespiratory fitness (VO2 max) and muscle strength, and (2) to establish the optimal cut-off points of VO2 max and arms muscle strength to perform adequate ECC.

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