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Standard bystander CPR versus continuous chest compressions only in out-of-hospital cardiac arrest
S10
Oral Presentations
Table 1 ROSC
Time to ROSC (s)
10/10*
482 ± 48#
I.O.—Epi I.V.—Epi 9/10* Placebo 1/10 * p < 0.05 versus placebo. # p < 0.05 versus I.V.
717 ± 79 (690)
after the second set of 200 CC and every 2 min, as necessary. Animals were randomized into three groups and epinephrine (0.045 mg/kg) or placebo was given according to group allocation until a perfusing rhythm or six unsuccessful defibrillations were attained. Group 1: I.O.—Epi (BoneInjectionGunR , WaisMed, Israel, tibia plateau) at 1; 4; 6.25; 8.5; 10.75 min after CC started. Group 2: I.V.—Epi (internal jugular vein) at 8.5; 10.75 min after CC started. Group 3: Placebo at 1; 4; 6.25; 8.5; 10.75 min after CC started. The rescuers were blinded to the drug administration. STATISTICS: Student’s t-test, Mann—Whitney-U-test and Fisher’s exact test. Results: (Table 1) Conclusions: Intraosseous epinephrine, administered earlier than I.V., results in shorter time to ROSC and improves 24-h good neurological outcome.
Number of Shocks to ROSC median (25;75%) 2 (1;3) 6 (1.75;6) (1)
Number of animals with good 24 h-Neuro Outcome 6/10* 3/10 0/10
References 1. Woollard M, Smith A, Whitfield R, et al. To blow or not to blow: a randomised controlled trial of compression-only and standard telephone CPR instructions in simulated cardiac arrest. Resuscitation 2003;59(1):123—31. 2. Deakin CD, Cheung S, Petley GW, Clewlow F. Assessment of the quality of cardiopulmonary resuscitation following modification of a standard telephone-directed protocol. Resuscitation 2007;72(3):436—43. 3. Dorph E, Wik L, Steen PA. Dispatcher-assisted cardiopulmonary resuscitation. An evaluation of efficacy amongst elderly. Resuscitation 2003;56(3):265—73.
doi:10.1016/j.resuscitation.2008.03.040 AS-027 Standard bystander CPR versus continuous chest compressions only in out-of-hospital cardiac arrest
doi:10.1016/j.resuscitation.2008.03.039
T.M. Olasveengen, L. Wik, P.A. Steen
AS-026 Adding interactive video communication to dispatch instructions improves the quality of bystander cardiopulmonary resuscitation in simulated cardiac arrests
Institute for Experimental Medical Research, Department of Anaesthesiology and The National Competence Centre for Emergency Medicine, Ulleval University Hospital, Norway
Matthew Huei-Ming Ma, Chih-Wei Yang, Hui-Chih Wang, Wen-Chu Chiang, Che-Wei Hsu, Chow-In Ko, Shyr-Chyr Chen Department of Emergency Medicine, National Taiwan University Hospital, Taiwan Introduction: Dispatch assistance increases bystander cardiopulmonary resuscitation (CPR) but the quality of dispatcher-assisted CPR (DA-CPR) remains unsatisfactory. This study was conducted to assess effects of adding interactive video communication to DA-CPR. Methods: In this simulation-based study, adults without CPR training within the past 5 years were recruited and randomized to receive dispatch assistance with either voice instruction alone (voice group) or interactive voice and video communication (video group) via a video cell phone. CPR performance was evaluated by reviewing the videos and mannequin reports. Results: 96 subjects were recruited, with 53 in the voice group and 43 in the video group. Chest compressions among the video group were faster (median rate 95.5 vs. 63.0 min−1 , P < 0.01), deeper (median depth 36.0 vs. 25.0 mm, P < 0.01), and of more appropriate depth (20.0% vs. 0%, P < 0.01). Differences in chest compressions with appropriate depth (40.0% vs. 31.4%, P < 0.05) and rate (95.8 vs. 65.9 min−1 , P < 0.01) became significant at 10 and 20 s after the start of chest compressions, respectively. The video group had more “hands-off” time (5.0 vs. 0 s, P < 0.01), longer time to first chest compression (145.0 vs. 116.0 s, P < 0.01), and total instruction time (150.0 vs. 121.0 s, P < 0.01), but a tendency towards shorter time to first “standard” chest compression (205.0 vs. 240.0 s, P = 0.34). Conclusions: Adding interactive video communication to DA-CPR improved the depth and rate of chest compressions. The benefit was achieved mainly through real-time feedback. Interactive videobased instructions have a potential in improving DA-CPR.
Introduction: We compared the outcome for patients receiving standard bystander cardiopulmonary resuscitation (S-BLS) vs. continuous chest compressions only (CCC). Methods: Retrospective, observational study of all nontraumatic cardiac arrest patients older than 18 years between May 2003 and December 2006 treated by Oslo EMS. Utstein characteristics were registered for patients receiving bystander S-BLS, CCC or no bystander CPR by reviewing Ambulance run sheets, Utstein forms and hospital records. Bystander CPR method and possible dispatcher instruction was registered by ambulance personnel. Results: Six-hundred ninety-two out of 808 cardiac arrests were included, of whom 277 (34%) received S-CPR and 153 (19%) CCC. More patients receiving CCC arrested at home (58% vs. 41%, p = 0.001) and fewer in public places (29% vs. 42%, p = 0.006). These patients were found more frequently in asystole (53% vs. 43%, p = 0.050) and less frequently in Ventricular Fibrillation/Ventricular Tachycardia (VF/VT) (35% vs. 43%, p = 0.037) compared to the S-BLS group. Fewer shocks were delivered (median 0 vs. 1 p = 0.015), intravenous access established less frequently (51% vs. 66%, p = 0.003), and adrenaline administered less frequently (37% vs. 48%, p = 0.039) in the CCC group compared to the S-BLS group. There were no differences in outcome between the two patient groups with 34 (12%) discharged from hospital in the S-BLS group, and 17 (11%) in the CCC group (p = 0.859), and no difference in survival sub-group analysis of patients presenting with initial VF/VT; 32 (25%) discharged from hospital with S-BLS vs. 12 (23%) with CCC (p = 0.841). Conclusions: Patients receiving continuous chest compressions from bystanders did not have a worse outcome than patients receiving standard CPR, even with a tendency to higher distribution of known negative predictive features. doi:10.1016/j.resuscitation.2008.03.041
Oral Presentations
Table 1 ROSC
Time to ROSC (s)
10/10*
482 ± 48#
I.O.—Epi I.V.—Epi 9/10* Placebo 1/10 * p < 0.05 versus placebo. # p < 0.05 versus I.V.
717 ± 79 (690)
after the second set of 200 CC and every 2 min, as necessary. Animals were randomized into three groups and epinephrine (0.045 mg/kg) or placebo was given according to group allocation until a perfusing rhythm or six unsuccessful defibrillations were attained. Group 1: I.O.—Epi (BoneInjectionGunR , WaisMed, Israel, tibia plateau) at 1; 4; 6.25; 8.5; 10.75 min after CC started. Group 2: I.V.—Epi (internal jugular vein) at 8.5; 10.75 min after CC started. Group 3: Placebo at 1; 4; 6.25; 8.5; 10.75 min after CC started. The rescuers were blinded to the drug administration. STATISTICS: Student’s t-test, Mann—Whitney-U-test and Fisher’s exact test. Results: (Table 1) Conclusions: Intraosseous epinephrine, administered earlier than I.V., results in shorter time to ROSC and improves 24-h good neurological outcome.
Number of Shocks to ROSC median (25;75%) 2 (1;3) 6 (1.75;6) (1)
Number of animals with good 24 h-Neuro Outcome 6/10* 3/10 0/10
References 1. Woollard M, Smith A, Whitfield R, et al. To blow or not to blow: a randomised controlled trial of compression-only and standard telephone CPR instructions in simulated cardiac arrest. Resuscitation 2003;59(1):123—31. 2. Deakin CD, Cheung S, Petley GW, Clewlow F. Assessment of the quality of cardiopulmonary resuscitation following modification of a standard telephone-directed protocol. Resuscitation 2007;72(3):436—43. 3. Dorph E, Wik L, Steen PA. Dispatcher-assisted cardiopulmonary resuscitation. An evaluation of efficacy amongst elderly. Resuscitation 2003;56(3):265—73.
doi:10.1016/j.resuscitation.2008.03.040 AS-027 Standard bystander CPR versus continuous chest compressions only in out-of-hospital cardiac arrest
doi:10.1016/j.resuscitation.2008.03.039
T.M. Olasveengen, L. Wik, P.A. Steen
AS-026 Adding interactive video communication to dispatch instructions improves the quality of bystander cardiopulmonary resuscitation in simulated cardiac arrests
Institute for Experimental Medical Research, Department of Anaesthesiology and The National Competence Centre for Emergency Medicine, Ulleval University Hospital, Norway
Matthew Huei-Ming Ma, Chih-Wei Yang, Hui-Chih Wang, Wen-Chu Chiang, Che-Wei Hsu, Chow-In Ko, Shyr-Chyr Chen Department of Emergency Medicine, National Taiwan University Hospital, Taiwan Introduction: Dispatch assistance increases bystander cardiopulmonary resuscitation (CPR) but the quality of dispatcher-assisted CPR (DA-CPR) remains unsatisfactory. This study was conducted to assess effects of adding interactive video communication to DA-CPR. Methods: In this simulation-based study, adults without CPR training within the past 5 years were recruited and randomized to receive dispatch assistance with either voice instruction alone (voice group) or interactive voice and video communication (video group) via a video cell phone. CPR performance was evaluated by reviewing the videos and mannequin reports. Results: 96 subjects were recruited, with 53 in the voice group and 43 in the video group. Chest compressions among the video group were faster (median rate 95.5 vs. 63.0 min−1 , P < 0.01), deeper (median depth 36.0 vs. 25.0 mm, P < 0.01), and of more appropriate depth (20.0% vs. 0%, P < 0.01). Differences in chest compressions with appropriate depth (40.0% vs. 31.4%, P < 0.05) and rate (95.8 vs. 65.9 min−1 , P < 0.01) became significant at 10 and 20 s after the start of chest compressions, respectively. The video group had more “hands-off” time (5.0 vs. 0 s, P < 0.01), longer time to first chest compression (145.0 vs. 116.0 s, P < 0.01), and total instruction time (150.0 vs. 121.0 s, P < 0.01), but a tendency towards shorter time to first “standard” chest compression (205.0 vs. 240.0 s, P = 0.34). Conclusions: Adding interactive video communication to DA-CPR improved the depth and rate of chest compressions. The benefit was achieved mainly through real-time feedback. Interactive videobased instructions have a potential in improving DA-CPR.
Introduction: We compared the outcome for patients receiving standard bystander cardiopulmonary resuscitation (S-BLS) vs. continuous chest compressions only (CCC). Methods: Retrospective, observational study of all nontraumatic cardiac arrest patients older than 18 years between May 2003 and December 2006 treated by Oslo EMS. Utstein characteristics were registered for patients receiving bystander S-BLS, CCC or no bystander CPR by reviewing Ambulance run sheets, Utstein forms and hospital records. Bystander CPR method and possible dispatcher instruction was registered by ambulance personnel. Results: Six-hundred ninety-two out of 808 cardiac arrests were included, of whom 277 (34%) received S-CPR and 153 (19%) CCC. More patients receiving CCC arrested at home (58% vs. 41%, p = 0.001) and fewer in public places (29% vs. 42%, p = 0.006). These patients were found more frequently in asystole (53% vs. 43%, p = 0.050) and less frequently in Ventricular Fibrillation/Ventricular Tachycardia (VF/VT) (35% vs. 43%, p = 0.037) compared to the S-BLS group. Fewer shocks were delivered (median 0 vs. 1 p = 0.015), intravenous access established less frequently (51% vs. 66%, p = 0.003), and adrenaline administered less frequently (37% vs. 48%, p = 0.039) in the CCC group compared to the S-BLS group. There were no differences in outcome between the two patient groups with 34 (12%) discharged from hospital in the S-BLS group, and 17 (11%) in the CCC group (p = 0.859), and no difference in survival sub-group analysis of patients presenting with initial VF/VT; 32 (25%) discharged from hospital with S-BLS vs. 12 (23%) with CCC (p = 0.841). Conclusions: Patients receiving continuous chest compressions from bystanders did not have a worse outcome than patients receiving standard CPR, even with a tendency to higher distribution of known negative predictive features. doi:10.1016/j.resuscitation.2008.03.041