Vol 5, No 1 (2020)
Research paper
Published online: 2020-02-12
Analysis of the quality of chest compressions during resuscitation in an understaffed team — randomised crossover manikin study
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Disaster Emerg Med J 2020;5(1):24-29.
Abstract
INTRODUCTION: According to the chain of survival, chest compressions (CCs) are crucial in every cardiac arrest patient. It is very challenging to provide high-quality resuscitation in a two-paramedic team. The task of an automatic chest compression device (ACCD) is to relieve the rescuer and improve the quality of CCs. Its influence on the quality of the whole resuscitation as well as the survival of patients is still subject to discussion worldwide. This study aimed to assess the quality of CCs during resuscitation in a two-paramedic team using ACCD.
MATERIAL AND METHODS: This research was designed as a prospective, randomised, cross-over, high-fidelity simulation study. Fifty-two double paramedic teams took part in the research. The role of the participants was to conduct full advanced resuscitation in a human patient’s simulator. Each team provided resuscitation twice. Once with an ACCD and once using manual compressions. Chest compression quality parameters, as well as chest compression fraction (CCF), were measured.
RESULTS : Statistically significant differences were found between manual and automated compressions in: mean depth (48 ± 4 mm vs. 56 ± 3 mm, p < 0.0001), mean rate (117 ± 9 mm vs. 103 ± 1 mm, p < 0.0001), percentage of CC with correct depth (46 ± 25 vs. 87 ± 13, p < 0.0001), rate (72 ± 22 vs. 96 ± 4, p < 0.0001), and recoil (55 ± 23 vs. 89 ± 13, p < 0.0001). CCF was also higher when the ACCD was used (74 ± 7% vs. 83 ± 2%, p < 0.0001).
CONCLUSIONS: The use of an ACCD increases the quality of compressions by improving CCF, chest recoil, and the percentage of compressions performed with adherence to guidelines.
Keywords: cardiopulmonary resuscitationautomated chest compression deviceparamedicquality assessmentsimulation study
References
- Wong CX, Brown A, Lau DH, et al. Epidemiology of Sudden Cardiac Death: Global and Regional Perspectives. Heart Lung Circ. 2019; 28(1): 6–14.
- Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2018; 15(10): e190–e252.
- Benjamin EJ, Blaha MJ, Chiuve SE, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017; 135(10): e146–e603.
- Wissenberg M, Lippert FK, Folke F, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA. 2013; 310(13): 1377–1384.
- Kishimori T, Kiguchi T, Kiyohara K, et al. Public-access automated external defibrillator pad application and favorable neurological outcome after out-of-hospital cardiac arrest in public locations: A prospective population-based propensity score-matched study. Int J Cardiol. 2020; 299: 140–146.
- Cheng A, Hunt EA, Grant D, et al. International Network for Simulation-based Pediatric Innovation, Research, and Education CPR Investigators. Variability in quality of chest compressions provided during simulated cardiac arrest across nine pediatric institutions. Resuscitation. 2015; 97: 13–19.
- Dabrowski M, Sip M, Dabrowska A, et al. It is impossible to follow the ERC algorithm in a two-paramedics ambulance team. Resuscitation. 2017; 118: e43.
- Hasselqvist-Ax I, Riva G, Herlitz J, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2015; 372(24): 2307–2315.
- Paradis NA, Martin GB, Rivers EP, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA. 1990; 263(8): 1106–1113.
- Sutton RM, Friess SH, Maltese MR, et al. Hemodynamic-directed cardiopulmonary resuscitation during in-hospital cardiac arrest. Resuscitation. 2014; 85(8): 983–986.
- Perkins GD, Handley AJ, Koster RW, et al. Adult basic life support and automated external defibrillation section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015; 95: 81–99.
- Sugerman NT, Edelson DP, Leary M, et al. Rescuer fatigue during actual in-hospital cardiopulmonary resuscitation with audiovisual feedback: a prospective multicenter study. Resuscitation. 2009; 80(9): 981–984.
- Soar J, Nolan JP, Böttiger BW, et al. Adult advanced life support section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015; 95: 100–147.
- Brooks SC, Anderson ML, Bruder E, et al. Part 6: Alternative Techniques and Ancillary Devices for Cardiopulmonary Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2): S436–S443.
- Gässler H, Kümmerle S, Ventzke MM, et al. Mechanical chest compression: an alternative in helicopter emergency medical services? Intern Emerg Med. 2015; 10(6): 715–720.
- Talikowska M, Tohira H, Finn J. Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2015; 96: 66–77.
- Idris AH, Guffey D, Aufderheide TP, et al. Resuscitation Outcomes Consortium (ROC) Investigators. Relationship between chest compression rates and outcomes from cardiac arrest. Circulation. 2012; 125(24): 3004–3012.
- Majer J, Smereka J, Ladny JR, et al. Quality of chest compressions during cardiopulmonary resuscitation performed by physicians: do we need to use mechanical chest compression devices? A multicenter, randomized, crossover study. Post N Med. 2018; XXXI(6): 314–321.
- Yannopoulos D, McKnite S, Aufderheide TP, et al. Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest. Resuscitation. 2005; 64(3): 363–372.
- Fried DA, Leary M, Smith DA, et al. The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation. Resuscitation. 2011; 82(8): 1019–1024.
- Wik L, Olsen JA, Persse D, et al. Why do some studies find that CPR fraction is not a predictor of survival? Resuscitation. 2016; 104: 59–62.
- Vaillancourt C, Everson-Stewart S, Christenson J, et al. Resuscitation Outcomes Consortium Investigators. The impact of increased chest compression fraction on return of spontaneous circulation for out-of-hospital cardiac arrest patients not in ventricular fibrillation. Resuscitation. 2011; 82(12): 1501–1507.
- Rea T, Olsufka M, Yin L, et al. The relationship between chest compression fraction and outcome from ventricular fibrillation arrests in prolonged resuscitations. Resuscitation. 2014; 85(7): 879–884.
- Brady W, Berlat JA. Hands-on defibrillation during active chest compressions: eliminating another interruption. Am J Emerg Med. 2016; 34(11): 2172–2176.
- Deakin CD, Thomsen JE, Løfgren Bo, et al. Achieving safe hands-on defibrillation using electrical safety gloves--a clinical evaluation. Resuscitation. 2015; 90: 163–167.
- Dabrowski M, Klosiewicz T, Sip M, et al. The final battle. What more can we do to be victorious with cardiac arrest? Preliminary data. Anestezjologia i Ratownictwo. 2018; 12: 111–116.
- Eftestøl T, Sunde K, Steen PA. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation. 2002; 105(19): 2270–2273.
- Bonnes JL, Brouwer MA, Navarese EP, et al. Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies. Ann Emerg Med. 2016; 67(3): 349–360.e3.
- Tranberg T, Lassen JF, Kaltoft AK, et al. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest before and after introduction of a mechanical chest compression device, LUCAS-2; a prospective, observational study. Scand J Trauma Resusc Emerg Med. 2015; 23: 37.
- Yamanaka S, Huh JiY, Nishiyama K, et al. The optimal number of personnel for good quality of chest compressions: A prospective randomized parallel manikin trial. PLoS One. 2017; 12(12): e0189412.
- Hunziker S, O'Connell KJ, Ranniger C, et al. Effects of designated leadership and team-size on cardiopulmonary resuscitation: The Basel-Washington SIMulation (BaWaSim) trial. J Crit Care. 2018; 48: 72–77.
- Eschmann NM, Pirrallo RG, Aufderheide TP, et al. The association between emergency medical services staffing patterns and out-of-hospital cardiac arrest survival. Prehosp Emerg Care. 2010; 14(1): 71–77.
- Jo CH, Cho GC, Ahn JH, et al. Rescuer-limited cardiopulmonary resuscitation as an alternative to 2-min switched CPR in the setting of inhospital cardiac arrest: a randomised cross-over study. Emerg Med J. 2015; 32(7): 539–543.
- Kim H, You J, Chung S. Influence of rescuer strength and shift cycle time on chest compression quality. Signa Vitae - A Journal In Intensive Care And Emergency Medicine. 2017; 13(1).
- Yang CW, Yen ZS, McGowan JE, et al. A systematic review of retention of adult advanced life support knowledge and skills in healthcare providers. Resuscitation. 2012; 83(9): 1055–1060.