Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses

BACKGROUND

Out-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity in Europe. We aim to investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectiveness of chest compression during CPR.

METHODS

This was prospective, randomized, crossover, controlled trial. Following a brief didactic session, 140 volunteer nurses inexperienced with feedback CPR devices attempted chest compression on a manikin using 3 CPR feedback devices (TrueCPR, CPR-Ezy, and iCPR) and standard basic life support (BLS) without feedback.

RESULTS

Comparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed differences in the effectiveness of chest compression (compressions with correct pressure point, correct depth, and sufficient decompression), which are, respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs 45.6 vs 39.6 mm); and compression rate (129.4 vs 110.2 vs 101.5 vs 103.5 min(-1)).

CONCLUSIONS

During the simulated resuscitation scenario, only TrueCPR significantly affected the increased effectiveness compression compared with standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirm the results in clinical practice.

Can the ETView VivaSight SL Rival Conventional Intubation Using the Macintosh Laryngoscope During Adult Resuscitation by Novice Physicians?: A Randomized Crossover Manikin Study

The aim of this study was to assess the performance of the ETView VivaSight SL (ETView) single-lumen airway tube with an integrated high-resolution imaging camera in a manikin-simulated cardiopulmonary resuscitation scenario with and without chest compression. This was a randomized crossover manikin trial. Following a brief training session, 107 volunteer novice physicians who were inexperienced with airway management attempted to intubate a manikin using a Macintosh laryngoscope (MAC) and an ETView, with and without chest compressions. The participants were instructed to make 3 attempts in each scenario. In this trial, we compared intubation time, intubation success rates, and glottic visibility using a Cormack & Lehane Grade. Dental compression and ease of use of each device were also assessed. Median intubation times for the ETView and MAC without chest compressions were 17 (IQR, 15-19) s and 27 (IQR, 25-33) s, respectively (P < 0.001). The ETView proved more successful on the first intubation attempt than the MAC, regardless of compressions. Continuation of compressions caused an increase in intubation times for both the ETView (P = 0.27) and the MAC (P < 0.005). The ETView VivaSight SL is an effective tool for endotracheal intubation when used by novice physicians in a manikin-simulated cardiac arrest, both with and without chest compressions.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT02295618.

Video rigid flexing laryngoscope (RIFL) vs Miller laryngoscope for tracheal intubation during pediatric resuscitation by paramedics: a simulation study

OBJECTIVES

Endotracheal intubation (ETI) is an essential resuscitation procedure in children. Video laryngoscopes have been developed to avoid intubation failures in a variety of scenarios, including cardiopulmonary resuscitation. We hypothesized that the video laryngoscope RIFL (AI Medical Devices, Inc, Williamston, MI) offers advantages in the ETI of a pediatric manikin while performing chest compressions (CCs).

METHODS

Randomized nonblinded crossover simulation trial conducted among 132 paramedics with no prior experience with RIFL. Each participant performed intubations with Miller (MIL; Mercury Medical, Clearwater, FL) laryngoscope and RIFL in a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, FL) in 3 airway scenarios: (a) normal airway at rest (without concomitant CC), (b) normal airway with mechanically controlled CC, and (c) difficult airway with concomitant CC. The primary outcome was the time to intubation, and secondary one was the success of the intubation attempt.

RESULTS

In the manikin at rest with normal airway, nearly all participants performed successful ETI both with MIL and RIFL, with similar intubation times. However, in the other scenarios (normal and difficult airway with uninterrupted CC), the results with RIFL were significantly better than with MIL (P < .05) for all the analyzed variables (success of first attempt, overall success rate, time to intubation, Cormac-Lehane grade, dental compression, and easy of intubation scores).

CONCLUSIONS

In simulated child arrest scenarios with normal/difficult airway conditions and with concomitant mechanical CC, paramedics performed better with the RIFL video laryngoscope than with the standard MIL.