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van Eijk JA, Doeleman LC, Loer SA, Koster RW, van Schuppen H, Schober P. Ventilation during cardiopulmonary resuscitation: A narrative review. Resuscitation 2024; 203:110366. [PMID: 39181499 DOI: 10.1016/j.resuscitation.2024.110366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/12/2024] [Accepted: 08/15/2024] [Indexed: 08/27/2024]
Abstract
Ventilation during cardiopulmonary resuscitation is vital to achieve optimal oxygenation but continues to be a subject of ongoing debate. This narrative review aims to provide an overview of various components and challenges of ventilation during cardiopulmonary resuscitation, highlighting key areas of uncertainty in the current understanding of ventilation management. It addresses the pulmonary pathophysiology during cardiac arrest, the importance of adequate alveolar ventilation, recommendations concerning the maintenance of airway patency, tidal volumes and ventilation rates in both synchronous and asynchronous ventilation. Additionally, it discusses ventilation adjuncts such as the impedance threshold device, the role of positive end-expiratory pressure ventilation, and passive oxygenation. Finally, this review offers directions for future research.
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Affiliation(s)
- Jeroen A van Eijk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
| | - Lotte C Doeleman
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Stephan A Loer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Rudolph W Koster
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, Netherlands
| | - Hans van Schuppen
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Patrick Schober
- Amsterdam UMC location Vrije Universiteit Amsterdam, Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
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Doeleman LC, Boomars R, Radstok A, Schober P, Dellaert Q, Hollmann MW, Koster RW, van Schuppen H. Ventilation during cardiopulmonary resuscitation with mechanical chest compressions: How often are two insufflations being given during the 3-second ventilation pauses? Resuscitation 2024; 199:110234. [PMID: 38723941 DOI: 10.1016/j.resuscitation.2024.110234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/07/2024] [Accepted: 04/30/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Mechanical chest compression devices in 30:2 mode provide 3-second pauses to allow for two insufflations. We aimed to determine how often two insufflations are provided in these ventilation pauses, in order to assess if prehospital providers are able to ventilate out-of-hospital cardiac arrest (OHCA) patients successfully during mechanical chest compressions. METHODS Data from OHCA cases of the regional ambulance service of Utrecht, The Netherlands, were prospectively collected in the UTrecht studygroup for OPtimal registry of cardIAc arrest database (UTOPIA). Compression pauses and insufflations were visualized on thoracic impedance and waveform capnography signals recorded by manual defibrillators. Ventilation pauses were analyzed for number of insufflations, duration of the subintervals of the ventilation cycles, and ratio of successfully providing two insufflations over the course of the resuscitation. Generalized linear mixed effects models were used to accurately estimate proportions and means. RESULTS In 250 cases, 8473 ventilation pauses were identified, of which 4305 (51%) included two insufflations. When corrected for non-independence of the data across repeated measures within the same subjects with a mixed effects analysis, two insufflations were successfully provided in 45% of ventilation pauses (95% CI: 40-50%). In 19% (95% CI: 16-22%) none were given. CONCLUSION Providing two insufflations during pauses in mechanical chest compressions is mostly unsuccessful. We recommend developing strategies to improve giving insufflations when using mechanical chest compression devices. Increasing the pause duration might help to improve insufflation success.
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Affiliation(s)
- Lotte C Doeleman
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
| | - René Boomars
- Regional Ambulance Service Utrecht (RAVU), Jan van Eijcklaan 6, Bilthoven, the Netherlands
| | - Anja Radstok
- Regional Ambulance Service Utrecht (RAVU), Jan van Eijcklaan 6, Bilthoven, the Netherlands
| | - Patrick Schober
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Anesthesiology, Boelelaan 1117, Amsterdam, Netherlands
| | | | - Markus W Hollmann
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Rudolph W Koster
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, Netherlands
| | - Hans van Schuppen
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
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Feasibility of Mouth-to-Mouth Ventilation through FPP2 Respirator in BLS Training during COVID-19 Pandemic (MOVERESP Study): Simulation-Based Study. CHILDREN 2022; 9:children9111751. [DOI: 10.3390/children9111751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
Background: Due to the COVID-19 pandemic, Basic Life Support (BLS) training has been limited to compression-only or bag–mask ventilation. The most breathable nanofiber respirators carry the technical possibility for inflation of the mannequin. The aim of this study was to assess the efficacy of mouth-to-mouth breathing through a FFP2 respirator during BLS. Methods: In the cross-over simulation-based study, the medical students performed BLS using a breathable nanofiber respirator for 2 min on three mannequins. The quantitative and qualitative efficacy of mouth-to-mouth ventilation through the respirator in BLS training was analyzed. The primary aim was the effectivity of mouth-to-mouth ventilation through a breathable respirator. The secondary aims were mean pause, longest pause, success in achieving the optimal breath volume, technique of ventilation, and incidence of adverse events. Results: In 104 students, effective breath was reached in 951 of 981 (96.9%) attempts in Adult BLS mannequin (Prestan), 822 of 906 (90.7%) in Resusci Anne, and 1777 of 1857 (95.7%) in Resusci Baby. In Resusci Anne and Resusci Baby, 28.9%/15.9% of visible chest rises were evaluated as low-, 33.0%/44.0% as optimal-, and 28.8%/35.8% as high-volume breaths. Conclusions: Mouth-to-mouth ventilation through a breathable respirator had an effectivity greater than 90%.
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van Schuppen H, Doeleman LC, Hollmann MW, Koster RW. Manual chest compression pause duration for ventilations during prehospital advanced life support - An observational study to explore optimal ventilation pause duration for mechanical chest compression devices. Resuscitation 2022; 180:24-30. [PMID: 36084804 DOI: 10.1016/j.resuscitation.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022]
Abstract
AIM Mechanical chest compression devices in the 30:2 mode generally provide a pause of three seconds to give two insufflations without evidence supporting this pause duration. We aimed to explore the optimal pause duration by measuring the time needed for two insufflations, during advanced life support with manual compressions. METHODS Prospectively collected data in the AmsteRdam REsuscitation STudies (ARREST) registry were analysed, including thoracic impedance signal and waveform capnography from manual defibrillators of the Amsterdam ambulance service. Compression pauses were analysed for number of insufflations, time interval from start of the compression pause to the end of the second insufflation, chest compression pause duration and ventilation subintervals. RESULTS During 132 out-of-hospital cardiac arrests, 1619 manual chest compression pauses to ventilate were identified. In 1364 (84%) pauses, two insufflations were given. In 28% of these pauses, giving two insufflations took more than three seconds. The second insufflation is completed within 3.8 seconds in 90% and within 5 seconds in 97.5% of these pauses. An increasing likelihood of achieving two insufflations is seen with increasing compression pause duration up to five seconds. CONCLUSION The optimal chest compression pause duration for mechanical chest compression devices in the 30:2 mode to provide two insufflations, appears to be five seconds, warranting further studies in the context of mechanical chest compression. A 5-second pause will allow providers to give two insufflations with a very high success rate. In addition, a 5-second pause can also be used for other interventions like rhythm checks and endotracheal intubation.
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Affiliation(s)
- Hans van Schuppen
- Amsterdam UMC Location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Lotte C Doeleman
- Amsterdam UMC Location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Amsterdam UMC Location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Rudolph W Koster
- Amsterdam UMC Location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, The Netherlands
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Michel J, Ilg T, Neunhoeffer F, Hofbeck M, Heimberg E. Implementation and Evaluation of Resuscitation Training for Childcare Workers. Front Pediatr 2022; 10:824673. [PMID: 35295697 PMCID: PMC8918630 DOI: 10.3389/fped.2022.824673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objective Children spend a large amount of time in daycare centers or schools. Therefore, it makes sense to train caregivers well in first-aid measures in children. The aim of this study is to evaluate whether a multimodal resuscitation training for childcare workers can teach adherence to resuscitation guidelines in a sustainable way. Materials and Methods Caregivers at a daycare center who had previously completed a first-aid course received a newly developed multimodal resuscitation training in small groups of 7-8 participants by 3 AHA certified PALS instructors and providers. The 4-h focused retraining consisted of a theoretical component, expert modeling, resuscitation exercises on pediatric manikins (Laerdal Resusci Baby QCPR), and simulated emergency scenarios. Adherence to resuscitation guidelines was compared before retraining, immediately after training, and after 6 months. This included evaluation of chest compressions per round, chest compression rate, compression depth, full chest recoil, no-flow time, and success of rescue breaths. For better comparability and interpretation of the results, the parameters were evaluated both separately and summarized in a resuscitation score reflecting the overall adherence to the guidelines. Results A total of 101 simulated cardiopulmonary resuscitations were evaluated in 39 participants. In comparison to pre-retraining, chest compressions per round (15.0 [10.0-29.0] vs. 30.0 [30.0-30.0], p < 0.001), chest compression rate (100.0 [75.0-120.0] vs. 112.5 [105-120.0], p < 0.001), correct compression depth (6.7% [0.0-100.0] vs. 100.0% [100.0-100.0], p < 0.001), no-flow time (7.0 s. [5.0-9.0] vs. 4.0 s. [3.0-5.0], p < 0.001), success of rescue breaths (0.0% [0.0-0.0] vs. 100.0% [100.0-100.0], p < 0.001), and resuscitation score were significantly improved immediately after training (3.9 [3.2-4.9] vs. 6.3 [5.6-6.7], p < 0.001). At follow-up, there was no significant change in chest compression rate and success of rescue breaths. Chest compressions per round (30.0 [15.0-30.0], p < 0.001), no-flow time (5.0 s. [4.0-8.0], p < 0.001), compression depths (100.0% [96.7-100.0], p < 0.001), and resuscitation score worsened again after 6 months (5.7 [4.7-6.4], p = 0.03). However, the results were still significantly better compared to pre-retraining. Conclusion Our multimodal cardiopulmonary resuscitation training program for caregivers is effective to increase the resuscitation performance immediately after training. Although the effect diminishes after 6 months, adherence to resuscitation guidelines was significantly better than before retraining.
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Affiliation(s)
- Jörg Michel
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen, Germany
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Effects of Bag Mask Ventilation and Advanced Airway Management on Adherence to Ventilation Recommendations and Chest Compression Fraction: A Prospective Randomized Simulator-Based Trial. J Clin Med 2020; 9:jcm9072045. [PMID: 32610672 PMCID: PMC7408746 DOI: 10.3390/jcm9072045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 01/16/2023] Open
Abstract
The role of advanced airway management (AAM) in cardiopulmonary resuscitation (CPR) is currently debated as observational studies reported better outcomes after bag-mask ventilation (BMV), and the only prospective randomized trial was inconclusive. Adherence to CPR guidelines ventilation recommendations is unknown and difficult to assess in clinical trials. This study compared AAM and BMV with regard to adherence to ventilation recommendations and chest compression fractions in simulated cardiac arrests. A total of 154 teams of 3–4 physicians were randomized to perform CPR with resuscitation equipment restricting airway management to BMV only or equipment allowing for all forms of AAM. BMV teams ventilated 6 ± 6/min and AAM teams 19 ± 8/min (range 3–42/min; p < 0.0001 vs. BMV). 68/78 BMV teams and 23/71 AAM teams adhered to the ventilation recommendations (p < 0.0001). BMV teams had lower compression fractions than AAM teams (78 ± 7% vs. 86 ± 6%, p < 0.0001) resulting entirely from higher no-flow times for ventilation (9 ± 4% vs. 3 ± 3 %; p < 0.0001). Compared to BMV, AAM leads to significant hyperventilation and lower adherence to ventilation recommendations but favourable compression fractions. The cumulative effect of deviations from ventilation recommendations has the potential to blur findings in clinical trials.
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Evaluation of a Multimodal Resuscitation Program and Comparison of Mouth-to-Mouth and Bag-Mask Ventilation by Relatives of Children With Chronic Diseases. Pediatr Crit Care Med 2020; 21:e114-e120. [PMID: 31834244 DOI: 10.1097/pcc.0000000000002204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Children with chronic critical illness are at higher risk for cardiopulmonary arrests. Before chronically ill children are discharged from hospital, family members receive training in basic life support at many institutions. We evaluated whether a multimodal training program is able to teach adherence to current resuscitation guidelines and whether laypersons can be trained to perform both bag-mask ventilation and mouth-to-mouth ventilation equally effective in infants. DESIGN Prospective observational study. SETTING Pediatric critical care unit of a tertiary referral center. SUBJECTS Relatives of children with chronic illness prior to discharge from hospital. INTERVENTIONS Multimodal emergency and cardiopulmonary resuscitation training program. MEASUREMENTS AND MAIN RESULTS Following participation in our cardiopulmonary resuscitation training program 56 participants performed 112 simulated cardiopulmonary resuscitations (56 with mouth-to-mouth ventilation, 56 with bag-mask ventilation). Nearly all participants checked for consciousness and breathing. Shouting for help and activation of the emergency response system was only performed in half of the cases. There was almost full adherence to the resuscitation guidelines regarding number of chest compressions, chest compression rate, compression depth, full chest recoil, and duration of interruption of chest compression for rescue breaths. The comparison of mouth-to-mouth ventilation and bag-mask ventilation revealed no significant differences regarding the rate of successful ventilation (mouth-to-mouth ventilation: 77.1% ± 39.6%, bag-mask ventilation: 80.4% ± 38.0%; p = 0.39) and the cardiopulmonary resuscitation performance. CONCLUSIONS A standardized multimodal cardiopulmonary resuscitation training program for family members of chronically ill children is effective to teach good cardiopulmonary resuscitation performance and adherence to resuscitation guidelines. Laypersons could be successfully trained to equally perform mouth-to-mouth and bag-mask ventilation technique.
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Oh JH. Importance of effective ventilation during cardiopulmonary resuscitation on outcomes of out-of-hospital cardiac arrest. Resuscitation 2019; 143:234-235. [DOI: 10.1016/j.resuscitation.2019.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 11/25/2022]
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Idris A, Chang MP, Leroux B, Lu Y, Ecenarro EA, Owens P, Wang HE. Reply to: Importance of effective ventilation during cardiopulmonary resuscitation on outcomes of out-of-hospital cardiac arrest. Resuscitation 2019; 143:236-237. [PMID: 31422104 DOI: 10.1016/j.resuscitation.2019.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ahamed Idris
- UT Southwestern, Emergency Medicine, 5323 Harry Hines Blvd, Dallas, TX 75225, United States.
| | - Mary P Chang
- UT Southwestern, Emergency Medicine, 5323 Harry Hines Blvd, Dallas, TX 75225, United States
| | - Brian Leroux
- UT Southwestern, Emergency Medicine, 5323 Harry Hines Blvd, Dallas, TX 75225, United States
| | - Yuanzheng Lu
- UT Southwestern, Emergency Medicine, 5323 Harry Hines Blvd, Dallas, TX 75225, United States
| | - Elisabete A Ecenarro
- UT Southwestern, Emergency Medicine, 5323 Harry Hines Blvd, Dallas, TX 75225, United States
| | - Pamela Owens
- UT Southwestern, Emergency Medicine, 5323 Harry Hines Blvd, Dallas, TX 75225, United States
| | - Henry E Wang
- UT Southwestern, Emergency Medicine, 5323 Harry Hines Blvd, Dallas, TX 75225, United States
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Berger C, Brinkrolf P, Ertmer C, Becker J, Friederichs H, Wenk M, Van Aken H, Hahnenkamp K. Combination of problem-based learning with high-fidelity simulation in CPR training improves short and long-term CPR skills: a randomised single blinded trial. BMC MEDICAL EDUCATION 2019; 19:180. [PMID: 31151450 PMCID: PMC6544917 DOI: 10.1186/s12909-019-1626-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/22/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Performance of sufficient cardiopulmonary resuscitation (CPR) by medical personnel is critical to improve outcomes during cardiac arrest. It has however been shown that even health care professionals possess a lack of knowledge and skills in CPR performance. The optimal method for teaching CPR remains unclear, and data that compares traditional CPR instructional methods with newer modalities of CPR instruction are needed. We therefore conducted a single blinded, randomised study involving medical students in order to evaluate the short- and long-term effects of a classical CPR education compared with a bilateral approach to CPR training, consisting of problem-based learning (PBL) plus high fidelity simulation. METHODS One hundred twelve medical students were randomized during a curricular anaesthesiology course to a control (n = 54) and an intervention (n = 58) group. All participants were blinded to group assignment and partook in a 30-min-lecture on CPR basics. Subsequently, the control group participated in a 90-min tutor-guided CPR hands-on-training. The intervention group took part in a 45-min theoretical PBL module followed by 45 min of high fidelity simulated CPR training. The rate of participants recognizing clinical cardiac arrest followed by sufficiently performed CPR was the primary outcome parameter of this study. CPR performance was evaluated after the intervention. In addition, a follow-up evaluation was conducted after 6 months. RESULTS 51.9% of the intervention group met the criteria of sufficiently performed CPR as compared to only 12.5% in the control group on the day of the intervention (p = 0.007). Hands-off-time as a marker for CPR continuity was significantly less in the intervention group (24.0%) as compared to the control group (28.3%, p = 0.007, Hedges' g = 1.55). At the six-month follow-up, hands-off-time was still significantly lower in the intervention group (23.7% vs. control group: 31.0%, p = 0.006, Hedges' g = 1.88) but no significant difference in sufficiently performed CPR was detected (intervention group: 71.4% vs. control group: 54.5%, p = 0.55). CONCLUSION PBL combined with high fidelity simulation training leads to a measurable short-term increase in initiating sufficient CPR by medical students immediately after training as compared to classical education. At six month post instruction, these differences remained only partially.
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Affiliation(s)
- Christian Berger
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Peter Brinkrolf
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Cristian Ertmer
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Jan Becker
- Institute for Education and Students Affairs-IFAS, Medical Faculty, University of Münster, Münster, Germany
| | - Hendrik Friederichs
- Institute for Education and Students Affairs-IFAS, Medical Faculty, University of Münster, Münster, Germany
| | - Manuel Wenk
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Hugo Van Aken
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Klaus Hahnenkamp
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
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Transthoracic Impedance Measured with Defibrillator Pads-New Interpretations of Signal Change Induced by Ventilations. J Clin Med 2019; 8:jcm8050724. [PMID: 31121817 PMCID: PMC6571933 DOI: 10.3390/jcm8050724] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 12/03/2022] Open
Abstract
Compressions during the insufflation phase of ventilations may cause severe pulmonary injury during cardiopulmonary resuscitation (CPR). Transthoracic impedance (TTI) could be used to evaluate how chest compressions are aligned with ventilations if the insufflation phase could be identified in the TTI waveform without chest compression artifacts. Therefore, the aim of this study was to determine whether and how the insufflation phase could be precisely identified during TTI. We synchronously measured TTI and airway pressure (Paw) in 21 consenting anaesthetised patients, TTI through the defibrillator pads and Paw by connecting the monitor-defibrillator’s pressure-line to the endotracheal tube filter. Volume control mode with seventeen different settings were used (5–10 ventilations/setting): Six volumes (150–800 mL) with 12 min−1 frequency, four frequencies (10, 12, 22 and 30 min−1) with 400 mL volume, and seven inspiratory times (0.5–3.5 s) with 400 mL/10 min−1 volume/frequency. Median time differences (quartile range) between timing of expiration onset in the Paw-line (PawEO) and the TTI peak and TTI maximum downslope were measured. TTI peak and PawEO time difference was 579 (432–723) ms for 12 min−1, independent of volume, with a negative relation to frequency, and it increased linearly with inspiratory time (slope 0.47, R2 = 0.72). PawEO and TTI maximum downslope time difference was between −69 and 84 ms for any ventilation setting (time aligned). It was independent (R2 < 0.01) of volume, frequency and inspiratory time, with global median values of −47 (−153–65) ms, −40 (−168–68) ms and 20 (−93–128) ms, for varying volume, frequency and inspiratory time, respectively. The TTI peak is not aligned with the start of exhalation, but the TTI maximum downslope is. This knowledge could help with identifying the ideal ventilation pattern during CPR.
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Hyun SH, Ryew CC. Kinetic analysis of cardiac compression-force according to the level of information provision in the cardiopulmonary resuscitation. J Exerc Rehabil 2019; 15:170-174. [PMID: 30899754 PMCID: PMC6416517 DOI: 10.12965/jer.1938024.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 01/23/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Che-Cheong Ryew
- Corresponding author: Che-Cheong Ryew, https://orcid.org/0000-0001-9473-3990, Department of Kinesiology, College of Natural Science, Jeju National University, 102 Jejudaehak-ro, Jeju 63243, Korea, E-mail:
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Lee JH, Na JU, Shin DH, Han SK, Choi PC, Cho JH. Manikin study showed that counting inflation breaths out loud improved the speed of resuming chest compressions during two-person paediatric cardiopulmonary resuscitation. Acta Paediatr 2018; 107:2120-2124. [PMID: 29722906 DOI: 10.1111/apa.14385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/06/2018] [Accepted: 04/26/2018] [Indexed: 11/27/2022]
Abstract
AIM We investigated whether counting inflation breaths out loud during cardiopulmonary resuscitation (CPR) led to an earlier resumption of chest compressions. METHODS In this randomised controlled manikin simulation study, conducted from February 2015 to April 2015, 32 fourth-year Korean medical students, equally divided into study and control groups, performed 10 cycles of 15:2 CPR while administering inflation breaths using a bag mask. The first study participant counted the number of inflation breaths out loud, and the second study participant was told to perform chest compressions as soon as they heard their colleague say two. The control group did not count out loud. The groups were blinded to the study outcomes and put in separate rooms. RESULTS The median chest compression interruption time was shorter in the study group than the control group (40 vs 46 seconds, p < 0.01, r = 0.70), and the median chest compression fraction (CCF) was higher (68 vs 62%, p < 0.01, r = 0.71). Other quality outcomes related chest compressions and ventilation did not differ between the groups. CONCLUSION Counting the number of inflation breaths out loud was a simple method that improved the speed of resuming chest compressions and increased CCFs in 15:2 CPR.
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Affiliation(s)
- Jang Hee Lee
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Ung Na
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Emergency Medicine, Graduate School, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - Dong Hyuk Shin
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Kuk Han
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil Cho Choi
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Hwi Cho
- Department of Emergency Medicine, Institute of Medical Sciences, School of Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, Korea
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14
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Is short always important? Heart Rhythm 2018; 15:256-257. [DOI: 10.1016/j.hrthm.2017.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Indexed: 11/24/2022]
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Brady WJ, Glass G, O'Connor RE. A better understanding of lay providers' CPR performance during resuscitation of out-of-hospital cardiac arrest. Resuscitation 2017; 121:A10-A11. [PMID: 29031626 DOI: 10.1016/j.resuscitation.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]
Affiliation(s)
- William J Brady
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908, USA.
| | - George Glass
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - Robert E O'Connor
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908, USA
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Quality of bystander cardiopulmonary resuscitation during real-life out-of-hospital cardiac arrest. Resuscitation 2017; 120:63-70. [PMID: 28903056 DOI: 10.1016/j.resuscitation.2017.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/27/2017] [Accepted: 09/09/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) can increase survival in out-of-hospital cardiac arrest (OHCA). However, little is known about bystander CPR quality in real-life OHCA. AIM To describe bystander CPR quality based on automated external defibrillator (AED) CPR process data during OHCA and compare it with the European Resuscitation Council 2010 and 2015 Guidelines. METHODS We included OHCA cases from the Capital Region, Denmark, (2012-2016) where a Zoll AED was used before ambulance arrival. For cases with at least one minute of continuous data, the initial 10min of CPR data were analysed for compression rate, depth, fraction and compressions delivered for each minute of CPR. Data are presented as median [25th;75th percentile]. RESULTS We included 136 cases. Bystander median compression rate was 101min-1 [94;113], compression depth was 4.8cm [3.9;5.8] and compressions per minute were 62 [48;73]. Of all cases, the median compression rate was 100-120min-1 in 42%, compression depth was 5-6cm in 26%, compression fraction≥60% in 51% and compressions delivered per minute exceeded 60 in 54%. In a minute-to-minute analysis, we found no evidence of deterioration in CPR quality over time. The median peri-shock pause was 27s [23;31] and the pre-shock pause was 19s [17;22]. CONCLUSIONS The median CPR performed by bystanders using AEDs with audio-feedback in OHCA was within guideline recommendations without deterioration over time. Compression depth had poorer quality compared with other parameters. To improve bystander CPR quality, focus should be on proper compression depth and minimizing pauses.
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2017; 20:3-24. [PMID: 32214897 PMCID: PMC7087749 DOI: 10.1007/s10049-017-0328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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Wang Y, Song J, Liu Y, Li Y, Liu Z. Mild Hypothermia Protects Pigs' Gastric Mucosa After Cardiopulmonary Resuscitation via Inhibiting Interleukin 6 (IL-6) Production. Med Sci Monit 2016; 22:3523-3528. [PMID: 27694796 PMCID: PMC5063424 DOI: 10.12659/msm.899688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to determine the effect of mild hypothermia therapy on gastric mucosa after cardiopulmonary resuscitation (CPR) and the underlying mechanism. Material/Methods Ventricular fibrillation was induced in pigs. After CPR, the surviving pigs were divided into mild hypothermia-treated and control groups. The changes in vital signs and hemodynamic parameters were monitored before cardiac arrest and at intervals of 0.5, 1, 2, 4, 6, 12, and 24 h after restoration of spontaneous circulation. Serum IL-6 was determined at the same time, and gastroscopy was performed. The pathologic changes were noted, and the expression of IL-6 was determined by hematoxylin and eosin (HE) staining and immunohistochemistry under light. Results The heart rate, mean arterial blood pressure, and cardiac output in both groups did not differ significantly. The gastric mucosa ulcer index evaluated by gastroscopy 2 h and 24 h after restoration of spontaneous circulation (ROSC) in the mild hypothermic group was lower than that the control group (P<0.05). The inflammatory pathologic score of gastric mucosa in the mild hypothermic group 6–24 h after ROSC was lower than that in the control group (P<0.05). Serum and gastric mucosa IL-6 expression 0.5–4 h and 6, 12, and 24 h after ROSC was lower in the mild hypothermic group than in the control group (P<0.05). Conclusions Mild hypothermia treatment protects gastric mucosa after ROSC via inhibiting IL-6 production and relieving the inflammatory reaction.
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Affiliation(s)
- Yan Wang
- Department of Digestion, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China (mainland)
| | - Jian Song
- Department of Gastroenterology and Hepatology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang, China (mainland)
| | - Yuhong Liu
- Department of Digestion, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China (mainland)
| | - Yaqiang Li
- Department of Digestion, Beijing Lu He Hospital Affiliated to Capital Medical University, Beijing, China (mainland)
| | - Zhengxin Liu
- Department of Digestion, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China (mainland)
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Oh JH. Letter to the Editor: Chest Compression Rate, Rescuer's Fatigue and Patient's Survival. J Korean Med Sci 2016; 31:1668-9. [PMID: 27550500 PMCID: PMC4999414 DOI: 10.3346/jkms.2016.31.10.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Je Hyeok Oh
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.
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20
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Rasmussen SE, Nebsbjerg MA, Krogh LQ, Bjørnshave K, Krogh K, Povlsen JA, Riddervold IS, Grøfte T, Kirkegaard H, Løfgren B. A novel protocol for dispatcher assisted CPR improves CPR quality and motivation among rescuers-A randomized controlled simulation study. Resuscitation 2016; 110:74-80. [PMID: 27658651 DOI: 10.1016/j.resuscitation.2016.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/14/2016] [Accepted: 09/09/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Emergency dispatchers use protocols to instruct bystanders in cardiopulmonary resuscitation (CPR). Studies changing one element in the dispatcher's protocol report improved CPR quality. Whether several changes interact is unknown and the effect of combining multiple changes previously reported to improve CPR quality into one protocol remains to be investigated. We hypothesize that a novel dispatch protocol, combining multiple beneficial elements improves CPR quality compared with a standard protocol. METHODS A novel dispatch protocol was designed including wording on chest compressions, using a metronome, regular encouragements and a 10-s rest each minute. In a simulated cardiac arrest scenario, laypersons were randomized to perform single-rescuer CPR guided with the novel or the standard protocol. PRIMARY OUTCOME a composite endpoint of time to first compression, hand position, compression depth and rate and hands-off time (maximum score: 22 points). Afterwards participants answered a questionnaire evaluating the dispatcher assistance. RESULTS The novel protocol (n=61) improved CPR quality score compared with the standard protocol (n=64) (mean (SD): 18.6 (1.4)) points vs. 17.5 (1.7) points, p<0.001. The novel protocol resulted in deeper chest compressions (mean (SD): 58 (12)mm vs. 52 (13)mm, p=0.02) and improved rate of correct hand position (61% vs. 36%, p=0.01) compared with the standard protocol. In both protocols hands-off time was short. The novel protocol improved motivation among rescuers compared with the standard protocol (p=0.002). CONCLUSIONS Participants guided with a standard dispatch protocol performed high quality CPR. A novel bundle of care protocol improved CPR quality score and motivation among rescuers.
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Affiliation(s)
- Stinne Eika Rasmussen
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Mette Amalie Nebsbjerg
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Lise Qvirin Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Katrine Bjørnshave
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Kristian Krogh
- Center for Health Sciences Education, Aarhus University, Palle Juul-Jensens Boulevard 82, Building B, 8200 Aarhus N, Denmark; Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jonas Agerlund Povlsen
- Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 9, 8200 Aarhus N, Denmark
| | - Ingunn Skogstad Riddervold
- Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 1st floor, 8200 Aarhus N, Denmark
| | - Thorbjørn Grøfte
- Department of Anaesthesiology and Intensive Care, Regional Hospital of Randers, Skovlyvej 1, 8930 Randers, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark; Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Internal Medicine, Regional Hospital of Randers, Skovlyvej 1, 8930 Randers, Denmark.
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An accurate method for real-time chest compression detection from the impedance signal. Resuscitation 2016; 105:22-8. [DOI: 10.1016/j.resuscitation.2016.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/02/2016] [Accepted: 04/25/2016] [Indexed: 11/22/2022]
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22
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Song KJ, Kim JB, Kim J, Kim C, Park SY, Lee CH, Jang YS, Cho GC, Cho Y, Chung SP, Hwang SO. Part 2. Adult basic life support: 2015 Korean Guidelines for Cardiopulmonary Resuscitation. Clin Exp Emerg Med 2016; 3:S10-S16. [PMID: 27752642 PMCID: PMC5052918 DOI: 10.15441/ceem.16.129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Keun Jeong Song
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Jinhee Kim
- Department of Anesthesiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chanwoong Kim
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sun Young Park
- Department of Nursing Science, Baekseok University, Cheonan, Korea
| | - Chang Hee Lee
- Department of Emergency Medical Service, Namseoul University, Cheonan, Korea
| | - Yong Soo Jang
- Department of Emergency Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Youngsuk Cho
- Department of Emergency Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Talikowska M, Tohira H, Bailey P, Finn J. Cardiopulmonary resuscitation quality: Widespread variation in data intervals used for analysis. Resuscitation 2016; 102:25-8. [DOI: 10.1016/j.resuscitation.2016.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/30/2015] [Accepted: 02/06/2016] [Indexed: 11/26/2022]
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Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, Gazmuri RJ, Travers AH, Rea T. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2016; 132:S414-35. [PMID: 26472993 DOI: 10.1161/cir.0000000000000259] [Citation(s) in RCA: 623] [Impact Index Per Article: 69.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Travers AH, Perkins GD, Berg RA, Castren M, Considine J, Escalante R, Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C. Part 3: Adult Basic Life Support and Automated External Defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2016; 132:S51-83. [PMID: 26472859 DOI: 10.1161/cir.0000000000000272] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review comprises the most extensive literature search and evidence evaluation to date on the most important international BLS interventions, diagnostics, and prognostic factors for cardiac arrest victims. It reemphasizes that the critical lifesaving steps of BLS are (1) prevention, (2) immediate recognition and activation of the emergency response system, (3) early high-quality CPR, and (4) rapid defibrillation for shockable rhythms. Highlights in prevention indicate the rational and judicious deployment of search-and-rescue operations in drowning victims and the importance of education on opioid-associated emergencies. Other 2015 highlights in recognition and activation include the critical role of dispatcher recognition and dispatch-assisted chest compressions, which has been demonstrated in multiple international jurisdictions with consistent improvements in cardiac arrest survival. Similar to the 2010 ILCOR BLS treatment recommendations, the importance of high quality was reemphasized across all measures of CPR quality: rate, depth, recoil, and minimal chest compression pauses, with a universal understanding that we all should be providing chest compressions to all victims of cardiac arrest. This review continued to focus on the interface of BLS sequencing and ensuring high-quality CPR with other important BLS interventions, such as ventilation and defibrillation. In addition, this consensus statement highlights the importance of EMS systems, which employ bundles of care focusing on providing high-quality chest compressions while extricating the patient from the scene to the next level of care. Highlights in defibrillation indicate the global importance of increasing the number of sites with public-access defibrillation programs. Whereas the 2010 ILCOR Consensus on Science provided important direction for the “what” in resuscitation (ie, what to do), the 2015 consensus has begun with the GRADE methodology to provide direction for the quality of resuscitation. We hope that resuscitation councils and other stakeholders will be able to translate this body of knowledge of international consensus statements to build their own effective resuscitation guidelines.
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26
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Affiliation(s)
- Rudolph W Koster
- From the Department of Cardiology, Academic Medical Center, Amsterdam
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27
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Monsieurs K, on behalf of the ERC Guidelines 2015 Writing Group, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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28
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2015; 18:748-769. [PMID: 32214896 PMCID: PMC7088113 DOI: 10.1007/s10049-015-0081-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015; 95:81-99. [PMID: 26477420 DOI: 10.1016/j.resuscitation.2015.07.015] [Citation(s) in RCA: 741] [Impact Index Per Article: 74.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 586] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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Perkins GD, Travers AH, Berg RA, Castren M, Considine J, Escalante R, Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C, Bierens JJ, Bourdon E, Brugger H, Buick JE, Charette ML, Chung SP, Couper K, Daya MR, Drennan IR, Gräsner JT, Idris AH, Lerner EB, Lockhat H, Løfgren B, McQueen C, Monsieurs KG, Mpotos N, Orkin AM, Quan L, Raffay V, Reynolds JC, Ristagno G, Scapigliati A, Vadeboncoeur TF, Wenzel V, Yeung J. Part 3: Adult basic life support and automated external defibrillation. Resuscitation 2015; 95:e43-69. [DOI: 10.1016/j.resuscitation.2015.07.041] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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. [PMID: 26247143 DOI: 10.1016/j.resuscitation.2015.07.036] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/10/2015] [Accepted: 07/25/2015] [Indexed: 11/25/2022]
Abstract
AIM To conduct a systematic review and meta-analysis to determine whether cardiopulmonary resuscitation (CPR) quality, as indicated by parameters such as chest compression depth, compression rate and compression fraction, is associated with patient survival from cardiac arrest. METHODS Five databases were searched (MEDLINE, Embase, CINAHL, Scopus and Cochrane) as well as the grey literature (MedNar). To satisfy inclusion criteria, studies had to document human cases of in- or out-of hospital cardiac arrest where CPR quality had been recorded using an automated device and linked to patient survival. Where indicated (I(2)<75%), meta-analysis was undertaken to examine the relationship between individual CPR quality parameters and either survival to hospital discharge (STHD) or return of spontaneous circulation (ROSC). RESULTS Database searching yielded 8,842 unique citations, resulting in the inclusion of 22 relevant articles. Thirteen were included in the meta-analysis. Chest compression depth was significantly associated with STHD (mean difference (MD) between survivors and non-survivors 2.59 mm, 95% CI: 0.71, 4.47); and with ROSC (MD 0.99 mm, 95% CI: 0.04, 1.93). Within the range of approximately 100-120 compressions per minute (cpm), compression rate was significantly associated with STHD; survivors demonstrated a lower mean compression rate than non-survivors (MD -1.17 cpm, 95% CI: -2.21, -0.14). Compression fraction could not be examined by meta-analysis due to high heterogeneity, however a higher fraction appeared to be associated with survival in cases with a shockable initial rhythm. CONCLUSIONS Chest compression depth and rate were associated with survival outcomes. More studies with consistent reporting of data are required for other quality parameters.
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Affiliation(s)
- Milena Talikowska
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia.
| | - Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia; St. John Ambulance, Western Australia, Belmont, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Fully automatic rhythm analysis during chest compression pauses. Resuscitation 2015; 89:25-30. [PMID: 25619441 DOI: 10.1016/j.resuscitation.2014.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/07/2014] [Accepted: 11/18/2014] [Indexed: 11/22/2022]
Abstract
AIM Chest compression artefacts impede a reliable rhythm analysis during cardiopulmonary resuscitation (CPR). These artefacts are not present during ventilations in 30:2 CPR. The aim of this study is to prove that a fully automatic method for rhythm analysis during ventilation pauses in 30:2 CPR is reliable an accurate. METHODS For this study 1414min of 30:2 CPR from 135 out-of-hospital cardiac arrest cases were analysed. The data contained 1942 pauses in compressions longer than 3.5s. An automatic pause detector identified the pauses using the transthoracic impedance, and a shock advice algorithm (SAA) diagnosed the rhythm during the detected pauses. The SAA analysed 3-s of the ECG during each pause for an accurate shock/no-shock decision. RESULTS The sensitivity and PPV of the pause detector were 93.5% and 97.3%, respectively. The sensitivity and specificity of the SAA in the detected pauses were 93.8% (90% low CI, 90.0%) and 95.9% (90% low CI, 94.7%), respectively. Using the method, shocks would have been advanced in 97% of occasions. For patients in nonshockable rhythms, rhythm reassessment pauses would be avoided in 95.2% (95% CI, 91.6-98.8) of occasions, thus increasing the overall chest compression fraction (CCF). CONCLUSION An automatic method could be used to safely analyse the rhythm during ventilation pauses. This would contribute to an early detection of refibrillation, and to increase CCF in patients with nonshockable rhythms.
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Murugiah K, Chen SI, Dharmarajan K, Nuti SV, Wayda B, Shojaee A, Ranasinghe I, Dreyer RP. Most important outcomes research papers on cardiac arrest and cardiopulmonary resuscitation. Circ Cardiovasc Qual Outcomes 2014; 7:335-45. [PMID: 24619323 DOI: 10.1161/circoutcomes.114.000957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Rhythm analysis during cardiopulmonary resuscitation: past, present, and future. BIOMED RESEARCH INTERNATIONAL 2014; 2014:386010. [PMID: 24527445 PMCID: PMC3910663 DOI: 10.1155/2014/386010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022]
Abstract
Survival from out-of-hospital cardiac arrest depends largely on two factors: early cardiopulmonary resuscitation (CPR) and early defibrillation. CPR must be interrupted for a reliable automated rhythm analysis because chest compressions induce artifacts in the ECG. Unfortunately, interrupting CPR adversely affects survival. In the last twenty years, research has been focused on designing methods for analysis of ECG during chest compressions. Most approaches are based either on adaptive filters to remove the CPR artifact or on robust algorithms which directly diagnose the corrupted ECG. In general, all the methods report low specificity values when tested on short ECG segments, but how to evaluate the real impact on CPR delivery of continuous rhythm analysis during CPR is still unknown. Recently, researchers have proposed a new methodology to measure this impact. Moreover, new strategies for fast rhythm analysis during ventilation pauses or high-specificity algorithms have been reported. Our objective is to present a thorough review of the field as the starting point for these late developments and to underline the open questions and future lines of research to be explored in the following years.
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