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Effectiveness of Smartwatch Guidance for High-Quality Infant Cardiopulmonary Resuscitation: A Simulation Study. Medicina (B Aires) 2021; 57:medicina57030193. [PMID: 33668789 PMCID: PMC7996349 DOI: 10.3390/medicina57030193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background and objectives: As in adults, the survival rates and neurological outcomes after infant Cardiopulmonary resuscitation (CPR) are closely related to the quality of resuscitation. This study aimed to demonstrate that using a smartwatch as a haptic feedback device increases the quality of infant CPR performed by medical professionals. Materials and methods: We designed a prospective, randomized, case-crossover simulation study. The participants (n = 36) were randomly allocated to two groups: control first group and smartwatch first group. Each CPR session consisted of 2 min of chest compressions (CCs) using the two-finger technique (TFT), 2 min of rest, and 2 min of CCs using the two-thumb encircling hands technique (TTHT). Results: The primary outcome was the variation in the “proportion of optimal chest compression duration” and “compression rate” between the smartwatch-assisted and non-smartwatch-assisted groups. The secondary outcome was the variation in the “compression depth” between two groups. The proportion of optimal CC duration was significantly higher in the smartwatch-assisted group than in the non-smartwatch-assisted group. The absolute difference from 220 was much smaller in the smartwatch-assisted group (218.02) than in the non-smartwatch-assisted group (226.59) (p-Value = 0.018). Conclusion: This study demonstrated the haptic feedback system using a smartwatch improves the quality of infant CPR by maintaining proper speed and depth regardless of the compression method used.
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Lee WH, Kim SH, Na JY, Lim YH, Cho SH, Cho SH, Park HK. Non-contact Sleep/Wake Monitoring Using Impulse-Radio Ultrawideband Radar in Neonates. Front Pediatr 2021; 9:782623. [PMID: 34993163 PMCID: PMC8724301 DOI: 10.3389/fped.2021.782623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background: The gold standard for sleep monitoring, polysomnography (PSG), is too obtrusive and limited for practical use with tiny infants or in neonatal intensive care unit (NICU) settings. The ability of impulse-radio ultrawideband (IR-UWB) radar, a non-contact sensing technology, to assess vital signs and fine movement asymmetry in neonates was recently demonstrated. The purpose of this study was to investigate the possibility of quantitatively distinguishing and measuring sleep/wake states in neonates using IR-UWB radar and to compare its accuracy with behavioral observation-based sleep/wake analyses using video recordings. Methods: One preterm and three term neonates in the NICU were enrolled, and voluntary movements and vital signs were measured by radar at ages ranging from 2 to 27 days. Data from a video camcorder, amplitude-integrated electroencephalography (aEEG), and actigraphy were simultaneously recorded for reference. Radar signals were processed using a sleep/wake decision algorithm integrated with breathing signals and movement features. Results: The average recording time for the analysis was 13.0 (7.0-20.5) h across neonates. Compared with video analyses, the sleep/wake decision algorithm for neonates correctly classified 72.2% of sleep epochs and 80.6% of wake epochs and achieved a final Cohen's kappa coefficient of 0.49 (0.41-0.59) and an overall accuracy of 75.2%. Conclusions: IR-UWB radar can provide considerable accuracy regarding sleep/wake decisions in neonates, and although current performance is not yet sufficient, this study demonstrated the feasibility of its possible use in the NICU for the first time. This unobtrusive, non-contact radar technology is a promising method for monitoring sleep/wake states with vital signs in neonates.
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Affiliation(s)
- Won Hyuk Lee
- Department of Electronics and Computer Engineering, Hanyang University, Seoul, South Korea
| | - Seung Hyun Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Jae Yoon Na
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Seok Hyun Cho
- Department of Otorhinolaryngology, Hanyang University College of Medicine, Seoul, South Korea
| | - Sung Ho Cho
- Department of Electronics and Computer Engineering, Hanyang University, Seoul, South Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
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Feasibility of non-contact cardiorespiratory monitoring using impulse-radio ultra-wideband radar in the neonatal intensive care unit. PLoS One 2020; 15:e0243939. [PMID: 33370375 PMCID: PMC7769476 DOI: 10.1371/journal.pone.0243939] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Current cardiorespiratory monitoring equipment can cause injuries and infections in neonates with fragile skin. Impulse-radio ultra-wideband (IR-UWB) radar was recently demonstrated to be an effective contactless vital sign monitor in adults. The purpose of this study was to assess heart rates (HRs) and respiratory rates (RRs) in the neonatal intensive care unit (NICU) using IR-UWB radar and to evaluate its accuracy and reliability compared to conventional electrocardiography (ECG)/impedance pneumography (IPG). Methods The HR and RR were recorded in 34 neonates between 3 and 72 days of age during minimal movement (51 measurements in total) using IR-UWB radar (HRRd, RRRd) and ECG/IPG (HRECG, RRIPG) simultaneously. The radar signals were processed in real time using algorithms for neonates. Radar and ECG/IPG measurements were compared using concordance correlation coefficients (CCCs) and Bland-Altman plots. Results From the 34 neonates, 12,530 HR samples and 3,504 RR samples were measured. Both the HR and RR measured using the two methods were highly concordant when the neonates had minimal movements (CCC = 0.95 between the RRRd and RRIPG, CCC = 0.97 between the HRRd and HRECG). In the Bland-Altman plot, the mean biases were 0.17 breaths/min (95% limit of agreement [LOA] -7.0–7.3) between the RRRd and RRIPG and -0.23 bpm (95% LOA -5.3–4.8) between the HRRd and HRECG. Moreover, the agreement for the HR and RR measurements between the two modalities was consistently high regardless of neonate weight. Conclusions A cardiorespiratory monitor using IR-UWB radar may provide accurate non-contact HR and RR estimates without wires and electrodes for neonates in the NICU.
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Use of a Virtual Reality Device for Basic Life Support Training: Prototype Testing and an Exploration of Users' Views and Experience. Simul Healthc 2020; 14:287-292. [PMID: 31490865 DOI: 10.1097/sih.0000000000000387] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Immediate initiation of cardiopulmonary resuscitation significantly increases the chances of survival after a cardiac arrest. Virtual reality devices allow the integration of features of real patients into training to facilitate interaction and feedback, thus improving performance. However, its use as a training tool remains underexplored. The aims of this study were to undertake initial testing of a virtual reality basic life support prototype and to explore users' views and experiences. METHODS We recruited 23 adult staff members working at a Central London University in England and exposed them to a 5-minute virtual reality experience. Each participant completed a prequestionnaire and postquestionnaire and took part in a focus group discussion. Quantitative data were descriptively analyzed, whereas qualitative data underwent thematic analysis. RESULTS Regardless of prior experience of using virtual reality and/or performing basic life support, most participants scored more than 90% for chest compressions and reported an increase in confidence and competence after the experience. Focus group discussions identified the following 4 key themes: experience and expectations; performance and feedback; interaction and immersion; and potential. CONCLUSIONS Our study suggests that virtual reality is an enjoyable method by which to teach basic life support. Although concerns over the accuracy of the tracking system and the small sample size weaken our conclusions regarding its ability to assess performance, our exploratory data are of value to educators, researchers, and policy makers. Future work needs to address our study limitations, consider how virtual reality fits into the broader context of training, and attend to accreditation and resource issues.
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Choi B, Kim T, Yoon SY, Yoo JS, Won HJ, Kim K, Kang EJ, Yoon H, Hwang SY, Shin TG, Sim MS, Cha WC. Effect of Watch-Type Haptic Metronome on the Quality of Cardiopulmonary Resuscitation: A Simulation Study. Healthc Inform Res 2019; 25:274-282. [PMID: 31777670 PMCID: PMC6859264 DOI: 10.4258/hir.2019.25.4.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/15/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives The aim of this study was to test the applicability of haptic feedback using a smartwatch to the delivery of cardiac compression (CC) by professional healthcare providers. Methods A prospective, randomized, controlled, case-crossover, standardized simulation study of 20 medical professionals was conducted. The participants were randomly assigned into haptic-first and non-haptic-first groups. The primary outcome was an adequate rate of 100–120/min of CC. The secondary outcome was a comparison of CC rate and adequate duration between the good and bad performance groups. Results The mean interval between CCs and the number of haptic and non-haptic feedback-assisted CCs with an adequate duration were insignificant. In the subgroup analysis, both the good and bad performance groups showed a significant difference in the mean CC interval between the haptic and non-haptic feedback-assisted CC groups—good: haptic feedback-assisted (0.57–0.06) vs. non-haptic feedback-assisted (0.54–0.03), p < 0.001; bad: haptic feedback-assisted (0.57–0.07) vs. non-haptic feedback-assisted (0.58–0.18), p = 0.005—and the adequate chest compression number showed significant differences— good: haptic feedback-assisted (1,597/75.1%) vs. non-haptic feedback-assisted (1,951/92.2%), p < 0.001; bad: haptic feedbackassisted (1,341/63.5%) vs. non-haptic feedback-assisted (523/25.4%), p < 0.001. Conclusions A smartwatch cardiopulmonary resuscitation feedback system could not improve rescuers' CC rate. According to our subgroup analysis, participants might be aided by the device to increase the percentage of adequate compressions after one minute.
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Affiliation(s)
- Boram Choi
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Young Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Sang Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Ho-Jeong Won
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea
| | - Eun Jin Kang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
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Afzalimoghaddam M, Karimialavijeh E, Zakipour G, Mirfazaelian H, Nejati A, Payandemehr P. Developing a Checklist for Cardiopulmonary Resuscitation (CPR) Quality Control in Emergency Department; a Qualitative Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2019; 7:e61. [PMID: 31875215 PMCID: PMC6905421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Monitoring the quality of cardiopulmonary resuscitation (CPR) could help in achieving favorable outcomes, decreasing mortality, and preventing post-CPR neurologic sequels. This study aimed to generate a user-friendly checklist for CPR quality control in emergency department (ED). METHOD A qualitative study was performed between January and December 2018. In the first step, two emergency medicine specialists searched currently available databases and extracted the factors related to CPR quality. Afterward, two sessions of focus group discussions were held. The participants included four emergency medicine specialists, two ED managers, one anesthesiologist, and one cardiologist. Subsequently, 20 medical specialists, consisting of 10 emergency medicine specialists, six anesthesiologists, and four cardiologists, were invited to a Delphi panel in order to rate the extracted items from the prior group discussions. RESULTS During the two rounds of focus group discussions, 38 items related to the quality of CPR were identified. A Delphi panel evaluated the items; 31 items with at least 75% agreement were selected. These 31 items were included in the final checklist and after a pilot study and adjustment of its content they were sorted in 10 categories as follows: 1. chest compression, 2. airway, 3. bag-mask ventilation, 4. cardiac monitoring, 5. defibrillation, 6. intravenous (IV) drug delivery, 7. Medications, 8. Advanced airway, 9. CPR sequence, and 10. Reversible causes. CONCLUSION Our study provides a checklist for monitoring the quality of CPR in ED, but it is still necessary to include other factors related to the ED environment on this checklist.
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Affiliation(s)
- Mohammad Afzalimoghaddam
- Emergency Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.,Prehospital and hospital emergency research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Karimialavijeh
- Emergency Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Prehospital and hospital emergency research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Zakipour
- Emergency Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.,Prehospital and hospital emergency research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Mirfazaelian
- Prehospital and hospital emergency research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Nejati
- Emergency Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.,Prehospital and hospital emergency research center, Tehran University of Medical Sciences, Tehran, Iran
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Effect of metronome guidance on infant cardiopulmonary resuscitation. Eur J Pediatr 2019; 178:795-801. [PMID: 30850868 DOI: 10.1007/s00431-019-03357-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/18/2019] [Accepted: 02/26/2019] [Indexed: 12/14/2022]
Abstract
This study was conducted to investigate the effect of metronome guidance on the performance of infant cardiopulmonary resuscitation (CPR). A total of 36 medical doctors conducted a 2-min single rescuer CPR with the two-finger technique (TFT) or two-thumb encircling hands technique (TT) on an infant manikin without metronome guidance (baseline test). After completing the baseline test, the participants were assigned to either a "guidance group" or "non-guidance group." The guidance group performed CPR with a high-pitched sound at 110 beats/min from a metronome (test 2), while the non-guidance group performed 2-min CPR without metronome guidance (test 1). Comparison between the results of tests 1 and 2 showed that the ratio of adequate chest compression rate was significantly different in both the TFT (73% [34-93] vs. 98% [95-99], P < 0.001) and the TT (53% [32-79] vs. 99% [98-100], P = 0.010). Other parameters including average depth and the ratio of adequate depth were not significantly different between tests 1 and 2 in both the TFT and TT.Conclusion: Metronome guidance improves the adequacy of chest compression rate during infant CPR without affecting chest compression depth in both the TFT and TT.Trial registration: Clinical Research Information Service, KCT0002735 What is Known: • The rate of chest compressions can be optimized by the use of metronome guidance in pediatric cardiopulmonary resuscitation (CPR). • An adverse effect of deteriorating chest compression depth was found while using a metronome guidance during adult CPR simulations. What is New: • The metronome guidance improved the adequacy of the chest compression rate during infant CPR without affecting other parameters including average depth and the ratio of adequate depth in both the two-finger chest compression technique and two-thumb encircling hand technique.
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