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Horning J, Griffith D, Slovis C, Brady W. Pre-Arrival Care of the Out-of-Hospital Cardiac Arrest Victim. Emerg Med Clin North Am 2023; 41:413-432. [PMID: 37391242 DOI: 10.1016/j.emc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Lay rescuers play a pivotal role in the recognition and initial management of out-of-hospital cardiac arrest. The provision of timely pre-arrival care by lay responders, including cardiopulmonary resuscitation and the use of automated external defibrillator before emergency medical service arrival, is important link in the chain of survival and has been shown to improve outcomes from cardiac arrest. Although physicians are not directly involved in bystander response to cardiac arrest, they play a key role in emphasizing the importance of bystander interventions.
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Affiliation(s)
- Jillian Horning
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Daniel Griffith
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Corey Slovis
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA; Department of Emergency Medicine, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - William Brady
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA.
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2
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Otero-Agra M, Jorge-Soto C, Cosido-Cobos ÓJ, Blanco-Prieto J, Alfaya-Fernández C, García-Ordóñez E, Barcala-Furelos R. Can a voice assistant help bystanders save lives? A feasibility pilot study chatbot in beta version to assist OHCA bystanders. Am J Emerg Med 2022; 61:169-174. [PMID: 36155252 DOI: 10.1016/j.ajem.2022.09.013] [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: 05/25/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Evaluating the usefulness of a chat bot as an assistant during CPR care by laypersons. METHODS Twenty-one university graduates and university students naive in basic life support participated in this quasi-experimental simulation pilot trial. A version beta chatbot was designed to guide potential bystanders who need help in caring for cardiac arrest victims. Through a Question-Answering (Q&A) flowchart, the chatbot uses Voice Recognition Techniques to transform the user's audio into text. After the transformation, it generates the answer to provide the necessary help through machine and deep learning algorithms. A simulation test with a Laerdal Little Anne manikin was performed. Participants initiated the chatbot, which guided them through the recognition of a cardiac arrest event. After recognizing the cardiac arrest, the chatbot indicated the start of chest compressions for 2 min. Evaluation of the cardiac arrest recognition sequence was done via a checklist and the quality of CPR was collected with the Laerdal Instructor App. RESULTS 91% of participants were able to perform the entire sequence correctly. All participants checked the safety of the scene and made sure to call 112. 62% place their hands on the correct compression point. A media time of 158 s (IQR: 146-189) was needed for the whole process. 33% of participants achieved high-quality CPR with a median of 60% in QCPR (IQR: 9-86). Compression depth had a median of 42 mm (IQR: 33-53) and compression rate had a median of 100 compressions/min (IQR: 97-100). CONCLUSION The use of a voice assistant could be useful for people with no previous training to perform de out-of-hospital cardiac arrest recognition sequence. Chatbot was able to guide all participants to call 112 and to perform continuous chest compressions. The first version of the chatbot for potential bystanders naive in basic life support needs to be further developed to reduce response times and be more effective in giving feedback on chest compressions.
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Affiliation(s)
- Martín Otero-Agra
- Pontevedra School of Nursing, University of Vigo, Joaquín Costa, 41, 36004 Pontevedra, Spain; REMOSS Research Group, Faculty of Physical Activity and Educational Science, University of Vigo, Campus a Xunqueira, s/n, 36005 Pontevedra. Spain
| | - Cristina Jorge-Soto
- SICRUS Research Group, Santiago Health Research Institute. Choupana 15706, Santiago de Compostela, Spain; CLINURSID Research Group, Faculty of Nursing of Santiago, University of Santiago de Compostela, Praza do Obradoiro, 0, 15705, Spain.
| | | | | | - Cristian Alfaya-Fernández
- REMOSS Research Group, Faculty of Physical Activity and Educational Science, University of Vigo, Campus a Xunqueira, s/n, 36005 Pontevedra. Spain
| | - Enrique García-Ordóñez
- REMOSS Research Group, Faculty of Physical Activity and Educational Science, University of Vigo, Campus a Xunqueira, s/n, 36005 Pontevedra. Spain
| | - Roberto Barcala-Furelos
- REMOSS Research Group, Faculty of Physical Activity and Educational Science, University of Vigo, Campus a Xunqueira, s/n, 36005 Pontevedra. Spain; CLINURSID Research Group, Faculty of Nursing of Santiago, University of Santiago de Compostela, Praza do Obradoiro, 0, 15705, Spain
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3
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Bielski K, Smereka J, Chmielewski J, Pruc M, Chirico F, Gasecka A, Litvinova N, Jaguszewski MJ, Nowak-Starz G, Rafique Z, Peacock FW, Szarpak L. Meta-analysis of chest compression-only versus conventional cardiopulmonary resuscitation by bystanders for adult with out-of-hospital cardiac arrest. Cardiol J 2021; 30:606-613. [PMID: 34622436 PMCID: PMC10508072 DOI: 10.5603/cj.a2021.0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND According to the guidelines of cardiopulmonary resuscitation (CPR) conducted by bystanders, two methods of CPR are feasible: standard CPR (sCPR) with mouth-to-mouth ventilations and continuous chest compression-only CPR (CCC) without rescue breathing. The goal herein, was to evaluate the effect of sCPR (30:2) and CCC on resuscitation outcomes in patients with out-of-hospital cardiac arrest (OHCA) patients. METHODS This study was a systematic review and meta-analysis. Using standardized criteria, Pub- Med, Web of Science, Scopus, EMBASE and Cochrane Collaboration were searched for trials assessing the effect of sCPR vs. CCC on resuscitation outcomes after adult OHCA. Random-effects model meta-analysis was applied to calculate the mean deviation (MD), odds ratio (OR) and 95% confidence interval (CI). RESULTS Overall, 3 randomized controlled trials and 12 non-randomized trials met the inclusion criteria. Survival to hospital discharge with sCPR was 10.2% compared to 9.3% in the CCC group (OR = 1.04; 95% CI: 0.93-1.16; p = 0.46). Survival to hospital discharge with good neurological outcome measured with the cerebral performance category (CPC 1 or 2) was 6.5% for sCPR vs. 5.8% for CCC (OR = 1.00; 95% CI: 0.84-1.20; p = 0.98). Prehospital return of spontaneous circulation (ROSC) in sCPR and CCC groups was 15.9% and 14.8%, respectively (OR = 1.13; 95% CI: 0.91-1.39; p = 0.26). Survival to hospital admission with ROSC occurred in 29.5% of the sCPR group compared to 28.4% in CCC group (OR = 1.20; 95% CI: 0.89-1.63; p = 0.24). CONCLUSIONS This systematic review and meta-analysis concluded that there were no significant differences in the resuscitation outcomes between the use of standard cardiopulmonary resuscitation and chest compression only.
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Affiliation(s)
- Karol Bielski
- Institute of Outcomes Research, Polonia Academy, Czestochowa, Poland
- Polish Society of Disaster Medicine, Warsaw, Poland
| | - Jacek Smereka
- Polish Society of Disaster Medicine, Warsaw, Poland
- Department of Emergency Medical Service, Medical University of Wroclaw, Poland
| | | | - Michal Pruc
- Polish Society of Disaster Medicine, Warsaw, Poland
- Institute of Outcomes Research, Polonia Academy, Czestochowa, Poland
| | - Francesco Chirico
- Postgraduate School of Occupational Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
- Health Service Department, State Police, Ministry of Interior, Milan, Italy
| | - Aleksandra Gasecka
- Laboratory of Experimental Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, the Netherlands
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Nataliia Litvinova
- European Medical School, International European University, Kiev, Ukraine
| | | | - Grazyna Nowak-Starz
- Collegium Medicum Institute of Health Sciences, Kochanowski University, Kielce, Poland
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, TX, United States
| | - Frank W Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, TX, United States
| | - Lukasz Szarpak
- Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.
- Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland.
- Polish Society of Disaster Medicine, Warsaw, Poland.
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4
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Die Ausbildung von Lehrerinnen und Lehrern als Multiplikatoren für den Wiederbelebungsunterricht an Schulen. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00870-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Zusammenfassung
Zielsetzung
Die Einführung des Wiederbelebungsunterrichts an Schulen soll die Reanimationsbereitschaft in der Gesellschaft und das Überleben von Menschen mit einem außerklinischen Herz-Kreislauf-Stillstand nachhaltig verbessern. Ziel der vorliegenden Untersuchung war es zu prüfen, wie Lehrkräfte als qualifizierte Multiplikatoren den Wiederbelebungsunterricht in ihren Schulen eigenständig durchführen.
Methodik
Die Uniklinik Köln qualifizierte in Kooperation mit dem Deutschen Rat für Wiederbelebung e. V. in einem speziell entwickelten Kurs Lehrkräfte von weiterführenden Schulen. Von Juli bis November 2019 erfolgte die Evaluation dieses Lehrermultiplikationskonzepts mittels einer webbasierten Umfrage.
Ergebnisse
An der Befragung nahmen 23 von 26 Schulen teil (88 %). Insgesamt haben 96 % (n = 22) der an der Befragung teilnehmenden Schulen den Wiederbelebungsunterricht eingeführt. Es wurden 229 Lehrkräfte ausgebildet, die in dem 2‑jährigen Beobachtungszeitraum 8612 Schüler trainierten. Im Mittel trainierte eine qualifizierte Lehrkraft in ihrer Schule 38 Schüler in Wiederbelebung. Die Multiplikationsfaktoren (Anzahl der trainierten Schülerinnen und Schüler pro Lehrkraft) waren schulindividuell unterschiedlich (Minimum/Maximum: 10/1747). Die schulintern projektverantwortlichen Lehrkräfte gaben an, sich sehr sicher in der eigenständigen Durchführung des Wiederbelebungsunterrichts zu fühlen.
Zusammenfassung
Speziell qualifizierte Lehrkräfte führen den Wiederbelebungsunterricht an ihren Schulen zuverlässig ein. Um noch mehr Schüler mit dem Wiederbelebungstraining zu erreichen, müssen die Multiplikationsfaktoren durch gezielte Unterstützungsangebote weiter erhöht werden.
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Al-Jeabory M, Safiejko K, Bialka S, Pruc M, Gasecka A, Szarpak L. Impact of COVID-19 on bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest: Is it as bad as we think? Cardiol J 2020; 27. [PMID: 33346369 PMCID: PMC8079114 DOI: 10.5603/cj.2020.a0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Mahdi Al-Jeabory
- Department of Emergency Medicine, Medical University of Warsaw, Poland
| | - Kamil Safiejko
- Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
| | - Szymon Bialka
- Department of Anesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Michal Pruc
- Polish Society of Disaster Medicine, Warsaw, Poland
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland,Laboratory of Experimental Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lukasz Szarpak
- Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland,Polish Society of Disaster Medicine, Warsaw, Poland,Maria Sklodowska-Curie Medical Academy in Warsaw, Poland
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6
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Impact of COVID-19 on bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest: Is it as bad as we think? Cardiol J 2020; 27:884-885. [PMID: 33346369 DOI: 10.5603/cj.a2020.0179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/25/2022] Open
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Katipoglu B, Madziala MA, Evrin T, Gawlowski P, Szarpak A, Dabrowska A, Bialka S, Ladny JR, Szarpak L, Konert A, Smereka J. How should we teach cardiopulmonary resuscitation? Randomized multi-center study. Cardiol J 2019; 28:439-445. [PMID: 31565794 DOI: 10.5603/cj.a2019.0092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A 2017 update of the resuscitation guideline indicated the use of cardiopulmonary resuscitation (CPR) feedback devices as a resuscitation teaching method. The aim of the study was to compare the influence of two techniques of CPR teaching on the quality of resuscitation performed by medical students. METHODS The study was designed as a prospective, randomized, simulation study and involved 115 first year students of medicine. The participants underwent a basic life support (BLS) course based on the American Heart Association guidelines, with the first group (experimental group) performing chest compressions to observe, in real-time, chest compression parameters indicated by software included in the simulator, and the second group (control group) performing compressions without this possibility. After a 10-minute resuscitation, the participants had a 30-minute break and then a 2-minute cycle of CPR. One month after the training, study participants performed CPR, without the possibility of observing real-time measurements regarding quality of chest compression. RESULTS One month after the training, depth of chest compressions in the experimental and control group was 50 mm (IQR 46-54) vs. 39 mm (IQR 35-42; p = 0.001), compression rate 116 CPM (IQR 102-125) vs. 124 CPM (IQR 116-134; p = 0.034), chest relaxation 86% (IQR 68-89) vs. 74% (IQR 47-80; p = 0.031) respectively. CONCLUSIONS Observing real-time chest compression quality parameters during BLS training may improve the quality of chest compression one month after the training including correct hand positioning, compressions depth and rate compliance.
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Affiliation(s)
- Burak Katipoglu
- Department of Emergency Medicine, Ufuk University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey., Turkey
| | | | - Togay Evrin
- Department of Emergency Medicine, Ufuk University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey., Turkey
| | - Pawel Gawlowski
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | | | - Agata Dabrowska
- Department of Rescue Medical Service, Poznan University of Medical Sciences, Poznan
| | - Szymon Bialka
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Jerzy Robert Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Lukasz Szarpak
- Medical Simulation Center, Lazarski University, Swieradowska 43 Str, 02-662 Warsaw, Poland
| | | | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
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8
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Nadolny K, Bujak K, Kucap M, Trzeciak P, Hudzik B, Borowicz A, Gąsior M. The Silesian Registry of Out-of-Hospital Cardiac Arrest: Study design and results of a three-month pilot study. Cardiol J 2018; 27:566-574. [PMID: 30444257 DOI: 10.5603/cj.a2018.0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/08/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite the introduction of the concept known as "Chain of Survival" has significantly increased survival rates in patients with out-of-hospital cardiac arrest (OHCA), short-term mortality in this group of patients is still very high. Epidemiological data on OHCA in Poland are limited. The aim of this study was to create a prospective registry on OHCA covering a population of 2.7 million inhabitants of Upper Silesia in Poland. Presented herein is the study design and results of a 3-month pilot study. METHODS The Silesian Registry of Out-of-Hospital Cardiac Arrest (SIL-OHCA) is a prospective, population-based registry of OHCA, of minimum duration which was planned for 12 months; from January 1st, 2018 to December 31st, 2018. The first 3 months of the study constituted the pilot phase. The inclusion criterion is the occurrence of OHCA in the course of activity of the Voivodeship Rescue Service in Katowice, Poland. RESULTS During the 3-month pilot phase of the study there were 390 cases of OHCA in which cardiopulmonary resuscitation was undertaken. Estimated frequency of OHCA in the population analyzed was 57 per 100,000 population per year. Shockable rhythm was present in 25.8% of cases. Return of spontaneous circulation was achieved in 35.1% of the whole cohort. 28.7% of patients were admitted to the hospital, including 2.8% of patients, who were admitted during an ongoing cardiopulmonary resuscitation. CONCLUSIONS Prehospital survival of patients with OHCA in Poland is still unsatisfactory. It is believed that data collected in SIL-OHCA registry will allow identification factors, which require improvement in order to reduce short- and long-term mortality of patients with OHCA.
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Affiliation(s)
- Klaudiusz Nadolny
- Voivodeship Rescue Service, Katowice, Poland.,Department of Emergency Medicine, Medical University of Białystok, Poland
| | - Kamil Bujak
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland.
| | - Michał Kucap
- Voivodeship Rescue Service, Katowice, Poland.,Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health, Medical University of Gdańsk, Poland
| | - Przemysław Trzeciak
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Bartosz Hudzik
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland.,Department of Nutrition-Related Disease Prevention, School of Public Health in Bytom, Medical University of Silesia in Katowice, Poland
| | | | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
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Smereka J, Iskrzycki Ł, Makomaska-Szaroszyk E, Bielski K, Frass M, Robak O, Ruetzler K, Czekajło M, Rodríguez-Núnez A, López-Herce J, Szarpak Ł. The effect of chest compression frequency on the quality of resuscitation by lifeguards. A prospective randomized crossover multicenter simulation trial. Cardiol J 2018; 26:769-776. [PMID: 30338845 DOI: 10.5603/cj.a2018.0121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/16/2018] [Accepted: 10/12/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The ability to perform high-quality cardiopulmonary resuscitation is one of the basic skills for lifeguards. The aim of the study was to assess the influence of chest compression frequency on the quality of the parameters of chest compressions performed by lifeguards. METHODS This prospective observational, randomized, crossover simulation study was performed with 40 lifeguards working in Warsaw, Wroclaw, and Poznan, Poland. The subjects then participated in a target study, in which they were asked to perform 2-min cycles of metronome-guided chest compressions at different rates: 80, 90, 100, 110, 120, 130, 140, and 150 compressions per minute (CPM). RESULTS The study involved 40 lifeguards. Optimal chest compression score calculated by manikin software was achieved for 110-120 CPM. Chest compression depth achieved 53 (interquartile range [IQR] 52-54) mm, 56 (IQR 54-57) mm, 52.5 (IQR 50-54) mm, 53 (IQR 52-53) mm, 50 (IQR 49-51) mm, 47 (IQR 44-51) mm, 41 (IQR 40-42) mm, 38 (IQR 38-43) mm for 80, 90, 100, 110, 120, 130, 140 and 150 CPM, respectively. The percentage of chest compressions with the correct depth was lower for rates exceeding 120 CPM. CONCLUSIONS The rate of 100-120 CPM, as recommended by international guidelines, is the optimal chest compression rate for cardiopulmonary resuscitation performed by lifeguards. A rate above 120 CPM was associated with a dramatic decrease in chest compression depth and overall chest compression quality. The role of full chest recoil should be emphasized in basic life support training.
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Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland., Wroclaw, Poland
| | - Łukasz Iskrzycki
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland., Wroclaw, Poland
| | | | | | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesia, Cleveland Clinic, Cleveland, OH, USA., Cleveland, United States
| | - Michael Czekajło
- Hounter Holmes McGuire Center for Simulation and Healthcare, Virginia Commonwealth University, Richmond, VA, USA, Richmond, United States
| | - Antonio Rodríguez-Núnez
- Paediatric Emergency and Critical Care Division, Paediatric Area Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain., Santiago de Compostela, Spain
| | - Jesús López-Herce
- Paediatric Intensive Care Department, Hospital General Universitario Gregorio Marannón, Medical School, Complutense University of Madrid, Madrid, Spain., Madrid, Spain
| | - Łukasz Szarpak
- Lazarski University, Warsaw, Poland. .,Hounter Holmes McGuire Center for Simulation and Healthcare, Virginia Commonwealth University, Richmond, VA, USA, Richmond, United States.
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