Abstract 240: Teaching Basic Life Support: Controlled Study with a 2-Stage Versus the Standard 4-Stage Approach

The first description of modern cardiopulmonary resuscitation (CPR) included the instruction to compress the chest “about 60 times per minute”1; however, the optimal compression rate was unknown. Franz Koenig is credited with describing the original technique for external cardiac massage, which included a compression rate of 30 to 40 per minute.2 But in the first published description of external cardiac massage in 1892, Friedrich Maass documented a better clinical response with a rate of 120 per minute.2 To this day, the optimal compression rate is the subject of controversy. Animal data indicate that cardiac output increases with compression rates up to as high as 150 per minute.3 In a canine model of prolonged cardiac arrest, compression rates of 120 per minute compared with 60 per minute increased mean aortic (systolic and diastolic) and coronary perfusion pressures, and 24-hour survival (61% versus 15%, P =0.03).4 In a study of 9 patients undergoing CPR, a compression rate of 120 per minute generated higher aortic peak pressures and coronary perfusion pressures compared with a compression rate of 60 per minute (the rate recommended by the 1980 American Heart Association [AHA] guidelines). This evidence is supported by another study of 23 patients in cardiac arrest in which compressions at 120 per minute resulted in significantly higher end-tidal carbon dioxide values compared with compressions at 80 per minute.5 Article see p 3004 The first large, prospective, observational study of the influence of chest compression rate on patient survival was published in this journal in 2005.6 The number of delivered chest compressions was recorded by trained observers during in-hospital resuscitation attempts. A higher chest compression rate was associated with a higher rate of return of spontaneous circulation (ROSC). The mean chest compression rate for initial survivors was 90 …

We evaluated the decrease in chest compression depth during continuous one-handed chest compression (OHCC) in an in-hospital paediatric arrest setting, and whether switching hands could delay the decrease in chest compression depth. In total, 30 healthcare providers were randomised into groups A and B. Group A performed test 1 (chest compressors alternated hands every 30 s in 2 min of OHCC), followed by test 2 (chest compressors used one hand for 2 min without switching to the other hand) and group B, vice versa. Participants performed 2 min continuous OHCC on a paediatric manikin on a bed. Mean compression depth (MCD) and mean compression rate (MCR) were analysed at 30 s intervals. The MCDs in 30 s intervals changed significantly with time passed in tests 1 and 2 (0-30 s: 43.4 ± 7.4 vs 42.8 ± 7.6 mm, 30-60 s: 42.8 ± 8.7 vs 40.3 ± 8.8 mm, 60-90 s: 40.5 ± 8.9 vs 38.2 ± 9.6 mm, 90-120 s: 40.2 ± 10.2 vs 36.9 ± 9.7 mm; P < 0.01). However, with the exception of the first 30 s interval, MCD in test 1 showed significantly higher values than in test 2 (P < 0.05). The MCRs in 30 s intervals did not change significantly with time passed in all tests and were not different between the two tests. All hand-off times measured during switching hands in test 1 were less than 1 s. Chest compression depth decreased significantly when continuous OHCC was performed without switching hands. Alternating hands every 30 s can delay the decrease in MCD and maintain deeper MCD for longer.

Background:In the clinical setting, the dispersed practitioners’ attention often leads to decreased competence in their performance. We aimed to investigate the effect of distracted practitioners on the quality of chest compression during cardiopulmonary resuscitation.Methods:A randomized controlled crossover simulation study was conducted. Participants were recruited from among doctors, nurses, and paramedics working in a university tertiary hospital. The paced auditory serial addition test (PASAT) was used as a tool for distracting participants. In the crossover design, each participant played 2 scenarios with a 20-minute time gap, by a random order; 2-minute continuous chest compressions with and without PASAT being conducted. The primary outcome was the percentage of compression with an adequate compression rate. Secondary outcomes were the percentage of compression with adequate depth, the percentage of compression with full chest wall recoil, mean compression rate (per minute), mean compression depth, and subjective difficulty of chest compression.Results:Forty-four participants were enrolled, and all of them completed the study. It was found that the percentage of compression with an adequate compression rate was lower when the PASAT was conducted. Although there was no difference in the percentage of compression with adequate depth (P = .88), the percentage of compression with complete chest recoil was lower when PASAT was conducted. In addition, while the mean compression rate was higher when PASAT was conducted, the mean compression depth was not significantly different (P = .65). The subjective difficulty was not different (P = .69).Conclusions:Health care providers who are distracted have a negative effect on the quality of chest compression, in terms of its rate and chest wall recoil.Trial registration:www.ClinicalTrials.gov, NCT03124290.

Introduction:When cardiac arrest occurs in a confined space, such as in an aircraft or ambulance, kneeling by the patient’s side may be difficult. Straddle chest compression is an alternative technique that can be used in a confined space. This study was performed to compare the quality of chest compressions in straddle versus conventional CPR on a manikin model.Methods:The participants were randomized into two groups using the sequential numbered, opaque, sealed envelope method chosen through block-of-four randomization: straddle and conventional chest compression technique. Each participant performed a maximum of 4 minutes of hands-only chest compressions, and quality parameters (compression rate and depth) were recorded from the defibrillator's monitor.Results:124 participants with mean age of 26.67 ± 6.90 years (27.58% male) were studied. There was no difference in the mean compression rate between the conventional and straddle chest compression techniques (126.18 ± 17.11 and 127.01 ± 21.01 compressions/min, respectively; p = 0.811) or their mean compression depth (43.8 ± 9.60 and 43.4 ± 9.10 mm, respectively; p = 0.830). The participants’ comfort and fatigue were assessed through changes in their vital signs. In both methods, statistically significant differences were observed in vital signs before and after performing chest compression, but the differences were not clinically significant. In addition, there was no difference between the 2 groups in this regard.Conclusion:The quality of CPR using the straddle chest compression was as good as conventional chest compression technique. No significant differences were found in the quality of chest compressions or the participants’ comfort and fatigue levels.

Training Basic Life Support saves lives. However, current BLS training approaches are time-consuming and costly. Alternative cost-efficient and effective training methods are highly needed. The present study evaluated whether a video-feedback supported peer-guided Basic Life Support training approach achieves similar practical performance as a standard instructor-guided training in laypersons. In a randomized controlled non-inferiority trial, 288 first-year medical students were randomized to two study arms with different Basic Life Support training methods: 1) Standard Instructor Feedback (SIF) or 2) a Peer Video Feedback (PVF). Outcome parameters were objective data for Basic Life Support performance (compression depth and rate) from a resuscitation manikin with recording software as well as overall Basic Life Support performance and subjective confidence. Non-inferiority margins (Δ) for these outcome parameters and sample size calculation were based on previous studies with Standard Instructor Feedback. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority. Results confirmed non-inferiority of Peer Video Feedback to Standard Instructor Feedback for compression depth (proportion difference PVF-SIF = 2.9%; 95% CI: -8.2% to 14.1%; Δ = -19%), overall Basic Life Support performance (proportion difference PVF-SIF = 6.7%; 95% CI: 0.0% to 14.3%; Δ = -27%) and subjective confidence for CPR performance (proportion difference PVF-SIF = -0.01; 95% CI: -0.18-0.17; Δ = -0.5) and emergency situations (proportion difference PVF-SIF = -0.02; 95% CI: -0.21-0.18; Δ = -0.5). Results for compression rate were inconclusive. Peer Video Feedback achieves comparable results as standard instructor-based training methods. It is an easy-to-apply and cost-efficient alternative to standard Basic Life Support training methods. To improve performance with respect to compression rate, additional implementation of a metronome is recommended.

Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins

BackgroundOut-of-hospital cardiac arrest (OHCA) presents significant challenges with low survival rates, emphasizing the need for effective bystander CPR training. In Basic Life Support (BLS) training, the role of instructors is pivotal as they assess and correct learners’ cardiopulmonary resuscitation (CPR) techniques to ensure proficiency in life-saving skills. This study evaluates the concordance between CPR quality assessments by Basic Life Support (BLS) instructors and those determined through Quantitative CPR (QCPR) devices, utilizing data from BLS courses conducted at National Cheng Kung University Hospital from October 2017 to April 2018.MethodsThe study analyzed existing data from BLS courses, comparing CPR quality assessments made by instructors with those recorded by QCPR devices. Key metrics such as chest compression speed, depth, and recoil were examined to identify the degree of consistency between human and automated evaluations.ResultsIn this study, CPR performance was analyzed using QCPR devices and BLS instructors across metrics like speed, depth, and recoil. Employing the Cohen kappa statistic revealed moderate to low interrater reliability, the kappa value is 0.65 (95% C.I. 0.65–0.65) for depth, 0.56 (95% C.I. 0.33–0.79) for speed, and 0.50 (95% C.I.0.28–0.71) for recoil. Correlation analysis visualized in a heatmap indicated a higher consistency in depth evaluations (correlation coefficient = 0.7) compared to speed and recoil, suggesting a need for improved alignment in CPR training assessments.ConclusionsThe study underscores the importance of refining CPR training methods and adopting advanced technological aids to enhance the reliability of CPR skill assessments. By improving the accuracy of these evaluations, the training can be better tailored to increase the effectiveness of life-saving interventions, potentially boosting survival rates in out-of-hospital cardiac arrest scenarios.

Background: In basic life support, chest compressions are a very important and basic skill. Acquiring the ability to perform chest compressions is affected by individual characteristics such as physique and physical strength, although all persons can learn to Perform Cardiopulmonary Resuscitation (CPR), including chest compressions. The aim of this study was to examine differences in physique between males and females and Basic Life Support (BLS) skill using a portable manikin with automated corrective feedback.Methods: Participants were 120 fourth-year preclinical dental school students (87 males, 33 females). For skill assessment, students performed chest compressions and single rescuer CPR using a Laerdal Resusci Anne Skill Reporter TM manikin for 2 minutes each before and after CPR. Outcome measures were (1) compression depth (mm), (2) compression rate (number of compressions per minute), (3) compression release depth (recoil, mm), and (4) hand position before and after the BLS course.Results: After the BLS course, compression depth and rate improved significantly. Both before and after the BLS course, male students performed deeper chest compressions than female students. In females, the duration of acceptable chest compressions was significantly shorter than in males.Conclusion: CPR performance was significantly different between males and females, probably due to differences in physique. Therefore, it is necessary for individualized instruction adapted to the learner’s characteristics.

IntroductionMedical and physician assistant (PA) students are often required to have Basic Life Support (BLS) education prior to engaging in patient care. Given the potential role of students in resuscitations, it is imperative to ensure that current BLS training prepares students to provide effective cardiopulmonary resuscitation (CPR). The objective of this study was to assess whether current BLS training produces student providers who can deliver BLS in an American Heart Association (AHA) guideline-adherent manner.MethodsStudents at a US medical school were recruited by convenience sampling. BLS performance immediately following a standard AHA BLS training course was evaluated during a two-minute CPR cycle using manikins. We also collected information on demographics, previous BLS training attendance, perceived comfort in providing CPR, and prior experiences in healthcare and providing or observing CPR.ResultsAmong 80 participants, we found that compression rate, depth, and inter-compression recoil were AHA guideline-adherent for 90.0%, 68.8%, and 79.3% of total compression time, respectively. Mean hands-off time was also within AHA guidelines. Mean number of unsuccessful ventilations per cycle was 2.2. Additionally, 44.3% of ventilations delivered were of adequate tidal volume, 12.2% were excessive, and 41.0% were inadequate. Past BLS course attendance, prior healthcare certification, and previous provision of real-life CPR were associated with improved performance.ConclusionFollowing BLS training, medical and PA students met a majority of AHA compressions guidelines, but not ventilations guidelines, for over 70% of CPR cycles. Maintaining compression depth and providing appropriate ventilation volumes represent areas of improvement. Conducting regular practice and involving students in real-life CPR may improve performance.

BackgroundSurvival of in-hospital-cardiac-arrests is lower when they occur at night and at weekends than when they occur during the day. Despite numerous studies, there is little evidence regarding the cardiopulmonary resuscitation quality at night and the influence of a feedback device depending on time of day. The present study investigates the differences between chest compressions at night and during the day, with and without the use of a feedback device.MethodsThe study was approved by the local Ethics Committee and registered in the German Clinical Trials Register on 22nd of February 2022 (DRKS00027309) prior to inclusion of the first participant. 158 medical professionals were randomized into one of two groups: “no feedback” and “feedback”-group. In both groups, participants carried out three two-minute intervals of cardiopulmonary resuscitation on a manikin at day and at night. Members of the “feedback”-group received guidance by a feedback device. Primary endpoint was the mean compression depth at two time-intervals at the beginning (t1 = 30–60 s) and the end (t2 = 480–540 s) of the experience at night. Secondary endpoints included mean compression depth, adequate compression depth (%), compression rate and effective compressions (%).ResultsAt night, mean compression depth was significantly higher in the “feedback”-group at t1 (47.7 ± 7.9 mm, 95% CI [45.6–49.8] vs 42.9 ± 11.0 mm, 95% CI [40.8–45.0]) and t2 (46.2 ± 7.9 mm, 95% CI [44.0–48.4] vs 39.6 ± 11.6 mm, 95% CI [37.3–41.8]). There was no significant difference in mean compression depth between day and night in the “no feedback”-group (41.4 ± 10.8 mm, 95% CI [39.3–43.5] vs 42.2 ± 10.8 mm, 95% CI [40.1–44.3]) nor in the “feedback-group” (47.4 ± 7.6 mm, 95% CI [45.3–49.4] vs 47.4 ± 7.5 mm; 95% CI [45.4–49.5]).ConclusionThe use of a real-time audiovisual feedback significantly improved compression depth during the day and night in a manikin-based simulation study with medical professionals.

Aim: It is important for teachers to have sufficient knowledgeabout basic life support (BLS) to reduce mortality and morbidity rates inlife-threatening events at schools. This study aimed to determine teachers’knowledge levels about BLSin XXXXX .Methods: 1,365 teachers in the city of XXXXX constituted its sample. Datawas collected using aquestionnaire with 35 questions about the teachers’ demographic information, attitudes towardsBLS and knowledge about up-to-date BLS practices (According to AHA 2015guidelines). Their knowledge levels were evaluated on an 18-point scale.Results: The data of 1.365 teachers who completely filled out thequestionnaire were analyzed. The teachers’ mean score on the BLS questionnairewas 7.93±2.16. Their BLS knowledge levels were not associated with gender, age,education level or the number of years since their most recent BLS training (p&amp;amp;gt;0.05). The ratios of teachers whoknew emergency call numbers (98.4%), were able to evaluate respiration (80.6%),had the ability to maintain airway patency (66.9%) and knew the startingcriteria for BLS (90.6%) were high. The ratio of teachers who knew the firstassessment of process steps (4.5%) and maximum time that should be spent(23.7%), compression site (17.8%), the number of compressions and compressionto respiration ratios (33.3%), depth of compression (37.6%), time forlife-saving exhalation (8.0%), the number of compressions per minute (15.6%),and for civilian first aiders, knew how to use an automatic external defibrillator(AED) (24.2%) were low.Conclusion: The teachers in XXXXX do not have sufficiently updated information about BLSpractices (the first BLS assessment and required time for BLS, BLS steps,respiration period, compression site, depth and the number of compressions).

To compare the ability to perform basic life support (BLS) skills on children and infants in a moving ambulance whether or not they are properly secured to the stretcher. Emergency Medicine Services provider ability to perform BLS skills was measured in moving ambulances on a closed course using an analog for child and infant cardiac arrest. Data were compared for child and infant manikins secured to the stretcher via different methods in simulated patient resuscitations performed by 24 participants. We found that there was no significant difference in mean rate ( P = 0.104), depth ( P = 0.21), or chest compression fraction ( P = 0.92) between tests on restrained and unrestrained pediatric manikins. For infants, there was a 4-mm difference in compression depth ( P = 0.0018). The clinical significance of this difference is not readily apparent. Infant tests did not show a difference in compression rate ( P = 0.35) or compression fraction ( P = 0.26). Across all tests, the rate and depth of compressions were adequate, but compression fraction was not adequate in the infant simulations. There were no differences in ventilations between restrained and unrestrained simulations (child P = 0.15; infant P = 0.13) but both were less than the American Heart Association recommendation. In this simulation study, it was found that there was no significant difference noted in BLS adequacy between unrestrained pediatric patients and those restrained with commercial devices. Overall, the ability to perform appropriate BLS on children was equivocal and our simulations suggested BLS could not be adequately performed on infants regardless of restraint type/status.

Resuscitation highlights in 2011

Trials of teaching methods in basic life support (4): comparison of simulated CPR performance at unannounced home testing after conventional or staged training.

Background: Cardiac arrest is one of the leading cause of death in the world with steadily increasing number over the years. Basic life support has been proven to lower the risks of tissue damage and further complication. Several study shows that BLS skill are lacking in some doctors and nurses. Objective: Therefore, the purpose of this study is knowing the retention of basic life support in medical student of Airlangga University. Methods: This descriptive study used cross sectional design. Subjects were students at faculty of medicine in Airlangga University who trained one year ago and completed their study of Basic Life Support. Fifty two subject were asked to practice their BLS techniques then scored based on modified American Hearth Assosiation (AHA)’s Basic life support skill checklist. Results: Based on the data, the percentage of students who did the retest correctly: response checked by shouting 92.31% students, response checked by tapping 69.23% students, call for help 44.23% students, airway checked 48.08% students, breathing checked 46.15% students, correct hand placement 100% students, compression rate 78.85% students, compression ratio 75% students, position 94.23% students, and compression depth 78.85% students. Conclusion: One year post training and test, 14 from 52 students could complete all the steps in basic life support skill. Less than a half of the students successfully done 3 out of 10 points that were being tested. Meanwhile, many aspects in circulation point show higher results all above 75%.