Quality of mechanical, manual standard and active compression-decompression CPR on the arrest site and during transport in a manikin model

ArticleinResuscitation 34(3):235-42 · July 1997with18 Reads
Impact Factor: 4.17 · DOI: 10.1016/S0300-9572(96)01087-8 · Source: PubMed
Abstract

The quality of mechanical CPR (M-CPR) was compared with manual standard CPR (S-CPR) and active compression-decompression CPR (ACD-CPR) performed by paramedics on the site of a cardiac arrest and during manual and ambulance transport. Each technique was performed 12 times on manikins using teams from a group of 12 paramedic students with good clinical CPR experience using a random cross-over design. Except for some lost ventilations the CPR effort using the mechanical device adhered to the European Resuscitation Council guidelines, with an added time requirement of median 40 s for attaching the device compared with manual standard CPR. Throughout the study, in comparison with mechanical CPR the quality of CPR with either manual method was significantly worse. In particular, there were considerable individual variations during stretcher transport. With S-CPR and ACD-CPR the median compression times were 38 and 31%, significantly lower than the recommended 50%, and 46-98% of the decompression efforts with ACD-CPR were too weak, particularly during transport on the stairs. With both manual methods, there were no significant differences in the CPR effort between the site of the arrest and the ambulance transport. However, compression rates were reduced and became more erratic during stretcher transport to the ambulance. When walking horizontally, a median of 19% of S-CPR compressions and 84% of ACD-CPR compressions were to weak. On the stairs, 68% of S-CPR compressions and 100% of ACD-CPR compressions were too weak. In conclusion, when evaluated on a manikin, in comparison with manual standard and ACD-CPR, mechanical CPR adhered more closely to ERC guidelines. This was particularly true when performing CPR during transport on a stretcher.

    • "... participants regarded ACD CPR difficult to use due to not being tall enough to apply the device149150151152. Hands off time, i.e. time without compressions, was described as longer when using a mechani..."
      Still, participants using the external mechanical compression device adhered more closely to CPR guidelines than participants using active compressiondecompression (ACD) CPR. ACD CPR caused a reduction of compression quality and many participants regarded ACD CPR difficult to use due to not being tall enough to apply the device149150151152. Hands off time, i.e. time without compressions, was described as longer when using a mechanical device than manual compressions [153].
    [Show abstract] [Hide abstract] ABSTRACT: High energy trauma is rare and, as a result, training of prehospital care providers often takes place during the real situation, with the patient as the object for the learning process. Such training could instead be carried out in the context of simulation, out of danger for both patients and personnel. The aim of this study was to provide an overview of the development and foci of research on simulation in prehospital care practice. An integrative literature review were used. Articles based on quantitative as well as qualitative research methods were included, resulting in a comprehensive overview of existing published research. For published articles to be included in the review, the focus of the article had to be prehospital care providers, in prehospital settings. Furthermore, included articles must target interventions that were carried out in a simulation context. The volume of published research is distributed between 1984- 2012 and across the regions North America, Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors, animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs), medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospital care providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage. Simulation were described as a positive training and education method for prehospital medical staff. It provides opportunities to train assessment, treatment and implementation of procedures and devices under realistic conditions. It is crucial that the staff are familiar with and trained on the identified topics, i.e., intubation, trauma care, CPR, ventilation and triage, which all, to a very large degree, constitute prehospital care. Simulation plays an integral role in this. The current state of prehospital care, which this review reveals, includes inadequate skills of prehospital staff regarding ventilation and CPR, on both children and adults, the lack of skills in paediatric resuscitation and the lack of knowledge in assessing and managing burns victims. These circumstances suggest critical areas for further training and research, at both local and global levels.
    Full-text · Article · Mar 2014 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
    0Comments 5Citations
    • "...outcomes when comparing manual to mechanical CPR in OHCA was evaluated. Good Stapleton [18], Sunde [19] Fair Axelsson [20], Dickinson [21] Olasveengen [22], Ong [12], Casner [23] Poor Compression adequac..."
      In this paper, a comprehensive review of studies to date relating to the quality of CPR and clinical outcomes when comparing manual to mechanical CPR in OHCA was evaluated. Good Stapleton [18], Sunde [19] Fair Axelsson [20], Dickinson [21] Olasveengen [22], Ong [12], Casner [23] Poor Compression adequacy (defined as 1.5 to 2 inches in depth, 60 compressions per min +/-10% and correct hand position). Thumper provided pre-defined correct compressions for 97% of the runs (n = 70) while manual compressions were performed correctly 37% of the runs (n = 27).
    [Show abstract] [Hide abstract] ABSTRACT: The aim of this paper was to conduct a systematic review of the published literature to address the question: "In pre-hospital adult cardiac arrest (asystole, pulseless electrical activity, pulseless Ventricular Tachycardia and Ventricular Fibrillation), does the use of mechanical Cardio-Pulmonary Resuscitation (CPR) devices compared to manual CPR during Out-of-Hospital Cardiac Arrest and ambulance transport, improve outcomes (e.g. Quality of CPR, Return Of Spontaneous Circulation, Survival)". Databases including PubMed, Cochrane Library (including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials), Embase, and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included manikin and human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case series and case reports. Out of 88 articles identified, only 10 studies met the inclusion criteria for further review. Of these 10 articles, 1 was Level of Evidence (LOE) 1, 4 LOE 2, 3 LOE 3, 0 LOE 4, 2 LOE 5. 4 studies evaluated the quality of CPR in terms of compression adequacy while the remaining six studies evaluated on clinical outcomes in terms of return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and Cerebral Performance Categories (CPC). 7 studies were supporting the clinical question, 1 neutral and 2 opposing. In this review, we found insufficient evidence to support or refute the use of mechanical CPR devices in settings of out-of-hospital cardiac arrest and during ambulance transport. While there is some low quality evidence suggesting that mechanical CPR can improve consistency and reduce interruptions in chest compressions, there is no evidence that mechanical CPR devices improve survival, to the contrary they may worsen neurological outcome.
    Full-text · Article · Jun 2012 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
    0Comments 25Citations
    • "...24] whereas EMS manikin studies have reported that up to 50% of the compressions were too deep [25,26]. Thus our study is not concurrent with other manikin studies and points out a skill that needs imp..."
      One study has shown that shallow compressions were associated with defibrillation failure [16] and other studies have shown that increasing compression depth was correlated with increasing short-term survival [22,23]. Clinical studies have documented prevalence of too shallow compressions [6,7,24] whereas EMS manikin studies have reported that up to 50% of the compressions were too deep [25,26]. Thus our study is not concurrent with other manikin studies and points out a skill that needs improvement.
    [Show abstract] [Hide abstract] ABSTRACT: Ambulance personnel play an essential role in the 'Chain of Survival'. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island. The Basic Life Support (BLS) and Automated External Defibrillator (AED) skills of the ambulance personnel were tested in a simulated cardiac arrest. Points were given according to a scoring sheet. One sample t test was used to analyze the deviation from optimal care according to the 2005 guidelines. After each assessment, individual feedback was given. On 3 consecutive days, we assessed the individual EMS teams responding to OHCA on the island. Overall, 70% of the maximal points were achieved. The hands-off ratio was 40%. Correct compression/ventilation ratio (30:2) was used by 80%. A mean compression depth of 40-50 mm was achieved by 55% and the mean compression depth was 42 mm (SD 7 mm). The mean compression rate was 123 per min (SD 15/min). The mean tidal volume was 746 ml (SD 221 ml). Only the mean tidal volume deviated significantly from the recommended (p = 0.01). During the rhythm analysis, 65% did not perform any visual or verbal safety check. The EMS providers achieved 70% of the maximal points. Tidal volumes were larger than recommended when mask ventilation was applied. Chest compression depth was optimally performed by 55% of the staff. Defibrillation safety checks were not performed in 65% of EMS providers.
    Full-text · Article · May 2012 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
    0Comments 3Citations
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