CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system

Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Resuscitation (Impact Factor: 4.17). 05/2007; 73(1):54-61. DOI: 10.1016/j.resuscitation.2006.10.027
Source: PubMed


Cardiopulmonary resuscitation (CPR) quality during actual cardiac arrest has been found to be deficient in several recent investigations. We hypothesized that real-time feedback during CPR would improve the performance of chest compressions and ventilations during in-hospital cardiac arrest.
An investigational monitor/defibrillator with CPR-sensing and feedback capabilities was used during in-hospital cardiac arrests from December 2004 to December 2005. Chest compression and ventilation characteristics were recorded and quantified for the first 5 min of resuscitation and compared to a baseline cohort of arrest episodes without feedback, from December 2002 to April 2004.
Data from 55 resuscitation episodes in the baseline pre-intervention group were compared to 101 resuscitations in the feedback intervention group. There was a trend toward improvement in the mean values of CPR variables in the feedback group with a statistically significant narrowing of CPR variable distributions including chest compression rate (104+/-18 to 100+/-13 min(-1); test of means, p=0.16; test of variance, p=0.003) and ventilation rate (20+/-10 to 18+/-8 min(-1); test of means, p=0.12; test of variance, p=0.04). There were no statistically significant differences between the groups in either return of spontaneous circulation or survival to hospital discharge.
Real-time CPR-sensing and feedback technology modestly improved the quality of CPR during in-hospital cardiac arrest, and may serve as a useful adjunct for rescuers during resuscitation efforts. However, feedback specifics should be optimized for maximal benefit and additional studies will be required to assess whether gains in CPR quality translate to improvements in survival.

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    • "During adult advanced life support the use of feedback devices during CPR are encouraged, since they improve rescuer ability to achieve correct chest compression depth, rate and chest recoil. The feedback devices also attempt to minimize no-flow time, as much as possible [5,6]. Although the quality deficiencies are similar in adult and pediatric resuscitation attempts, the feedback devices currently available are recommended for children at least 8 years of age. "
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    ABSTRACT: A 2-year-old boy found in cardiac arrest secondary to drowning received standard CPR for 35 minutes and was transported to a tertiary hospital for rewarming from hypothermia. Chest compressions in hospital were started using two-thumb encircling hands technique. Subsequently two-thumbs direct sternal compression technique and after sternal force/depth sensor placement, chest compression with classic one-hand technique were done. By using CPR recording/feedback defibrillator, quantitative CPR quality data and invasive arterial pressures were available for analyses for 5 hours and 35 minutes. 316 compressions with the two-thumb encircling hands technique provided a mean (SD) systolic arterial pressure (SAP) of 24 (4) mmHg, mean arterial pressure (MAP) 18 (3) and diastolic arterial pressure (DAP) of 15 (3) mmHg. ~6000 compressions with the two thumbs direct compression technique created a mean SAP of 45 (7) mmHg, MAP 35 (4) mmHg and DAP of 30 (3) mmHg. ~20,000 compressions with the sternal accelerometer in place produced SAP 50 (10) mmHg, MAP 32 (5) mmHg and DAP 24 (4) mmHg. Restoration of spontaneous circulation (ROSC) was achieved at the point when the child achieved normothermia by using peritoneal dialysis. Unfortunately, the child died ten hours after ROSC without any signs of neurological recovery. This case demonstrates improved hemodynamic parameters with classic one-handed technique with real-time quantitative quality of CPR feedback compared to either the two-thumbs encircling hands or two-thumbs direct sternal compression techniques. We speculate that the improved arterial pressures were related to improved chest compression depth when a real-time CPR recording/feedback device was deployed. Trial registration NCT00951704.
    Full-text · Article · Jul 2013 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
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    • "Notably the subjects in the 6 months group were “right on spot”, but as training progressed, showed a drift towards too high rates. This may indicate that as training goes on the participants may get overly vigorous and that more focus might be needed on this phenomenon, alternatively support the use of technical or cognitive tools for correct psychomotor output keeping frequency of compressions correct [31-33]. "
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    ABSTRACT: Background: Multiplayer virtual world (MVW) technology creates opportunities to practice medical procedures and team interactions using serious game software. This study aims to explore medical students' retention of knowledge and skills as well as their proficiency gain after pre-training using a MVW with avatars for cardio-pulmonary resuscitation (CPR) team training. Methods: Three groups of pre-clinical medical students, n = 30, were assessed and further trained using a high fidelity full-scale medical simulator: Two groups were pre-trained 6 and 18 months before assessment. A reference control group consisting of matched peers had no MVW pre-training. The groups consisted of 8, 12 and 10 subjects, respectively. The session started and ended with assessment scenarios, with 3 training scenarios in between. All scenarios were video-recorded for analysis of CPR performance. Results: The 6 months group displayed greater CPR-related knowledge than the control group, 93 (±11)% compared to 65 (±28)% (p < 0.05), the 18 months group scored in between (73 (±23)%).At start the pre-trained groups adhered better to guidelines than the control group; mean violations 0.2 (±0.5), 1.5 (±1.0) and 4.5 (±1.0) for the 6 months, 18 months and control group respectively. Likewise, in the 6 months group no chest compression cycles were delivered at incorrect frequencies whereas 54 (±44)% in the control group (p < 0.05) and 44 (±49)% in 18 months group where incorrectly paced; differences that disappeared during training. Conclusions: This study supports the beneficial effects of MVW-CPR team training with avatars as a method for pre-training, or repetitive training, on CPR-skills among medical students.
    Full-text · Article · Dec 2012 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
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    • "네킹 시스템을 이용한 훈련(Wlk, Myklebust, Anestad, & Steen, 2005), 실시간 시청각 되먹임 감시장비(Abella et al., 2007), 비디오 자가 학습법(박상섭 & 박대성, 2009; Braslow et al., 1997; Lynch, et al., 2005 "
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    ABSTRACT: Purpose: The purpose of this study was to evaluate the effects of BLS training in nursing students and their retention period. Methods: The participants were 48 nursing students enrolled in M University in Mokpo. Data were collected from September, 2009 through September 2010. Nursing students were tested for their knowledge, attitude, confidence before, immediately after, 4 weeks after, 8 weeks after, 6 months after, and 1 year after BLS training. In addition, their knowledge and skill of cardiopulmonary resuscitation were tested 5 times. Data were analyzed using the SPSS/PC 12.0 statistical program Results: Knowledge, attitude and confidence were significantly increased immediately after compared to before BLS training. Knowledge and confidence 6 months after, and attitude, performance ability and technical precision for ventilation and compression 4 weeks after BLS training were significantly decreased compared to immediately after. Conclusion: Overall retention of BLS training effects among nursing students, without reinforcement, decreases significantly after six months following initial training. BLS training in nursing students should be repeated every six months, especially performance training of BLS should be repeated every 4 weeks. In addition, to maintain the knowledge and skills of BLS, appropriate renewal time of certification and improvement of training programs are necessary.
    Preview · Article · Apr 2012
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