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Teaching laypersons BLS/AED using the two-stage teaching technique was noninferior to the four-stage teaching technique, although the pass rate was -2% (95% confidence interval: -18 to 15%) lower with the two-stage teaching technique.

SummaryThirty surf lifeguards (mean (SD) age: 25.1 (4.8) years; 21 male, 9 female) were randomly assigned to perform 2 9 3 min of cardiopulmonary resuscitation on a manikin using mouth-to-face-shield ventilation (AMBU â LifeKey) and mouth-to-pocket-mask ventilation (Laerdal Pocket Mask TM ). Interruptions in chest compressions, effective ventilation (visible chest rise) ratio, tidal volume and inspiratory time were recorded. Interruptions in chest compressions per cycle were increased with mouth-to-face-shield ventilation (mean (SD) 8.6 (1.7) s) compared with mouth-topocket-mask ventilation (6.9 (1.2) s, p < 0.0001). The proportion of effective ventilations was less using mouth-toface-shield ventilation (199/242 (82%)) compared with mouth-to-pocket-mask ventilation (239/240 (100%), p = 0.0002). Tidal volume was lower using mouth-to-face-shield ventilation (mean (SD) 0.36 (0.20) l) compared with mouth-to-pocket-mask ventilation (0.45 (0.20) l, p = 0.006). No differences in inspiratory times were observed between mouth-to-face-shield ventilation and mouth-to-pocket-mask ventilation. In conclusion, mouth-to-face-shield ventilation increases interruptions in chest compressions, reduces the proportion of effective ventilations and decreases delivered tidal volumes compared with mouth-to-pocket-mask ventilation.

Introduction: Dispatcher assisted CPR (DA-CPR) increases rate and quality of CPR and improves survival. Several studies have shown that changing one element in a dispatcher’s protocol improve CPR performance. Whether one improvement counter the effect of another improvement is unknown and the effect of combining several beneficial elements in a dispatcher protocol remains to be clarified. Hypothesis: A novel DA-CPR protocol, combining several single elements improving CPR performance, is superior to a standard DA-CPR protocol. Methods: Based on previous research and pilot studies a novel DA-CPR protocol including new wording on chest compression depth and hand position, the use of a metronome, provision of encouragements and introducing a 10-sec rest per minute was developed. Subsequently, laypersons were randomized to perform chest compression-only DA-CPR on a manikin with either the novel DA-CPR protocol or a standard DA-CPR protocol. Data on CPR quality was collected on video recordings and from the manikin and evaluated by two assessors blinded to the experimental groups. The primary outcome was a composite endpoint of time to first compression, hand position, compression depth and -rate and hands-off time, which were rated separately each minute and merged into an overall score (max 22 points). Results: 128 laypersons were included in the study. The novel protocol (n=61, three were excluded) significantly improved the CPR quality compared to the standard protocol (n=64) (mean (SD)): 18.6 (1.4) points vs. 17.5 (1.7) points, p<0.001. The novel protocol resulted in significantly deeper (mean (SD): 58 (12) mm vs. 52 (13) mm, p=0.02) and faster (mean (SD): 114 (11) min-1 vs. 110 (13) min-1, p=0.04) compressions when compared to the standard protocol. The novel protocol resulted in shorter time to first compression (median (IQR): 65 (59, 70) sec vs. 72 (66, 81) sec, p<0.001) and better hand position for compressions (61% vs. 36%, p=0.01) compared to the standard protocol. As intended, hands-off time per minute was prolonged with the novel protocol (median (IQR): 6 (5, 7) sec vs. 0 (0, 1) sec). Conclusions: In a simulated cardiac arrest scenario, a novel protocol for DA-CPR was superior to a standard DA-CPR protocol. Both protocols resulted in high quality CPR.