Relationship Between Chest Compression Rates and Outcomes From Cardiac Arrest

Objectives: The 2010 American Heart Association Guidelines stress the importance of high quality cardiopulmonary resuscitation (CPR) as a predictor of survival from cardiac arrest. However, resuscitation training is often facilitated and evaluated by instructors without access to objective measures of CPR quality. This study aims to determine whether instructors experienced in the area of adult resuscitation (emergency department staff and senior residents) can accurately assess the quality of chest compressions as a component of their global assessment of a simulated resuscitation scenario. Methods: This is a prospective observational study in which objective chest compression quality data (rate, depth, and fraction) were collected from the simulation manikin and compared to subjective instructor assessment. Data were collected during weekly simulation training sessions for residents, medical students, and nursing students. Results: We included data from 24 simulated resuscitation scenarios assessed by 1 of 15 instructors. Subjective assessment of chest compression quality identified an adequate compression rate (100-120 compressions per minute) with a sensitivity of 0.17 (confidence interval [CI] 0.02-0.32) and specificity of 0.06 (CI −0.04-0.15), adequate depth (>50 mm) with a sensitivity of 0 and specificity of 0.38 (CI 0.18-0.57), and adequate fraction (>80%) with a sensitivity of 1 and a specificity of 0.25 (CI 0.08-0.42). Conclusion: Instructor assessment of chest compression rate, depth, and fraction demonstrates poor sensitivity and specificity when compared to the data from the simulation manikin. These results support the use of objective and technologically supported measures of chest compression quality for feedback during resuscitation education using simulators. RÉSUMÉObjectif: Dans les lignes directrices de 2010 de l'American Heart Association, on insiste sur l'importance de la qualité de la réanimation cardiopulmonaire (RCP) comme facteur prévisionnel de survie à un arrêt cardiaque. Toutefois, les séances de formation de réanimation sont souvent données et évaluées par des instructeurs, sans mesure objective de la qualité de la RCP. L'étude visait à déterminer si les instructeurs expérimentés dans le domaine de la réanimation chez les adultes (personnel au service des urgences, résidents séniors) pouvaient évaluer avec exactitude la qualité des compressions thoraciques, et ce, comme l'un des éléments de l'évaluation globale de scénarios de réanimation. Méthode: Il s'agit d'une étude d'observation prospective, dans laquelle il y a eu collecte de données objectives sur la qualité des compressions thoraciques (fréquence, profondeur, fraction) à partir de simulations sur mannequin, et comparaison avec l'évaluation subjective des instructeurs. Les données ont été recueillies durant les séances hebdomadaires de simulation, préparées à l'intention des résidents, des étudiants en médecine et des étudiants en soins infirmiers. Résultats: Les données recueillies provenaient de 24 séances de simula...

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“…A sensitivity analysis was performed using a widened adequacy criteria, accepting a rate of 100-125 18 and a depth of >44 mm. 19,20 …”

Section: Resultsmentioning

confidence: 99%

Accuracy of instructor assessment of chest compression quality during simulated resuscitation

Brennan

McGraw

Brooks

2016

CJEM

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“…According to the literature, the strong consensus about the target CC depth and CC rate has not yet been reached [25,26]. Kilgannon et al [25] showed that CC rate between 121 and 140 cpm had the greatest probability of return of spontaneous circulation (ROSC) (odds ratio 4.48; 95% confidence interval 1.42-14.14).…”

Section: Both European and American Guidelines For Resuscitationmentioning

confidence: 99%

Factors influencing high-quality chest compressions during cardiopulmonary resuscitation scenario, according to 2015 American Heart Association Guidelines

et al. 2018

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A b s t r a c tBackground and aim: Recent American Heart Association guidelines from 2010 and 2015 stressed the importance of high-quality chest compression and defined standards for compression rate, depth, recoil, and maximal acceptable time for interruptions. High-quality cardiopulmonary resuscitation (CPR) is the "cornerstone" of a system of care that can optimise outcomes beyond the return of spontaneous circulation. Methods:One hundred medical students were enrolled to the study. Study participants, after attending a Basic Life Support Course according to American Heart Association 2015 guidelines, performed 2-min CPR on a Resusci Anne ® QCPR Manikin. The following data were collected: age, sex, and health status. The study made use of a Tanita MC-980 MA for body composition analysis.Results: Mean height of participants was 170.2 ± 8.3 cm, and mean weight was 65 ± 11.8 kg. Mean body mass index was 22.1 ± 2.7, and mean fat-free mass (FFM) was 50.1 ± 10.5 kg. The mean fat mass (FAT%) was 22.9 ± 7.6. Basal metabolic rate, FFM, trunk muscle mass, left arm muscle mass, and right arm muscle mass were positively correlated with compression depth (all p for trend < 0.05). Mean compression depth was 49.7 ± 8.4 (for female 48.7 ± 7.9 mm, for male 42.4 ± 9.5 mm; p = 0.144). Compression rate for males and females was the same, at 114 ×/min (p = 0.769). Conclusions:In our study, basal metabolic rate, FFM, trunk muscle mass, and left and right arm muscle mass were positively correlated with compression depth. Moreover, an arm muscle mass rise of 1 kg caused a rise of compression depth parameter of 7.3 mm, while when chest compression was performed by females, a fall of compression depth of 3.3 mm was seen.

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“…Several studies have examined the relationship between chest compression rate, compression depth, and survival. [10][11][12][13][14] A metaanalysis by Wallace et al found that survival was improved with chest compression depths of at least 51 mm and compression rates between 85 and 100 compressions per minute. 14 Vadeboncoeur et al conducted an observational study examining the influence of an educational intervention on high quality CPR and its impact on neurologically intact survival from OHCA and found that chest compressions with a depth of at least 51 mm were independently associated with survival from cardiac arrest with a favourable neurologic outcome.…”

Section: Compression Rate and Depthmentioning

confidence: 99%

The impact of prehospital resuscitation research on in-hospital care

Mausz

Cheskes

2015

CJEM

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Since their introduction over 40 years ago, paramedics have been trained to deliver select advanced life support interventions in the community with the goal of reducing morbidity and mortality from cardiovascular disease and trauma. The ensuing decades witnessed a great deal of interest in paramedic care, with an exponential growth in prehospital resuscitation research. As part of the CJEM series on emergency medical services (EMS), we review recent prehospital research in out-of-hospital cardiac arrest and discuss how, in a novel departure from the origins of EMS, prehospital research is beginning to influence in-hospital care. We discuss emerging areas of study related to cardiopulmonary resuscitation (CPR) quality, therapeutic hypothermia, termination of resuscitation, and the use of end-tidal carbon dioxide measurement, as well as the subtle ripple effects that prehospital research is having on the broader understanding of the management of these critically ill patients. RÉSUMÉDepuis leur arrivée il y a plus d'une quarantaine d'années, les ambulanciers paramédicaux sont formés pour pratiquer certaines interventions de réanimation cardiorespiratoire (RCR) médicalisée dans la collectivité dans le but de réduire la morbidité et la mortalité liées aux maladies cardiovasculaires et aux traumas. Au cours des décennies suivantes, les soins paramédicaux ont suscité un vif intérêt, qui s'est accompagné d'une forte croissance de la recherche en réanimation préhospitalière. Dans le cadre de la série d'articles portant sur les services médi-caux d'urgence (SMU) dans le JCMU, il sera question de la recherche récente sur la prise en charge préhospitalière des arrêts cardiaques qui surviennent dans la collectivité ainsi que de l'influence que commence à avoir la recherche dans le domaine préhospitalier sur les soins hospitaliers, influence qui signe une nouvelle orientation par rapport au point de départ des SMU. L'article portera sur de nouveaux champs d'étude liés à la qualité de la RCR, à l'hypothermie thérapeutique, à l'arrêt des manoeuvres de réanimation et à l'utilisation de la mesure du gaz carbonique en fin d'expiration ainsi que sur les effets d'entraînement discrets que la recherche dans le domaine préhospitalier a sur la compréhension élargie du traitement des personnes gravement malades ou blessées.

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Relationship Between Chest Compression Rates and Outcomes From Cardiac Arrest

Cited by 357 publications

References 26 publications

Accuracy of instructor assessment of chest compression quality during simulated resuscitation

Accuracy of instructor assessment of chest compression quality during simulated resuscitation

Factors influencing high-quality chest compressions during cardiopulmonary resuscitation scenario, according to 2015 American Heart Association Guidelines

The impact of prehospital resuscitation research on in-hospital care

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