Abstract
Background
External chest compressions (ECC) are essential components of resuscitation and are usually performed without any adjuncts in professional healthcare. Even for healthcare professionals during in-hospital and out-of-hospital resuscitation poor performance in ECC has been reported in recent years. Although several stand-alone devices have been developed none has been implemented as a standard in patient care. The aim of this study was to examine if the use of a mechanical device providing visual feedback and audible assistance during ECC improves performance of healthcare professionals following minimal and simplified instructions.
Methods
In a prospective, randomized cross-over study 81 healthcare professionals performed ECC for 3 min (in the assumed setting of a secured airway) twice on a manikin (Skillreporter ResusciAnne®, with PC-Skillreporting System Version 1.3.0, Laerdal, Stavanger, Norway) in a mock cardiac arrest scenario. Group 1 (n=40) performed ECC with the device first followed by classic ECC and group 2 (n=41) in the opposite order. Minimal instructions were standardized and provided by video instruction (1 min 38 s). Endpoints were achievement of a mean compression rate between 90 and 110/min and a mean compression depth of 40–50 mm. In addition participants had to answer questionnaires about demographic data, professional experience and recent recommendations for ECC as well as their impression of the device concerning the ease of use and their personal level of confidence. Data were analyzed for group-related and inter-group differences using SAS (Version 9.1.3, SAS Institute, Cary, NC).
Results
A total of 81 healthcare professionals regularly involved in resuscitation attempts in pre-hospital or in-hospital settings took part in the study with no differences between the groups: females 35.8% (n=52), emergency medical technicians 32.1% (n=26), anesthesia nurses 32.1% (n=26), physicians (anesthesiology) 45% (n=29). In group 1 33 out of 40 (82.5%; 99.7±4.82/min; 95% confidence interval 95% CI: 98.1–101.2/min) reached the correct range for compression rate and 29/40 (72.5%; 44.0±4.95 mm; 95% CI: 42.4–45.6 mm) the correct compression depth using the assisting device. Afterwards they conducted classic ECC without the device and deteriorated significantly: correct compression rate was achieved by 12/40 (30%, p≤0.0001; 110.6±11.0/min (95% CI: 107.1–114.1/min), while 25/40 (62.5%; 44.5±5.63 mm; 95% CI: 42.6–46.3 mm) met the correct compression depth. Group 2 performed poorer in ECC without assistance and 5/41 (12.2%; 104.5±21.35/min; 95% CI: 97.8–111.3/min) reached the correct rate whereas 21/41 (51.2%; 39.6±7.61 mm; 95% CI: 37.2–42.0 mm) compressed to the appropriate depth. Using the device there was a significant improvement in the second evaluation with 34/41 (82.9%, p≤0.0001; 101.7±4.68/min; 95% CI: 100.2–103.2/min) reaching the correct rate and 36/41 (87.8%, p≤0.0001; 43.9±4.16 mm; 95% CI: 42.6–45.2 mm) the correct depth.
Conclusions
The tested device is easy to use after instruction of less than 3 min and improves ECC performance of healthcare professionals in simulated cardiac arrest with respect to compression depth as well as compression rate.
Zusammenfassung
Hintergrund
Thoraxkompressionen (TK) sind essenzieller Bestandteil der Reanimation und werden auch von professionellen Anwendern zumeist ohne Hilfsmittel durchgeführt, obwohl bereits verschiedene Instrumente entwickelt wurden. Ziel dieser Studie war es, ein mechanisches Gerät, das visuelle Rückmeldung und auditive Unterstützung bei den TK bietet, in der Anwendung durch professionelle Helfer nach minimaler Einweisung zu evaluieren.
Material und Methoden
Es absolvierten 81 Probanden 2-mal über 3 min TK im Simulationsmodell. Gruppe 1 startete (n=40) mit Hilfsmittel, danach folgten klassische TK ohne Hilfsmittel; Gruppe 2 (n=41) umgekehrt. Minimale Instruktionen zum Gerät wurden durch ein Video (1 min, 38 s) vermittelt. Endpunkte waren das Erreichen einer mittleren Kompressionsfrequenz von 90–110/min und einer mittleren Drucktiefe zwischen 40 und 50 mm; hierbei wurde innerhalb und zwischen den Gruppen verglichen.
Ergebnisse
In Gruppe 1 erreichten 33 der 40 Teilnehmer [82.5%; 99,7±4,82/min; 95%-Konfidenzintervall (95%-CI): 98,1–101,2/min] mit dem Hilfsmittel die korrekte Frequenz, 29 der 40 Teilnehmer die korrekte Tiefe (72,5%; 44,0±4,95 mm; 95%-CI: 42,4–45,6 mm) und verschlechterten sich ohne Gerät, bei der Frequenz signifikant auf 12/40 (30%; p≤0,0001; 110,6±11,0/min; 95%-CI: 107,1–114,1/min) und zur Tiefe 25 der 40 Teilnehmer (62,5%; 44,5±5,63 mm; 95%-CI: 42,6–46,3 mm). Gruppe 2 zeigte ohne Hilfsmittel zunächst schlechtere Leistungen: korrekte Frequenz bei 5 der 41 Teilnehmer (12,2%; 104,5±21,35/min; 95%-CI: 97,8–111,3/min); korrekte Tiefe bei 21 der 41 Teilnehmer (51,2%; 39,6±7,61 mm; 95%-CI: 37,2–42,0 mm). Mit Anwendung des Hilfsmittels konnte eine signifikante Verbesserung ermittelt werden: korrekte Frequenz bei 34 der 41 Teilnehmer (82,9%, p≤0,0001; 101,7±4,68/min; 95%-CI: 100,2–103,2/min), korrekte Tiefe bei 36 der 41 Teilnehmer (87,8%, p≤0,0001; 43,9±4,16 mm; 95%-CI: 42,6–45,2 mm).
Schlussfolgerung
Das getestete Hilfsmittel ist nach minimaler Einweisung einfach zu verwenden. Die Qualität der TK professioneller Anwender konnte hinsichtlich Drucktiefe und -frequenz signifikant verbessert werden.
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Conflict of interests
The authors declare that Health Affairs Ltd., Berkhamsted, United Kingdom, provided the tested devices to the investigators of the study. The sponsor did not contribute to the study design, data collection and interpretation or the decision to submit for publication. None of the authors have other financial relationships or conflicts concerning this or competing manufacturers. The authors of this study tested a feedback device provided by Laerdal in 2010 [22].
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The results were presented in part at the Resuscitation Science Symposium, AHA Scientific Sessions, Dallas, Texas, USA, 2005 and at the 8th scientific congress of the European Resuscitation Council, Resuscitation 2006, Stavanger, Norway.
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Skorning, M., Derwall, M., Brokmann, J. et al. External chest compressions using a mechanical feedback device. Anaesthesist 60, 717–722 (2011). https://doi.org/10.1007/s00101-011-1871-6
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DOI: https://doi.org/10.1007/s00101-011-1871-6