Quality of Chest Compressions Differs over Time between Advanced and Basic Life Support
Affiliation(s)
1 Department of Emergency, Värnamo County Hospital, Region Jönköpings län, Sweden. 2 School of Health Sciences, University of Borås, Borås, Sweden. 3 Physio-Control Sverige/Jolife AB, Ideon Science Park, Lund, Sweden.
1 Department of Emergency, Värnamo County Hospital, Region Jönköpings län, Sweden. 2 School of Health Sciences, University of Borås, Borås, Sweden. 3 Physio-Control Sverige/Jolife AB, Ideon Science Park, Lund, Sweden.
ABSTRACT
Purpose: According to guideline recommendations, chest compressions (CC) during cardiopulmonary resuscitation (CPR) should be performed at a rate of 100 - 120 per minute, with a CC fraction (CCF) of ≥80%. The aim of this work is to explore whether CC quality differs between advanced life support (ALS) and basic life support (BLS) performed by two rescuers. Method: Cardiopulmonary resuscitation was performed by two ambulance personnel in ten ALS and ten BLS manikin scenarios. Data from these scenarios were then compared with data on ten ALS cases from the clinical setting, all with non-shockable rhythms. Data from the first two 5-minute periods of CC were evaluated from impedance data (LIFEPAK 12 defibrillator monitors) using a modified Laerdal Skillmaster manikin. Quality parameters compared were: number of CC pauses (CCPs), total time of CC (%), number of CC given and CC rate/min. Results: During the first 5 minutes, the BLS manikin scenarios had the highest number of CCPs, 15 (14 - 16), compared with the ALS manikin scenario, 14 (13 - 15), and the clinical ALS cases, 12 (10 - 15). The BLS scenario also had the highest CCFs, 81% (77% - 85%), and number of CC, 450 (435 - 495), compared with the ALS manikin scenario, 75% (64% - 81%) and 400 (365 - 444) respectively, and the clinical ALS cases, 63% (50% - 74%) and 408 (306 - 489). The median rate of CC/min in the BLS scenario was 115 (110 - 120) compared with the ALS manikin scenario, 110 (106 - 115), and the clinical ALS cases, 130 (118 - 146). During the second 5-minute period, the BLS scenario had the highest number of CCPs, 16 (15 - 17), compared with 15 (14 - 16) for the ALS manikin scenario and 11 (11 - 12) for the clinical ALS cases. The CCF in the BLS setting was 79% (75% - 83%), and the number of CC 455 (430 - 480), compared with the ALS manikin scenario, 79% (74% - 84%) and 435 (395 - 480) respectively, and the clinical ALS cases, 71% (57% - 77%) and 388 (321 - 469) respectively. The median CC rate was 118 (113 - 124) for BLS, 111 (105 - 120) for ALS manikins and 123 (103 - 128) CC/min for clinical ALS cases. Conclusion: None of the groups being studied could deliver CC at a rate of 100 - 120 CC/min or a CCF of ≥80% over the whole 10-minute period in any of the resuscitation scenarios analyzed. However, BLS had the best compliance with CC quality recommendations according to the 2010 guidelines.
Purpose: According to guideline recommendations, chest compressions (CC) during cardiopulmonary resuscitation (CPR) should be performed at a rate of 100 - 120 per minute, with a CC fraction (CCF) of ≥80%. The aim of this work is to explore whether CC quality differs between advanced life support (ALS) and basic life support (BLS) performed by two rescuers. Method: Cardiopulmonary resuscitation was performed by two ambulance personnel in ten ALS and ten BLS manikin scenarios. Data from these scenarios were then compared with data on ten ALS cases from the clinical setting, all with non-shockable rhythms. Data from the first two 5-minute periods of CC were evaluated from impedance data (LIFEPAK 12 defibrillator monitors) using a modified Laerdal Skillmaster manikin. Quality parameters compared were: number of CC pauses (CCPs), total time of CC (%), number of CC given and CC rate/min. Results: During the first 5 minutes, the BLS manikin scenarios had the highest number of CCPs, 15 (14 - 16), compared with the ALS manikin scenario, 14 (13 - 15), and the clinical ALS cases, 12 (10 - 15). The BLS scenario also had the highest CCFs, 81% (77% - 85%), and number of CC, 450 (435 - 495), compared with the ALS manikin scenario, 75% (64% - 81%) and 400 (365 - 444) respectively, and the clinical ALS cases, 63% (50% - 74%) and 408 (306 - 489). The median rate of CC/min in the BLS scenario was 115 (110 - 120) compared with the ALS manikin scenario, 110 (106 - 115), and the clinical ALS cases, 130 (118 - 146). During the second 5-minute period, the BLS scenario had the highest number of CCPs, 16 (15 - 17), compared with 15 (14 - 16) for the ALS manikin scenario and 11 (11 - 12) for the clinical ALS cases. The CCF in the BLS setting was 79% (75% - 83%), and the number of CC 455 (430 - 480), compared with the ALS manikin scenario, 79% (74% - 84%) and 435 (395 - 480) respectively, and the clinical ALS cases, 71% (57% - 77%) and 388 (321 - 469) respectively. The median CC rate was 118 (113 - 124) for BLS, 111 (105 - 120) for ALS manikins and 123 (103 - 128) CC/min for clinical ALS cases. Conclusion: None of the groups being studied could deliver CC at a rate of 100 - 120 CC/min or a CCF of ≥80% over the whole 10-minute period in any of the resuscitation scenarios analyzed. However, BLS had the best compliance with CC quality recommendations according to the 2010 guidelines.
KEYWORDS
Cardiac Arrest, External Chest Compression, Cardiac Resuscitation, Advanced Life Support, Basic Life Support
Cardiac Arrest, External Chest Compression, Cardiac Resuscitation, Advanced Life Support, Basic Life Support
Cite this paper
Lindblad, P. , Victorén, A. , Axelsson, C. and Härdig, B. (2015) Quality of Chest Compressions Differs over Time between Advanced and Basic Life Support. International Journal of Clinical Medicine, 6, 944-953. doi: 10.4236/ijcm.2015.612124.
Lindblad, P. , Victorén, A. , Axelsson, C. and Härdig, B. (2015) Quality of Chest Compressions Differs over Time between Advanced and Basic Life Support. International Journal of Clinical Medicine, 6, 944-953. doi: 10.4236/ijcm.2015.612124.
References
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http://dx.doi.org/10.1016/j.resuscitation.2011.04.006 [24] Sanghavi, P., Jena, A.B., Newhouse, J.P. and Zaslavsky, A.M. (2015) Outcomes after Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support. JAMA Internal Medicine, 175, 196-204.
http://dx.doi.org/10.1001/jamainternmed.2014.5420 [25] Wang, H.E., Simeone, S.J., Weaver, M.D. and Callaway, C.W. (2009) Interruptions in Cardiopulmonary Resuscitation from Paramedic Endotracheal Intubation. Annals of Emergency Medicine, 54, 645-652.
http://dx.doi.org/10.1016/j.annemergmed.2009.05.024 [26] Stecher, F.S., Olsen, J.A., Stickney, R.E. and Wik, L. (2008) Transthoracic Impedance Used to Evaluate Performance of Cardiopulmonary Resuscitation during Out of Hospital Cardiac Arrest. Resuscitation, 79, 432-437.
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http://dx.doi.org/10.1001/jama.300.12.1423 [30] Brouwer, T., Walker, R., Koster, R. and Chapman, F. (2013) Association between Potentially Avoidable Pauses in Chest Compressions and Survival from Out-of-Hospital Cardiac Arrest. Resuscitation, 84, S3.
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[1] Vukmir, R.B. (2006) Survival from Prehospital Cardiac Arrest Is Critically Dependent upon Response Time. Resuscitation, 69, 229-234.
http://dx.doi.org/10.1016/j.resuscitation.2005.08.014 [2] Sasson, C., Rogers, M.A., Dahl, J. and Kellermann, A.L. (2010) Predictors of Survival from Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. Circulation: Cardiovascular Quality and Outcomes, 3, 63-81.
http://dx.doi.org/10.1161/CIRCOUTCOMES.109.889576 [3] Travers, A.H., Rea, T.D., Bobrow, B.J., Edelson, D.P., Berg, R.A., et al. (2010) Part 4: CPR Overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122, S676-S684.
http://dx.doi.org/10.1161/CIRCULATIONAHA.110.970913 [4] Bobrow, B.J., Clark, L.L., Ewy, G.A., Chikani, V., Sanders, A.B., et al. (2008) Minimally Interrupted Cardiac Resuscitation by Emergency Medical Services for Out-of-Hospital Cardiac Arrest. JAMA, 299, 1158-1165.
http://dx.doi.org/10.1001/jama.299.10.1158 [5] Berdowski, J., Berg, R.A., Tijssen, J.G.P. and Koster, R.W. (2010) Global Incidences of Out-of-Hospital Cardiac Arrest and Survival Rates: Systematic Review of 67 Prospective Studies. Resuscitation, 81, 1479-1487.
http://dx.doi.org/10.1016/j.resuscitation.2010.08.006 [6] Nolan, J.P., Soar, J., Zideman, D.A., Biarent, D. and Bossaert, L.L. (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive Summary. Resuscitation, 81, 1219-1276.
http://dx.doi.org/10.1016/j.resuscitation.2010.08.021 [7] Vaillancourt, C., Everson-Stewart, S., Christenson, J., Andrusiek, D., Powell, J., et al. (2011) The Impact of Increased Chest Compression Fraction on Return of Spontaneous Circulation for Out-of-Hospital Cardiac Arrest Patients Not in Ventricular Fibrillation. Resuscitation, 82, 1501-1507.
http://dx.doi.org/10.1016/j.resuscitation.2011.07.011 [8] Olasveengen, T.M., Wik, L., Kramer-Johansen, J., Sunde, K., Pytte, M., et al. (2007) Is CPR Quality Improving? A Retrospective Study of Out-of-Hospital Cardiac Arrest. Resuscitation, 75, 260-266.
http://dx.doi.org/10.1016/j.resuscitation.2007.04.016 [9] Ewy, G.A., Zuercher, M., Hilwig, R.W., Sanders, A.B., Berg, R.A., et al. (2007) Improved Neurological Outcome with Continuous Chest Compressions Compared with 30:2 Compressions-to-Ventilations Cardiopulmonary Resuscitation in a Realistic Swine Model of Out-of-Hospital Cardiac Arrest. Circulation, 116, 2525-2530.
http://dx.doi.org/10.1161/CIRCULATIONAHA.107.711820 [10] Field, R.A., Soar, J., Davies, R.P., Akhtar, N. and Perkins, G.D. (2012) The Impact of Chest Compression Rates on Quality of Chest Compressions—A Manikin Study. Resuscitation, 83, 360-364.
http://dx.doi.org/10.1016/j.resuscitation.2011.07.012 [11] Bhanji, F., et al. (2010) Part 16: Education, Implementation, and Teams: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122, S920-S933.
http://dx.doi.org/10.1161/CIRCULATIONAHA.110.971135 [12] Meaney, P.A., et al. (2013) Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital: A Consensus Statement from the American Heart Association. Circulation, 128, 417-435.
http://dx.doi.org/10.1161/CIR.0b013e31829d8654 [13] Foo, N.-P., Chang, J.-H., Lin, H.-J. and Guo, H.-R. (2010) Rescuer Fatigue and Cardiopulmonary Resuscitation Positions: A Randomized Controlled Crossover Trial. Resuscitation, 81, 579-584.
http://dx.doi.org/10.1016/j.resuscitation.2010.02.006 [14] Fried, D.A., et al. (2011) The Prevalence of Chest Compression Leaning during In-Hospital Cardiopulmonary Resuscitation. Resuscitation, 82, 1019-1024.
http://dx.doi.org/10.1016/j.resuscitation.2011.02.032 [15] Haque, I.U., Udassi, J.P., Udassi, S., Theriaque, D.W., Shuster, J.J. and Zaritsky, A.L. (2008) Chest Compression Quality and Rescuer Fatigue with Increased Compression to Ventilation Ratio during Single Rescuer Pediatric CPR. Resuscitation, 79, 82-89.
http://dx.doi.org/10.1016/j.resuscitation.2008.04.026 [16] Berg, R.A., et al. (2010) Part 5: Adult Basic Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122, S685-S705.
http://dx.doi.org/10.1161/CIRCULATIONAHA.110.970939 [17] Neumar, R.W., et al. (2010) Part 8: Adult Advanced Cardiovascular Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122, S729-S767.
http://dx.doi.org/10.1161/CIRCULATIONAHA.110.970988 [18] Koster, R.W., et al. (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult Basic Life Support and Use of Automated External Defibrillators. Resuscitation, 81, 1277-1292.
http://dx.doi.org/10.1016/j.resuscitation.2010.08.009 [19] Deakin, C.D., et al. (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult Advanced Life Support. Resuscitation, 81, 1305-1352.
http://dx.doi.org/10.1016/j.resuscitation.2010.08.017 [20] Deakin, C.D., et al. (2010) Part 8: Advanced Life Support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation, 81, e93-e174.
http://dx.doi.org/10.1016/j.resuscitation.2010.08.027 [21] Kampmeier, T.G., et al. (2014) Chest Compression Depth after Change in CPR Guidelines-Improved but Not Sufficient. Resuscitation, 85, 503-508.
http://dx.doi.org/10.1016/j.resuscitation.2013.12.030 [22] Olasveengen, T.M., Wik, L. and Steen, P.A. (2008) Quality of Cardiopulmonary Resuscitation before and during Transport in Out-of-Hospital Cardiac Arrest. Resuscitation, 76, 185-190.
http://dx.doi.org/10.1016/j.resuscitation.2007.07.001 [23] Bakalos, G., et al. (2011) Advanced Life Support versus Basic Life Support in the Pre-Hospital Setting: A Meta-Analysis. Resuscitation, 82, 1130-1137.
http://dx.doi.org/10.1016/j.resuscitation.2011.04.006 [24] Sanghavi, P., Jena, A.B., Newhouse, J.P. and Zaslavsky, A.M. (2015) Outcomes after Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support. JAMA Internal Medicine, 175, 196-204.
http://dx.doi.org/10.1001/jamainternmed.2014.5420 [25] Wang, H.E., Simeone, S.J., Weaver, M.D. and Callaway, C.W. (2009) Interruptions in Cardiopulmonary Resuscitation from Paramedic Endotracheal Intubation. Annals of Emergency Medicine, 54, 645-652.
http://dx.doi.org/10.1016/j.annemergmed.2009.05.024 [26] Stecher, F.S., Olsen, J.A., Stickney, R.E. and Wik, L. (2008) Transthoracic Impedance Used to Evaluate Performance of Cardiopulmonary Resuscitation during Out of Hospital Cardiac Arrest. Resuscitation, 79, 432-437.
http://dx.doi.org/10.1016/j.resuscitation.2008.08.007 [27] Alonso, E., et al. (2015) Reliability and Accuracy of the Thoracic Impedance Signal for Measuring Cardiopulmonary Resuscitation Quality Metrics. Resuscitation, 88, 28-34. [28] Lim, S.H., et al. (2010) Part 7: CPR Techniques and Devices: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation, 81, e86-92.
http://dx.doi.org/10.1016/j.resuscitation.2010.08.026 [29] Nichol, G., et al. (2008) Regional Variation in Out-of-Hospital Cardiac Arrest Incidence and Outcome FREE. JAMA, 300, 1423-1431.
http://dx.doi.org/10.1001/jama.300.12.1423 [30] Brouwer, T., Walker, R., Koster, R. and Chapman, F. (2013) Association between Potentially Avoidable Pauses in Chest Compressions and Survival from Out-of-Hospital Cardiac Arrest. Resuscitation, 84, S3.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.024 [31] Aufderheide, T.P. and Lurie, K.G. (2004) Death by Hyperventilation: A Common and Life-Threatening Problem during Cardiopulmonary Resuscitation. Critical Care Medicine, 32, S345-S351.
http://dx.doi.org/10.1097/01.CCM.0000134335.46859.09 [32] Wik, L., et al. (2005) Quality of Cardiopulmonary Resuscitation during Out-of-Hospital Cardiac Arrest. JAMA, 293, 299-304.
http://dx.doi.org/10.1001/jama.293.3.299 [33] Dyson, K., Bray, J., Smith, K., Bernard, S., Straney, L. and Finn, J. (2015) Paramedic Exposure to Out-of-Hospital Cardiac Arrest Is Rare and Declining in Victoria, Australia. Resuscitation, 89, 93-98.
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