Feedback systems for the quality of chest compressions during cardiopulmonary resuscitation

167 p.Se define la parada cardiorrespiratoria como la detención súbita de la actividad mecánica del corazón, confirmada por la ausencia de signos de circulación. En caso de parada cardiorrespiratoria, dos actuaciones son clave para la supervivencia del paciente: la reanimación cardiopulmonar (RCP) precoz, y la desfibrilación precoz. La RCP consiste en proporcionar compresiones torácicas y ventilaciones al paciente para mantener un mínimo flujo de sangre oxigenada a los órganos vitales. La calidad de las compresiones está relacionada con la supervivencia del paciente. Por esta razón las guías de resucitación recomiendan el uso de sistemas de feedback que monitorizan la calidad de la RCP en tiempo real. Estos dispositivos se sitúan generalmente entre el pecho del paciente y las manos del rescatador, y guían al rescatador para ayudarle a alcanzar la profundidad y frecuencia de compresión objetivo. Esta tesis explora nuevas alternativas para monitorizar la calidad de las compresiones durante la RCP. Se han seguido dos estrategias: usar la señal de impedancia transtorácica (ITT), que es adquirida por los desfibriladores actuales a través de los parches de desfibrilación, y usar la aceleración del pecho, que podría ser registrada usando un dispositivo adicional

Development of an Objective Measurement System for Quality Assessment of Chest Compressions during CPR

Out-of-hospital cardiac arrest is the third leading cause of death in Europe, with an associated survival rate of only 8%. A rapid and effective intervention of the community with the application of the Basic Life Support (BLS) algorithm and the execution of Cardiopulmonary Resuscitation (CPR), emphasizing chest compressions, can double chances of victim survival. Being CPR of critical impact on victim survival and extremely accessible to all the community, it is important and necessary to guarantee the quality of BLS education, optimizing CPR skills acquisition and knowledge retention. In this context, the use of devices to support CPR training trough real-time feedback are considered by international guidelines an important tool for BLS education as they allow training monitorization and show improvement on CPR training performance and skills acquisition. Based on this educational need, this project presents several approaches, from electronic sensors to exploratory optical fiber technology, for the development of a low-cost feedback device for CPR training, focused on assessing chest compression quality, in order to facilitate a more objective and regular training, potentiating a more effective knowledge acquisition and retention. From all the technologies tested, the selected approaches for prototype development showed great response and robustness to chest compressions during CPR training, providing accurate assessment of specific parameters of chest compressions, according to current international guidelines. Thus, it is expected that the proposed solution could provide an alternative or a complementary tool for CPR skills acquisition and maintenance on BLS education. As future work, it is recommended the inclusion of ventilation related measurements and further development envisioning educational validation.A paragem cardíaca em contexto pré-hospitalar constitui a terceira causa de morte a nível europeu, com uma taxa de sobrevivência associada de apenas 8%. A intervenção rápida e eficaz da comunidade com a aplicação do algoritmo de Suporte Básico de Vida (SBV) e a execução da manobra de Ressuscitação Cardiopulmonar (RCP), com especial ênfase nas compressões torácicas, pode chegar a duplicar a probabilidade de sobrevivência das vítimas. Tendo esta manobra um impacto crucial na sobrevivência, e sendo extremamente acessível e exequível por qualquer membro da comunidade, é essencial e necessário garantir a qualidade da educação em SBV, otimizando a aquisição e retenção de competências de RCP. Neste contexto, o uso de dispositivos que apoiam o treino da manobra de RCP através de feedback em tempo real são considerados pelas diretrizes internacionais ferramentas importantes na educação em SBV, dado que permitem a monitorização do treino e mostram melhorias na performance da manobra e na aquisição de competências. Tendo por base esta necessidade educacional, este projeto apresenta várias abordagens (desde o uso de sensores eletrónicos à exploração do usa da fibra ótica enquanto sensor) para o desenvolvimento de um dispositivo de feedback de custo controlado, com foco na qualidade das compressões torácicas, de maneira a facilitar um treino mais objetivo e regular, que potencie a aquisição e retenção destas competências. De todas as abordagens testadas, a usada no desenvolvimento do protótipo de treino mostrou uma resposta muito adequada e robusta às compressões efetuadas durante o treino de RCP, fornecendo uma leitura e avaliação precisas de parâmetros específicos das compressões torácicas, de acordo com as atuais diretrizes internacionais. Posto isto, espera-se que a solução proposta providencie uma alternativa ou uma ferramenta complementar na aquisição e manutenção das competências de RCP na educação em SBV. Como trabalho futuro, recomenda-se a inclusão dos parâmetros de treino de RCP relacionados com a ventilação e desenvolvimento de estudos de validação educacional

Do automated real-time feedback devices improve CPR quality? A systematic review of literature.

Aim: Automated real-time feedback devices have been considered a potential tool to improve the quality of cardiopulmonary resuscitation (CPR). Despite previous studies supporting the usefulness of such devices during training, others have conflicting conclusions regarding its efficacy during real-life CPR. This systematic review aimed to assess the effectiveness of automated real-time feedback devices for improving CPR performance during training, simulation and real-life resuscitation attempts in the adult and paediatric population. Methods: Articles published between January 2010 and November 2020 were searched from BVS, Cinahl, Cochrane, PubMed and Web of Science, and reviewed according to a pre-defined set of eligibility criteria which included healthcare providers and randomised controlled trial studies. CPR quality was assessed based on guideline compliance for chest compression rate, chest compression depth and residual leaning. Results: The selection strategy led to 19 eligible studies, 16 in training/simulation and three in real-life CPR. Feedback devices during training and/or simulation resulted in improved acquisition of skills and enhanced performance in 15 studies. One study resulted in no significant improvement. During real resuscitation attempts, three studies demonstrated significant improvement with the use of feedback devices in comparison with standard CPR (without feedback device). Conclusion: The use of automated real-time feedback devices enhances skill acquisition and CPR performance during training of healthcare professionals. Further research is needed to better understand the role of feedback devices in clinical setting

A Study to Assess the Effectiveness of Cardiopulmonary Resuscitation Demonstration on Knowledge, Attitude and Practice among Relatives of Cardiac Patients in GKNM Hospital, Coimbatore

A quasi experimental study was conducted to “Assess the Effectiveness of Cardiopulmonary Resuscitation Demonstration on Knowledge, Attitude and Practice among Relatives of Cardiac Patients in GKNM Hospital, Coimbatore”. OBJECTIVES: 1. To assess the level of knowledge, attitude and practice regarding cardiopulmonary resuscitation among relatives of cardiac patients. 2. To assess the effectiveness of CPR demonstration among relatives of cardiac patients. 3. To determine the association between knowledge, attitude and practice score to selected demographic variables. Research design: Quasi pre experimental one group pretest posttest design. Setting: GKD auditorium of G. Kuppuswamy Naidu Memorial Hospital, Coimbatore. Samples: 30 subjects were selected who fulfilled the criteria. Conceptual framework: Ludwig Bertalanffy’s General System Theory was adopted. METHOD: Semi structured interview questionnaire was used to asses knowledge, attitude scale to assess attitude and checklist was used to assess practice during the pretest. Cardiopulmonary resuscitation demonstration was conducted followed by the post test. Outcomes were evaluated by descriptive and inferential statistics. RESULTS: The mean difference of knowledge was 9.73, with combined SD of 5.51 and ‘t’ value of 15.35. Paired ‘t’ test showed that there was a significant difference in pretest and posttest level of knowledge at 0.05 level. The calculated attitude ‘t’ value (5.56) was higher than table value. The calculated practice ‘t’ value (85.57) was higher than table value. The study concluded that there was a significant difference in pretest and posttest levels of knowledge, attitude and practice levels. CONCLUSION: Demonstration of cardiopulmonary resuscitation was effective in improving knowledge, attitude and practice of cardiopulmonary resuscitation among relatives of cardiac patients

Role of Adaptive Team Coordination during Cardiopulmonary Resuscitation

Plus de 200 000 patients en Amérique du Nord subissent un arrêt cardiaque à l’hôpital chaque année, mais moins de 25 % des patients survivent jusqu’à leur congé de l’hôpital. Lorsque le coeur aux battements arythmiques d’un patient ne parvient pas à faire circuler efficacement le sang, une équipe de secouristes procèdent à des interventions vitales définies en fonction d’algorithmes de réanimation cardiorespiratoire (RCR). Depuis l’adoption des lignes directrices de l’American Heart Association (AHA) il y a plus de 30 ans, les travaux de recherche ont principalement porté sur l’amélioration des taux de survie grâce à l’efficacité des tâches techniques de RCR. Au cours de la dernière décennie, une plus grande importance a été accordée aux facteurs associés à la performance d’équipe. Outre les facteurs propres au patient, les chances de survie dépendent du délai de traitement et de la qualité de la RCR que vient compliquer l’interaction de multiples intervenants qui tentent d’orchestrer des mesures de secours concurrentes. Ainsi, la coordination et le travail d’équipe inefficaces font partir des plus grands obstacles à une réanimation réussie en équipe. Dans le cadre de la présente thèse, la relation entre les différents mécanismes de coordination et le résultat technique de la RCR, mesurée en temps passif dans deux contextes de recherche empirique de réanimation simulée, a été mise à l’essai. Les résultats laissent croire que si l’action explicite constitue la caractéristique déterminante des mécanismes de coordination utilisés en réanimation cardiaque en équipe, les équipes qui performent le mieux coordonnent leurs activités de manière différente de celles qui performent le moins bien, et qu’il existe un lien important entre les tendances en matière de mécanismes de coordination et la réussite de la RCR, qui change en fonction des exigences de la tâche. Ces résultats combinés permettent d’établir un cadre de coordination proposé pour les soins de réanimation actifs et de proposer des aspects pratiques pour la formation en RCR et une contribution méthodologique aux futurs travaux de recherche.In-hospital cardiac arrest affects over 200,000 patients in North America each year, but less than 25% of patients survive to hospital discharge. When a patient’s arrhythmic heart is unable to effectively circulate blood, a team of rescuers provide lifesaving interventions according to Cardiopulmonary Resuscitation (CPR) rescue algorithms. Since the inception of the American Heart Association (AHA) CPR guidelines over 30 years ago, research pursuits to improve survival rates have primarily focused on the technical tasks such as CPR technique. Over the past decade, there has been increased focus on team performance related to treatment delays and CPR quality, touting ineffective coordination and teamwork as some of the largest obstacles to successful team resuscitation. The objective of this work was to validate a proposed framework outlining the relationship among explicit and implicit coordination mechanisms required for successful CPR performance: minimal interruptions (hands-off ratio), rapid initiation of chest compressions and defibrillation. The framework was tested in two independent studies of simulated adult and pediatric resuscitation of in-hospital cardiac arrest. The results showed that while team performance improved over time, the main Explicit and Implicit coordination type patterns were stable. Instead, small shifts occurred within the Information and Action coordination sub-types. Explicit coordination was dominant throughout all resuscitation scenarios, but only Implicit coordination was associated with better hands-off ratio performance. In both studies, higher performing teams coordinated differently than lower performing teams and there was a significant relationship between the patterns of coordination mechanisms and CPR performance. The combined results are used to refine a proposed coordination framework for acute resuscitation care and propose practical implications for CPR training and methodological contribution for future research

I'm Fine: Systemic Affect of Critical Incidents in Emergency Medical Service Personnel Communication

Indiana University-Purdue University Indianapolis (IUPUI)EMS personnel experience emotionally charged calls, such as CPR, trauma, or domestic violence. This study examined the changes on communication by these events. Communication Complex metaframework allowed use of other disciplines. There is a lack of scholarship surrounding EMS communication. Research from other military and other fields was translated into the EMS community. Mental illness is a growing concern in EMS as 37% contemplate suicide and 6% complete it. Part of understanding the affect is an exploration of how the culture of EMS (i.e. training, traditions, machismo) shapes the way new EMS are acculturated. EMS have repeated exposure to trauma over a career. These exposures change communication patterns. Using a three-chapter autoethnography, I was able to examine my communication and mental status changes from rookie until retiring 14 years later with PTSD and constant suicidal ideation. Ethnographic interviews of veteran EMS provided insight into the old school ideology of emotional repression and shelving. I analyzed using the NREMT Patient Assessment skill sheet as a guide in a three-step process to discover and reassess themes. The primary survey indicated common job-related stressors- pedi calls and staffing problems. The secondary survey revealed themes of emotions, senses, and support. Finally, the reassessment revealed subtle changes in EMS culture, including decreased PTSD stigma, increased resiliency training, and increased administrative support. Future research could examine the effect of spousal support and changes in cultural emotional suppression. The goal is to develop programs to help allies understand the emotionality in EMS and create dedicated support structures to increase EMS mental health

Pre-hospital trauma care: training and preparedness of, and practices by, medical general practitioners in Limpopo Province.

M.Fam.Med., Faculty of Health Sciences, University of the Witwatersrand, 2009Trauma is a pandemic that has a significant negative impact on the lives of its victims and national economies. This descriptive study was conducted on 103 private medical general practitioners in Limpopo Province. Ethical approval for the study was obtained from the University of the Witwatersrand Committee for research on Human Subjects (Medical). Approval protocol number M050230. The aim of the study was to determine the state of pre-hospital trauma care: training and preparedness of and practice by private medical general practitioners (GPs) in Limpopo Province. Data was collected by means of an anonymous, confidential, self-administered questionnaire. The objectives were to determine demographic features of the respondents; determine the status of emergency pre-hospital trauma training, preparedness and practice amongst the respondents; and to determine their incentives and disincentives to trauma medicine training, preparedness and practice in Limpopo province. The response rate was 36%. Fifty five per cent (55%) of the respondents had received trauma training since they commenced work as GPs. The proportion of GPs who said that they received trauma training while working in hospitals casualty departments was 52%. The number of respondents who completed ATLS was 24 (23%). Five (21%) of those who had completed ATLS updated their qualifications during years 2001 to 2005. Of the GPs surveyed 46% were not aware of ATLS course offered by the College of Emergency Care at Polokwane City. The majority of the respondents graduated as medical practitioners from the university of Pretoria (38%) and MEDUNSA (31%). But undergoing trauma management training was not associated with the medical schools from which 4 respondents graduated as medical practitioners (p=0.767; Fisher’s exact=0.827; Pearson chi2 = 4.9075). The medical schools from which respondents graduated as medical practitioners was also not related to the amount of private medical practice that comprised emergency care (p= 0.372). Undergoing trauma training was not associated with the age of a GP (p value= 0.120; Fisher exact=0.127). Sex was not found to be associated with trauma training (p=0.895; Fisher exact=1.000). Sex also had no link to the proportion of medical practice comprising emergency care (p-value=0.153; Fisher ‘s exact=0.214; Pearson Chi2). Even though location of GP’s practice was reported to be both an incentive and disincentive to trauma management training it was found not to be associated with trauma management training (p=0.393; Fisher exact=0.426; Pearson chi2 =1.5687) There was no association between location of GP’s practice and preparedness for trauma management. The exception to the finding was in terms of availability of chest drains where the p-value was 0.001. It was found that 31% of respondents who indicated that they had chest drains were based in rural areas while about 6% were practicing in urban areas. Availability of morphine and other analgesics (p-value=0.025, Fisher’s exact=0.038, Pearson Chi2 (1)=5.0165) were associated with preparedness for trauma. There was no association between type of GP practice and trauma management training (Pearson Chi2 (2) =2.1242. p- value = 0.346. Fisher’s exact = 0.429). Almost 95% of those who stated that they spent at least 50% of their time in private general medical practice were full-time. Being in full-time private general medical practice did not necessarily translate into a higher proportion of the practice that comprised trauma care. It was found that 64% of the respondents who were in full-time private general medical practice had an emergency trauma care burden of less than 10% compared to 36% that had a proportion of 10% and more. Amongst part-time practitioners the percentage of those whose burden of trauma care was less than 10% was equal to that of those with 10% and more. The findings implied lack of an association between time spent in private general medical practice and proportion of the practice that constitutes trauma care (p=0.621). The commonest method of updating trauma management skills was through personal study (37% of respondents) followed by attendance of trauma meetings (24% of respondents). Trauma trained GPs tended to have a higher proportion of their practices that comprised emergency trauma care (p-value = 0.030; Fisher’s exact =0.050) than those who had not. The frequently used sources of trauma management information were personal experience (58%) of the respondents followed by continuing medical education (50% of respondents). Almost 50.8% of the respondents reported that they were fairly skilled to manage in a pre-hospital setting various types of injuries. Minor soft tissue injuries were the type of trauma that 68% of the respondents said that they could manage excellently. Incentives factors to both trauma training and practice were high trauma prevalence (33.3% of respondents-training: and 20.7% of respondents-practice); performance improvement (20% of respondents-training: 12.1% of respondents respectively-practice); adequate and managed trauma care facilities (17% of respondents-training: 10.4% of respondents-practice); trauma care support (6.7% of respondents-training: 6.9% of respondents-practice); the need to improve trauma knowledge and skills (17% of respondents-training: 17.2% of respondents-practice) and; strategic GP practice location (7% of respondents-training: 6.9% of respondents-practice). Major disincentives to both trauma training and practice were lack of time for trauma care (28.9% respondents-training: 14.9% respondents practice); unsupportive staff (10% respondents-training: 14.9% respondents-practice); perceived high cost of trauma care and poor rewards (15.6% respondents-training: 11.7% respondents-practice); substandard and inaccessible trauma care facilities (15.6% respondents-training: 24.5% respondents-practice); under-utilized trauma knowledge and skills (6.7% respondents-training: 4.3% respondents-practice); 6 restrictive healthcare regulations and policies (2.2% respondents-training: 2% respondents-practice); and low number of trauma patients seen (11.1% respondents-training: 3.2% respondents-practice). In terms of preparedness for trauma the respondents were ill-prepared for trauma as evidenced by insufficient trauma equipment and drugs. Whereas almost all the respondents (frequency 102 or 99%) had stethoscopes only 7% had cricothyrotomy set. Only 18% of them had needle with one-way valve and chest drains. The trauma drug that appeared to have been the most widely stocked was adrenaline with a frequency of 96 or 93%. It was followed by aspirin with a frequency of 95 or 92%. Ketamine and zidovudine were drugs that were least stocked by the respondents. Their frequencies were 27 or 26%) and 33 or 32% respectively. The other equipment that was infrequently available at GPs’ rooms was goggles (frequency 46%) suggesting poor adherence to safety measures. There were low levels of preparedness to manage trauma patients independently with 43% reporting that they could independently adhere to universal safety measures. Whereas 52% of the respondents stated that they had received training in CPR 54.5% stated that they were equipped and prepared to open and protect the airway; 43% could independently provide adequate breathing while 45% of them could restore and maintain sufficient circulation, indicating a need to improve levels of CPR training. It was recommended that more general practitioners in Limpopo province should be trained and involved in trauma care. It was further recommended that awareness should be raised about the ATLS offered at the College of Emergency Care in Polokwane City. Further research is needed to explore how trauma trained GPs could be better equipped, prepared and supported in the management of trauma. There was also a need to address the disincentive factors to trauma training, preparedness and practice while strengthening the incentives. Given the critical shortage of advanced emergency practitioners (such as paramedics) in Limpopo province, there was perhaps a need to consider how GPs, with their 7 advanced medical qualifications and strategic positioning within communities, could be better deployed in pre-hospital trauma care

Developing a labour and birth orientation program

Purpose and Background: The purpose of this practicum was to re-develop the labour and birth orientation program at the Queen Elizabeth Hospital in Charlottetown, PE. The need for this practicum was identified following a substantial staff turnover. This potentiated a need for orientation of a number of registered nurses to labour and birth. During orientation, presentation of program content consisted of two days of traditional classroom style teaching followed by a six-week preceptorship, where the majority of labour and birth knowledge and content would be acquired during this time and facilitated by the preceptor. This led to inconsistencies in information provided to new learners. Evaluation was determined by a written exam and preceptor feedback; inconsistencies were noted by unit leaders and preceptors with these methods of evaluation. Methods: A literature review was undertaken to explore the theoretical underpinnings for the program, Kolb’s Experiential Learning theory, and to explore the literature on the benefits and orientations programs. Also, a consultation plan and report was conducted, which provided a theoretical and evidence-based framework program development. Conclusion: The final program describes methods by which labour and birth content is presented to orientees, and includes 16 learning modules; 15 of which were developed. Additionally, the formal orientation process, method for evaluation of the orientee, and methods for remediation for individuals who are having difficulties with the orientation process are described throughout the program