Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality improvement

The most popular method of training in basic life support and AED remains instructor-led training courses. Recent reviews provide good evidence to support alternative methods of training including lay instructors, self-directed learning (web, video, poster) and CPR feedback/prompt devices

Cardiovascular function and neurologic outcome after cardiac arrest in dogs. The cardiovascular post-resuscitation syndrome

We studied cardiovascular changes and neurologic outcome at 72 h in 42 healthy dogs after normothermic ventricular fibrillation cardiac arrest (no blood flow) of 7.5, 10, or 12.5 min duration, reversed by standard external cardiopulmonary resuscitation (CPR) (≤ 10 min) and followed by controlled ventilation to 20 h and intensive care to 72 h. We found no difference in resuscitability, mortality, neurologic deficit scores, or overall performance categories between the three insult groups. There was no major pulmonary dysfunction. During controlled normotension post-CPR, all dogs presented a transient reduction in cardiac output. In the 12.5-min cardiac arrest group the decrease in cardiac output persisted beyond 12 h post-CPR (P < 0.01) and was associated with more severe arrhythmias (P < 0.05) and worse morphologic myocardial damage (P < 0.01). Both cardiac and neurologic malfunction at 72 h correlated with arrest time. Only cardiac malfunction correlated with CPR time. Neurologic recovery correlated with mild (inadvertent) pre-arrest hypothermia, diastolic arterial pressure during CPR and absence of cardiovascular impairment at 12 h post-CPR. We conclude that prolonged cardiac arrest in previously healthy dogs is followed by persistent cardiovascular derangements that correlate with impaired neurologic recovery

Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality training: A randomised crossover mannequin pilot study

Outcome after cardiac arrest is dependent on the quality of chest compressions (CC). A great number of devices have been developed to provide guidance during CPR. The present study evaluates a new CPR feedback system (Mini-VREM: Mini-Virtual Reality Enhanced Mannequin) designed to improve CC during training. Methods: Mini-VREM system consists of a Kinect® (Microsoft, Redmond, WA, USA) motion sensing device and specifically developed software to provide audio-visual feedback. Mini-VREM was connected to a commercially available mannequin (Laerdal Medical, Stavanger, Norway). Eighty trainees (healthcare professionals and lay people) volunteered in this randomised crossover pilot study. All subjects performed a 2min CC trial, 1h pause and a second 2min CC trial. The first group (FB/NFB, n=40) performed CC with Mini-VREM feedback (FB) followed by CC without feedback (NFB). The second group (NFB/FB, n=40) performed vice versa. Primary endpoints: adequate compression (compression rate between 100 and 120min-1 and compression depth between 50 and 60mm); compressions rate within 100-120min-1; compressions depth within 50-60mm. Results: When compared to the performance without feedback, with Mini-VREM feedback compressions were more adequate (FB 35.78% vs. NFB 7.27%, p< 0.001) and more compressions achieved target rate (FB 72.04% vs. 31.42%, p< 0.001) and target depth (FB 47.34% vs. 24.87%, p= 0.002). The participants perceived the system to be easy to use with effective feedback. Conclusions: The Mini-VREM system was able to improve significantly the CC performance by healthcare professionals and by lay people in a simulated CA scenario, in terms of compression rate and dept

Kids (learn how to) save lives in the school with the serious game Relive

Introduction Relive is a serious game focusing on increasing kids and young adults’ awareness on CPR. We evaluated the use of Relive on schoolchildren. Methods A longitudinal, prospective study was carried out in two high schools in Italy over a 8-month period, divided in three phases: baseline, competition, and retention. Improvement in schoolchildren's CPR awareness, in terms of knowledge (MCQ results) and skills (chest compression (CC) rate and depth), was evaluated. Usability of Relive and differences in CC performance according to sex and BMI class were also evaluated. Results At baseline, students performed CC with a mean depth of 31 mm and a rate of 95 cpm. In the competition phase, students performed CC with a mean depth of 46 mm and a rate of 111 cpm. In the retention phase, students performed CC with a mean depth of 47 mm and a rate of 131 cpm. Thus, the training session with Relive during the competition phase affected positively both CC depth (p < 0.001) and rate (p < 0.001). Such an effect persisted up to the retention phase. CC depth was also affected by gender (p < 0.01) and BMI class (p < 0.01). Indeed, CC depth was significantly greater in male players and in players with higher BMI. Seventy-three percent of students improved their CPR knowledge as represented by an increases in the MCQ score (p < 0.001). The participants perceived the Relive to be easy to use with effective feedback. Conclusions Relive is an useful tool to spread CPR knowledge and improve CPR skills in schoolchildren

Relive: A serious game to learn how to save lives

A recent review has provided evidence in support of new and alternative methods for CPR training.1 Among these, are the “serious games”, which are applications developed using computer game technologies more often associated with entertainment, but characterized by a serious purpose. Indeed, during the last decade, many serious games have been developed and used successfully in the field of health, including training of both technical and non-technical skills relevant to the surgical area.2 The Italian Resuscitation Council (IRC) has implemented a serious game for the Viva! Campaign 20133 called Viva! Game (http://www.viva2013.it/viva-game)

Advanced life support provider course in Italy: A 5-year nationwide study to identify the determinants of course success

INTRODUCTION: The advanced life support (ALS) provider course is the gold standard for teaching and assessing competence in advanced resuscitation. Outcomes over a 5-year period of European Resuscitation (ERC)/IRC ALS provider courses in Italy were investigated, and the factors associated with course success are described. METHODS: In 2008, the Italian Resuscitation Council (IRC) created a database in which every ERC/IRC ALS course was recorded. Data from courses organized from 2008 to 2012 were analysed. The data included: candidate's age and degree (medical doctor (MD) or nurse), medical specialty of MD candidates, course outcomes, duration and reference guidelines, number of instructors and course director. Relationships between the course outcomes and the courses and candidates' characteristics were analysed using logistic regression. RESULTS: A total of 13,624 candidates were evaluated from 871 courses. Among the candidates, 55% were MDs and 45% were nurses. Ninety-seven percent of candidates passed the final evaluation, while 3% failed. Candidates who passed were younger (37 [31-44] vs. 43 [37-50] years, p&lt;0.0001) and had a greater pre-course resuscitation knowledge (multiple choice quiz (MCQ) score: 88 [83-93] vs. 80 [73-87], p&lt;0.0001) compared to those who failed. The course pass rate was higher for MDs compared to nurses (98% vs. 95%, p&lt;0.0001) and participants in emergency disciplines were most significantly associated with course success (chi(2) 71, p&lt;0.0001). In the multivariate analysis, an older age (OR 0.926, 95%CI [0.915-0.937]) was independently associated with course failure, while being a MD (OR 3.021, 95%CI [2.212-4.132]), having a higher pre-course MCQ score (OR 1.033, 95%CI [1.026-1.040]) together with a higher candidate/instructor ratio (OR 1.314, 95%CI [1.067-1.618]), and having a longer course duration (OR 1.717, 95%CI [1.090-2.703]), were independently associated with success. CONCLUSIONS: Younger age, professional background, and pre-course resuscitation knowledge are the most important predictors of ALS provider course success, together with higher candidate/instructor ratios and longer course durations

"Identifying the hospitalised patient in crisis"-A consensus conference on the afferent limb of Rapid Response Systems

Background: Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patient deterioration or a clear description of what constitutes patient monitoring. Methods: A consensus conference of international experts in safety, RRS, healthcare technology, education, and risk prediction was convened to review current knowledge and opinion on clinical monitoring. Using established consensus procedures, four topic areas were addressed: (1) To what extent do physiologic abnormalities predict risk for patient deterioration? (2) Do workload changes and their potential stresses on the healthcare environment increase patient risk in a predictable manner? (3) What are the characteristics of an "ideal" monitoring system, and to what extent does currently available technology meet this need? and (4) How can monitoring be categorized to facilitate comparing systems? The major findings include: (1) vital sign aberrations predict risk, (2) monitoring patients more effectively may improve outcome, although some risk is random, (3) the workload implications of monitoring on the clinical workforce have not been explored, but are amenable to study and should be investigated, (4) the characteristics of an ideal monitoring system are identifiable, and it is possible to categorize monitoring modalities. It may also be possible to describe monitoring levels, and a system is proposed. (C) 2010 Elsevier Ireland Ltd. All rights reserved