Are chest compression depths measured by the Resusci Anne SkillReporter and CPRmeter the same?

Objective. We investigated whether data collected using the Resusci Anne SkillReporter were comparable with those collected using the CPRmeter (cardiopulmonary resuscitation meter -an accelerometer feedback device used to provide high-quality chest compressions). Materials and Methods. Fifty continuous chest compressions were performed using a Resusci Anne SkillReporter and a CPRmeter under two conditions (Experiment 1: complete chest wall recoil; Experiment 2: incomplete chest wall recoil). The conditions were defined according to visual feedback signals provided by the CPRmeter. A single healthcare worker performed 20 repetitions under each experimental condition alternately. Chest compression data were collected and analyzed using the Laerdal PC SkillReporting System and QCPR Review software. Results. The mean difference in chest compression depth between the Resusci Anne SkillReporter and CPRmeter was 6.7 ± 1.2 mm in Experiment 1 (95% CI: 6.1~7.3) and was significantly higher in Experiment 2 (17.3 ± 1.9 mm; 95% CI: 16.4~18.2; p < 0.001). Conclusions. The chest compression depth measured by the Resusci Anne SkillReporter was significantly different from that of the CPRmeter. Cardiopulmonary resuscitation instructors, trainees, and researchers should be aware of this difference to ensure the most accurate interpretation of their training or experimental results

A Study on the Expansion of the Audiences’ Aesthetic Experience by Applying the Punctum in Interactive Installations

This study suggests ways to expand aesthetic experience through Roland Barthes’ concept the punctum found while creating the interactive artwork deBallution based on the audiences’ throwing activities. Roland Barthes defined the punctum in his book Camera Lucida as applying not a studium or thematic element but the elements of personal experience and memory to an aesthetic element in the photograph. This study develops a methodology for applying the punctum to interactive artwork based on the five symbolic elements of the punctum mentioned by Roland Barthes: String, Speck, Cut, Little hole, and Cast of the dice. It also confirms whether audiences actually experienced the five elements of the punctum and the studium through user testing conducted after making a new test version of the interactive artwork deBallution: Randomized Trip

Major diferences between conventional and compression-only cardiopulmonary resuscitation

Dear Editor, I read the article by Skulec et al. “Rescuer fatigue does not correlate to energy expenditure during simulated basic life support,” with great interest. (1) Although conventional cardiopulmonary resuscitation (CCPR) has been considered a standard CPR method since 1960, compressiononly CPR (COCPR) has emerged as an alternative method to CCPR because of some evidence favoring COCPR. (2,3) Terefore, numerous studies have attempted to determine whether COCPR could indeed improve the quality of CPR. A systematic review of these studies confrmed several obvious diferences. (4) First, CCPR may provide greater chest compression depth (CCD) and maintain adequate CCD for a longer period than COCPR. Second, COCPR may result in greater rescuer fatigue than CCPR. Tird, COCPR may guarantee a higher number of total compressions and higher chest compression fraction (CCF). Te result presented by Skulec et al. is surprising because it is contrary to the current evidence. Is it true that the energy expenditure of CCPR is higher than that of COCPR? I partially agree with their conclusion. However, there are some important issues that need to be addressed to accurately interpret the study results. Te researchers limited the ventilation phase to 5 seconds. Recently, I conducted a similar study comparing CCPR and COCPR. In my experience, the average compression time per CPR cycle was 15.6 ± 1.8 s, and the average ventilation time per cycle was 9.4 ± 1.7 s during the 10-minCCPR trials conducted by the CPR team member (medical doctor) of our hospital (n = 20, unpublished data). Te CCF of the CCPR group was calculated as 63.7% and that of the COCPR group was 99.2%. Clinical data also showed that the median interruption time for 2 ventilations was 7 seconds and longer pauses for ventilations were not associated with a worse outcome. (5) Limiting the ventilation phase to 5 seconds could theoretically increase the CCF over 75%. Considering that even highly experienced rescuers could maintain a CCF as high as 63.7%, limiting the ventilation phase to 5 seconds might stress the novice rescuers (medical students), which may affect the energy expenditure of the CCPR group. As expected, the ventilation phase can serve as a resting period during CCPR. In my experience, the rescuer’s heart rate decreases rapidly afer the chest compression phase and reaches the baseline level afer the ventilation phase. Te CCPR group’s heart rates exhibited a sine wave pattern. Tis fnding indicates how the ventilation phase plays a role during CCPR. Limiting the ventilation phase to 5 seconds might result in an incomplete alleviation of the rescuer’s workload. In addition, the researchers provided continuous feedback to the study participants throughout the experiments. Although this feedback might be reproduced by dispatcher-assisted CPR as indicated by the authors, it was unrealistic considering the varied environment of out-of-hospital cardiac arrests. If the researcher wanted to compare the energy expenditure between CCPR and COCPR, other interventions, which could afect the CPR quality or energy expenditure, should not be used. Although there were some concerns, this study could shed new light on comparing CCPR and COCPR. Further study should be warranted to confrm whether the energy expenditure of CCPR is indeed highe

Why should we switch chest compression providers every 2 minutes during cardiopulmonary resuscitation?

Objective. Tis study was conducted to determine whether trained male rescuers could maintain adequate chest compression depth (CCD) for longer than the current recommended guidelines of 2 minutes. Methods. Forty male medical doctors administered a 5-minute single rescuer cardiopulmonary resuscitation (CPR) to a manikin on the foor with conventional CPR or randomly administered continuous chest compressions (CCC). Te ratio of compression to ventilation was set to 30:2 with mouth-to-mouth technique during conventional CPR. Chest compression data were recorded with an accelerometer device and divided into 1-minute segments for analysis. Results. Although average CCD maintained the recommended depths throughout 5 minutes in conventional CPR, it decreased signifcantly with CCC (1 minute: 55.4 ± 4.5 mm; 2 minutes: 54.2 ± 5.4 mm; 3 minutes: 52.6 ± 5.6 mm; 4 minutes: 51.6 ± 5.5 mm; 5 minutes: 49.9 ± 5.8 mm, p < 0.001). Te average chest compression numbers (ACCN) per minute were maintained over 80/min and have not been changed signifcantly within 5 minutes in the CCC. However, it didn’t reach to the 80/min and decreased signifcantly afer 3minutes compared to the baseline ACCN during frst 1-minute segment in the conventional CPR. Conclusions. Despite the chest compression providers being limited to trained male medical doctors, the average CCD decreased signifcantly within 5minutes with CCC. Although maintaining adequate CCD, ACCN in each minute decreased signifcantly afer 3minutes in the conventional CPR. Terefore, we should rotate chest compression providers every 2minutes regardless of the rescuer’s qualifcations and CPR methods

Effects of bed height on the performance of endotracheal intubation and bag mask ventilation

Objectives. This study was performed to evaluate whether different bed heights affect the performance of airway procedures. Methods. Thirty three medical doctors performed endotracheal intubation (EI) and bag mask ventilation (BMV) using three different bed heights; knee height, mid-thigh height, and anterior superior iliac spine (ASIS) height. For EI, performance was assessed based on intubation time, intubation success, and damage to teeth. For BMV, performance was assessed based on tidal volume, ventilation rate, peak pressure, minute ventilation, and airway opening. In addition, three numeric rating scales (NRS; 1 to 10) were used to assess the level of difficulty for each procedure and the doctors’ self-confidence. NRS scoring was based on posture (comfortable to uncomfortable), handling (easy to hard), and visual field (good to bad). Results. No significant differences in performance were observed for EI or BMV at the three different bed heights. However, all of the NRS scores were significantly different among the different bed heights (P<0.001), and were poorest for the knee height beds: knee height (EI: posture 5.8~7.3, handling 4.3~5.7, visual field 3.9~5.5; BMV: posture 7.1~8.0, handling 5.9~7.2, 95% CI), mid-thigh height (EI: posture 2.9~4.0, handling 2.9~4.0, visual field 2.7~3.8; BMV: posture 2.4~3.2, handling 2.3~3.5) and ASIS height (EI: posture 2.2~3.5, handling 2.6~3.8, visual field 2.1~3.4; BMV: posture 2.9~4.4, handling 4.7~6.1). Conclusions. Although the participants reported that the knee height beds were the least comfortable, hardest to handle, and made seeing the vocal cord difficult, these caveats did not affect their performance during airway procedures