Conrad Arnfinn Bjørshol

Quality of chest compressions during 10 min of single-rescuer basic life support with different compression: ventilation ratios in a manikin model

INTRODUCTION Good quality basic life support (BLS) improves outcome during cardiac arrest. As fatigue may reduce BLS performance over time we wanted to examine the quality of chest compressions in a single-rescuer scenario during prolonged BLS with different compression:ventilation ratios (C:V ratios). MATERIAL AND METHODS Professional paramedics were asked to perform single-rescuer BLS with C:V ratios of 15:2, 30:2 and 50:2 for 10 min each in random order. A Laerdal Medical Resusci Anne Simulator with PC Skillreporting System was used for BLS quality analysis. Total number of chest compressions, compression depth and compression rate were measured and the differences between the C:V ratios were analysed with repeated measures ANOVA. For analysis of fatigue, chest compression variables for each 2-min period were analysed and compared with the first 2-min period using repeated measures ANOVA. RESULTS Altogether 50 paramedics completed the study. The mean number of chest compressions increased significantly from 604 to 770 and 862 with C:V ratios of 15:2, 30:2 and 50:2, respectively. Chest compression rate was significantly higher with C:V ratio of 15:2 compared to 30:2 and 50:2 but was above 100 per minute for all three ratios. However, the mean chest compression depth did not change significantly between the different C:V ratios. The number of chest compressions did not change significantly with time for any of the three C:V ratios. Compression depth did decline after the first 2-min period for 30:2 and 50:2 as did compression rate for all three ratios. However all were above the guideline limits for the entire test period. CONCLUSION Increasing the C:V ratio increases the number of chest compressions during 10 min of BLS. Compression depth and compression rate were within guideline recommendations for all three ratios. We found no decline in chest compression quality below guideline recommendations during 10 min of BLS with any of the three different C:V ratios.

Hospital employees improve basic life support skills and confidence with a personal resuscitation manikin and a 24-min video instruction

INTRODUCTION The use of a personal resuscitation manikin with video instruction is reportedly as effective as traditional instructor-led courses in teaching lay people basic life support (BLS). We applied this method to an entire hospital staff to determine its effect on their practical and self-judged BLS skills. METHODS All 5382 employees at Stavanger University Hospital were asked to learn or refresh their BLS skills with the personal resuscitation manikin and video instruction. Prior to and nine months after training, all employees were asked to rate their BLS skills on a scale from one to five. Additionally, randomly chosen study subjects were tested for BLS skills pre-training and six months post-training during 2min of resuscitation on a manikin. RESULTS In total, 5118 employees took part in the BLS training program. The number of correct chest compressions increased significantly from 60 (5-102) to 119 (75-150) in the pre- vs. post-training periods, respectively, P<0.01, but the number of correct MTM ventilations did not change. Self-reported BLS skills increased from 3.1 (+/-1.0) pre-training to 3.8 (+/-0.8) post-training, P=0.031. CONCLUSION After distributing a personal resuscitation manikin with video instruction to an entire hospital staff, the median number of correctly performed chest compressions doubled and self-confidence in BLS skills improved significantly. This is a simple and less time-consuming method than instructor-led courses in preparing hospital employees in the basic handling of cardiac arrest.

Decay in chest compression quality due to fatigue is rare during prolonged advanced life support in a manikin model

BackgroundThe aim of this study was to measure chest compression decay during simulated advanced life support (ALS) in a cardiac arrest manikin model.Methods19 paramedic teams, each consisting of three paramedics, performed ALS for 12 minutes with the same paramedic providing all chest compressions. The patient was a resuscitation manikin found in ventricular fibrillation (VF). The first shock terminated the VF and the patient remained in pulseless electrical activity (PEA) throughout the scenario. Average chest compression depth and rate was measured each minute for 12 minutes and divided into three groups based on chest compression quality; good (compression depth ≥ 40 mm, compression rate 100-120/minute for each minute of CPR), bad (initial compression depth < 40 mm, initial compression rate < 100 or > 120/minute) or decay (change from good to bad during the 12 minutes). Changes in no-flow ratio (NFR, defined as the time without chest compressions divided by the total time of the ALS scenario) over time was also measured.ResultsBased on compression depth, 5 (26%), 9 (47%) and 5 (26%) were good, bad and with decay, respectively. Only one paramedic experienced decay within the first two minutes. Based on compression rate, 6 (32%), 6 (32%) and 7 (37%) were good, bad and with decay, respectively. NFR was 22% in both the 1-3 and 4-6 minute periods, respectively, but decreased to 14% in the 7-9 minute period (P = 0.002) and to 10% in the 10-12 minute period (P < 0.001).ConclusionsIn this simulated cardiac arrest manikin study, only half of the providers achieved guideline recommended compression depth during prolonged ALS. Large inter-individual differences in chest compression quality were already present from the initiation of CPR. Chest compression decay and thereby fatigue within the first two minutes was rare.

A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams

BackgroundAlthough nurses must be able to respond quickly and effectively to cardiac arrest, numerous studies have demonstrated poor performance. Simulation is a promising learning tool for resuscitation team training but there are few studies that examine simulation for training defibrillation and cardiopulmonary resuscitation (D-CPR) in teams from the nursing education perspective. The aim of this study was to investigate the extent to which nursing student teams follow the D-CPR-algorithm in a simulated cardiac arrest, and if observing a simulated cardiac arrest scenario and participating in the post simulation debriefing would improve team performance.MethodsWe studied video-recorded simulations of D-CPR performance in 28 nursing student teams. Besides describing the overall performance of D-CPR, we compared D-CPR performance in two groups. Group A (n = 14) performed D-CPR in a simulated cardiac arrest scenario, while Group B (n = 14) performed D-CPR after first observing performance of Group A and participating in the debriefing. We developed a D-CPR checklist to assess team performance.ResultsOverall there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. While few teams performed opening the airways and examination of breathing correctly, all teams used a 30:2 compression: ventilation ratio.We found no difference between Group A and Group B in D-CPR performance, either in regard to total points on the check list or to time variables.ConclusionWe found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team-training of nursing students.

Improving Survival after Cardiac Arrest

Abstract Each year, approximately half a million people suffer out‐of‐hospital cardiac arrest (CA) in Europe: The majority die. Survival after CA varies greatly between regions and countries. The authors give an overview of the important elements necessary to promote improved survival after CA as a function of the chain of survival and formula for survival concepts. The chain of survival incorporates bystanders (who identify warning symptoms, call the emergency dispatch center, initiate cardiopulmonary resuscitation [CPR]), dispatchers (who identify CA, and instruct and reassure the caller), first responders (who provide high‐quality CPR, early defibrillation), paramedics and other prehospital care providers (who continue high‐quality CPR, and provide timely defibrillation and advanced life support, transport to CA center), and hospitals (targeted temperature management, percutaneous coronary intervention, delayed prognostication). The formula for survival concept consists of (1) medical science (international guidelines), (2) educational efficiency (e.g., low‐dose, high‐frequency training for lay people, first responders, and professionals; and (3) local implementation of all factors in the chain of survival and formula for survival. Survival rates after CA can be advanced through the improvement of the different factors in both the chain of survival and the formula for survival. Importantly, the neurologic outcome in the majority of CA survivors has continued to improve.

Exploring How Lay Rescuers Overcome Barriers to Provide Cardiopulmonary Resuscitation: A Qualitative Study.

BACKGROUND Survival rates after out-of-hospital cardiac arrest (OHCA) vary considerably among regions. The chance of survival is increased significantly by lay rescuer cardiopulmonary resuscitation (CPR) before Emergency Medical Services (EMS) arrival. It is well known that for bystanders, reasons for not providing CPR when witnessing an OHCA incident may be fear and the feeling of being exposed to risk. The aim of this study was to gain a better understanding of why barriers to providing CPR are overcome. METHODS Using a semi-structured interview guide, 10 lay rescuers were interviewed after participating in eight OHCA incidents. Qualitative content analysis was used. The lay rescuers were questioned about their CPR-knowledge, expectations, and reactions to the EMS and from others involved in the OHCA incident. They also were questioned about attitudes towards providing CPR in an OHCA incident in different contexts. RESULTS The lay rescuers reported that they were prepared to provide CPR to anybody, anywhere. Comprehending the severity in the OHCA incident, both trained and untrained lay rescuers provided CPR. They considered CPR provision to be the expected behavior of any community citizen and the EMS to act professionally and urgently. However, when asked to imagine an OHCA in an unclear setting, they revealed hesitation about providing CPR because of risk to their own safety. CONCLUSION Mutual trust between community citizens and towards social institutions may be reasons for overcoming barriers in providing CPR by lay rescuers. A normative obligation to act, regardless of CPR training and, importantly, without facing any adverse legal reactions, also seems to be an important factor behind CPR provision. Mathiesen WT , Bjørshol CA , Høyland S , Braut GS , Søreide E . Exploring how lay rescuers overcome barriers to provide cardiopulmonary resuscitation: a qualitative study. Prehosp Disaster Med. 2017;32(1):27-32.

Optimising basic skills in adult cardiopulmonary resuscitation

Every day, people die suddenly from unexpected cardiac arrest. Cardiopulmonary resuscitation (CPR), consisting of chest compressions and mouth-to-mouth ventilations, can save many of these lives when it is performed with good quality. We trained an entire university hospital staff in basic life support (BLS) using a DVD video and a personal resuscitation manikin. Ninety-five per cent of the hospital staff attended the training, and our analysis has shown that the number of good chest compressions doubled when they were tested 6 months after training as compared with pre-training. The number of good mouth-to-mouth ventilations was low and did not improve after training. We also examined the quality of chest compressions during BLS with three different compression : ventilation (C : V) ratios; 15 : 2, 30 : 2 and 50 : 2. There was no difference in chest compression depth or rate between the different ratios, but the no-flow time decreased with increasing C : V ratios. Further, we examined the extent of chest compression decay during 10 min of advanced life support (ALS) provided by paramedics. Only five of 19 paramedics showed any decay in chest compression depth, and only one within the first 2 min. There was great inter-individual variation in chest compression depth already from the beginning of the resuscitation attempt; this was a much greater problem than decay because of rescuer fatigue. We also examined the quality of CPR during performance of ALS with and without exposure to socioemotional stress in a high-fidelity simulation. The stress exposure did give an increase in subjective stress, but despite that, the quality of CPR remained identical in the two conditions. This shows that it is possible to provide high-quality CPR without being affected by exposure to a significant level of stress.

Great variation between ICU physicians in the approach to making end-of-life decisions.

End‐of‐life (EOL) decision‐making in the intensive care unit (ICU) is difficult, but is rarely practiced in simulated settings. We wanted to explore different strategies ICU physicians use when making EOL decisions, and whether attitudes towards EOL decisions differ between a small‐group simulation setting and a large‐group plenary setting.

Creating the interprofessional health team of the future.

We noticed that medical, nursing and paraAs interprofessional staff we have He was previously employed at SAFER and has medical students in Stavanger each had professional training days which included simulation training, and with our clinical background we saw opportunities for a shared learning arena that reflected the everyday clinical challenges in patient therapy. Collaboration across the professions is commensurate with the modern view of training both nationally and internationally (1). Interprofessional collaborative learning has been highlighted by Report No. 13 to the Storting (2011 – 12) (2) and the World Health Organization (3), among others.

Laerdal MiniAnne with a counting device: does it improve performance?

The Laerdal MiniAnne personal resuscitation manikin with a self-instruction video can effectively teach lay persons basic life support (BLS) in less than 30 minutes [1]. The aim of this study was to assess if the quality of BLS could be improved by adding a counting device to the manikin. The aim of the counting device, which counts the number of correct chest compressions and mouth-to-mouth (MTM) ventilations during two minutes, is to give feedback and thereby improve performance.