Enrico Contri

Complete chest recoil during laypersons' CPR: Is it a matter of weight? ☆

Introduction: Chest compressions depth and complete chest recoil are both important for high‐quality Cardio‐Pulmonary Resuscitation (CPR). It has been demonstrated that anthropometric variables affect chest compression depth, but there are no data about they could influence chest recoil. The aim of this study was to verify whether physical attributes influences chest recoil in lay rescuers. Methods: We evaluated 1 minute of compression‐only CPR performed by 333 laypersons immediately after a Basic Life Support and Automated External Defibrillation (BLS/AED) course. The primary endpoint was to verify whether anthropometric variables influence the achievement a complete chest recoil. Secondary endpoint was to verify the influence of anthropometric variables on chest compression depth. Results: We found a statistically significant association between weight and percentage of compressions with correct release (p ≤ 0.001) and this association was found also for height, BMI and sex. People who are heavier, who are taller, who have a greater BMI and who are male are less likely to achieve a complete chest recoil. Regarding chest compressions depth, we confirm that the more a person weighs, the more likely the correct depth of chest compressions will be reached. Conclusions: Anthropometric variables affect not only chest compression depth, but also complete chest recoil. CPR instructors should tailor their attention during training on different aspect of chest compression depending on the physical characteristics of the attendee.

Is it time to consider visual feedback systems the gold standard for chest compression skill acquisition

High-quality chest compressions are pivotal for improving survival from cardiac arrest. The rate and depth of compressions, chest recoil and hand position are important parameters affecting the overall quality of chest compressions, which is correlated with blood flow and oxygen delivery to the heart and brain and, consequently, with rate of ROSC and neurologically intact survival at hospital discharge [1]. During the last decade, some automated feedback devices have been investigated to improve CPR performance during cardiac arrest [2]. However, the applicability of these systems on a large scale is questionable and more attention has been focused on FS for training with unclear effects [3]. Two recently published RCTs brought new highquality evidence on this topic. Both RCTs evaluated the effect of an automated computerized real-time FS (Laerdal QCPR®) able to measure CPR quality, which can be connected wirelessly to a training mannequin and displayed on pads or laptops (Additional file 1). Baldi et al. [4] randomized 450 laypersons of various age participating in BLS courses in a three-arm study. The authors demonstrated that both a 1-minute training or a 10-minute training with the FS was superior to a standard course in terms of the percentage of compressions with correct depth, with complete chest recoil and with correct hand position. In this trial, assessment of the chest compression skill acquisition was performed at the end of the course. Cortegiani et al. [5] randomized 144 trainers in a twoarm study comparing a standard course plus a 2-minute chest compressions training with the FS versus instructorbased feedback only. The intervention group demonstrated a significantly higher overall quality and percentage of correctly released chest compressions and a more appropriate compression rate. Interestingly, in this trial, outcomes assessment was performed 7 days after the course. The median age of participants was lower than for the other trial (17 years for both groups) because it specifically focused on secondary school students. There is now high-grade evidence to support the effect of a visual FS in terms of chest compression skill acquisition for laypersons. Further research should evaluate the effect of a visual FS at longer time points and for training (and retraining) of healthcare personnel, focusing on patient-centered outcomes. Moreover, high-quality studies comparing different FSs are needed.

Protocol of a multicenter international randomized controlled manikin study on different protocols of cardiopulmonary resuscitation for laypeople (MANI-CPR)

Introduction Out-of-hospital cardiac arrest is one of the leading causes of death in industrialised countries. Survival depends on prompt identification of cardiac arrest and on the quality and timing of cardiopulmonary resuscitation (CPR) and defibrillation. For laypeople, there has been a growing interest on hands-only CPR, meaning continuous chest compression without interruption to perform ventilations. It has been demonstrated that intentional interruptions in hands-only CPR can increase its quality. The aim of this randomised trial is to compare three CPR protocols performed with different intentional interruptions with hands-only CPR. Methods and analysis This is a prospective randomised trial performed in eight training centres. Laypeople who passed a basic life support course will be randomised to one of the four CPR protocols in an 8 min simulated cardiac arrest scenario on a manikin: (1) 30 compressions and 2 s pause; (2) 50 compressions and 5 s pause; (3) 100 compressions and 10 s pause; (4) hands-only. The calculated sample size is 552 people. The primary outcome is the percentage of chest compression performed with correct depth evaluated by a computerised feedback system (Laerdal QCPR). Ethics and dissemination . Due to the nature of the study, we obtained a waiver from the Ethics Committee (IRCCS Policlinico San Matteo, Pavia, Italy). All participants will sign an informed consent form before randomisation. The results of this study will be published in peer-reviewed journal. The data collected will also be made available in a public data repository. Trial registration number NCT02632500.

Are final year medical students ready to save lives in Italy? Not yet

We read with interest the paper by Perkins GD and colleagues on a series of initiatives to improve outcomes from out-of-hospital cardiac arrest in which teaching cardiopulmonary resuscitation (CPR) to schoolchildren play a key role.1 Evidence in the literature confirms that teaching CPR in school saves lives.2 If even schoolchildren know CPR, even more so a young doctor should know how to treat a cardiac arrest. However, since we …

Pressione intracranica in corso di CEC: valutazione con tecnica ecografica

Finalita: valutazione non invasiva con tecnica ecografica (ONSD) dell’aumento della pressione intracranica (PIC) in soggetti sottoposti a intervento cardiochirurgico con supporto di circolazione extracorporea (CEC) normotermica. Metodi: abbiamo condotto un’analisi prospettica su 15 pazienti sottoposti a interventi di cardiochirurgia con supporto di circolazione extracorporea in CEC. La stima della pressione intracranica e stata effettuata mediante misurazione del diametro delle guaine durali del nervo ottico (ONSD) tramite ecografia. Analizzando la variazione dell’ONSD e stata valutata durante l’intero arco dell’intervento constestualmente all’analisi dei fattori che maggiormenmente influiscono nell’autoregolazione cerebrale e all’eventuale sviluppo di edema cerebrale. Risultati: sulla base dei dati ad oggi disponibili (15 pazienti) e stato rilevato un significativo aumento del diamentro delle guaauine durali del nervo ottico in pazienti sottoposti a CEC a seguito della circolazione extracorporea rispetto al valore basale (p<0.011). L’aumento dell’ONSD correla significativamente con il crollo della pressione arteriosa media (MAP) (R2 0.43, p<0.008) e con l’eta dei pazienti (p<0.01). Conclusioni: la circolazione extracorporea e in grado di provocare un modesto aumento della pressione intracranica pur non raggiungendo valori francamente patologici.