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Training approaches for the deployment of a mechanical chest compression device: a randomised controlled manikin study.

ABSTRACT: OBJECTIVES:To evaluate the effect of training strategy on team deployment of a mechanical chest compression device. DESIGN:Randomised controlled manikin trial. SETTING:Large teaching hospital in the UK. PARTICIPANTS:Twenty teams, each comprising three clinicians. Participating individuals were health professionals with intermediate or advanced resuscitation training. INTERVENTIONS:Teams were randomised in a 1:1 ratio to receive either standard mechanical chest compression device training or pit-crew device training. Training interventions lasted up to 1?h. Performance was measured immediately after training in a standardised simulated cardiac arrest scenario in which teams were required to deploy a mechanical chest compression device. PRIMARY AND SECONDARY OUTCOME MEASURES:Primary outcome was chest compression flow fraction in the minute preceding the first mechanical chest compression. Secondary outcomes included cardiopulmonary resuscitation quality and mechanical device deployment metrics, and non-technical skill performance. Outcomes were assessed using video recordings of the test scenario. RESULTS:In relation to the primary outcome of chest compression flow fraction in the minute preceding the first mechanical chest compression, we found that pit-crew training was not superior to standard training (0.76 (95% CI 0.73 to 0.79)?vs 0.77 (95% CI 0.73 to 0.82), mean difference -0.01 (95% CI -0.06 to 0.03), P=0.572). There was also no difference between groups in performance in relation to any secondary outcome. CONCLUSIONS:Pit-crew training, compared with standard training, did not improve team deployment of a mechanical chest device in a simulated cardiac arrest scenario. TRIAL REGISTRATION NUMBER:ISRCTN43049287; Pre-results.

SUBMITTER: Couper K

PROVIDER: S-EPMC5879816 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Training approaches for the deployment of a mechanical chest compression device: a randomised controlled manikin study.

Couper Keith K Velho Rochelle M RM Quinn Tom T Devrell Anne A Lall Ranjit R Orriss Barry B Yeung Joyce J Perkins Gavin D GD

BMJ open 20180201 2

<h4>Objectives</h4>To evaluate the effect of training strategy on team deployment of a mechanical chest compression device.<h4>Design</h4>Randomised controlled manikin trial.<h4>Setting</h4>Large teaching hospital in the UK.<h4>Participants</h4>Twenty teams, each comprising three clinicians. Participating individuals were health professionals with intermediate or advanced resuscitation training.<h4>Interventions</h4>Teams were randomised in a 1:1 ratio to receive either standard mechanical chest ...[more]

PMID: 29391379

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Project description:New chest compression detection technology allows for the recording and graphical depiction of clinical cardiopulmonary resuscitation (CPR) chest compressions. The authors sought to determine the inter-rater reliability of chest compression pattern classifications by human raters. Agreement with automated chest compression classification was also evaluated by computer analysis.This was an analysis of chest compression patterns from cardiac arrest patients enrolled in the ongoing Resuscitation Outcomes Consortium (ROC) Continuous Chest Compressions Trial. Thirty CPR process files from patients in the trial were selected. Using written guidelines, research coordinators from each of eight participating ROC sites classified each chest compression pattern as 30:2 chest compressions, continuous chest compressions (CCC), or indeterminate. A computer algorithm for automated chest compression classification was also developed for each case. Inter-rater agreement between manual classifications was tested using Fleiss's kappa. The criterion standard was defined as the classification assigned by the majority of manual raters. Agreement between the automated classification and the criterion standard manual classifications was also tested.The majority of the eight raters classified 12 chest compression patterns as 30:2, 12 as CCC, and six as indeterminate. Inter-rater agreement between manual classifications of chest compression patterns was ? = 0.62 (95% confidence interval [CI] = 0.49 to 0.74). The automated computer algorithm classified chest compression patterns as 30:2 (n = 15), CCC (n = 12), and indeterminate (n = 3). Agreement between automated and criterion standard manual classifications was ? = 0.84 (95% CI = 0.59 to 0.95).In this study, good inter-rater agreement in the manual classification of CPR chest compression patterns was observed. Automated classification showed strong agreement with human ratings. These observations support the consistency of manual CPR pattern classification as well as the use of automated approaches to chest compression pattern analysis.

Project description:BackgroundRecently, we developed a chest compression device that can move the chest compression position without interruption during CPR and be remotely controlled to minimize rescuer exposure to infectious diseases. The purpose of this study was to compare its performance with conventional mechanical CPR device in a mannequin and a swine model of cardiac arrest.Materials and methodsA prototype of a remote-controlled automatic chest compression device (ROSCER) that can change the chest compression position without interruption during CPR was developed, and its performance was compared with LUCAS 3 in a mannequin and a swine model of cardiac arrest. In a swine model of cardiac arrest, 16 male pigs were randomly assigned into the two groups, ROSCER CPR (n = 8) and LUCAS 3 CPR (n = 8), respectively. During 5 minutes of CPR, hemodynamic parameters including aortic pressure, right atrial pressure, coronary perfusion pressure, common carotid blood flow, and end-tidal carbon dioxide partial pressure were measured.ResultsIn the compression performance test using a mannequin, compression depth, compression time, decompression time, and plateau time were almost equal between ROSCER and LUCAS 3. In a swine model of cardiac arrest, coronary perfusion pressure showed no difference between the two groups (p = 0.409). Systolic aortic pressure and carotid blood flow were higher in the LUCAS 3 group than in the ROSCER group during 5 minutes of CPR (p < 0.001, p = 0.008, respectively). End-tidal CO2 level of the ROSCER group was initially lower than that of the LUCAS 3 group, but was higher over time (p = 0.022). A Kaplan-Meier survival analysis for ROSC also showed no difference between the two groups (p = 0.46).ConclusionThe prototype of a remote-controlled automated chest compression device can move the chest compression position without interruption during CPR. In a mannequin and a swine model of cardiac arrest, the device showed no inferior performance to a conventional mechanical CPR device.

Dataset Information

Training approaches for the deployment of a mechanical chest compression device: a randomised controlled manikin study.

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Training approaches for the deployment of a mechanical chest compression device: a randomised controlled manikin study.

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