Comparison of Bystander Fatigue and CPR Quality when Using Ui Continuous Chest Compressions Versus 30:2 Compressions to Ventilations: A Randomized Cross over over Trial CAEP Niagara Falls 2012 CAEP St John s June 2011
Shawn Liu BSc Christian Vaillancourt MD Ann Kasaboski BSc Monica Taljaard PhD Department of Emergency Medicine Ottawa Hospital Research Institute University of Ottawa, Ottawa, ON CAEP St John s June 2011
Our Generous Sponsor Department of Emergency Medicine Academic Grant CPR process monitors provided by Zoll Disclosure No financial i or intellectual t l conflict of interest to declare
Background Out of Hospital Cardiac Arrest (OOHCA) is the second leading cause of death in Canada, 85% occur at home CPR increases OOHCA survival l3 to 4 times Bystanders often hesitate to initiate CPR because of its mouth to to mouth component
Background International ti lr Resuscitation ti Guidelines in 2010 changed CPR technique from 30:2 compressions to ventilation ratio (30:2) to continuous chest compressions (CCC) Meant to increase bystander CPR rates and to minimize compression interruptions
Objectives In a population most likely to perform CPR on a cardiac arrest victim (aged 55) To compare bystander fatigue, and CPR quality After 5 Minutes of CPR using 30:2 versus CCC
Methods Design: Randomized Cross Over Study Setting: 3 campuses at The Ottawa Hospital and the Kanata Seniors Centre Subjects: Participants aged 55 and older Clinical Frailty Scale 3 No physical limitations or disease limiting CPR performance Ethics: Approved by The Ottawa Hospital Research Ethics Board Written informed consent from all participants
Canadian Study of Health and Aging Clinical i l Frailty Scale
Inclusion and Exclusion Criteria
Methods: Participants received CPR demonstration and supervised practice session for 1 2 minutes Received feedback on CPR performance during practice session, but not during study intervention (except metronome at 100/min) Participants then asked to perform two 5 minute sessions of CPR on an At Actar Manikin Blocked random assignment to starting CPR method concealed Participants given as much time as they needed to rest between CPR sessions
Methods Outcome Measures: 1) CPR Quality Measures: Number of chest compressions per minute Total number of chest compressions with adequate depth ( 2 inches or 50.8 mm) Measured with Zoll R series Monitor 2) Bystander Fatigue Measures (taken before and after each CPR session): Heart Rate (HR) Mean Arterial Pressure (MAP) Validated Borg Rating of Perceived Exertion
Measuring CPR Quality
Validated Borg Scale
Methods Desired Sample Size Calculated to be 60 participants Data Analysis Descriptive Statistics Paired t test with 95% confidence intervals Comparison of mean differences between paired groups Mixed effect regression model for each minute of CPR time
Participant Characteristics Started Started All Characteristic (%) with CCC with 30:2 N = 63 N = 30 N = 33 Mean Age ±SD 70.8±6.4 69.9±6.3 71.6±6.5 Female (%) 42 (67.8) 19 (63.3) 3) 23 (69.7) Clinical Frailty Score 1 (%) 39 (61.9) 18 (60.0) 0) 21 (63.6) 6) 2 (%) 18 (28.6) 8 (26.7) 10 (30.3) 3 (%) 6 (9.5) 4 (13.3) 3) 2 (6.1)
Participant Characteristics Characteristic (%) Started Started All with CCC with 30:2 N = 63 N = 30 N = 33 CPR Training (%) 38 (60.3) 20 (67.8) 18 (54.5) CPR Experience (%) 6 (9.5) 3 (10.0) 0) 3 (9.1) Initial Borg Score 8.0±2.0 8.1±2.0 (mean±sd) Initial MAP (mean±sd) 85.0±11.4 99.9±16.3 Initial HR (mean±sd) 72.7±9.57±9 72.6±10.5
Paired T Test Test Comparisons Between Methods (Mean Differences) Participant Fatigue CCC 30:2 Mean Diff (95% CI) Borg Scale (n=63)* 3.6 2.9 0.7 (0.3 to 1.3) HR (n=63) 9.7 10.2 0.5 ( 3.4 to 2.7) MAP (n=63) 7.7 7.3 0.4 ( 2.0 to 2.8) *Statistically ti ti significant, ifi but not clinically i ll relevant
Paired T Test Test Comparisons Between Methods (Absolute Differences) Mean Diff CPR Quality CCC 30:2 (95% CI) Compression 2.11 99.7 101.8* rate/min ( 3.7 to 0.1) Total count of 107.3 480.0** 376.3 cc/5min (66.9 to 140.5) Total count of 56.66 381.5** 324.9 adequate cc/5min (32.3 to 91.5) cc = chest compressions * Statistically significant only, p < 0.05 ** Statistically and clinically significant, p < 0.0001
Number of Correct Chest Compressions per Minute of CPR (N=63) 100 Cor rrect Ch hest Co ompres ssions 90 80 70 60 50 40 30 20 10 CCC 30:2 0 1 2 3 4 5 Minute of CPR
Participant Survey Results (N=63) 1. Could you have continued CPR? CCC 30:2 No Longer 16.1% 6.5% 1 Minute 22.6% 22.6% 2 or more Minutes 62.9% 71.0% 2. Which method did you prefer? CCC 30:2 30.6% 69.4% 3. Did you feel more tired at the beginning of the second CPR sessioncompared to how you felt at the beginning of the first CPR session? Yes No 33.9% 66.1%
Discussion There were no differences attributable to group assignment (p > 0.05) 05) Randomization was successful Participants maintained a similar level of exertion regardless of task demand We did not find clinically significant differences in fatigue level between groups However, participants preferred the 30:2 method
Discussion CPR quality decreased faster in the CCC group The number of adequate compressions per minute remained higher than the 30:2 group If participants completed more than 5 minutes of CPR, would the adequate compression rate for 30:2 have been higher than CCC? We did not measure full chest decompression
Conclusions Levels of fatigue were similar in both groups CPR quality decreased dfaster over time with ih the CCC versus the 30:2 method CCC produced more chest compressions of good quality compared to the 30:2 method after 5 minutes
Acknowledgements We are thankful to all the volunteers who participated in our study