Verbesserung der CPR mithilfe von ... - Laerdal Medical

Verbesserung der CPR mithilfe von
Feedbacksystemen
Dieses Dokument beinhaltet Abstracts von Studien und liefert Ihnen eine Übersicht über CPR‐
Feedback‐Systeme im direkten Zusammenhang mit der untenstehenden Überlebensformel. Studien
belegen, dass CPR‐Feedbacksysteme die Qualität und Effizienz der CPR entscheidend beeinflussen
können. Die Referenzen finden Sie am Ende des Dokuments.
Aus Aktualitätsgründen haben wir die Abstracts der Studie in englischer Sprache veröffentlicht. Bei
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Medical themes:
Increased survival with more emphasis on CPR
In Seattle 1 , Rea found that VF survival increased from 33% to 46% with the introduction of a new
protocol using a single shock with no rhythm reanalysis or post‐defibrillation pulse checks, and extended
the period of cardiopulmonary resuscitation from 1 to 2 minutes. This protocol, which is similar to
Guidelines 2010, significantly increased the time for CPR vs defibrillation.
CPR – much more than buying time for defibrillation
Eilevstjønn and Rea evaluated 1100 episodes of EMS treated cardiac arrest within ROC. Fifty percent of
the patients who had the heart restarted were not defibrillated. For those discharged alive, one third
were not defibrillated.(ERC2012) These findings underscore the importance of CPR for the treatment of
shockable and non‐shockable cardiac arrest.

High chest compression fraction is an independent determinant of survival in VF cardiac arrest
Christensen and coworkers from ROC analyzed 506 cases and found highest survival when chest
compression fraction was between 61 and 80%.
Chest compression fraction is important for non‐VF patients
Vaillancourt 2 found a trend to increased ROSC with increasing chest compression fraction for non‐VF
patients.
Poor chest compressions does not circulate adrenaline
EMS, trained to Guidelines 2000, used a chest compression depth of only 34mm and a chest
compression fraction of only 50% according to Wik 3 . When this treatment was given to laboratory pigs,
no hemodynamic effect of adrenaline could be detected
Short chest compression pauses does not reduce blood pressure
Contrary to the previous animal studies, this study in humans demonstrates that blood pressures achieved
before the rhythm analysis pause do not necessarily decrease after the pause but may even increase if the
duration of the pause is under ten seconds and the quality of CPR is good both before and after the pause. 4
Leaning is common and affect patient outcome
Fried 5 found incomplete release in 91% of the patient cases and in 12% of all pediatric chest
compressions. According to Zuercher 6 , leaning impairs both cardiac output and myocardial blood flow
during cardiac arrest.
The importance of chest compression depth
Suboptimal compression depth was found in half of patients by 2005 guideline standards and almost all
by 2010 standards as well as an inverse association between compression depth and rate. A strong
association between survival outcomes and increased compression depth could be demonstrated, but
no clear evidence to support or refute the 2010 recommendations of >50 mm 7 .
Guidelines 2010 require doubling of compression force.
In a study by Wik 3 , average compression depth without feedback was 34mm and applied force for
34mm depth is about 25kg according to Nysaether 8 and Tomlinson 9 . With guidelines 2010, 50mm chest
compression depth will require a force of at 50kg for the average patient.
CPR Meter is safe
Zuercher 10 found that devices like the CPR Meter do not impair hemodynamics during piglet CPR.
CPR is safe for victims not in cardiac arrest
ILCOR 11 state that serious complications among non‐arrest patients receiving dispatch‐assisted
bystander CPR occurred infrequently. Of 247 non‐arrest patients with complete follow‐up who received

chest compressions from a bystander, 12% experienced discomfort; only 5 (2%) suffered a fracture; and
no patients suffered visceral organ injury.
Education themes:
CPR feedback devices is recommended during training
A review by Yeoung 12 provides good evidence supporting the use of CPR feedback/prompt devices
during CPR training as a strategy to improve CPR skill acquisition and retention. The review include a
VAM study by Wik 13 where subjects who received first 1 initial plus 5 short training sessions shortly
thereafter performed better during skill retention testing than those who only received 1 initial training.
Oermann 14 found that monthly training with a VAM feedback resulted in superior performance vs
annual training. These studies supports our strategy of low dose, high frequency training.
CPR feedback devices offer just in time training
Another study by Wik 15 randomized participants to do 3 min CPR on a manikin, both with and without
VAM feedback. The group who did CPR first with feedback performed better than the group without
feedback. Interestlingly, the group who received feedback first continued to perform at least as good
when feedback was turned off. This study supports our strategy that feedback can facilitate just in time
training.
Implementation themes:
Decay in EMS chest compression quality due to fatigue is rare
Half of the providers compressed the chest according to guidelines depth in this study of EMS prolonged
resuscitation. Chest compression decay and thereby fatigue within the first two minutes was rare,
suggesting that the paramedics were capable of performing good chest compressions but they did not
know how hard to push 16 .
QCPR improved CPR
Real-time visual and audible feedback by MRx with QCPR altered performance to more closely conform
with guidelines. 17 . However, since there was little room for improvement in CPR quality by these EMS
systems (Pittsburgh and Seattle), no improvement in patient outcomes could be detected.

Compression quality is better with CPR meter
A study by Skorning 18 evaluated CPR Meter. Depth improved from 45% correct to 73% correct and rate
improved from 64% to 95% correct. Leaning improved from 4.4% to 0.2%.
QCPR feedback improve leaning
Niles 19 found that automated feedback helped reduce leaning from 50% to 27% of all chest
compressions in a series of in‐hospital pediatric arrest.
Compression quality is better with a combination of feedback and debriefing.
The combination of feedback and debriefing improved compression rate compliance from 45% to 84%
and resulted in a doubling of participants providing compressions of both adequate rate and depth,
from 29% vs. 64% 20 .
Patient outcome is better with a combination of feedback and debriefing.
This study by Edelson 21 report an increase in ROSC, a decrease in ventilations per minute and an
increase in chest compression depth when MRx with QXPR was complemented with debriefing.
Feedback is also helpful in helicopter and moving ambulance
Real time automated feedback improves certain aspects of CPR quality in flying helicopters and moving
ambulance vehicles. The effect of feedback guidance was most pronounced for chest compression rate. 22
Voice prompts in addition to audiovisual feedback did not add value.
In this clinical trial 23 , compression depth and rate, as well as survival was good both with and without
voice prompts in addition to visual feedback and a metronome.
QCPR require mattress compression
When CPR is performed in a bed, mattress compression and hence accelerometer error is was 13mm.
When a stretcher was used, the error was 4mm 24 . These data suggest that about 15mm must be added
for CPR in a bed, according to Monsieurs 25 .
RefShare
All papers cited are available on RefShare – our library of medical science.
To access, go to Knowledgelink, select tools and select Refshare. Here you can search using keywords.
Helge Myklebust, August 2012

REFERENCES
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cardiopulmonary resuscitation. Resuscitation 2011;82:1019‐24.
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chest compressions by professionals in simulated cardiac arrest. Resuscitation 2010.
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decreased with automated corrective feedback. Resuscitation 2009;80:553‐7.
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quality and resuscitation training by combining audiovisual feedback and debriefing. Crit Care Med
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with performance debriefing. Arch Intern Med 2008;168:1063‐9.
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debriefing does not modify CPR quality or outcomes in out of hospital cardiac arrest‐‐a prospective,
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24. Nishisaki A, Nysaether J, Sutton R, et al. Effect of mattress deflection on CPR quality assessment for
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