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Example of the computation of chest compression depth and rate. The spectral analysis of the chest and back acceleration every 2 seconds allows computing chest displacement and mattress displacement. Subtraction of both values gives the actual chest compression depth, d c c = 50 mm. Estimated average rate r c c was 99.4 cpm.
Source publication
Background . Cardiopulmonary resuscitation (CPR) feedback devices are being increasingly used. However, current accelerometer-based devices overestimate chest displacement when CPR is performed on soft surfaces, which may lead to insufficient compression depth. Aim . To assess the performance of a new algorithm for measuring compression depth and r...
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Objectives:
Out-of-hospital cardiac arrest has poor prognosis and patients rarely survive unless they receive immediate cardiopulmonary resuscitation from bystanders. In 2012, the British Heart Foundation launched its PocketCPR training application to simplify bystander cardiopulmonary resuscitation training and overcome barriers to resuscitation....
Citations
... Our search identified a total of 557 records. After removing duplicates, 387 titles and abstracts were screened and 16 full texts were included in the systematic review [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. No records were identified through grey literature scanning. ...
... Most of the included studies were randomized trials [20,21,[23][24][25][26][27]29,31,32,34,35], and all of them were performed in hospital settings. Except for two articles that did not specify the performers' characteristics [22,28], all studies involved CPR performers ranging from novices to experts (Table 1). ...
... Overall, the included articles show substantial heterogeneity of experimental conditions. For instance, feedback about CPR quality was provided to performers in 11 studies out of 16 [21,22,[24][25][26][27][28]30,[32][33][34]. Only in 8 studies, different weights were added to the manikins in order to simulate a real pediatric or adult torso [22,[25][26][27]31,32], and 10 studies used external accelerometers in addition to internal sensors of the manikins [22,[24][25][26][27][28]30,[32][33][34]. ...
... Alternatively, accelerometer-based systems use chest acceleration to calculate compression parameters [9]. Despite of their reliability, these systems need complex signal processing [10][11][12] to extract parameters of interest and present a measurement error due to integration processes [10]. The combination of these approaches overcomes some of the reported limitations, but with an increased cost and processing complexity [13,14]. ...
High-quality cardiopulmonary resuscitation (CPR) has a critical impact on the survival of sudden cardiac arrest victims. The use of automated devices to support CPR training through real-time feedback are considered an important educational tool, optimizing CPR skills acquisition and knowledge retention. Considering this educational need, this paper presents the development of a controlled-cost feedback device for CPR training, with focus on chest compression quality. Several sensory approaches were tested for functionality and performance, leading to the selection of a digital infrared sensor combined with a piezoresistive pressure sensor. This approach showed a good response and robustness to chest compressions during CPR training, providing accurate assessment of specific parameters of chest compressions. Usability testing, mimicking a training-like situation, showed promising results and confirmed the applicability of this approach to real-time training or post-training analysis. It is expected that the proposed solution could provide an alternative or a complementary tool for CPR skills acquisition and maintenance, promoting regular training and to a broader population.
... Moreover, chest compression quality during in-hospital CPR is often suboptimal on a soft surface . Performing CPR on a mattress in bed results in mattress and bedframe deflection and negatively influences compression depth on the sternum during manikin CPR (Lin et al., 2017;Nishisaki et al., 2012;Oh et al., 2016;Ruiz de Gauna et al., 2016;Sainio et al., 2014). Other factors that might influence compression quality are bed height (Perkins et al., 2003;Perkins et al., 2006), sex (Amacher et al., 2017;Jaafar et al., 2015) and body mass index (BMI) (Jaafar et al., 2015;Krikscionaitiene et al., 2013). ...
... In addition, phase one results were obtained performing CPR on the floor whilst in phase two the manikin was laying on a mattress in bed. This different CPR position (kneeling on a stable floor vs. standing next to or kneeling in a less stable bed) and the potential unfavourable influence of mattress deflection on compression depth during CPR in bed might also explain the lower success rates in phase two (Hasegawa et al., 2020;Lin et al., 2017;Nishisaki et al., 2009;Nishisaki et al., 2012;Noordergraaf et al., 2009;Oh et al., 2016;Ruiz et al., 2016;Sainio et al., 2014). ...
Introduction
Chest compression quality during in-hospital resuscitation is often suboptimal on a soft surface. Scientific evidence regarding the effectiveness of a backboard is scarce. This single-blinded manikin study evaluated the effect of a backboard on compression depth, rate and chest recoil performed by nurses. Sex, BMI, age and clinical department were considered as potential predictors.
Methods
Using self-learning, nurses were retrained to achieve a minimal combined compression score at baseline. This combined score consisted of ≥70% compressions with depth 50–60 mm, ≥70% compressions with complete release (≤5mm) and a mean compression rate of 100–120 bpm. Subsequently, nurses were allocated to a backboard or control group and performed a two-minute cardiopulmonary resuscitation test. The main outcome measure was the difference in proportion of participants achieving a combined compression score of ≥70%.
Results
In total 278 nurses were retrained, 158 nurses dropped out and 120 were allocated to the backboard (n = 61) or control group (n = 59). The proportion of participants achieving a combined compression score of ≥70% was not significantly different (p = 0.475) and suboptimal in both groups: backboard group 47.5% (backboard) versus 41.0% (control). Older age (≥51 years) was associated with a lower probability of achieving a combined compression score >70% [OR = 0.133; 95% confidence interval (CI), 0.037–0.479; p = 0.002].
Conclusion
Using a backboard did not significantly improve compression quality in our study. Important decay of compression skills was observed in both groups, highlighting the importance of frequent retraining, particularly in some age groups.
... Dies hat das Potenzial, die Effektivität zu mindern. Dennoch kann eine effektive Drucktiefe auch auf einer weichen Unterlage erreicht werden, wenn derjenige der die Wiederbelebung durchführt genügend Kraft aufbringt, um das Zusammendrücken der Matratze zu kompensieren [70][71][72][73][74][75][76]. ...
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), cardiopulmonary resuscitation (CPR) quality measurement, new technologies, safety, and foreign body airway obstruction.
... Our search identified a total of 557 records. After removing duplicates, 387 titles and abstracts were screened and 16 full texts were included in the systematic review [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. No records were identified through grey literature scanning. ...
... Most of the included studies were randomized trials [20,21,[23][24][25][26][27]29,31,32,34,35], and all of them were performed in hospital settings. Except for two articles that did not specify the performers' characteristics [22,28], all studies involved CPR performers ranging from novices to experts (Table 1). ...
... Overall, the included articles show substantial heterogeneity of experimental conditions. For instance, feedback about CPR quality was provided to performers in 11 studies out of 16 [21,22,[24][25][26][27][28]30,[32][33][34]. Only in 8 studies, different weights were added to the manikins in order to simulate a real pediatric or adult torso [22,[25][26][27]31,32], and 10 studies used external accelerometers in addition to internal sensors of the manikins [22,[24][25][26][27][28]30,[32][33][34]. ...
To achieve optimal chest compression depth, victims of cardiac arrest should be placed on a firm surface. Backboards are usually placed between the mattress and the back of a patient in the attempt to increase cardiopulmonary resuscitation (CPR) quality, but their effectiveness remains controversial. A systematic search was performed to include studies on humans and simulation manikins assessing CPR quality with or without backboards. The primary outcome of the meta-analysis was the difference in chest compression depth between these two conditions. Out of 557 records, 16 studies were included in the review and all were performed on manikins. The meta-analysis, performed on 15 articles, showed that the use of backboards during CPR increases chest compression depth by 1.46 mm in manikins. Despite statistically significant, this increase could have a limited clinical impact on CPR, due to the substantial heterogeneity of experimental conditions and the scarcity of other CPR quality indicators.
... 90,97,101À 105 CPR feedback devices that account for mattress compression (eg, the use of dual accelerometers or increasing compression depth targets) can help CPR providers ensure adequate compression depth when CPR is performed on a mattress. 95,99,101,103,105,106 In making these recommendations, the task forces highlight the importance of high-quality chest compressions for optimizing outcomes from cardiac arrest. ...
This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 20 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 3 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.
Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.
The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
... 90,97,101-105 CPR feedback devices that account for mattress compression (eg, the use of dual accelerometers or increasing compression depth targets) can help CPR providers ensure adequate compression depth when CPR is performed on a mattress. 95,99,101,103,105,106 In making these recommendations, the task force highlights the importance of high-quality chest compressions for optimizing outcomes from cardiac arrest. ...
This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.
Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.
The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
... The increased workload and fatigability cause insufficient compression depth, recoil, and rate. 11,12 Recent studies have shown that performing CPR on mattresses reduces CC quality. 9,[12][13][14] In theory, backboard placement between the patient and the mattress should provide a firm and stable surface, should decrease the compliance of the underlying mattress by increasing the surface area of the applied force, and should decrease the distance of the vertical hand movement. ...
... Cheng, et al and Guana, et al reported that the mean mattress compression depth is significantly lower with backboards when compared to only mattresses. 2,11 The increased mattress compression increases the vertical distance for the provider's hands to travel and increases the workload of the CPR provider. The increased workload and fatigue of the providers cause insufficient CCs. ...
Introduction
High-quality chest compressions (CCs) are associated with high survival rates and good neurological outcomes in cardiac arrest patients. The 2015 American Heart Association (AHA; Dallas, Texas USA) Guidelines for Resuscitation defined and recommended high-quality CCs during cardiopulmonary resuscitation (CPR). However, CPR providers struggle to achieve high-quality CCs. There is a debate about the use of backboards during CPR in literature. Some studies suggest backboards improve CC quality, whereas others suggest that backboards can cause delays. This is the first study to evaluate all three components of high-quality CCs: compression depth, recoil depth, and rate, at the same time with a high number of subjects. This study evaluated the impact of backboards on CC quality during CPR. The primary outcome was the difference in successful CC rates between two groups.
Methods
This was a randomized, controlled, single-blinded study using a high-fidelity mannequin. The successful CC rates, means CC depths, recoil depths, and rates achieved by 6th-grade undergraduate medical students during two minutes of CPR were compared between two randomized groups: an experimental group (backboard present) and a control group (no backboard).
Results
Fifty-one of all 101 subjects (50.5%) were female, and the mean age was 23.9 (SD = 1.01) years. The number and the proportion of successful CCs were significantly higher in the experimental group (34; 66.7%) when compared to the control group (19; 38.0%; P = .0041). The difference in mean values of CC depth, recoil depth, and CC rate was significantly higher in the experiment group.
Conclusion
The results suggest that using a backboard during CPR improves the quality of CCs in accordance with the 2015 AHA Guidelines.
... A possible solution to this problem would be to use two accelerometers. We explored the accuracy of our algorithm when using two accelerometers to compensate for mattress displacement elsewhere [24]. The data analyzed in this study were collected when CPR was provided with the patient laying on the floor, so this limitation does not affect the results. ...
Background
The use of real-time feedback systems to guide rescuers during cardiopulmonary resuscitation (CPR) significantly contributes to improve adherence to published resuscitation guidelines. Recently, we designed a novel method for computing depth and rate of chest compressions relying solely on the spectral analysis of chest acceleration. That method was extensively tested in a simulated manikin scenario. The purpose of this study is to report the results of this method as tested in human out-of-hospital cardiac arrest (OHCA) cases.
Materials and methods
The algorithm was evaluated retrospectively with seventy five OHCA episodes recorded by monitor-defibrillators equipped with a CPR feedback device. The acceleration signal and the compression signal computed by the CPR feedback device were stored in each episode. The algorithm was continuously applied to the acceleration signals. The depth and rate values estimated every 2-s from the acceleration data were compared to the reference values obtained from the compression signal. The performance of the algorithm was assesed in terms of the sensitivity and positive predictive value (PPV) for detecting compressions and in terms of its accuracy through the analysis of measurement error.
Results
The algorithm reported a global sensitivity and PPV of 99.98% and 99.79%, respectively. The median (P75) unsigned error in depth and rate was 0.9 (1.7) mm and 1.0 (1.7) cpm, respectively. In 95% of the analyzed 2-s windows the error was below 3.5 mm and 3.1 cpm, respectively.
Conclusions
The CPR feedback algorithm proved to be reliable and accurate when tested retrospectively with human OHCA episodes. A new CPR feedback device based on this algorithm could be helpful in the resuscitation field.
... This method presented a high accuracy. Detailed results are presented in reference [19]. ...
