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Abstract Background. Unstable conditions during ambulance transportation are not conducive to the performance of high-quality cardiopulmonary resuscitation by emergency medical technicians. Objective. The present study was conducted to clarify differences in the quality of chest compression and associated muscle activity between static and ambulanc...
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The purpose of this study was to analyze eletromyographic (EMG) signal of biceps femoris (BF), vastus
lateralis (VL), lumbar multifidus (LM), anterior tibialis (AT), and medial gastrocnemius (MG) during the deadlift (DL) and stiff-legged deadlift (SLDL). Fourteen men (26.71 ± 4.99 yrs; body mass 88.42 ± 12.39 kg; 177.71 ± 8.86 cm) voluntarily part...
The purpose of this study was to analyze eletromyographic (EMG) signal of biceps femoris (BF), vastus
lateralis (VL), lumbar multifidus (LM), anterior tibialis (AT), and medial gastrocnemius (MG) during the deadlift (DL) and stiff-legged deadlift (SLDL). Fourteen men (26.71 ± 4.99 yrs; body mass 88.42 ± 12.39 kg; 177.71 ± 8.86 cm) voluntarily part...
Citations
... Rescuer position, shoulder muscle strength, shoulder motion, and shoulder arm position are interrelated factors that affect the CPR kinematics and quality. [5][6][7] The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) is an upper limb functional performance test designed to evaluate the function of elbow, shoulder, and shoulder girdle musculature. [8] It determines shoulder muscle strength objectively and accurately, and also evaluates proprioception and motor control. ...
... In one study, chest compressions were mainly done by f lexion and extension of the hip joint while kneeling on the ground and by the elbow and shoulder joints while in the standing position. [6] In this study using integrated electromyography during CPR, the strength values of the deltoid, pectoralis major, triceps brachii, vastus lateralis, and gastrocnemius muscles were found to be significantly higher in CPR performed in the standing position compared to the kneeling position. In emergency departments and the remaining units of the hospital, CPR is performed on a suitable stretcher. ...
Objectives: This study aims to examine the effect of upper extremity performance using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) on cardiopulmonary resuscitation (CPR) quality criteria according to the European Resuscitation Council (ERC) Guidelines for Resuscitation 2015, including chest compression rate, depth, and recoil.
Patients and methods: This simulation-based study included 105 paramedic students (43 males, 62 females; median age: 19 years; range, 18 to 20 years) attending a two-year paramedic program between February 2018 and April 2018. The CKCUEST was used to determine upper extremity performance scores, including the touch number, normalized, and power score of the paramedic students. A TrueCPR® feedback device was used to measure CPR quality criteria throughout the study. The characteristics of the providers, such as height, weight, body mass index (BMI), and fat-free mass were also analyzed.
Results: Adequate compression depth had a positive correlation with body fat-free mass (r=0.397, p<0.001), power score (r=0.326, p=0.001), height (r=0.326, p=0.001), weight (r=0.314, p=0.001), and BMI (r=0.204, p=0.037). Full chest recoil had a negative correlation with the power score (r=-0.249, p=0.010) and height (r=-0.219, p=0.025). None of the variables were significantly different between the groups with and without the correct compression rate. In the receiver operating characteristic curve analysis for power score and correct compression depth as 100%, the area under the curve was 0.845 (p<0.001).
Conclusion: The power score combination of upper extremity functionality and the rescuer’s weight is the main factor affecting chest compression depth. However, this score is negatively correlated with full chest recoil.
... In clinical settings, rescuers usually have to perform CPR in a kneeling or standing posture with their hands on the patient's sternum while keeping the upper limbs upright [19,20], which is a very physically exhausting posture and movement. It can be found that a progressive reduction in the percentage of correct chest compressions after 1 minute of chest compressions [15,21,22]. ...
Background: Whether intermittent chest compressions have an effect on the quality of CPR is worthy of discussion. The purpose of this study was to investigate differences in the chest compression quality of emergency medical technicians (EMTs) performing cardiopulmonary resuscitation (CPR) with different rest intervals.
Methods: Seventy male firefighters with EMT licenses participated in this study. Participants completed body composition measurements and three CPR quality tests, as follows: (1) CPR-uninterrupted for 10 minutes; (2) after 2 days of rest, CPR 10s-intermittent (CPR-10s), for 2 minutes each time and 5 cycles; (3) after another 2 days of rest, CPR 20s-intermittent (CPR-20s), for 2 minutes each time and 5 cycles.
Results: Body composition results showed that body mass (BM), body mass index (BMI), upper limb muscle mass (ULMM), core muscle mass (CMM), and upper limb-core muscle mass (UL+CMM) were positively correlated with chest compression depth (CCD) (p < 0.05). Analysis of the three different modes of CPR quality analysis indicated significant differences in the chest compression fraction (CCF, F = 6.801, p = 0.001), chest compression rebound rate (CCRR, F = 3.919, p = 0.021), and ratings of perceived exertion (RPE, F = 23.815, p < 0.001). Among the different performance cycles of CPR-10s, significant differences were found in CCF, CCD, CCR (chest compression rate), and RPE (p < 0.05). On the other hand, among the different performance cycles of CPR-20s, significant differences were found in CCD, CCR, and RPE (p < 0.05). Moreover, the CCF, CCD, and RPE scores of the two tests reached significant differences in specific phases (p < 0.05).
Conclusions: This study confirmed that the upper limb muscle mass or the weight of the upper body of EMTs is positively correlated with the quality of CPR. In addition, intermittent chest compressions with safe interruption intervals can reduce fatigue caused by long-term chest compressions and maintain better chest compression quality.
... Heart rate (HR) was measured at rest, during chest compression, and during recovery using a Life Scope 8 (Nihon Kohden Co., Tokyo, Japan). During chest compressions, the surface EMG collected data from the triceps brachii, deltoid, trapezius, erector spinae, external oblique muscle, rectus femoris, biceps femoris, and medial gastrocnemius muscles using SX230-1000 electrodes (Biometrics Ltd., UK) (Trowbridge et al., 2009;Yasuda et al., 2013). The electrodes were attached to the belly of each muscle, and the skin was abraded and cleaned with alcohol before attachment to minimize impedance. ...
Aim:
Cardiopulmonary resuscitation is vital for survival after cardiac arrest, and chest compressions are an important aspect of this. When performing chest compression in a hospital setting, the rescuer often has to kneel on the bed to overcome inconvenient differences in height between the rescuer and the bed. However, as yet no study has evaluated the quality of chest compressions in this position. The aim of this study was to examine the impact on the quality of chest compressions while kneeling on the bed.
Methods:
Fifteen female students performed 2-min chest compressions on a manikin placed on the floor and a bed. Measurement parameters included compression depth, heart rate, integrated electromyogram, and a visual analog scale. The parameters were measured every 30 s and were statistically compared between the conditions.
Results:
Compression depth at 30, 60, 90, and 120 s differed significantly between the conditions. Heart rate values at 150 and 210 s of recovery significantly differed between the conditions. Integrated electromyogram values for the trapezius, rectus femoris, and biceps femoris differed between the floor and bed conditions during 2-min chest compressions, whereas the external oblique muscle significantly differed at 60 and 120 s. Visual analog scales for fatigue, effectiveness, and stability significantly differed between the conditions.
Conclusion:
Kneeling on the bed does not enable grounding of the toe, causing the upper body to be unstable and limiting generation of the power required for chest compression. Our results suggest that rotation every minute is necessary to maintain effective cardiopulmonary resuscitation while kneeling on the bed.
... [15][16][17] Particularly, increasing fatigue causes flexion at the elbow, which has a high ROM, and this, in turn, weakens the compression force applied directly downward on the patient's chest, thus hindering effective chest compression. 7, 18 Zhang et al 17 proved that the effectiveness of chest compression is diminished after 1 minute of CPR by 1 rescuer because of increased fatigue. Bjørshol et al 19 proved in a simulation study that even professional paramedics feel fatigue after 2 minutes of CPR and thus provide less effective chest compressions. ...
... 7,8 On the other hand, performing chest compressions with the elbow locked by extending the wrist prevents the elbow from flexing even if the rescuer becomes tired, thus enabling the rescuer to maintain an adequate depth of compression throughout the 8 minutes of chest compression. Yasuda et al 18 proved that performing chest compressions while kneeling relaxes the triceps brachial muscle and may cause elbow flexion. If fatigue increases, Data were presented as number (%) or mean and SD. ...
Objectives:
Length of stay (LOS) and boarding for pediatric psychiatric patients presenting in the emergency department (ED) have been understudied, despite evidence that children with psychiatric disorders experience longer LOS relative to those without. This investigation examined correlates of LOS and boarding among youth with psychiatric disorders presenting to the ED in a large, statewide database.
Methods:
Using the 2010 to 2013 Florida ED discharge database, generalized linear mixed models were used to examine for associations between LOS and patient and hospital characteristics among pediatric patients (<18 years) who presented with a primary psychiatric diagnosis (N = 44,328).
Results:
Patients had an overall mean ± SD ED LOS of 5.96 ± 8.64 hours. Depending on the definition used (ie, 12 or 6 hours), between 23% and 58% of transferred patients were boarded. Patient characteristics associated with a longer LOS included female sex, being 15 to 17 years old, Hispanic ethnicity, having Medicaid or VA/TriCare insurance, having impulse control problems, having mood or psychotic disorders, and exhibiting self-harm behaviors. Patient transfer, large hospital size, and rural designation were associated with longer LOS. Teaching hospital status and profit status were not significantly associated with LOS.
Conclusions:
These data suggest that LOS for pediatric psychiatry patients in the ED varies significantly by psychiatric presentation, patient disposition, and hospital factors. Such findings have implications for quality of care, patient safety, and health outcomes.
... Consequently, weight cannot be applied perpendicular to the sternum; therefore, pressure may be applied using arm strength to maintain the depth of chest compressions although there is no evidence to prove this. However, Yasuda et al. [8] examined the muscles used for chest compressions in a moving ambulance using electromyography and reported that there was significantly higher activity of the triceps brachii, biceps femoris, and pectoralis major muscles; therefore, in CPR performed on an unstable floor, the effectiveness of chest compressions is dependent on the upper limb muscles. These findings suggest that walking CPR involves more muscle activity than straddling CPR and may lead to fatigue afterwards. ...
The optimal strategy to ensure chest compression quality for patients being transported on a stretcher has not been established yet. We hypothesised that straddling cardiopulmonary resuscitation may improve chest compression quality in patients being transported on stretchers. We conducted a prospective randomised crossover study using manikins to investigate whether straddling cardiopulmonary resuscitation improves chest compression quality (depth, recoil, rate, correct hand position) performed on patients during stretcher transportation compared to walking cardiopulmonary resuscitation. Walking and straddling cardiopulmonary resuscitation were performed for 2 minutes each. The mean chest compression depth (mm) for 2 minutes was significantly greater in the straddling cardiopulmonary resuscitation group than in the walking cardiopulmonary resuscitation group (median, 51.3 [interquartile range, 46.7–55.5] versus 40.9 [34.6–50.1], P = 0.003). An adequate depth of chest compressions could not be achieved when walking cardiopulmonary resuscitation was performed by female participants, but the depth of chest compressions was within the acceptable range when female participants performed straddling cardiopulmonary resuscitation. On the other hand, the degree of deterioration was relatively small in male participants, even when they performed walking cardiopulmonary resuscitation. In patients with cardiac arrest being transported on a stretcher, straddling cardiopulmonary resuscitation improved the depth of chest compressions compared to walking cardiopulmonary resuscitation. Female rescuers, in particular, may consider using straddling cardiopulmonary resuscitation.
... CPR at kneeling position showed the least ergonomic position for the rescuer despite previous studies that favour kneeling in term of achieving good quality of chest compression [6][7][8]. It is commonly taught in CPR courses and training and frequently adapted by the paramedic in prehospital care. ...
CPR is a live-saving procedure commonly performed in emergency department. Chest compression is a crucial component of CPR requires the rescuer to provide large force at certain rate. Emergency medical staff frequently needs to perform CPR in uncomfortable and awkward position such as kneeling on the floor or stretcher, standing in moving ambulance and standing on step-stool. Musculoskeletal pain and fatigue are often reported among rescuer after performing. The study aimed to assess the ergonomic risk factor of musculoskeletal disorders in rescuer performing chest compression at 3 different positions: kneeling, standing and step-on-stool. A cross-sectional study involving 30 participants consist of emergency doctors, nurses and paramedic was carried out in Emergency and Trauma Department of Hospital Universiti Sains Malaysia, Kelantan. All participants were required to perform chest compression on mannequin each at kneeling, standing and step-on-stool position. Participants are video graphed while performing high-quality CPR. Ergonomic risk score is assessed by using Rapid Entire Body Assessment (REBA) tool. This study showed that the highest mean REBA score recorded at kneeling position, followed by standing position and step-on-stool position. Mean REBA score at all 3 positions belongs to high risk group and it is necessary to further investigate and implement change as soon as possible.
... During CPR practise, triceps brachii plays an important role in extending the elbow [17], whereas rectus abdominis controls the trunk and stabilizes the upper body to provide a proper force distribution during chest compressions [6]. For this reason, contractile properties of these muscles were measured through non-invasive and non-demanding TMG in this study. ...
Objective
To analyse the acute muscular fatigue (AMF) in triceps brachii and rectus abdominis during compression-only and standard cardiopulmonary resuscitation (CPR) performed by certified basic life support providers.
Methods
Twenty-six subjects were initially recruited and randomly allocated to two study groups according to the muscles analysed; eighteen finally met the inclusion criteria (nine in each group). Both groups carried out two CPR tests (compression-only and standard CPR) of 10 min divided into five 2-min intermittent periods. The ventilation method was freely chosen by each participant (mouth-to-mouth, pocket-mask or bag-valve-mask). CPR feedback was provided all the time. AMF was measured by tensiomyography at baseline and after each 2-min period of the CPR test, in triceps brachii or rectus abdominis according to the study group.
Results
Rectus abdominis’ contraction time increased significantly during the fifth CPR period (p = 0.020). Triceps brachii’s radial muscle belly displacement (p = 0.047) and contraction velocity (p = 0.018) were lower during compression-only CPR than during standard CPR. Participants who had trained previously with feedback devices achieved better CPR quality results in both protocols. Half of participants chose bag-valve-mask to perform ventilations but attained lower significant ventilation quality than the other subjects.
Conclusions
Compression-only CPR induces higher AMF than standard CPR. Significantly higher fatigue levels were found during the fifth CPR test period, regardless of the method. Adequate rescuer’s strength seems to be a requisite to take advantage of CPR quality feedback devices. Training should put more emphasis on the quality of ventilation during CPR.
... Electrodes of 5 x 5 cm were placed symmetric to the sensor. Increasing amplitudes of stimulation were delivered (50, 75 and 100 mA) [13], with a resting period of 15 seconds between consecutive measures to minimize the effect of fatigue and potentiation [14]. ...
Objective: To analyse the acute muscular fatigue (AMF) in triceps brachii and rectus abdominis during compression-only and standard cardiopulmonary resuscitation (CPR) performed by and certified basic life support providers.
Methods: Twenty-six subjects were initially recruited and randomly allocated to two study groups according to the muscles analysed; eighteen finally met the inclusion criteria (nine in each group). Both groups carried out two CPR tests (compression-only and standard CPR) of 10 min divided into five 2-min intermittent periods. The ventilation method was freely chosen by each participant (mouth-to-mouth, pocket-mask or bag-valve-mask). CPR feedback was provided all the time. AMF was measured by tensiomyography at baseline and after each 2-min period of the CPR test, in triceps brachii or rectus abdominis according to the study group.
Results: Rectus abdominis' contraction time increased significantly during the fifth CPR period (p = 0.020). Triceps brachii's radial muscle belly displacement (p = 0.047) and contraction velocity (p = 0.018) were lower during compression-only CPR than during standard CPR. Participants who had trained previously with feedback devices achieved better CPR quality results in both protocols. Half of participants chose bag-valve-mask to perform ventilations but attained lower significant ventilation quality than the other subjects.
Conclusions: Compression-only CPR induces higher AMF than standard CPR. Significantly higher fatigue levels were found during the fifth CPR test period, regardless of the method. Adequate rescuer's strength seems to be a requisite to take advantage of CPR quality feedback devices. Training should put more emphasis on the quality of ventilation during CPR.
... In female students, there was a correlation between chest compression depth and height, but there was no correlation between depth and physique in male students. Chest compressions were performed with bending at the hip joint and involved the upper arm muscles, pectoralis major, erector spinae, and thigh muscles [14,15]. Therefore, to achieve effective chest compression depth, more muscle activity is required in a short person because of the lower center of gravity. ...
... To increase the equipment fidelity in this study, the Laerdal mannequin Resusci Anne® (Laerdal Medical GmbH, Puchheim, Germany) was used and the vital signs were dynamically simulated with the monitor iSimulate ALSi® (Skillqube GmbH, Wiesloch, Germany). The Laerdal Resusci Anne is globally used in education and research [33], [34], [35]. To enhance environment fidelity, every scenario had different characteristic accessories, e.g. in one case of simulated heart attack, a patient was watching sports sitting on a sofa with a football flag while eating potato crisps. ...
Newly developed mHealth tools need to be tested in standardized conditions without possible patient harm before implementation. One possible approach to secure these two conditions is to analyze the mHealth tool in a medical simulation center. Medical simulation centers create realistic routine or emergency scenarios with the aid of computer-operated mannequins. Medical simulation is widely established, especially in emergency medicine, because it combines theoretical knowledge and practical skills. To evaluate a mHealth concept in the field of prehospital emergency medicine in a medical simulation center, distinctive scenarios should be used. The mHealth concept in this study was a mobile, high definition, real-time video connection between the emergency site and a remote medical expert. Since all participants in this study confirmed that the chosen scenarios were realistic and relevant, a medical simulation center appears to be a suitable model for testing mHealth concepts in prehospital emergency medicine.
