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Original Research

Open Access

Automatic compression improves adherence to advanced life support protocol in two-paramedic team. A randomized simulation study

  • Tomasz Kłosiewicz1
  • Mateusz Puślecki1,2
  • Łukasz Szarpak3,4,5
  • Marek Dąbrowski6
  • Bartłomiej Perek2

1Department of Medical Rescue, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60608 Poznań, Poland

2Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 1/2 Długa Street, 61-848 Poznań, Poland

3Maria Sklodowska-Curie Bialystok Oncology Center,12 Ogrodowa Street, 15-027 Białystok, Poland

4Maria Sklodowska-Curie Medical Academy in Warsaw, Aleja Solidarności 12/4, 03-411 Warszawa, Poland

5Polish Society of Disaster Medicine, PO box 78, 05-090 Raszyn Warsaw, Poland

6Department of Medical Education, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland

DOI: 10.22514/sv.2020.16.0110 Vol.17,Issue 1,January 2021 pp.79-88

Published: 08 January 2021

*Corresponding Author(s): Tomasz Kłosiewicz E-mail: klosiewicz.tomek@gmail.com

Abstract

Introduction: The use of protocols reduces the risk of human error and increases healthcare professionals’ adherence to guidelines. In a team of only two providers, following Advanced Life Support (ALS) protocol might be challenging. Automated Chest Compressions Devices (ACCD) may increase the quality of chest compressions. The aim of this study was to evaluate if the use of ACCD in resuscitation by a two-paramedic crew improves adherence to the ALS protocol. Materials and Methods: This study was designed as a prospective randomized high-fidelity cross-over simulation trial. Fifty-two doubleperson teams were enrolled. Each team performed two full resuscitation scenarios: one with ACCD (the experimental group-ACC) and one with manual compressions (the control group-MAN). Results: ACC achieved shorter mean durations of resuscitation loops, being less prolonged in relation to recommended durations than MAN (13 vs. 23 sec over recommended respectively, P = 0.0003). ACC also achieved mean times for supraglottic airway completion significantly faster than MAN: 224 ± 66 s vs 122 ± 35 s (P < 0.0001). In ACC, the intravenous line was obtained earlier then in MAN (162 ± 35 s vs 183 ± 45 s, P = 0.0111). Moreover, the first and second doses of adrenaline (epinephrine) were administered earlier 272± 58 s vs 232 ± 57 s (P = 0.0014) for the first and 486 ± 96 s vs 424 ± 69 s (P = 0.0007) for the second doses, respectively. Mean chest compression fraction (CCF) in MAN group was significantly lower (74 ± 4%) than in ACC group (83 ± 2%) (P < 0.0001). Conclusions: In a simulated setting, ACCD used by two-person paramedic teams yielded earlier achievement of resuscitation endpoints and improved delivery time of compressions. which may have implications for effective clinical resuscitation.

Keywords

Quality of health care; Advanced cardiac life support; Cardiopulmonary resuscitation; Automated Chest Compression; High fidelity simulation training

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Tomasz Kłosiewicz,Mateusz Puślecki,Łukasz Szarpak,Marek Dąbrowski,Bartłomiej Perek. Automatic compression improves adherence to advanced life support protocol in two-paramedic team. A randomized simulation study. Signa Vitae. 2021. 17(1);79-88.

References

[1] Schluep M, Gravesteijn BY, Stolker RJ, Endeman H, Hoeks SE. One-year survival after in-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2019; 132: 90-100.

[2] Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveengen T, et al. European resuscitation council guidelines for resuscitation 2015 section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015; 95: 81-99.

[3] Grunau B, Kawano T, Tallon J, Scheuermeyer F, Reynolds J, Besserer F, et al. Abstract 344: the association between als response interval and out-of hospital cardiac arrest outcomes. Circulation. 2018; 138: A344.

[4] Vargas M, Buonanno P, Iacovazzo C, Servillo G. Adrenaline for out of hospital cardiac arrest: a systematic review and meta-analysis of randomized controlled trials. Resuscitation. 2019; 136: 54-60.

[5] Dyson K, Bray J, Smith K, Bernard S, Straney L, Finn J. Paramedic exposure to out-of-hospital cardiac arrest is rare and declining in victoria, Australia. Resuscitation. 2016; 89: 93-98.

[6] Kłosiewicz T, Skitek-Adamczak I, Zieliński M. Emergency medical system response time does not affect incidence of return of spontaneous circulation after prehospital resuscitation in one million central European agglomeration residents. Kardiologia Polska. 2017; 75: 240-246.

[7] Abella BS, Alvarado JP, Myklebust H, Edelson DP, Barry A, O’Hearn N, et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. Journal of the American Medical Association. 2005; 293: 305-310.

[8] Lugtenberg M, Burgers JS, Westert GP. Effects of evidence-based clinical practice guidelines on quality of care: a systematic review. Quality & Safety in Health Care. 2009; 18: 385-392.

[9] Miller AG, Breslin ME, Pineda LC, Fox JW. An asthma protocol improved adherence to evidence-based guidelines for pediatric subjects with status asthmaticus in the emergency department. Respiratory Care. 2015; 60: 1759-1764.

[10] Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. Chest. 2008; 133: 56-61.

[11] Ebben RHA, Vloet LCM, Verhofstad MHJ, Meijer S, Mintjes-de Groot JAJ, van Achterberg T. Adherence to guidelines and protocols in the pre-hospital and emergency care setting: a systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2013; 21: 9.

[12] McEvoy MD, Field LC, Moore HE, Smalley JC, Nietert PJ, Scarbrough SH. The effect of adherence to acls protocols on survival of event in the setting of in-hospital cardiac arrest. Resuscitation. 2014; 85: 82-87.

[13] Cheskes S, Schmicker RH, Rea T, Morrison LJ, Grunau B, Drennan IR, et al. The association between AHA CPR quality guideline compliance and clinical outcomes from out-of-hospital cardiac arrest. Resuscitation. 2017; 116: 39-45.

[14] Remino C, Baronio M, Pellegrini N, Aggogeri F, Adamini R. Automatic and manual devices for cardiopulmonary resuscitation: a review. Advances in Mechanical Engineering. 2018; 10: 1-14.

[15] Zhu N, Chen Q, Jiang Z, Liao F, Kou B, Tang H, et al. A meta-analysis of the resuscitative effects of mechanical and manual chest compression in out-of-hospital cardiac arrest patients. Critical Care Medicine. 2019; 23: 1-11.

[16] Wang PL, Brooks SC. Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database of Systematic Reviews. 2018; 8: CD007260.

[17] Dabrowski M, Klosiewicz T, Sip M, Zalewski R, Dabrowska A, Wieczorek W, et al. The final battle. What more can we do to be victorious with cardiac arrest? Preliminary data. Anestezjologia i Ratownictwo. 2018; 12: 111-116.

[18] Mader T, Coute R, Kellogg A, Harris J, Millay S, Jensen L. Restoring coronary perfusion pressure before defibrillation after chest compression interruptions. Journal of Emergency Medicine. 2014; 2: 29-35.

[19] Yu T, Weil MH, Tang W, Sun S, Klouche K, Povoas H, et al. Adverse outcomes of interrupted precordial compression during automated defibrillation. Circulation 2002; 106: 368-372.

[20] Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al. European resuscitation council guidelines for resuscitation 2015 section 3. Adult advanced life suport. Resuscitation. 2015; 95: 100-147.

[21] Bjørshol CA, Sunde K, Myklebust H, Assmus J, Søreide E. Decay in chest compression quality due to fatigue is rare during prolonged advanced life support in a manikin model. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2011; 19: 46.

[22] Kessler DO, Peterson DT, Bragg A, Lin Y, Zhong J, Duff J, et al. Causes for pauses during simulated pediatric cardiac arrest. Pediatric Critical Care Medicine. 2018; 18: e311-e317.

[23] Fumagalli F, Silver AE, Tan Q, Zaidi N, Ristagno G. Cardiac rhythm analysis during ongoing cardiopulmonary resuscitation using the analysis during compressions with fast reconfirmation technology. Heart Rhythm. 2018; 15: 248-255.

[24] Takegawa R, Shiozaki T, Ohnishi M, Tachino J, Muroya T, Sakai T, et al. Abstract 209: the triple CPR 16 study: does rhythm truly needed to be checked every 2 minutes in Cardiopulmonary Arrest Patients?Circulation. 2018; 138: A209.

[25] Sugerman NT, Edelson DP, Leary M, Weidman EK, Herzberg DL, Vanden Hoek TL, et al. Rescuer fatigue during actual in-hospital cardiopulmonary resuscitation with audiovisual feedback: a prospective multicenter study. Resuscitation. 2009; 80: 981-984.

[26] Tomte O, Sunde K, Lorem T, Weidman EK, Herzberg DL, Vanden Hoek TL, et al. Advanced life support performance with manual and mechanical chest compressions in a randomized, multicentre manikin study. Resuscitation. 2009; 80: 1152-1157.

[27] Bielski A, Rivas E, Ruetzler K, Smereka J, Puslecki M, Dabrowski M, et al. Comparison of blind intubation via supraglottic airway devices versus standard intubation during different airway emergency scenarios in inexperienced hand. Medicine. 2018; 97: e12593.

[28] Sanson G, Ristagno G, Caggegi GD, Patsoura A, Xu V, Zambon M, et al. Impact of ‘synchronous’ and ‘asynchronous’ CPR modality on quality bundles and outcome in out-of-hospital cardiac arrest patients. Internal and Emergency Medicine. 2019; 14: 1129-1137.

[29] Bircher NG, Chan PS, Xu Y. Delays in cardiopulmonary resuscitation, defibrillation, and adrenaline administration all decrease survival in in-hospital cardiac arrest. Anesthesiology. 2019; 130 :414-422.

[30] Perkins G, Kenna C, Ji C, Deakin C, Nolan J, Quinn T et al. The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial. Intensive Care Medicine. 2020; 46: 426-436.

[31] Johansson J, Hammerby R, Oldgren J, Rubertsson S, Gedeborg R. Adrenaline administration during cardiopulmonary resuscitation: poor adherence to clinical guidelines. Acta Anaesthesiologica Scandinavica. 2004; 48: 909-913.

[32] Friberg N, Schmidbauer S, Walther Ch, Englund E. Skeletal and soft tissue injuries after manual and mechanical chest compressions. European Heart Journal-Quality of Care and Clinical Outcomes. 2019; 5: 259-265.

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