chest compression depth during resuscitation of adults and children: a systematic review

Poster Presentations / Resuscitation 84S (2013) S8–S98 S25

groups. The total number of compressions per minutes was higherin CO-CPR than in ST-CPR. However the effective number of com-pressions (≥5 cm) was higher in ST-CPR than in CO-CPR after 3 min(p = 0.001). The change in MBP before and after performing CPR didnot differ between the 2 groups. However, the change in HR duringthe 8 min of CPR was higher in CO-CPR than in ST-CPR (p = 0.007).

Conclusion: The CPR quality of chest compressions was higherin ST-CPR than in CO-CPR during 8 min of CPR.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.074

AP043

Chest compression depth during resuscitationof adults and children: A systematic review

Laura Wuyts 1, Nathalie Kegels 1, KoenraadMonsieurs 2,∗

1 Antwerp University, Antwerp, Belgium2 Antwerp University Hospital, Edegem, Belgium

Purpose of the study: The optimal compression depth dur-ing cardiopulmonary resuscitation is unknown. This review aimedto answer the question: “Does a deeper compression during car-diopulmonary resuscitation, in adults and children with cardiacarrest in any setting, compared with chest compression of 5 cm(2 in.), improve coronary perfusion pressure, return of spontaneouscirculation (ROSC), survival to hospital discharge or survival at 30days with good neurological outcome?”.

Materials and methods: Systematic literature review searchingPubMed and Science Direct with the search terms ‘heart arrest’,‘cardiopulmonary resuscitation’ and ‘compression depth’.

Results: The search resulted in 221 articles. After exclusionbased on eligibility and inclusion of relevant articles, 17 articleswere considered, of which 6 animal studies and one manikin study.There were no randomised controlled trials. Five animals studieswith a low level of evidence showed an association between deepercompressions and improved coronary perfusion, systemic bloodpressure, cardiac output, improved ROSC and 24-h survival. Tworetrospective human studies claimed that the 2010 guidelines ofthe European Resuscitation Council (ERC) and the American HeartAssociation (AHA) recommended too deep chest compressions inchildren, without benefit of ROSC or survival. In a total of threeobservational studies in adults, a compression depth of more than5 cm (2 in.) was associated with improved ROSC, improved 24-hsurvival and improved survival to hospital discharge with goodneurologic outcome.

Conclusions: An increase in compression depth is associatedwith improved ROSC, improved 24-h survival and improved sur-vival to discharge with good neurologic outcome. We found onlyweak evidence to compress more than 5 cm (2 in.) deep in adultsand children with cardiac arrest.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.075

AP044

Agreement between two systems ofresuscitation maneuvers evaluation related tobasic life support: “The man or the machine?”

Salvador Quintana ∗, Manel Cerdà, Xavier Balanzó,Josep M. Giraldo, Manel Pacheco, Baltasar Sánchez

Catalan Ressuscitation Council, Catalonia, Spain

Introduction: Chest compressions are situated at the secondlink of the survival chain, and resuscitation success is related to

the “great quality” of these maneuvers. The teaching of knowledgeand skills according to guidelines in basic life support (BLS) is stan-dardized. The aim of this study was to match one objective system(feedback software) of evaluation of great quality cardiopulmonaryresuscitation with a subjective system (instructors).

Methods: Three instructors (A, B and C) matched their punctu-ation in a blind way among them and with the Laerdal PC SkillReporting v4.2.1 Software (LSRS). 54 technicians in emergencytransport accepted to participate in the study during their yearlyretraining. Instructors were asked to make a qualitative evalua-tion (pass or fail) and a quantitative punctuation of the items thatare registered by the LSRS: hands correct placement, compres-sion depth and rate and decompression (given by percents). Thoseparticipants who achieved more than 50% of correct punctuationpassed the evaluation. Cohen’s Kappa (K) was used for qualita-tive variables. Intraclass correlation coefficient (ICC) was used toevaluate quantitative variables agreement.

Results: A and B disagreed in a 22% (K = 0.52), A and C in a 26%(K = 0.45), B and C in a 15% (K = 0.7). Comparing to LSRS, instructorA disagreed in a 26% (K = 0.45), instructor B in a 34% (K = 0.35) andinstructor C in a 30% (K = 0.41). The four ICC calculated fluctuatebetween 0.388 and 0.489.

Conclusions: Instructors evaluate the BLS maneuvers with toomuch heterogeneity. This study confirms the need of using feed-back devices for life support teaching. The use of LSRS could helpinstructors to learn how to evaluate and so decrease the hetero-geneity among them.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.076

AP045

Transitioning to faster release velocity improveshemodynamic power in the inferior vena cavairrespective of chest compression depth

Joshua Lampe 1,∗, Josiah Garcia 1, Tai Yin 1, GeorgeBratinov 1, Christopher Kaufman 2, Lance Becker 1

1 University of Pennsylvania, Philadelphia, PA, USA2 ZOLL Medical Corporation, Chelmsford, MA, USA

Introduction: The quality of chest compressions (CC) duringcardiac arrest varies between rescuers. While it is not as well under-stood as depth and rate, CC release velocity could play an importantrole in CC efficacy. We tested the hypothesis that transitioning fromslow to fast release velocity will improve hemodynamics within theinferior vena cava (IVC) at two different CC depths.

Methods: CPR hemodynamics in 12 domestic swine (∼30 kg)were studied using standard physiological monitoring. A flowprobe was placed on the IVC while a pressure catheter wasplaced in the right heart. Hemodynamic power was determined(power = flow × pressure). Ventricular fibrillation (VF) was electri-cally induced. A mechanical CC device that was affixed to the chestof the animal was started after ten minutes of untreated VF. CCrelease was changed so that sternal recoil lasted 100 ms (WF1),200 ms (WF2), or 300 ms (WF3). CC were delivered at a rate of100 per minute and at a depth of 32 mm (n = 9) and 48 mm (n = 3).Transitions between waveforms occurred every 2 min and wererandomized.

Results: Transitioning from slow to faster release velocities sig-nificantly improved hemodynamic power in the IVC (figure) withsimilar trends in absolute IVC flow. Although the absolute mag-nitude of differences between waveforms was smaller at higherdepth, similar directional changes were observed and relativechange was similar between the two different depths.