Effective compression ratio-A new measurement of the quality of thorax compression during CPR

PURPOSE: Computer-based feedback systems for assessing the quality of cardiopulmonary resuscitation (CPR) are widely used these days. Recordings usually involve compression and ventilation dependent variables. Thorax compression depth, sufficient decompression and correct hand position are displayed but interpreted independently of one another. We aimed to generate a parameter, which represents all the combined relevant parameters of compression to provide a rapid assessment of the quality of chest compression-the effective compression ratio (ECR). METHODS: The following parameters were used to determine the ECR: compression depth, correct hand position, correct decompression and the proportion of time used for chest compressions compared to the total time spent on CPR. Based on the ERC guidelines, we calculated that guideline compliant CPR (30:2) has a minimum ECR of 0.79. To calculate the ECR, we expanded the previously described software solution. In order to demonstrate the usefulness of the new ECR-parameter, we first performed a PubMed search for studies that included correct compression and no-flow time, after which we calculated the new parameter, the ECR. RESULTS: The PubMed search revealed 9 trials. Calculated ECR values ranged between 0.03 (for basic life support [BLS] study, two helpers, no feedback) and 0.67 (BLS with feedback from the 6th minute). CONCLUSION: ECR enables rapid, meaningful assessment of CPR and simplifies the comparability of studies as well as the individual performance of trainees. The structure of the software solution allows it to be easily adapted to any manikin, CPR feedback devices and different resuscitation guidelines (e.g. ILCOR, ERC).

Comparing three CPR feedback devices and standard BLS in a single rescuer scenario: a randomised simulation study

BACKGROUND Efficiently performed basic life support (BLS) after cardiac arrest is proven to be effective. However, cardiopulmonary resuscitation (CPR) is strenuous and rescuers' performance declines rapidly over time. Audio-visual feedback devices reporting CPR quality may prevent this decline. We aimed to investigate the effect of various CPR feedback devices on CPR quality. METHODS In this open, prospective, randomised, controlled trial we compared three CPR feedback devices (PocketCPR, CPRmeter, iPhone app PocketCPR) with standard BLS without feedback in a simulated scenario. 240 trained medical students performed single rescuer BLS on a manikin for 8min. Effective compression (compressions with correct depth, pressure point and sufficient decompression) as well as compression rate, flow time fraction and ventilation parameters were compared between the four groups. RESULTS Study participants using the PocketCPR performed 17±19% effective compressions compared to 32±28% with CPRmeter, 25±27% with the iPhone app PocketCPR, and 35±30% applying standard BLS (PocketCPR vs. CPRmeter p=0.007, PocketCPR vs. standard BLS p=0.001, others: ns). PocketCPR and CPRmeter prevented a decline in effective compression over time, but overall performance in the PocketCPR group was considerably inferior to standard BLS. Compression depth and rate were within the range recommended in the guidelines in all groups. CONCLUSION While we found differences between the investigated CPR feedback devices, overall BLS quality was suboptimal in all groups. Surprisingly, effective compression was not improved by any CPR feedback device compared to standard BLS. All feedback devices caused substantial delay in starting CPR, which may worsen outcome.

Phytoplankton niches estimated from CPR data in the North Atlantic

We combine phytoplankton occurrence data for 119 species from the continuous plankton recorder with climatological environmental variables in the North Atlantic to obtain ecological response functions of each species using the MaxEnt statistical method. These response functions describe how the probability of occurrence of each species changes as a function of environmental conditions and can be reduced to a simple description of phytoplankton realized niches using the mean and standard deviation of each environmental variable, weighted by its response function. Although there was substantial variation in the realized niche among species within groups, the envelope of the realized niches of North Atlantic diatoms and dinoflagellates are mostly separate in niche space.

Do Regime Legal da Cédula de Produto Rural (CPR)

Inclui notas explicativas

Spatial distribution of key zooplankton species using continuous plankton recorder (CPR) data from the North Atlantic (2000-2009)

The continuous plankton recorder (CPR) survey is an upper layer plankton monitoring program that has regularly collected samples, at monthly intervals, in the North Atlantic and adjacent seas since 1946. Water from approximately 6 m depth enters the CPR through a small aperture at the front of the sampler and travels down a tunnel where it passes through a silk filtering mesh of 270 µm before exiting at the back of the CPR. The plankton filtered on the silk is analyzed in sections corresponding to 10 nautical miles (approx. 3 m**3 of seawater filtered) and the plankton microscopically identified (Richardson et al., 2006 and reference therein). In the present study we used the CPR data to investigate the current basin scale distribution of C. finmarchicus (C5-C6), C. helgolandicus (C5-C6), C. hyperboreus (C5-C6), Pseudocalanus spp. (C6), Oithona spp. (C1-C6), total Euphausiida, total Thecosomata and the presence/absence of Cnidaria and the Phytoplankton Colour Index (PCI). The PCI, which is a visual assessment of the greenness of the silk, is used as an indicator of the distribution of total phytoplankton biomass across the Atlantic basin (Batten et al., 2003). Monthly data collected between 2000 and 2009 were gridded using the inverse-distance interpolation method, in which the interpolated values were the nodes of a 2 degree by 2 degree grid. The resulting twelve monthly matrices were then averaged within the year and in the case of the zooplankton the data were log-transformed (i.e. log10 (x+1).

The Defamation Act 2013 and CPR 3.4 and 24:a sting in causation’s tail

Examines the Court of Appeal judgment in Tesla Motors Ltd v BBC on whether the claim that a review of a vehicle on the BBC "Top Gear" programme constituted malicious falsehood should be struck out under CPR 3.4(2) on the ground there was insufficient evidence to show that any loss in revenue suffered by the manufacturer was attributable to the review. Considers the implications of the decision for commercial claimants seeking to establish that defamation caused them "serious harm", which, pursuant to the Defamation Act 2013 s.1(2), requires evidence of actual or likely serious financial loss.

Test of a smock system on CPR primary emergency measures and medical errors during simulated emergencies

Rates of survival of victims of sudden cardiac arrest (SCA) using cardio pulmonary resuscitation (CPR) have shown little improvement over the past three decades. Since registered nurses (RNs) comprise the largest group of healthcare providers in U.S. hospitals, it is essential that they are competent in performing the four primary measures (compression, ventilation, medication administration, and defibrillation) of CPR in order to improve survival rates of SCA patients. The purpose of this experimental study was to test a color-coded SMOCK system on: 1) time to implement emergency patient care measures 2) technical skills performance 3) number of medical errors, and 4) team performance during simulated CPR exercises. The study sample was 260 RNs (M 40 years, SD=11.6) with work experience as an RN (M 7.25 years, SD=9.42).Nurses were allocated to a control or intervention arm consisting of 20 groups of 5-8 RNs per arm for a total of 130 RNs in each arm. Nurses in each study arm were given clinical scenarios requiring emergency CPR. Nurses in the intervention group wore different color labeled aprons (smocks) indicating their role assignment (medications, ventilation, compression, defibrillation, etc) on the code team during CPR. Findings indicated that the intervention using color-labeled smocks for pre-assigned roles had a significant effect on the time nurses started compressions (t=3.03, p=0.005), ventilations (t=2.86, p=0.004) and defibrillations (t=2.00, p=.05) when compared to the controls using the standard of care. In performing technical skills, nurses in the intervention groups performed compressions and ventilations significantly better than those in the control groups. The control groups made significantly (t=-2.61, p=0.013) more total errors (7.55 SD 1.54) than the intervention group (5.60, SD 1.90). There were no significant differences in team performance measures between the groups. Study findings indicate use of colored labeled smocks during CPR emergencies resulted in: shorter times to start emergency CPR; reduced errors; more technical skills completed successfully; and no differences in team performance.

Does video feedback analysis improve CPR performance in phase 5 medical students?

Background The use of simulation in medical education is increasing, with students taught and assessed using simulated patients and manikins. Medical students at Queen’s University of Belfast are taught advanced life support cardiopulmonary resuscitation as part of the undergraduate curriculum. Teaching and feedback in these skills have been developed in Queen’s University with high-fidelity manikins. This study aimed to evaluate the effectiveness of video compared to verbal feedback in assessment of student cardiopulmonary resuscitation performance Methods Final year students participated in this study using a high-fidelity manikin, in the Clinical Skills Centre, Queen’s University Belfast. Cohort A received verbal feedback only on their performance and cohort B received video feedback only. Video analysis using ‘StudioCode’ software was distributed to students. Each group returned for a second scenario and evaluation 4 weeks later. An assessment tool was created for performance assessment, which included individual skill and global score evaluation. Results One hundred thirty eight final year medical students completed the study. 62 % were female and the mean age was 23.9 years. Students having video feedback had significantly greater improvement in overall scores compared to those receiving verbal feedback (p = 0.006, 95 % CI: 2.8–15.8). Individual skills, including ventilation quality and global score were significantly better with video feedback (p = 0.002 and p < 0.001, respectively) when compared with cohort A. There was a positive change in overall score for cohort B from session one to session two (p < 0.001, 95 % CI: 6.3–15.8) indicating video feedback significantly benefited skill retention. In addition, using video feedback showed a significant improvement in the global score (p < 0.001, 95 % CI: 3.3–7.2) and drug administration timing (p = 0.004, 95 % CI: 0.7–3.8) of cohort B participants, from session one to session two. Conclusions There is increased use of simulation in medicine but a paucity of published data comparing feedback methods in cardiopulmonary resuscitation training. Our study shows the use of video feedback when teaching cardiopulmonary resuscitation is more effective than verbal feedback, and enhances skill retention. This is one of the first studies to demonstrate the benefit of video feedback in cardiopulmonary resuscitation teaching.

Time Delays on the Identification of the Need for CPR for Limited English Proficient 9-1-1 Callers

Thesis (Master's)--University of Washington, 2016-08