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Bystander fatigue and CPR quality by older bystanders: a randomized crossover trial comparing continuous chest compressions and 30:2 compressions to ventilations

  • Shawn Liu (a1), Christian Vaillancourt (a1) (a2) (a3), Ann Kasaboski (a1) and Monica Taljaard (a1) (a3)

Abstract

Objectives

This study sought to measure bystander fatigue and cardiopulmonary resuscitation (CPR) quality after five minutes of CPR using the continuous chest compression (CCC) versus the 30:2 chest compression to ventilation method in older lay persons, a population most likely to perform CPR on cardiac arrest victims.

Methods

This randomized crossover trial took place at three tertiary care hospitals and a seniors’ center. Participants were aged ≥55 years without significant physical limitations (frailty score ≤3/7). They completed two 5-minute CPR sessions (using 30:2 and CCC) on manikins; sessions were separated by a rest period. We used concealed block randomization to determine CPR method order. Metronome feedback maintained a compression rate of 100/minute. We measured heart rate (HR), mean arterial pressure (MAP), and Borg Exertion Scale. CPR quality measures included total number of compressions and number of adequate compressions (depth ≥5 cm).

Results

Sixty-three participants were enrolled: mean age 70.8 years, female 66.7%, past CPR training 60.3%. Bystander fatigue was similar between CPR methods: mean difference in HR -0.59 (95% CI −3.51-2.33), MAP 1.64 (95% CI −0.23-3.50), and Borg 0.46 (95% CI 0.07-0.84). Compared to 30:2, participants using CCC performed more chest compressions (480.0 v. 376.3, mean difference 107.7; p<0.0001) and more adequate chest compressions (381.5 v. 324.9, mean difference. 62.0; p=0.0001), although good compressions/minute declined significantly faster with the CCC method (p=0.0002).

Conclusions

CPR quality decreased significantly faster when performing CCC compared to 30:2. However, performing CCC produced more adequate compressions overall with a similar level of fatigue compared to the 30:2 method.

Objectifs

L’étude visait à mesurer la fatigue des passants et la qualité de la réanimation cardiorespiratoire (RCR) ressentie après 5 minutes de manœuvres effectuées selon la méthode des compressions thoraciques continues (CTC) ou celle de l’alternance des compressions et des insufflations dans un ratio de 30/2 chez des personnes âgées profanes en la matière, segment de la population le plus susceptible d’effectuer des manœuvres de RCR sur des personnes ayant subi un arrêt cardiaque.

Méthode

Il s’agit d’un essai croisé, à répartition aléatoire, qui a été mené dans trois hôpitaux de soins tertiaires et dans un centre pour personnes âgées. Les participants étaient des personnes de 55 ans et plus, sans limites physiques importantes (score de fragilité ≤3/7). Les sujets ont effectué des manœuvres de RCR sur des mannequins durant deux séances de 5 minutes chacune (selon la méthode 30/2 ou des CTC), séparées par une période de repos. L’ordre des méthodes de RCR a été déterminé au hasard et à l’insu des chercheurs. L’utilisation d’un métronome a permis de maintenir une cadence de 100 compressions/minute. Ont été mesurés la fréquence cardiaque (FC), la pression artérielle moyenne (PAM) et le score de perception de l’effort selon l’échelle de Borg. Les mesures de la qualité des manœuvres de RCR comprenaient le nombre total de compressions et le nombre de bonnes compressions (profondeur ≥5 cm).

Résultats

Soixante-trois personnes ont participé à l’étude : l’âge moyen était de 70,8 ans, il y avait 66,7 % de femmes et 60,3 % des participants avaient déjà suivi une formation en RCR. Le degré de fatigue causée par l’une ou l’autre des méthodes de RCR et ressentie par les passants était sensiblement le même; ainsi l’écart moyen de la FC était de −0,59 (IC à 95 % : −3,51 à 2,33); celui de la PAM, de 1,64 (IC à 95 % : −0,23 à 3,50); et celui du score de Borg, de 0,46 (IC à 95 % : 0,07 à 0,84). La méthode des CTC a permis d’effectuer plus de compressions thoraciques (480,0 contre [c.] 376,3; écart moyen : 107,7; p<0,0001) et plus de bonnes compressions thoraciques (381,5 c. 324,9; écart moyen : 62,0; p=0,0001) que la méthode 30/2, mais le nombre de bonnes compressions par minute a diminué beaucoup plus rapidement avec la méthode des CTC (p=0,0002).

Conclusions

La qualité de la RCR a diminué beaucoup plus rapidement avec la méthode des CTC qu’avec la méthode 30/2. Toutefois, la méthode des CTC a permis, dans l’ensemble, d’effectuer plus de bonnes compressions que la méthode 30/2, et ce, pour un degré comparable de fatigue.

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Copyright

Corresponding author

Correspondence to: Christian Vaillancourt, The Ottawa Hospital, Civic Campus, Clinical Epidemiology Unit, F649, 1053 Carling Ave., Ottawa, ON, Canada K1Y 4E9; Email: cvaillancourt@ohri.ca

Footnotes

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This project was presented in abstract form at the Canadian Association of Emergency Physicians’ Annual Scientific Conference, Niagara Falls, ON, 2012.

Footnotes

References

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