Association of chest compression and recoil velocities with depth and rate in manual cardiopulmonary resuscitation

doi:10.1016/j.resuscitation.2019.07.023

Resuscitation

Volume 142, September 2019, Pages 119-126

https://doi.org/10.1016/j.resuscitation.2019.07.023 Get rights and content

Abstract

Aim

Maximum velocity during chest recoil has been proposed as a metric for chest compression quality during cardiopulmonary resuscitation (CPR). This study investigated the relationship of the maximum velocities during compression and recoil phases with compression depth and rate in manual CPR.

Methods

We measured compression instances in out-of-hospital cardiac arrest recordings using custom Matlab programs. Each compression cycle was characterized by depth and rate, maximum compression and recoil velocities (CV and RV), and compression and recoil durations (total and effective). Mean compression and recoil velocities were computed as depth divided by compression and recoil durations, respectively. We correlated CV and RV with their corresponding mean velocities (total and effective), characterized by Pearson's correlation coefficient.

Results

CV/RV were strongly correlated with their corresponding mean velocities, with a median r of 0.83 (0.77–0.88)/0.82 (0.76–0.87) in per patient analysis, 0.86/0.88 for all the population. Correlation with mean effective velocities had a median r of 0.91 (0.87–0.94)/0.92 (0.89–0.94) in per-patient, 0.92/0.94 globally (p < 0.001). Total and effective compression and recoil durations were inversely proportional to compression rate. We observed similar RV values among compressions regardless of whether they were compliant with recommended depth and rate. Conversely, we observed different RV values among compressions having the same depth and rate, but presenting very distinct compression waveforms.

Conclusion

CV and RV were highly correlated with compression depth and compression and recoil times, respectively. Better understanding of the relationship between novel and current quality metrics could help with the interpretation of CPR quality studies.

Introduction

High-quality cardiopulmonary resuscitation (CPR) is key to improving outcomes of cardiac arrest victims.1, 2, 3 CPR quality metrics of compression depth4, 5 and rate,⁶ chest compression fraction,⁷ and duration of peri-shock pause (compression cessation prior to and following electrical shock)8, 9 have been independently associated with survival to hospital discharge among victims of out-of-hospital cardiac arrest (OHCA). Complete chest recoil is another component of high-quality CPR since rescuer leaning is common during resuscitation10, 11 and may compromise the blood flow generated by chest compressions.12, 13, 14

Measure of leaning requires force sensors usually built into bulky and expensive devices.¹⁵ Chest compression release velocity has been proposed as an alternative indirect measure to identify leaning.16, 17 More affordable accelerometer-based devices characterize the movement of the patient's chest to provide feedback to the rescuers. The term release velocity has been used by some authors to refer to the maximum velocity achieved by the chest during the recoil phase as measured by these devices. However, since this measure characterizes how the chest moves rather than how the rescuer releases the force, we have suggested recoil velocity (RV) as a more accurate term.¹⁸ A recent study with out-of-hospital CPR data concluded that, even though the probability of leaning was higher for lower RV values, there was a high overlap in the distributions, and thus RV was ineffective at predicting leaning.¹⁸

Recoil velocity has also been proposed for monitoring chest compression quality. Its influence on blood flow and blood pressure and its relation with end-tidal CO₂ levels during CPR have been studied in animal models of cardiac arrest.¹⁹ The significance of RV as predictor of survival and favourable neurological outcome20, 21, 22 and as predictor of achieved end-tidal CO₂ levels during CPR²³ has also been assessed in human models. Additionally, RV has been studied as a potential new CPR quality metric in children.²⁴

When a new chest compression quality metric is proposed, its potential relationship with existing well-established metrics should be carefully analysed.²¹ Understanding these relationships would ensure that studies are well designed and account for confounding factors when interpreting results. For this purpose, we performed a retrospective observational study using CPR data from OHCA episodes containing a large number of chest compression instances. Our hypothesis was that RV is strongly correlated with the mean velocity of the chest during recoil, which in turn is defined as compression depth divided by recoil time. We similarly analysed compression velocity (CV), defined as the maximum velocity achieved during chest compression. We introduce the concepts of effective compression and recoil times and analyse CV and RV in relation to them as well.

Section snippets

Data collection

Data were extracted from adult (≥18 years) OHCA episodes collected from 2013 through 2017 by Tualatin Valley Fire and Rescue (TVF&R), an advanced life support fire agency that serves eleven incorporated cities in Oregon, USA. Episodes (one per patient) were collected as part of the Resuscitation Outcomes Consortium (ROC) Epistry effort at the Portland (OR, USA) site approved by the Oregon Health & Science University (OHSU) Institutional Review Board (IRB00001736). No patient identifying data

Results

Of 703 uses of monitor-defibrillators by TVF&R during 2013 through 2017, 18 cases were excluded because the patients were younger than 18 years of age, and 69 because very few (<200 compressions) or no CPR was administered. In the 616 episodes that met our inclusion criteria, with a median (IQR) duration of 32 (27–47) min, a total of 1,162,766 compression instances were automatically detected, a median of 1726 (1043–2609) compressions per episode. We discarded 86,262 (7%) compressions with

Discussion

Recoil velocity (RV), defined as the maximum velocity achieved by the chest during the recoil phase, has been proposed as a new CPR quality metric. In human studies, contradictory results have been presented. Kovacs et al. reported an independent association between RV and improved survival and favourable neurological outcome.²¹ In another study by Cheskes et al., statistically significant differences in RV were reported between survivors and non-survivors on univariate analysis.²² However,

Conclusions

Recoil (or release) velocity has been proposed as a new CPR quality metric. In the absence of leaning, compression and recoil velocities are directly correlated with compression depth and inversely proportional to compression and recoil times, respectively. This relationship was significantly stronger when restricted to effective depth and durations. Understanding these relationships could help to better interpret the results of CPR quality studies related to recoil velocity.

Conflict of interest statement

Author Digna M González-Otero is employed by BEXEN Cardio, a Spanish medical device manufacturer that markets an accelerometer-based CPR feedback device.

The authors confirm that there has been no significant financial support for this work that could have influenced its outcome.

Acknowledgements

Authors from the University of the Basque Country received financial support from the Basque Government through the grants IT1087-16 (for research groups) and 2018222012 (research projects oriented to health development). Author from BEXEN Cardio received financial support from the Spanish Ministry of Economy, Industry and Competitiveness through the program Torres Quevedo PTQ-16-08201.

We would like to thank the EMS providers and staff of Tualatin Valley Fire and Rescue for their dedication and

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Rescuers’ characteristics associated with the correct chest compression during cardiopulmonary resuscitation
2022, Enfermeria Intensiva
Analizar las características físicas, antropométricas y formativas de los reanimadores asociadas a la correcta compresión y reexpansión torácica durante la reanimación cardiopulmonar.
Estudio observacional prospectivo. Profesionales y estudiantes sanitarios de urgencias y cuidados críticos realizaron 2 min de compresiones torácicas sobre un maniquí. Se evaluó la profundidad y la presión residual tras las compresiones, y se estudió su asociación a diferentes variables (físicas, antropométricas y formativas) mediante la creación de modelos de regresión logística.
Participaron 238 voluntarios. Que el reanimador tuviese una experiencia previa en menos de 6 reanimaciones cardiopulmonares (OR: 3,03; IC 95%: 1,2-7,63) se asoció a una mayor probabilidad de no lograr una profundidad adecuada en las compresiones. Una mayor estatura (OR: 0,93; IC 95%: 0,87-0,99) y fuerza de aprehensión (OR: 0,94; IC 95%: 0,89-0,99) fueron condiciones que actuaron como factores predisponentes a la ejecución de una técnica correcta. Ninguna característica se asoció a la adecuación de la reexpansión torácica.
La experiencia previa del reanimador es el factor más fuertemente asociado a la correcta ejecución de las compresiones torácicas. En menor medida, también influye la estatura y la fuerza del tren superior del profesional. No se han identificado factores asociados a la adecuación de la reexpansión torácica tras las compresiones.
To analyse the caregivers’ physical, anthropometrical and educational characteristics associated with adequate chest compression and full chest recoil during cardiopulmonary resuscitation (CPR).
An observational prospective research study was conducted. Emergency and critical care health professionals and students performed two minutes of chest compressions on a dummy. Depth and residual leaning after the compressions were assessed and their association with several variables (physical, anthropometrical, and educational) was analysed using logistic regression models.
Two hundred thirty-eight volunteers participated. Previous experience of the rescuer in less than six CPRs (OR: 3.03; CI 95%: 1.2-7.63) was related to a higher probability of not achieving an adequate depth of compressions. Greater height (OR: .93; 95% CI: .87-.99) and grip strength (OR: .94; 95% CI: .89-.99) were associated with correct performance of chest compression. We did not find any characteristic related to chest recoil.
The caregiver's previous experience with CPR was the strongest factor associated with adequate performance of chest compressions. To a lesser extent, the professional's height and upper body muscle strength also have an influence. No factors associated with the adequacy of full chest recoil were identified.
Chest compression release velocity: An independent determinant of end-tidal carbon dioxide in out-of-hospital cardiac arrest
2022, American Journal of Emergency Medicine
Citation Excerpt :
This could imply that the previously observed effect of CCRV on ETCO2 is associated with the effect of CC depth on ETCO2. Recently, Gonzàlez-Otero et al. found that CC at a fixed depth could have a variable CCRV and inversely, CC with different depths could have a similar CCRV, depending on the vigorousness and impulsiveness of the CC [4]. Therefore, we set up a study to further explore this phenomenon and to explore the possible relation between CCRV and the CC depth, as well as the effect of the CCRV on ETCO2.
Chest compression (CC) depth, CC rate and ventilatory rate (VR) are known to have an impact on end-tidal carbon dioxide (ETCO₂) values. Chest compression release velocity (CCRV) is increasingly acknowledged as a novel metric in cardiopulmonary resuscitation (CPR). The objective of this study was to analyze whether CCRV would have any effect on ETCO₂ values.
In out-of-hospital cardiac arrests (OHCA), effects of CC depth, CC rate, CCRV and VR on ETCO₂ were analyzed through linear mixed effect models. A stratification was made on a CCRV of 300, 400 and 500 mm/s. In these categories, mean ETCO₂ values were corrected for CC depth and compared through a one-way ANOVA.
A 10 mm increase in CC depth was associated with a 1.5 mmHg increase in ETCO₂ (p < 0.001), a 100 mm/s increase in CCRV with a 0.8 mmHg increase (p = 0.010) and a 5 breaths per minute increase in VR with a 2.0 mmHg decrease (p < 0.001). CC depth was strongly correlated with CCRV (Pearson's r = 0.709, p < 0.001). After adjusting for CC depth, ETCO₂ was on average 6.5 mmHg higher at a CCRV of 500 than at 400 mm/s (p = 0.005) and 5.3 mmHg higher than at 300 mm/s (p = 0.033).
In OHCA patients, higher CCRV values resulted in higher ETCO₂ values. This effect is independent of CC depth, despite the strong correlation between CCRV and CC depth.
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El nivel de conocimientos aumentó respecto al basal y fue mayor en los alumnos de cursos superiores (p < 0,001). La secuencia completa de soporte vital básico fue realizada por el 16,5% de los escolares de 3° de Educación Primaria, el 54,4% de los de 5° de Educación Primaria y el 28,5% de los de 1° de Educación Secundaria Obligatoria (p = 0,030). Los siguientes parámetros de calidad de las compresiones mejoraron de forma significativa con la edad: continuidad de las compresiones (p < 0,001), porcentaje de compresiones realizadas con una profundidad correcta (p = 0,002) y mediana de profundidad (p < 0,001), mientras que el porcentaje de compresiones con descompresión correcta descendió significativamente (p < 0,001).
Un programa formativo teórico-práctico de 2 h, impartido por los profesores de Educación Física, contribuye a mejorar la capacidad de los niños menores de 13 años para reconocer la emergencia, poner en marcha la cadena de supervivencia e iniciar las compresiones torácicas, aunque posiblemente sus características antropométricas no les permitan alcanzar la calidad ideal establecida para esta maniobra.
To quantitatively assess the learning capacity of school children aged between 8-12 years in basic life support (theory and practice) after a feasible school training programme.
Quasi-experimental study with a convenience sample of 567 pupils in 3rd, 5th and 1st year of Primary Education, and Compulsory Secondary Education, respectively, from 3 public schools in Galicia. They received 2 h (one theoretical and another practical) of basic life support training by their Physical Education teachers, as part of the school program. The children were evaluated by a theoretical test and a practical skill test that measured the quality of chest compressions, and assessed the performance of the basic life support sequence.
The level of knowledge increased with respect to the baseline, and was higher in the higher grades (P < .001). The complete basic life support sequence was carried out by 16.5% of pupils in the 3rd year of Primary Education, 54.4% of pupils in the 5th year of Primary Education, and 28.5% of pupils in the 1st year of Secondary Education (P = .030). The following compression quality parameters improved significantly with age: continuity of compressions (P < .001), percentage of compressions performed at correct depth (P = .002), and median depth (P < .001), while the percentage of compressions with correct decompression decreased significantly (P < .001).
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Characterize release and recoil dynamics in chest compressions during prolonged cardiopulmonary resuscitation (CPR) efforts, which are increasingly prevalent.
Force and depth of chest compressions, and their rates of change, were calculated from records extracted from CPR monitors used during prolonged resuscitation efforts for out-of-hospital cardiac arrest and tracked over time. Metrics were normalized to the median of the first 100 compressions.
Kruskal-Wallis ANOVA and Jonckheere-Terpstra trend analyses were used for differences and trends. Averages are reported as median (interquartile range). Correlations among metrics are reported as coefficients of determination.
In 471 cases of adult subjects receiving at least 1000 compressions, peak depths varied modestly over the course of extended resuscitation efforts, staying within a narrow range without a trend over the course of resuscitation efforts. Increases in recoil velocity and decreases in recoil interval also remained within limited ranges (5%, 6% variation respectively). By contrast, force waveforms changed substantially. Peak force decreased monotonically reaching a 38% decrease for compression numbers > 3500, similar to a decrease in release rate (39%) and an increase in release interval (39%).
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Clinical paperAssociation of chest compression and recoil velocities with depth and rate in manual cardiopulmonary resuscitation

Abstract

Aim

Methods

Results

Conclusion

Introduction

Section snippets

Data collection

Results

Discussion

Conclusions

Conflict of interest statement

Acknowledgements

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Trends Anaesth Crit Care

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Clinical paper
Association of chest compression and recoil velocities with depth and rate in manual cardiopulmonary resuscitation