Cardiopulmonary Resuscitation Interruptions With Use of a Load-Distributing Band Device During Emergency Department Cardiac Arrest
Presented at the 10th annual scientific meeting of the Society for Emergency Medicine, February 2009, Singapore; and as a poster at the 18th annual scientific meeting of Singapore General Hospital, April 2009, Singapore.
Received 30 August 2009; received in revised form 23 October 2009 and 2 December 2009; accepted 5 January 2010. published online 08 February 2010. Corrected Proof
Study objective
Our primary aim is to measure no-flow time and no-flow ratio before and after an emergency department (ED) switched from manual to a load-distributing band mechanical cardiopulmonary resuscitation (CPR) device.
Methods
This was a phased, before-after cohort evaluation at an urban tertiary hospital ED. We collected continuous video and chest compression data with the Physiocontrol CodeStat Suite 7.0 for resuscitations during the period just before and after adoption of load-distributing band CPR. All out-of-hospital, nontraumatic cardiac arrest, adult patients were eligible. From February 2007 to July 2008, there were 26 manual and 41 load-distributing band cases.
Results
Patients in both phases were comparable in terms of demographics, medical history, witnessed arrest, arrest location, bystander CPR rates, out-of-hospital defibrillation, initial rhythm, and ED defibrillation. The median no-flow time, defined as the sum of all pauses between compressions longer than 1.5 seconds, during the first 5 minutes of resuscitation, was manual CPR 85 seconds (interquartile range [IQR] 45 to 112 seconds) versus load-distributing band 104 seconds (IQR 69 to 151 seconds). The mean no-flow ratio, defined as no-flow time divided by segment length, was manual 0.28 versus load-distributing band 0.40 (difference=−0.12; 95% confidence interval −0.22 to −0.02). However, from 5 to 10 minutes into the resuscitation, median no-flow time was manual 85 seconds (IQR 59 to 151 seconds) versus load-distributing band 52 seconds (IQR 34 to 82 seconds) and mean no-flow ratio manual 0.34 versus load-distributing band 0.21 (difference=0.13; 95% confidence interval 0.02 to 0.24). The average time to apply load-distributing band CPR during this period was 152 seconds.
Conclusion
Application of a load-distributing band in the ED is associated with a higher no-flow ratio than manual CPR in the first 5 minutes of resuscitation. We suggest that attention to team training, rapid application of the device to minimize interruption, and feedback from defibrillator and video recordings may be useful to improve resuscitation team performance.
‡Singapore General Hospital, Singapore; the Emergency Medicine Department, National University Hospital, Singapore
§the Accident and Emergency, Changi General Hospital, Singapore.
Address for correspondence: Marcus Ong Eng Hock, MBBS (S'pore), MPH, Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608; 65-63213590, fax 65-63214873
Please see page XX for the Editor’s Capsule Summary of this article.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was supported by a grant from ZOLL Medical Corporation. Dr. Marcus Ong reports receiving reimbursement for travel expenses to attend a course in November 2006 related to the study. He reports no other financial benefits (stock, stock options) from this relationship. Mr. Yong was employed as a research coordinator funded through the study grant. No other authors report financial disclosures.
Supervising editor: Deborah B. Diercks, MD
Author contributions: MEHO and AA conceived the study objectives and methodology. MEHO prepared the study protocols. MEHO, AA, BS-HL, VYKO, LT, and SHA supervised the acquisition of data. PS provided statistical advice and analyzed the data. AS and KLY managed the database and the administration of the study. MEHO drafted the article, and all authors contributed to the final article. MEHO takes responsibility for the paper as a whole.
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