Kobi Ludwin1, *Lukasz Iskrzycki1, 2, Jerzy Robert Ladny3, Jolanta Majer4, Jacek Smereka1, 2, Wojciech Wieczorek5, 6, Klaudiusz Nadolny3, Halla Kaminska7, Lukasz Szarpak3, 6
Impact of a LUCAS 3 on chest compression quality during simulated cardiopulmonary resuscitation performed by lifeguards: a randomized crossover study
Wpływ zastosowania systemu LUCAS 3 na jakość uciśnięć klatki piersiowej podczas symulowanej resuscytacji krążeniowo-oddechowej wykonywanej przez ratowników wodnych: badanie randomizowane krzyżowe
1Polish Society of Disaster Medicine, Warsaw, Poland
2Department of Emergency Medical Service, Wroclaw Medical University, Poland
3Department of Emergency Medicine and Disaster, Medical University of Bialystok, Poland
4Department of Emergency Medicine, Holy Mary Memorial Provincial Specialist Hospital, Czestochowa, Poland
5Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia in Katowice, Poland
6Department of Emergency Medicine, Medical University of Warsaw, Poland
7Department of Children’s Diabetology, Medical University of Silesia in Katowice, Poland
Streszczenie
Wstęp. Wysokiej jakości uciski klatki piersiowej stanowią jeden z kluczowych elementów resuscytacji krążeniowo-oddechowej, bezpośrednio wpływających na szanse powrotu spontanicznego krążenia. Wytyczne Amerykańskiego Towarzystwa Kardiologicznego zalecają, aby uciski klatki piersiowej były prowadzone z częstością 100-120 uciśnięć na minutę, przy głębokości uciśnięć od 5 do 6 cm oraz przy zachowaniu pełnej relaksacji klatki piersiowej po każdym jej uciśnięciu.
Cel pracy. Celem badania było porównanie jakości parametrów uciskania klatki piersiowej wykonywanych w sposób bezprzyrządowy przez ratowników wodnych oraz wykonywanych z wykorzystaniem mechanicznego systemu kompresji klatki piersiowej LUCAS 3.
Materiał i metody. Przeprowadziliśmy randomizowane krzyżowe badanie z wykorzystaniem symulatora człowieka (Resusci Anne). Trzydziestu ośmiu ratowników wodnych wykonywało dwuminutowe cykle resuscytacji krążeniowo-oddechowej podczas scenariusza pozaszpitalnego zatrzymania krążenia w wyniku podtopienia.
Wyniki. Mediana głębokości uciśnięć klatki piersiowej podczas bezprzyrządowego uciskania klatki piersiowej wynosiła 46 mm (IQR: 42-50) i była statystycznie istotnie niższa niż w przypadku zastosowania systemu LUCAS 3 – 50 mm (IQR: 49-51).
Częstotliwość ucisków klatki piersiowej z wykorzystaniem systemu LUCAS 3 oraz w sposób bezprzyrządowy wynosiła odpowiednio 127 (IQR: 120-135) vs. 100 (IQR: 99-101) uciśnięć na minutę. W przypadku zastosowania systemu LUCAS 3 stopień niepoprawnej relaksacji klatki piersiowej został osiągnięty na poziomie 0% (IQR: 0-1), zaś w przypadku bezprzyrządowego uciskania klatki piersiowej wynosił on 48% (IQR: 34-65).
Wnioski. Zastosowanie systemu kompresji klatki piersiowej LUCAS 3 istotnie statystycznie podniosło jakość ucisków klatki piersiowej w porównaniu z bezprzyrządowym uciskaniem klatki piersiowej wykonywanym przez ratowników wodnych.
Summary
Introduction. High quality chest compressions, which are one of the basic elements of resuscitation procedures, directly affect the chances of returning of spontaneous circulation. The American Society of Cardiology recommends that compressions should be performed with a frequency of 100 to 120 compressions per minute with a depth of 5-6 cm and allowing for the full chest relaxation after each compression.
Aim. The aim of the study was to compare the quality parameters of chest compressions performed during manual chest compressions and resuscitation performed with the use of the LUCAS 3 chest compression system.
Material and methods. We conducted randomized crossover study on manikin (Resusci Anne). Thirty-eight lifeguards participated in an out-of-hospital simulation of cardiac mechanism caused by drowning during which lifeguards performed 2-min cycle of cardiopulmonary resuscitation.
Results. The median depth of chest compressions for manual chest compression was 46 mm (IQR: 42-50) and was statistically significantly lower than when using the mechanical compression system LUCAS 3 – 50 mm (IQR: 49-51). Compression rate with and without mechanical chest compression LUCAS 3 varied and was at 127 (IQR: 120-135) vs. 100 (IQR: 99-101) compressions per minute, respectively. When using the LUCAS 3 chest compression system, we achieved a 0% (IQR: 0-1) of incomplete chest relaxation vs. 48% (IQR: 34-65) when performing manual chest compressions.
Conclusions. The use of the LUCAS 3 chest compression system significantly increased the quality of chest compressions compared to the manual compression of the chest performed by lifeguards.
INTRODUCTION
The ability to perform cardiopulmonary resuscitation is one of basic procedures which lifeguards should be able to perform. Drowning is a major cause of morbidity and mortality worldwide, predominately affecting low- and middle-income countries (LMICs). According to the World Health Organization (WHO), drowning accounted for an estimated 372,000 deaths in 2012 (1). Patients in age from 1 to 18 years (2) are especially susceptible with over 450 children drowning each day worldwide and thousands suffering debilitating injuries, including brain injury, as a result of drowning events. In high-income countries (HICs), drowning risk factors include male gender, less than 14 years of age (3, 4), risky behavior including alcohol use (3, 5), rural areas (6), low income (7), and lack of supervision (3).
However, regardless of the cause of cardiac arrest, lifeguards should perform high quality cardiopulmonary resuscitation. According to the current guidelines for cardiopulmonary resuscitation (CPR) published in 2015 by the European Resuscitation Council (8, 9), CPR should be based on high-quality chest compressions and rescue breaths. The guidelines recommend that for adults chest compressions are performed with a frequency of chest compressions (CCPM) of 100-120 compressions. The depth of compressions should be of least 5 cm, and allow for the full relaxation of the chest after each pressure. An additional aspect of cardiopulmonary resuscitation is performing rescue breaths, which should be of volume of 6-7 mL/kg.
However, according to the studies, many people do not achieve a proper depth when compressing chest and also perform the compressions at too high. The quality of chest compressions is influenced by many factors including the physical condition of lifeguards. The search for solutions that may improve the quality of chest compressions is one of the main directions of research in emergency medicine.
AIM
The aim of the study was to compare the quality parameters of chest compressions performed during manual chest compressions and resuscitation performed using the LUCAS 3 chest compression system.
MATERIAL AND METHODS
Design
This was a prospective randomized crossover simulation study where each participant performed chest compression with and without LUCAS 3 device. The study is a continuation of the research cycle undertaken by the authors to determine the most optimal method of chest compressions by lifeguards (10).
Setting
Study was conducted from May 2017 to December 2017. The study protocol was approved by the Institutional Review Board of the International Institute of Rescue Research and Education (Approval no. 32.12.2017.IRB).
Participants
The participation in the study was voluntary. 38 lifeguards with a professional experience over 2 years were included. The only exclusion criterion for this study was having a degree in a medical field (i.e. paramedic studies).
Training
Prior to the study, all participants took part in a study regarding elements of basic life support, which also included the operating of the mechanical chest compression device LUCAS 3 (fig. 1). LUCAS 3 is an electric-powered mechanical chest compression device. LUCAS 3 was designed to work in two modes: 30 chest compressions to 2 rescue breaths, or constant compressions at a consistent rate and depth (11, 12). After theoretical part and demonstration of the correct way of using the device, the participants had a 20-minute practical training regarding the usage of the device.
Fig. 1. LUCAS 3 mechanical chest compression device
Study protocol
During the main study, the participants were performing a 2-minute cardiopulmonary resuscitation cycle with and without the usage of LUCAS 3. In order to simulate the patient in cardiac arrest requiring cardiopulmonary resuscitation we used Resusci Anne Simulator (Laerdal, Stavanger, Norway).
The participants were divided into two groups. In order to assign the patients to the aforementioned groups we used the coin throw technique. The first group performed cardiopulmonary resuscitation without using a chest compression system. The second group performed resuscitation using the LUCAS 3 chest compression system. The participants then had a 30-minute break and then performed cardiopulmonary resuscitation using a different technique. A detailed randomization procedure is presented on figure 2. Compressions of the chest were performed continuously, in order to make it possible a supraglottic airway device was used as it allows for asynchronous resuscitation (13).
Fig. 2. CONSORT flow chart
Measurements
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Piśmiennictwo
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