Veronika Weichert1, Timur Sellmann2, Dietmar Wetzchewald3, Bernd Gasch4, Sabina Hunziker5, Stephan Marsch6. 1. Department of Orthopedics and Trauma Surgery, Bethesda Hospital, Duisburg, Germany. 2. Department of Anaesthesiology, Bethesda Hospital, Duisburg, Germany; Department of Anaesthesiology 1, Witten/Herdecke University, Witten, Germany. 3. Institution for Emergency Medicine, Arnsberg, Germany. 4. Department of Psychology, Technical University of Dortmund, Dortmund, Germany. 5. Department of Medical Intensive Care, University Hospital of Basel, Basel, Switzerland. 6. Department of Medical Intensive Care, University Hospital of Basel, Basel, Switzerland. Electronic address: stephan.marsch@usb.ch.
Abstract
AIM OF THE STUDY: While the 2005 cardiopulmonary resuscitation (CPR) guidelines recommended to provide CPR for five cycles before the next cardiac rhythm check, the current 2010 guideline now recommend to provide CPR for 2 min. Our aim was to compare adherence to both targets in a simulator-based randomized trial. METHODS:119 teams, consisting of three to four physicians each, were randomized to receive a graphical display of the simplified circular adult BLS algorithm with the instruction to perform CPR for either 2 min or five cycles 30:2. Subsequently teams had to treat a simulated unwitnessed cardiac arrest. Data analysis was performed using video-recordings obtained during simulations. The primary endpoint was adherence, defined as being within ±20% of the instructed target (i.e. 96-144s in the 2 min teams and 4-6 cycles in the fivex30:2 teams). RESULTS: 22/62 (35%) of the "two minutes" teams and 48/57 (84%) of the "five×30:2″ teams provided CPR within a range of ± 20% of their instructed target (P<0.0001). The median time of CPR prior to rhythm check was 91s and 87s, respectively, (P=0.59) with a significant larger variance (P=0.023) in the "two minutes" group. CONCLUSIONS: This randomized simulator-based trial found better adherence and less variance to an instruction to continue CPR for five cycles before the next cardiac rhythm check compared to continuing CPR for 2 min. Avoiding temporal targets whenever possible in guidelines relating to stressful events appears advisable.
RCT Entities:
AIM OF THE STUDY: While the 2005 cardiopulmonary resuscitation (CPR) guidelines recommended to provide CPR for five cycles before the next cardiac rhythm check, the current 2010 guideline now recommend to provide CPR for 2 min. Our aim was to compare adherence to both targets in a simulator-based randomized trial. METHODS: 119 teams, consisting of three to four physicians each, were randomized to receive a graphical display of the simplified circular adult BLS algorithm with the instruction to perform CPR for either 2 min or five cycles 30:2. Subsequently teams had to treat a simulated unwitnessed cardiac arrest. Data analysis was performed using video-recordings obtained during simulations. The primary endpoint was adherence, defined as being within ±20% of the instructed target (i.e. 96-144s in the 2 min teams and 4-6 cycles in the fivex30:2 teams). RESULTS: 22/62 (35%) of the "two minutes" teams and 48/57 (84%) of the "five×30:2″ teams provided CPR within a range of ± 20% of their instructed target (P<0.0001). The median time of CPR prior to rhythm check was 91s and 87s, respectively, (P=0.59) with a significant larger variance (P=0.023) in the "two minutes" group. CONCLUSIONS: This randomized simulator-based trial found better adherence and less variance to an instruction to continue CPR for five cycles before the next cardiac rhythm check compared to continuing CPR for 2 min. Avoiding temporal targets whenever possible in guidelines relating to stressful events appears advisable.
Authors: Sami Rifai; Timur Sellmann; Dietmar Wetzchewald; Heidrun Schwager; Franziska Tschan; Sebastian G Russo; Stephan Marsch Journal: Int J Environ Res Public Health Date: 2020-10-29 Impact factor: 3.390
Authors: Paulina S C Kliem; Kai Tisljar; Sira M Baumann; Pascale Grzonka; Gian Marco De Marchis; Stefano Bassetti; Roland Bingisser; Sabina Hunziker; Stephan Marsch; Raoul Sutter Journal: J Clin Med Date: 2022-01-15 Impact factor: 4.241