In simulation practice/training, are there set standards for monitoring quality of a resuscitation attempt? beyond rate/depth of compressions and time off chest?
If you search in publications about ACLS and BLS you can't find any quality measurement but chest compression rate, depth, recoil, and compression fraction. Also, AHA does not define any other factors for good resuscitation.
But there are different types of simulators as high-fidelities and low-fidelities.
High-fidelities are more modern simulators that could show real-time quality factors and are proven to be more effective in teaching medical students.
I refer you to these articles:
- McCoy CE, Rahman A, Rendon JC, et al. Randomized Controlled Trial of Simulation vs. Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation. West J Emerg Med. 2019;20(1):15-22. doi:10.5811/westjem.2018.11.39040 .
- Rea TD, Helbock M, Perry S, et al. Increasing the use of cardiopulmonary resuscitation during out-of-hospital ventricular fibrillation arrest: survival implications of guideline changes. Circulation. 2006;114(25):2760–5.
- Wik L, Kramer-Johansen J, Myklebust H, et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA. 2005;293(3):299–304.
Beyond depth and rate- chest recoil is also measured by new devices, and AHA regards these as most important factors in determining the quality of CPR.
AHA guidelines focusses on high quality CPR taking important measures in rate, depth, chest recoil and chest compression. Its a simulation technique, but the use of audio visual feedback device gets a better idea focussing on quality of CPR
CPR is a bad joke; ACLS, PALS and BLS are mostly a counterproductive waste of time. By far the most effective emergency treatment for infarction, smoke inhalation, drowning, carbon monoxide poisoning, and numerous other conditions is mask administration of Carbogen, which is typically a mixture of 5% CO2 and 95% oxygen in a pressurized tank. Inhaling this mixture enhance every aspect of oxygen transport and delivery and cardiopulmonary function. 100 years ago Carbogen was commonly carried on fire trucks throughout the country, but it was frightened from existence by Dr. Ralph Waters, who characterized CO2 as "toxic waste, like urine" that must be "rid from the body."
In addition to CPR rate, depth, release and cpr fraction; the other important factor is to not over ventilate. In our system survival from OHCA with good neurological outcomes increased from 5% to 18%, over an 8 year period due to the addition of a cpr feedback device (Zoll monitor x series) and re-education.
Re-education was the real key, having every paramedic in our system go thru the simulation lab. Prior to the simulation training there was a tendency to push too fast with rates over 130 and too many interruptions results in low compression fractions. My team is presenting our results at NAEMSP a national EMS meeting in January 2020. There are numerous articles on this topic. But the two links below are a good start.
https://emj.bmj.com/content/29/1/3.short
https://cpr.heart.org/en/resuscitation-science/high-quality-cpr
well said sir
debriefing, good communication and feedback play a pivotal role.
Ya the articles show the original team work
Could certainly make a strong argument for capnography but with regards to a scenario there would likely need to be at minimum ALS personnel present for this monitoring equipment though you don't need an advanced airway specifically. Field experience speaking Oxygen is something I'd be looking at in addition, especially in the case of a witnessed arrest (not practical when picking up an unknown downtime but you're probably putting pads on if they're still warm without obvious signs of death).
Have a look at this antique document. They knew more 100 years ago than we know today. try reading my published paper called "Four Forgotten Giants of Anesthesia History". It's shocking to confront the realization that we have discarded such valuable medical treatments and principles
Simulation CPR would be more difficult to determine quality outside of the standards you have identified vs live CPR where you can assess quality through pulse check while performing CPR and good wave form on the monitor and EtC02. I think it would be imprortant to have participants mention the things they would be looking for and/or expecting with high quality CPR. Simulation is always prone to issues of 'realism' so unless the quality of mannikin and/or assessment tools has changed I'd say stick with the above. Good luck!
Even the Red Cross admits that CPR confers little improvement in long term outcome. They fiddle with statistics to alter their recommendations to preserve and promote their profitable CPR/ACLS/PALS racket. Emergency Carbogen treatment is far simpler, cheaper, and more effective. It is ridiculous that Carbogen has been abandoned and literally banished from all medical textbooks. This amounts to an outrageous hoax that has killed countless patients. It is covertly promoted by powerful corporations that profit at the price of public health.
Forgot to mention compression fraction. So for every 5 minute interval how many times were compressions stopped. Of course we need to stop chest compressions during the pulse/rhythm check(5-10 seconds). But many times these pulse checks last 20-40 seconds or even worse with 1-2 minute interruptions for endotracheal intubation. Need to practice to not stop compressions during airway interventions. Furthermore, research shows no difference between ETI and supraglottic devices for OHCA.
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