Resuscitation 96 (2015) 142–147

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Simulation and education

Two minutes CPR versus five cycles CPR prior to reanalysis of the cardiac rhythm: A prospective, randomized simulator-based trial夽 Veronika Weichert a,1 , Timur Sellmann b,c,1 , Dietmar Wetzchewald d , Bernd Gasch e , Sabina Hunziker f , Stephan Marsch f,∗ a

Department of Orthopedics and Trauma Surgery, Bethesda Hospital, Duisburg, Germany Department of Anaesthesiology, Bethesda Hospital, Duisburg, Germany c Department of Anaesthesiology 1, Witten/Herdecke University, Witten, Germany d Institution for Emergency Medicine, Arnsberg, Germany e Department of Psychology, Technical University of Dortmund, Dortmund, Germany f Department of Medical Intensive Care, University Hospital of Basel, Basel, Switzerland b

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Article history: Received 14 April 2015 Received in revised form 12 June 2015 Accepted 19 July 2015 Keywords: Cardiopulmonary resuscitation Randomized controlled trial Guideline adherence Simulation

a b s t r a c t 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. 96–144 s 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 91 s and 87 s, 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. © 2015 Elsevier Ireland Ltd. All rights reserved.

1. Introduction Periods of chest compressions and intermittent defibrillations are the core components of the cardiopulmonary resuscitation (CPR) algorithm for decades. So far, there are no patient outcome data regarding the optimal duration of the periods of chest compressions between subsequent defibrillations. The 2005 resuscitation guidelines recommended five CPR cycles at

夽 A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2015.07.023. ∗ Corresponding author. Fax: +41 61 265 53 00. 1

E-mail address: [email protected] (S. Marsch). VW and TS contributed equally to the work.

http://dx.doi.org/10.1016/j.resuscitation.2015.07.023 0300-9572/© 2015 Elsevier Ireland Ltd. All rights reserved.

30 compressions and 2 ventilations each prior to the reanalysis of the cardiac rhythm.1,2 By contrast, the current 2010 guidelines, while maintaining a 30:2 compression to ventilation ratio for medically trained rescuers and health-care providers, recommend providing CPR for 2 min before checking the rhythm and, if indicated, defibrillation.3,4 The change from a quantitative measure (five cycles) to a temporal measure (2 min) may be regarded as trivial. However, there is solid evidence from clinical5–7 and simulator-based studies8–11 demonstrating that adherence to the recommended CPR algorithms is far from optimal. In addition, adherence may substantially vary between single components of the algorithm7,8,12 and the mere change in the sequence of two measures was shown to have a significant effect on the quality of execution.12 A recent simulator-based study reported a high variance in the number of resuscitation cycles performed resulting in

V. Weichert et al. / Resuscitation 96 (2015) 142–147

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Fig. 1. Graphical algorithms, adapted from the simplified BLS algorithm of the 2010 CPR guidelines were distributed to the participants prior to the simulated cardiac arrest. Left panel: version distributed to “two minutes” teams. Right panel: version distributed to the “five × 30:2 teams.

likelihood of

Two minutes CPR versus five cycles CPR prior to reanalysis of the cardiac rhythm: A prospective, randomized simulator-based trial.

While the 2005 cardiopulmonary resuscitation (CPR) guidelines recommended to provide CPR for five cycles before the next cardiac rhythm check, the cur...
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