Effectiveness of a simplified cardiopulmonary resuscitation training program for the non-medical staff of a university hospital

PubMed Central

2014-01-01

Background The 2010 Consensus on Science and Treatment Recommendations Statement recommended that short video/computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered an effective alternative to instructor-led basic life support courses. The purpose of this study was to examine the effectiveness of a simplified cardiopulmonary resuscitation (CPR) training program for non-medical staff working at a university hospital. Methods Before and immediately after a 45-min CPR training program consisting of instruction on chest compression and automated external defibrillator (AED) use with a personal training manikin, CPR skills were automatically recorded and evaluated. Participants’ attitudes towards CPR were evaluated by a questionnaire survey. Results From September 2011 through March 2013, 161 participants attended the program. We evaluated chest compression technique in 109 of these participants. The number of chest compressions delivered after the program versus that before was significantly greater (110.8 ± 13.0/min vs 94.2 ± 27.4/min, p < 0.0001), interruption of chest compressions was significantly shorter (0.05 ± 0.34 sec/30 sec vs 0.89 ± 3.52 sec/30 sec, p < 0.05), mean depth of chest compressions was significantly greater (57.6 ± 6.8 mm vs 52.2 ± 9.4 mm, p < 0.0001), and the proportion of incomplete chest compressions of <5 cm among all chest compressions was significantly decreased (8.9 ± 23.2% vs 38.6 ± 42.9%, p < 0.0001). Of the 159 participants who responded to the questionnaire survey after the program, the proportion of participants who answered ‘I can check for a response,’ ‘I can perform chest compressions,’ and ‘I can absolutely or I think I can use an AED’ increased versus that before the program (81.8% vs 19.5%, 77.4% vs 10.1%, 84.3% vs 23.3%, respectively). Conclusions A 45-min simplified CPR training program on chest compression and AED use improved CPR quality and the attitude towards CPR and AED use of non-medical staff of a university hospital. PMID:24887037

Induction of a shorter compression phase is correlated with a deeper chest compression during metronome-guided cardiopulmonary resuscitation: a manikin study.

PubMed

Chung, Tae Nyoung; Bae, Jinkun; Kim, Eui Chung; Cho, Yun Kyung; You, Je Sung; Choi, Sung Wook; Kim, Ok Jun

2013-07-01

Recent studies have shown that there may be an interaction between duty cycle and other factors related to the quality of chest compression. Duty cycle represents the fraction of compression phase. We aimed to investigate the effect of shorter compression phase on average chest compression depth during metronome-guided cardiopulmonary resuscitation. Senior medical students performed 12 sets of chest compressions following the guiding sounds, with three down-stroke patterns (normal, fast and very fast) and four rates (80, 100, 120 and 140 compressions/min) in random sequence. Repeated-measures analysis of variance was used to compare the average chest compression depth and duty cycle among the trials. The average chest compression depth increased and the duty cycle decreased in a linear fashion as the down-stroke pattern shifted from normal to very fast (p<0.001 for both). Linear increase of average chest compression depth following the increase of the rate of chest compression was observed only with normal down-stroke pattern (p=0.004). Induction of a shorter compression phase is correlated with a deeper chest compression during metronome-guided cardiopulmonary resuscitation.

Improved chest recoil using an adhesive glove device for active compression–decompression CPR in a pediatric manikin model☆

PubMed Central

Udassi, Jai P.; Udassi, Sharda; Lamb, Melissa A.; Lamb, Kenneth E.; Theriaque, Douglas W.; Shuster, Jonathan J.; Zaritsky, Arno L.; Haque, Ikram U.

2013-01-01

Objective We developed an adhesive glove device (AGD) to perform ACD-CPR in pediatric manikins, hypothesizing that AGD-ACD-CPR provides better chest decompression compared to standard (S)-CPR. Design Split-plot design randomizing 16 subjects to test four manikin-technique models in a crossover fashion to AGD-ACD-CPR vs. S-CPR. Healthcare providers performed 5 min of CPR with 30:2 compression:ventilation ratio in the four manikin models: (1) adolescent; (2) child two-hand; (3) child one-hand; and (4) infant two-thumb. Methods Modified manikins recorded compression pressure (CP), compression depth (CD) and decompression depth (DD). The AGD consisted of a modified oven mitt with an adjustable strap; a Velcro patch was sewn to the palmer aspect. The counter Velcro patch was bonded to the anterior chest wall. For infant CPR, the thumbs of two oven mitts were stitched together with Velcro. Subjects were asked to actively pull up during decompression. Subjects’ heart rate (HR), respiratory rate (RR) and recovery time (RT) for HR/RR to return to baseline were recorded. Subjects were blinded to data recordings. Data (mean ± SEM) were analyzed using a two-tailed paired t-test. Significance was defined qualitatively as P ≤ 0.05. Results Mean decompression depth difference was significantly greater with AGD-ACD-CPR compared to S-CPR; 38–75% of subjects achieved chest decompression to or beyond baseline. AGD-ACD-CPR provided 6–12% fewer chest compressions/minute than S-CPR group. There was no significant difference in CD, CP, HR, RR and RT within each group comparing both techniques. Conclusion A simple, inexpensive glove device for ACD-CPR improved chest decompression with emphasis on active pull in manikins without excessive rescuer fatigue. The clinical implication of fewer compressions/minute in the AGD group needs to be evaluated. PMID:19683849

Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative.

PubMed

Niles, Dana E; Duval-Arnould, Jordan; Skellett, Sophie; Knight, Lynda; Su, Felice; Raymond, Tia T; Sweberg, Todd; Sen, Anita I; Atkins, Dianne L; Friess, Stuart H; de Caen, Allan R; Kurosawa, Hiroshi; Sutton, Robert M; Wolfe, Heather; Berg, Robert A; Silver, Annemarie; Hunt, Elizabeth A; Nadkarni, Vinay M

2018-05-01

Pediatric in-hospital cardiac arrest cardiopulmonary resuscitation quality metrics have been reported in few children less than 8 years. Our objective was to characterize chest compression fraction, rate, depth, and compliance with 2015 American Heart Association guidelines across multiple pediatric hospitals. Retrospective observational study of data from a multicenter resuscitation quality collaborative from October 2015 to April 2017. Twelve pediatric hospitals across United States, Canada, and Europe. In-hospital cardiac arrest patients (age < 18 yr) with quantitative cardiopulmonary resuscitation data recordings. None. There were 112 events yielding 2,046 evaluable 60-second epochs of cardiopulmonary resuscitation (196,669 chest compression). Event cardiopulmonary resuscitation metric summaries (median [interquartile range]) by age: less than 1 year (38/112): chest compression fraction 0.88 (0.61-0.98), chest compression rate 119/min (110-129), and chest compression depth 2.3 cm (1.9-3.0 cm); for 1 to less than 8 years (42/112): chest compression fraction 0.94 (0.79-1.00), chest compression rate 117/min (110-124), and chest compression depth 3.8 cm (2.9-4.6 cm); for 8 to less than 18 years (32/112): chest compression fraction 0.94 (0.85-1.00), chest compression rate 117/min (110-123), chest compression depth 5.5 cm (4.0-6.5 cm). "Compliance" with guideline targets for 60-second chest compression "epochs" was predefined: chest compression fraction greater than 0.80, chest compression rate 100-120/min, and chest compression depth: greater than or equal to 3.4 cm in less than 1 year, greater than or equal to 4.4 cm in 1 to less than 8 years, and 4.5 to less than 6.6 cm in 8 to less than 18 years. Proportion of less than 1 year, 1 to less than 8 years, and 8 to less than 18 years events with greater than or equal to 60% of 60-second epochs meeting compliance (respectively): chest compression fraction was 53%, 81%, and 78%; chest compression rate was 32%, 50%, and 63%; chest compression depth was 13%, 19%, and 44%. For all events combined, total compliance (meeting all three guideline targets) was 10% (11/112). Across an international pediatric resuscitation collaborative, we characterized the landscape of pediatric in-hospital cardiac arrest chest compression quality metrics and found that they often do not meet 2015 American Heart Association guidelines. Guideline compliance for rate and depth in children less than 18 years is poor, with the greatest difficulty in achieving chest compression depth targets in younger children.

Easy-to-learn cardiopulmonary resuscitation training programme: a randomised controlled trial on laypeople’s resuscitation performance

PubMed Central

Ko, Rachel Jia Min; Lim, Swee Han; Wu, Vivien Xi; Leong, Tak Yam; Liaw, Sok Ying

2018-01-01

INTRODUCTION Simplifying the learning of cardiopulmonary resuscitation (CPR) is advocated to improve skill acquisition and retention. A simplified CPR training programme focusing on continuous chest compression, with a simple landmark tracing technique, was introduced to laypeople. The study aimed to examine the effectiveness of the simplified CPR training in improving lay rescuers’ CPR performance as compared to standard CPR. METHODS A total of 85 laypeople (aged 21–60 years) were recruited and randomly assigned to undertake either a two-hour simplified or standard CPR training session. They were tested two months after the training on a simulated cardiac arrest scenario. Participants’ performance on the sequence of CPR steps was observed and evaluated using a validated CPR algorithm checklist. The quality of chest compression and ventilation was assessed from the recording manikins. RESULTS The simplified CPR group performed significantly better on the CPR algorithm when compared to the standard CPR group (p < 0.01). No significant difference was found between the groups in time taken to initiate CPR. However, a significantly higher number of compressions and proportion of adequate compressions was demonstrated by the simplified group than the standard group (p < 0.01). Hands-off time was significantly shorter in the simplified CPR group than in the standard CPR group (p < 0.001). CONCLUSION Simplifying the learning of CPR by focusing on continuous chest compressions, with simple hand placement for chest compression, could lead to better acquisition and retention of CPR algorithms, and better quality of chest compressions than standard CPR. PMID:29167910

Easy-to-learn cardiopulmonary resuscitation training programme: a randomised controlled trial on laypeople's resuscitation performance.

PubMed

Ko, Rachel Jia Min; Lim, Swee Han; Wu, Vivien Xi; Leong, Tak Yam; Liaw, Sok Ying

2018-04-01

Simplifying the learning of cardiopulmonary resuscitation (CPR) is advocated to improve skill acquisition and retention. A simplified CPR training programme focusing on continuous chest compression, with a simple landmark tracing technique, was introduced to laypeople. The study aimed to examine the effectiveness of the simplified CPR training in improving lay rescuers' CPR performance as compared to standard CPR. A total of 85 laypeople (aged 21-60 years) were recruited and randomly assigned to undertake either a two-hour simplified or standard CPR training session. They were tested two months after the training on a simulated cardiac arrest scenario. Participants' performance on the sequence of CPR steps was observed and evaluated using a validated CPR algorithm checklist. The quality of chest compression and ventilation was assessed from the recording manikins. The simplified CPR group performed significantly better on the CPR algorithm when compared to the standard CPR group (p < 0.01). No significant difference was found between the groups in time taken to initiate CPR. However, a significantly higher number of compressions and proportion of adequate compressions was demonstrated by the simplified group than the standard group (p < 0.01). Hands-off time was significantly shorter in the simplified CPR group than in the standard CPR group (p < 0.001). Simplifying the learning of CPR by focusing on continuous chest compressions, with simple hand placement for chest compression, could lead to better acquisition and retention of CPR algorithms, and better quality of chest compressions than standard CPR. Copyright: © Singapore Medical Association.

Comparison of chest compression quality between the modified chest compression method with the use of smartphone application and the standardized traditional chest compression method during CPR.

PubMed

Park, Sang-Sub

2014-01-01

The purpose of this study is to grasp difference in quality of chest compression accuracy between the modified chest compression method with the use of smartphone application and the standardized traditional chest compression method. Participants were progressed 64 people except 6 absentees among 70 people who agreed to participation with completing the CPR curriculum. In the classification of group in participants, the modified chest compression method was called as smartphone group (33 people). The standardized chest compression method was called as traditional group (31 people). The common equipments in both groups were used Manikin for practice and Manikin for evaluation. In the meantime, the smartphone group for application was utilized Android and iOS Operating System (OS) of 2 smartphone products (G, i). The measurement period was conducted from September 25th to 26th, 2012. Data analysis was used SPSS WIN 12.0 program. As a result of research, the proper compression depth (mm) was shown the proper compression depth (p< 0.01) in traditional group (53.77 mm) compared to smartphone group (48.35 mm). Even the proper chest compression (%) was formed suitably (p< 0.05) in traditional group (73.96%) more than smartphone group (60.51%). As for the awareness of chest compression accuracy, the traditional group (3.83 points) had the higher awareness of chest compression accuracy (p< 0.001) than the smartphone group (2.32 points). In the questionnaire that was additionally carried out 1 question only in smartphone group, the modified chest compression method with the use of smartphone had the high negative reason in rescuer for occurrence of hand back pain (48.5%) and unstable posture (21.2%).

A higher chest compression rate may be necessary for metronome-guided cardiopulmonary resuscitation.

PubMed

Chung, Tae Nyoung; Kim, Sun Wook; You, Je Sung; Cho, Young Soon; Chung, Sung Phil; Park, Incheol

2012-01-01

Metronome guidance is a simple and economical feedback system for guiding cardiopulmonary resuscitation (CPR). However, a recent study showed that metronome guidance reduced the depth of chest compression. The results of previous studies suggest that a higher chest compression rate is associated with a better CPR outcome as compared with a lower chest compression rate, irrespective of metronome use. Based on this finding, we hypothesized that a lower chest compression rate promotes a reduction in chest compression depth in the recent study rather than metronome use itself. One minute of chest compression-only CPR was performed following the metronome sound played at 1 of 4 different rates: 80, 100, 120, and 140 ticks/min. Average compression depths (ACDs) and duty cycles were compared using repeated measures analysis of variance, and the values in the absence and presence of metronome guidance were compared. Both the ACD and duty cycle increased when the metronome rate increased (P = .017, <.001). Average compression depths for the CPR procedures following the metronome rates of 80 and 100 ticks/min were significantly lower than those for the procedures without metronome guidance. The ACD and duty cyle for chest compression increase as the metronome rate increases during metronome-guided CPR. A higher rate of chest compression is necessary for metronome-guided CPR to prevent suboptimal quality of chest compression. Copyright © 2012 Elsevier Inc. All rights reserved.

Update on mechanical cardiopulmonary resuscitation devices.

PubMed

Rubertsson, Sten

2016-06-01

The aim of this review is to update and discuss the use of mechanical chest compression devices in treatment of cardiac arrest. Three recently published large multicenter randomized trials have not been able to show any improved outcome in adult out-of-hospital cardiac arrest patients when compared with manual chest compressions. Mechanical chest compression devices have been developed to better deliver uninterrupted chest compressions of good quality. Prospective large randomized studies have not been able to prove a better outcome compared to manual chest compressions; however, latest guidelines support their use when high-quality manual chest compressions cannot be delivered. Mechanical chest compressions can also be preferred during transportation, in the cath-lab and as a bridge to more invasive support like extracorporeal membrane oxygenation.

Assessment of low-contrast detectability for compressed digital chest images

NASA Astrophysics Data System (ADS)

Cook, Larry T.; Insana, Michael F.; McFadden, Michael A.; Hall, Timothy J.; Cox, Glendon G.

1994-04-01

The ability of human observers to detect low-contrast targets in screen-film (SF) images, computed radiographic (CR) images, and compressed CR images was measured using contrast detail (CD) analysis. The results of these studies were used to design a two- alternative forced-choice (2AFC) experiment to investigate the detectability of nodules in adult chest radiographs. CD curves for a common screen-film system were compared with CR images compressed up to 125:1. Data from clinical chest exams were used to define a CD region of clinical interest that sufficiently challenged the observer. From that data, simulated lesions were introduced into 100 normal CR chest films, and forced-choice observer performance studies were performed. CR images were compressed using a full-frame discrete cosine transform (FDCT) technique, where the 2D Fourier space was divided into four areas of different quantization depending on the cumulative power spectrum (energy) of each image. The characteristic curve of the CR images was adjusted so that optical densities matched those of the SF system. The CD curves for SF and uncompressed CR systems were statistically equivalent. The slope of the CD curve for each was - 1.0 as predicted by the Rose model. There was a significant degradation in detection found for CR images compressed to 125:1. Furthermore, contrast-detail analysis demonstrated that many pulmonary nodules encountered in clinical practice are significantly above the average observer threshold for detection. We designed a 2AFC observer study using simulated 1-cm lesions introduced into normal CR chest radiographs. Detectability was reduced for all compressed CR radiographs.

Use of a Real-Time Training Software (Laerdal QCPR®) Compared to Instructor-Based Feedback for High-Quality Chest Compressions Acquisition in Secondary School Students: A Randomized Trial.

PubMed

Cortegiani, Andrea; Russotto, Vincenzo; Montalto, Francesca; Iozzo, Pasquale; Meschis, Roberta; Pugliesi, Marinella; Mariano, Dario; Benenati, Vincenzo; Raineri, Santi Maurizio; Gregoretti, Cesare; Giarratano, Antonino

2017-01-01

High-quality chest compressions are pivotal to improve survival from cardiac arrest. Basic life support training of school students is an international priority. The aim of this trial was to assess the effectiveness of a real-time training software (Laerdal QCPR®) compared to a standard instructor-based feedback for chest compressions acquisition in secondary school students. After an interactive frontal lesson about basic life support and high quality chest compressions, 144 students were randomized to two types of chest compressions training: 1) using Laerdal QCPR® (QCPR group- 72 students) for real-time feedback during chest compressions with the guide of an instructor who considered software data for students' correction 2) based on standard instructor-based feedback (SF group- 72 students). Both groups had a minimum of a 2-minute chest compressions training session. Students were required to reach a minimum technical skill level before the evaluation. We evaluated all students at 7 days from the training with a 2-minute chest compressions session. The primary outcome was the compression score, which is an overall measure of chest compressions quality calculated by the software expressed as percentage. 125 students were present at the evaluation session (60 from QCPR group and 65 from SF group). Students in QCPR group had a significantly higher compression score (median 90%, IQR 81.9-96.0) compared to SF group (median 67%, IQR 27.7-87.5), p = 0.0003. Students in QCPR group performed significantly higher percentage of fully released chest compressions (71% [IQR 24.5-99.0] vs 24% [IQR 2.5-88.2]; p = 0.005) and better chest compression rate (117.5/min [IQR 106-123.5] vs 125/min [115-135.2]; p = 0.001). In secondary school students, a training for chest compressions based on a real-time feedback software (Laerdal QCPR®) guided by an instructor is superior to instructor-based feedback training in terms of chest compression technical skill acquisition. Australian New Zealand Clinical Trials Registry ACTRN12616000383460.

Effect of the rate of chest compression familiarised in previous training on the depth of chest compression during metronome-guided cardiopulmonary resuscitation: a randomised crossover trial

PubMed Central

Bae, Jinkun; Chung, Tae Nyoung; Je, Sang Mo

2016-01-01

Objectives To assess how the quality of metronome-guided cardiopulmonary resuscitation (CPR) was affected by the chest compression rate familiarised by training before the performance and to determine a possible mechanism for any effect shown. Design Prospective crossover trial of a simulated, one-person, chest-compression-only CPR. Setting Participants were recruited from a medical school and two paramedic schools of South Korea. Participants 42 senior students of a medical school and two paramedic schools were enrolled but five dropped out due to physical restraints. Intervention Senior medical and paramedic students performed 1 min of metronome-guided CPR with chest compressions only at a speed of 120 compressions/min after training for chest compression with three different rates (100, 120 and 140 compressions/min). Friedman's test was used to compare average compression depths based on the different rates used during training. Results Average compression depths were significantly different according to the rate used in training (p<0.001). A post hoc analysis showed that average compression depths were significantly different between trials after training at a speed of 100 compressions/min and those at speeds of 120 and 140 compressions/min (both p<0.001). Conclusions The depth of chest compression during metronome-guided CPR is affected by the relative difference between the rate of metronome guidance and the chest compression rate practised in previous training. PMID:26873050

Resuscitation quality of rotating chest compression providers at one-minute vs. two-minute intervals: A mannequin study.

PubMed

Kılıç, D; Göksu, E; Kılıç, T; Buyurgan, C S

2018-05-01

The aim of this randomized cross-over study was to compare one-minute and two-minute continuous chest compressions in terms of chest compression only CPR quality metrics on a mannequin model in the ED. Thirty-six emergency medicine residents participated in this study. In the 1-minute group, there was no statistically significant difference in the mean compression rate (p=0.83), mean compression depth (p=0.61), good compressions (p=0.31), the percentage of complete release (p=0.07), adequate compression depth (p=0.11) or the percentage of good rate (p=51) over the four-minute time period. Only flow time was statistically significant among the 1-minute intervals (p<0.001). In the 2-minute group, the mean compression depth (p=0.19), good compression (p=0.92), the percentage of complete release (p=0.28), adequate compression depth (p=0.96), and the percentage of good rate (p=0.09) were not statistically significant over time. In this group, the number of compressions (248±31 vs 253±33, p=0.01) and mean compression rates (123±15 vs 126±17, p=0.01) and flow time (p=0.001) were statistically significant along the two-minute intervals. There was no statistically significant difference in the mean number of chest compressions per minute, mean chest compression depth, the percentage of good compressions, complete release, adequate chest compression depth and percentage of good compression between the 1-minute and 2-minute groups. There was no statistically significant difference in the quality metrics of chest compressions between 1- and 2-minute chest compression only groups. Copyright © 2017 Elsevier Inc. All rights reserved.

Improved recognition of ineffective chest compressions after a brief Crew Resource Management (CRM) training: a prospective, randomised simulation study.

PubMed

Haffner, Leopold; Mahling, Moritz; Muench, Alexander; Castan, Christoph; Schubert, Paul; Naumann, Aline; Reddersen, Silke; Herrmann-Werner, Anne; Reutershan, Jörg; Riessen, Reimer; Celebi, Nora

2017-03-03

Chest compressions are a core element of cardio-pulmonary resuscitation. Despite periodic training, real-life chest compressions have been reported to be overly shallow and/or fast, very likely affecting patient outcomes. We investigated the effect of a brief Crew Resource Management (CRM) training program on the correction rate of improperly executed chest compressions in a simulated cardiac arrest scenario. Final-year medical students (n = 57) were randomised to receive a 10-min computer-based CRM or a control training on ethics. Acting as team leaders, subjects performed resuscitation in a simulated cardiac arrest scenario before and after the training. Team members performed standardised overly shallow and fast chest compressions. We analysed how often the team leader recognised and corrected improper chest compressions, as well as communication and resuscitation quality. After the CRM training, team leaders corrected improper chest compressions (35.5%) significantly more often compared with those undergoing control training (7.7%, p = 0.03*). Consequently, four students have to be trained (number needed to treat = 3.6) for one improved chest compression scenario. Communication quality assessed by the Leader Behavior Description Questionnaire significantly increased in the intervention group by a mean of 4.5 compared with 2.0 (p = 0.01*) in the control group. A computer-based, 10-min CRM training improved the recognition of ineffective of chest compressions. Furthermore, communication quality increased. As guideline-adherent chest compressions have been linked to improved patient outcomes, our CRM training might represent a brief and affordable approach to increase chest compression quality and potentially improve patient outcomes.

2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

PubMed

Atkins, Dianne L; de Caen, Allan R; Berger, Stuart; Samson, Ricardo A; Schexnayder, Stephen M; Joyner, Benny L; Bigham, Blair L; Niles, Dana E; Duff, Jonathan P; Hunt, Elizabeth A; Meaney, Peter A

2018-01-02

This focused update to the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care follows the Pediatric Task Force of the International Liaison Committee on Resuscitation evidence review. It aligns with the International Liaison Committee on Resuscitation's continuous evidence review process, and updates are published when the International Liaison Committee on Resuscitation completes a literature review based on new science. This update provides the evidence review and treatment recommendation for chest compression-only CPR versus CPR using chest compressions with rescue breaths for children <18 years of age. Four large database studies were available for review, including 2 published after the "2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Two demonstrated worse 30-day outcomes with chest compression-only CPR for children 1 through 18 years of age, whereas 2 studies documented no difference between chest compression-only CPR and CPR using chest compressions with rescue breaths. When the results were analyzed for infants <1 year of age, CPR using chest compressions with rescue breaths was better than no CPR but was no different from chest compression-only CPR in 1 study, whereas another study observed no differences among chest compression-only CPR, CPR using chest compressions with rescue breaths, and no CPR. CPR using chest compressions with rescue breaths should be provided for infants and children in cardiac arrest. If bystanders are unwilling or unable to deliver rescue breaths, we recommend that rescuers provide chest compressions for infants and children. © 2017 American Heart Association, Inc.

Effect of the rate of chest compression familiarised in previous training on the depth of chest compression during metronome-guided cardiopulmonary resuscitation: a randomised crossover trial.

PubMed

Bae, Jinkun; Chung, Tae Nyoung; Je, Sang Mo

2016-02-12

To assess how the quality of metronome-guided cardiopulmonary resuscitation (CPR) was affected by the chest compression rate familiarised by training before the performance and to determine a possible mechanism for any effect shown. Prospective crossover trial of a simulated, one-person, chest-compression-only CPR. Participants were recruited from a medical school and two paramedic schools of South Korea. 42 senior students of a medical school and two paramedic schools were enrolled but five dropped out due to physical restraints. Senior medical and paramedic students performed 1 min of metronome-guided CPR with chest compressions only at a speed of 120 compressions/min after training for chest compression with three different rates (100, 120 and 140 compressions/min). Friedman's test was used to compare average compression depths based on the different rates used during training. Average compression depths were significantly different according to the rate used in training (p<0.001). A post hoc analysis showed that average compression depths were significantly different between trials after training at a speed of 100 compressions/min and those at speeds of 120 and 140 compressions/min (both p<0.001). The depth of chest compression during metronome-guided CPR is affected by the relative difference between the rate of metronome guidance and the chest compression rate practised in previous training. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Evaluation of chest compression effect on airway management with air-Q, aura-i, i-gel, and Fastrack intubating supraglottic devices by novice physicians: a randomized crossover simulation study.

PubMed

Komasawa, Nobuyasu; Ueki, Ryusuke; Kaminoh, Yoshiroh; Nishi, Shin-Ichi

2014-10-01

In the 2010 American Heart Association guidelines, supraglottic devices (SGDs) such as the laryngeal mask are proposed as alternatives to tracheal intubation for cardiopulmonary resuscitation. Some SGDs can also serve as a means for tracheal intubation after successful ventilation. The purpose of this study was to evaluate the effect of chest compression on airway management with four intubating SGDs, aura-i (aura-i), air-Q (air-Q), i-gel (i-gel), and Fastrack (Fastrack), during cardiopulmonary resuscitation using a manikin. Twenty novice physicians inserted the four intubating SGDs into a manikin with or without chest compression. Insertion time and successful ventilation rate were measured. For cases of successful ventilation, blind tracheal intubation via the intubating SGD was performed with chest compression and success or failure within 30 s was recorded. Chest compression did not decrease the ventilation success rate of the four intubating SGDs (without chest compression (success/total): air-Q, 19/20; aura-i, 19/20; i-gel, 18/20; Fastrack, 19/20; with chest compression: air-Q, 19/20; aura-i, 19/20; i-gel, 16/20; Fastrack, 18/20). Insertion time was significantly lengthened by chest compression in the i-gel trial (P < 0.05), but not with the other three devices. The blind intubation success rate with chest compression was the highest in the air-Q trial (air-Q, 15/19; aura-i, 14/19; i-gel, 12/16; Fastrack, 10/18). This simulation study revealed the utility of intubating SGDs for airway management during chest compression.

Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins.

PubMed

Jäntti, H; Silfvast, T; Turpeinen, A; Kiviniemi, V; Uusaro, A

2009-04-01

The adequate chest compression rate during CPR is associated with improved haemodynamics and primary survival. To explore whether the use of a metronome would affect also chest compression depth beside the rate, we evaluated CPR quality using a metronome in a simulated CPR scenario. Forty-four experienced intensive care unit nurses participated in two-rescuer basic life support given to manikins in 10min scenarios. The target chest compression to ventilation ratio was 30:2 performed with bag and mask ventilation. The rescuer performing the compressions was changed every 2min. CPR was performed first without and then with a metronome that beeped 100 times per minute. The quality of CPR was analysed with manikin software. The effect of rescuer fatigue on CPR quality was analysed separately. The mean compression rate between ventilation pauses was 137+/-18compressions per minute (cpm) without and 98+/-2cpm with metronome guidance (p<0.001). The mean number of chest compressions actually performed was 104+/-12cpm without and 79+/-3cpm with the metronome (p<0.001). The mean compression depth during the scenario was 46.9+/-7.7mm without and 43.2+/-6.3mm with metronome guidance (p=0.09). The total number of chest compressions performed was 1022 without metronome guidance, 42% at the correct depth; and 780 with metronome guidance, 61% at the correct depth (p=0.09 for difference for percentage of compression with correct depth). Metronome guidance corrected chest compression rates for each compression cycle to within guideline recommendations, but did not affect chest compression quality or rescuer fatigue.

Image splitting and remapping method for radiological image compression

NASA Astrophysics Data System (ADS)

Lo, Shih-Chung B.; Shen, Ellen L.; Mun, Seong K.

1990-07-01

A new decomposition method using image splitting and gray-level remapping has been proposed for image compression, particularly for images with high contrast resolution. The effects of this method are especially evident in our radiological image compression study. In our experiments, we tested the impact of this decomposition method on image compression by employing it with two coding techniques on a set of clinically used CT images and several laser film digitized chest radiographs. One of the compression techniques used was full-frame bit-allocation in the discrete cosine transform domain, which has been proven to be an effective technique for radiological image compression. The other compression technique used was vector quantization with pruned tree-structured encoding, which through recent research has also been found to produce a low mean-square-error and a high compression ratio. The parameters we used in this study were mean-square-error and the bit rate required for the compressed file. In addition to these parameters, the difference between the original and reconstructed images will be presented so that the specific artifacts generated by both techniques can be discerned by visual perception.

Chest compression rates and survival following out-of-hospital cardiac arrest.

PubMed

Idris, Ahamed H; Guffey, Danielle; Pepe, Paul E; Brown, Siobhan P; Brooks, Steven C; Callaway, Clifton W; Christenson, Jim; Davis, Daniel P; Daya, Mohamud R; Gray, Randal; Kudenchuk, Peter J; Larsen, Jonathan; Lin, Steve; Menegazzi, James J; Sheehan, Kellie; Sopko, George; Stiell, Ian; Nichol, Graham; Aufderheide, Tom P

2015-04-01

Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions/min. A recent clinical study reported optimal return of spontaneous circulation with rates between 100 and 120/min during cardiopulmonary resuscitation for out-of-hospital cardiac arrest. However, the relationship between compression rate and survival is still undetermined. Prospective, observational study. Data is from the Resuscitation Outcomes Consortium Prehospital Resuscitation IMpedance threshold device and Early versus Delayed analysis clinical trial. Adults with out-of-hospital cardiac arrest treated by emergency medical service providers. None. Data were abstracted from monitor-defibrillator recordings for the first five minutes of emergency medical service cardiopulmonary resuscitation. Multiple logistic regression assessed odds ratio for survival by compression rate categories (<80, 80-99, 100-119, 120-139, ≥140), both unadjusted and adjusted for sex, age, witnessed status, attempted bystander cardiopulmonary resuscitation, location of arrest, chest compression fraction and depth, first rhythm, and study site. Compression rate data were available for 10,371 patients; 6,399 also had chest compression fraction and depth data. Age (mean±SD) was 67±16 years. Chest compression rate was 111±19 per minute, compression fraction was 0.70±0.17, and compression depth was 42±12 mm. Circulation was restored in 34%; 9% survived to hospital discharge. After adjustment for covariates without chest compression depth and fraction (n=10,371), a global test found no significant relationship between compression rate and survival (p=0.19). However, after adjustment for covariates including chest compression depth and fraction (n=6,399), the global test found a significant relationship between compression rate and survival (p=0.02), with the reference group (100-119 compressions/min) having the greatest likelihood for survival. After adjustment for chest compression fraction and depth, compression rates between 100 and 120 per minute were associated with greatest survival to hospital discharge.

Instructions to "push as hard as you can" improve average chest compression depth in dispatcher-assisted cardiopulmonary resuscitation.

PubMed

Mirza, Muzna; Brown, Todd B; Saini, Devashish; Pepper, Tracy L; Nandigam, Hari Krishna; Kaza, Niroop; Cofield, Stacey S

2008-10-01

Cardiopulmonary resuscitation (CPR) with adequate chest compression depth appears to improve first shock success in cardiac arrest. We evaluate the effect of simplification of chest compression instructions on compression depth in dispatcher-assisted CPR protocol. Data from two randomized, double-blinded, controlled trials with identical methodology were combined to obtain 332 records for this analysis. Subjects were randomized to either modified Medical Priority Dispatch System (MPDS) v11.2 protocol or a new simplified protocol. The main difference between the protocols was the instruction to "push as hard as you can" in the simplified protocol, compared to "push down firmly 2in. (5cm)" in MPDS. Data were recorded via a Laerdal ResusciAnne SkillReporter manikin. Primary outcome measures included: chest compression depth, proportion of compressions without error, with adequate depth and with total release. Instructions to "push as hard as you can", compared to "push down firmly 2in. (5cm)", resulted in improved chest compression depth (36.4 mm vs. 29.7 mm, p<0.0001), and improved median proportion of chest compressions done to the correct depth (32% vs. <1%, p<0.0001). No significant difference in median proportion of compressions with total release (100% for both) and average compression rate (99.7 min(-1) vs. 97.5 min(-1), p<0.56) was found. Modifying dispatcher-assisted CPR instructions by changing "push down firmly 2in. (5cm)" to "push as hard as you can" achieved improvement in chest compression depth at no cost to total release or average chest compression rate.

Analysis of actual pressure point using the power flexible capacitive sensor during chest compression.

PubMed

Minami, Kouichiro; Kokubo, Yota; Maeda, Ichinosuke; Hibino, Shingo

2017-02-01

In chest compression for cardiopulmonary resuscitation (CPR), the lower half of the sternum is pressed according to the American Heart Association (AHA) guidelines 2010. These have been no studies which identify the exact location of the applied by individual chest compressions. We developed a rubber power-flexible capacitive sensor that could measure the actual pressure point of chest compression in real time. Here, we examined the pressure point of chest compression by ambulance crews during CPR using a mannequin. We included 179 ambulance crews. Chest compression was performed for 2 min. The pressure position was monitored, and the quality of chest compression was analyzed by using a flexible pressure sensor (Shinnosukekun™). Of the ambulance crews, 58 (32.4 %) pressed the center and 121 (67.6 %) pressed outside the proper area of chest compression. Many of them pressed outside the center; 8, 7, 41, and 90 pressed on the caudal, left, right, and cranial side, respectively. Average compression rate, average recoil, average depth, and average duty cycle were 108.6 counts per minute, 0.089, 4.5 cm, and 48.27 %, respectively. Many of the ambulance crews did not press on the sternal lower half definitely. This new device has the potential to improve the quality of CPR during training or in clinical practice.

The effect of hydraulic bed movement on the quality of chest compressions.

PubMed

Park, Maeng Real; Lee, Dae Sup; In Kim, Yong; Ryu, Ji Ho; Cho, Young Mo; Kim, Hyung Bin; Yeom, Seok Ran; Min, Mun Ki

2017-08-01

The hydraulic height control systems of hospital beds provide convenience and shock absorption. However, movements in a hydraulic bed may reduce the effectiveness of chest compressions. This study investigated the effects of hydraulic bed movement on chest compressions. Twenty-eight participants were recruited for this study. All participants performed chest compressions for 2min on a manikin and three surfaces: the floor (Day 1), a firm plywood bed (Day 2), and a hydraulic bed (Day 3). We considered 28 participants of Day 1 as control and each 28 participants of Day 2 and Day 3 as study subjects. The compression rates, depths, and good compression ratios (>5-cm compressions/all compressions) were compared between the three surfaces. When we compared the three surfaces, we did not detect a significant difference in the speed of chest compressions (p=0.582). However, significantly lower values were observed on the hydraulic bed in terms of compression depth (p=0.001) and the good compression ratio (p=0.003) compared to floor compressions. When we compared the plywood and hydraulic beds, we did not detect significant differences in compression depth (p=0.351) and the good compression ratio (p=0.391). These results indicate that the movements in our hydraulic bed were associated with a non-statistically significant trend towards lower-quality chest compressions. Copyright © 2017 Elsevier Inc. All rights reserved.

Resuscitation quality assurance for out-of-hospital cardiac arrest--setting-up an ambulance defibrillator telemetry network.

PubMed

Lyon, R M; Clarke, S; Gowens, P; Egan, G; Clegg, G R

2010-12-01

Out-of-hospital cardiac arrest (OHCA) is a leading cause of pre-hospital mortality. Chest compressions performed during cardiopulmonary resuscitation aim to provide adequate perfusion to the vital organs during cardiac arrest. Poor resuscitation technique and the quality of pre-hospital CPR influences outcome from OHCA. Transthoracic impedance (TTI) measurement is a useful tool in the assessment of the quality of pre-hospital resuscitation by ambulance crews but TTI telemetry has not yet been performed in the United Kingdom. We describe a pilot study to implement a data network to collect defibrillator TTI data via telemetry from ambulances. Prospective, observational pilot study over a 5-month period. Modems were fitted to 40 defibrillators on ambulances based in Edinburgh. TTI data was sent to a receiving computer after resuscitation attempts for OHCA. 58 TTI traces were transmitted during the pilot period. Compliance with the telemetry system was high. The mean ratio of chest compressions was 73% (95% CI 69-77%), the mean chest compression rate was 128 (95% CI 122-134). The mean time interval from chest compression interruption to shock delivery was 27 s (95% CI 22-32 s). Trans-thoracic impedance analysis is an effective means of recording important measures of resuscitation quality including the hands-on-the-chest time, compression rate and defibrillation interval time. TTI data transmission via telemetry is straightforward, efficient and allows resuscitation data to be captured and analysed from a large geographical area. Further research is warranted on the impact of post-resuscitation reporting on the quality of resuscitation delivered by ambulance crews. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Instructions to “push as hard as you can” improve average chest compression depth in dispatcher-assisted Cardiopulmonary Resuscitation

PubMed Central

Mirza, Muzna; Brown, Todd B.; Saini, Devashish; Pepper, Tracy L; Nandigam, Hari Krishna; Kaza, Niroop; Cofield, Stacey S.

2008-01-01

Background and Objective Cardiopulmonary Resuscitation (CPR) with adequate chest compression depth appears to improve first shock success in cardiac arrest. We evaluate the effect of simplification of chest compression instructions on compression depth in dispatcher-assisted CPR protocol. Methods Data from two randomized, double-blinded, controlled trials with identical methodology were combined to obtain 332 records for this analysis. Subjects were randomized to either modified Medical Priority Dispatch System (MPDS) v11.2 protocol or a new simplified protocol. The main difference between the protocols was the instruction to “push as hard as you can” in the simplified protocol, compared to “push down firmly 2 inches (5cm)” in MPDS. Data were recorded via a Laerdal® ResusciAnne® SkillReporter™ manikin. Primary outcome measures included: chest compression depth, proportion of compressions without error, with adequate depth and with total release. Results Instructions to “push as hard as you can”, compared to “push down firmly 2 inches (5cm)”, resulted in improved chest compression depth (36.4 vs 29.7 mm, p<0.0001), and improved median proportion of chest compressions done to the correct depth (32% vs <1%, p<0.0001). No significant difference in median proportion of compressions with total release (100% for both) and average compression rate (99.7 vs 97.5 per min, p<0.56) was found. Conclusions Modifying dispatcher-assisted CPR instructions by changing “push down firmly 2 inches (5cm)” to “push as hard as you can” achieved improvement in chest compression depth at no cost to total release or average chest compression rate. PMID:18635306

Relationship between weight of rescuer and quality of chest compression during cardiopulmonary resuscitation

PubMed Central

2014-01-01

Background According to the guidelines for cardiopulmonary resuscitation (CPR), the rotation time for chest compression should be about 2 min. The quality of chest compressions is related to the physical fitness of the rescuer, but this was not considered when determining rotation time. The present study aimed to clarify associations between body weight and the quality of chest compression and physical fatigue during CPR performed by 18 registered nurses (10 male and 8 female) assigned to light and heavy groups according to the average weight for each sex in Japan. Methods Five-minute chest compressions were then performed on a manikin that was placed on the floor. Measurement parameters were compression depth, heart rate, oxygen uptake, integrated electromyography signals, and rating of perceived exertion. Compression depth was evaluated according to the ratio (%) of adequate compressions (at least 5 cm deep). Results The ratio of adequate compressions decreased significantly over time in the light group. Values for heart rate, oxygen uptake, muscle activity defined as integrated electromyography signals, and rating of perceived exertion were significantly higher for the light group than for the heavy group. Conclusion Chest compression caused increased fatigue among the light group, which consequently resulted in a gradual fall in the quality of chest compression. These results suggested that individuals with a lower body weight should rotate at 1-min intervals to maintain high quality CPR and thus improve the survival rates and neurological outcomes of victims of cardiac arrest. PMID:24957919

Coronary blood flow during cardiopulmonary resuscitation in swine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bellamy, R.F.; DeGuzman, L.R.; Pedersen, D.C.

1984-01-01

Recent papers have raised doubt as to the magnitude of coronary blood flow during closed-chest cardiopulmonary resuscitation. We will describe experiments that concern the methods of coronary flow measurement during cardiopulmonary resuscitation. Nine anesthetized swine were instrumented to allow simultaneous measurements of coronary blood flow by both electromagnetic cuff flow probes and by the radiomicrosphere technique. Cardiac arrest was caused by electrical fibrillation and closed-chest massage was performed by a Thumper (Dixie Medical Inc., Houston). The chest was compressed transversely at a rate of 66 strokes/min. Compression occupied one-half of the massage cycle. Three different Thumper piston strokes were studied:more » 1.5, 2, and 2.5 inches. Mean aortic pressure and total systemic blood flow measured by the radiomicrosphere technique increased as Thumper piston stroke was lengthened (mean +/- SD): 1.5 inch stroke, 23 +/- 4 mm Hg, 525 +/- 195 ml/min; 2 inch stroke, 33 +/- 5 mm Hg, 692 +/- 202 ml/min; 2.5 inch stroke, 40 +/- 6 mm Hg, 817 +/- 321 ml/min. Both methods of coronary flow measurement (electromagnetic (EMF) and radiomicrosphere (RMS)) gave similar results in technically successful preparations (data expressed as percent prearrest flow mean +/- 1 SD): 1.5 inch stroke, EMF 12 +/- 5%, RMS 16 +/- 5%; 2 inch stroke, EMF 30 +/- 6%, RMS 26 +/- 11%; 2.5 inch stroke, EMF 50 +/- 12%, RMS 40 +/- 20%. The phasic coronary flow signal during closed-chest compression indicated that all perfusion occurred during the relaxation phase of the massage cycle. We concluded that coronary blood flow is demonstrable during closed-chest massage, but that the magnitude is unlikely to be more than a fraction of normal.« less

[A brief history of resuscitation - the influence of previous experience on modern techniques and methods].

PubMed

Kucmin, Tomasz; Płowaś-Goral, Małgorzata; Nogalski, Adam

2015-02-01

Cardiopulmonary resuscitation (CPR) is relatively novel branch of medical science, however first descriptions of mouth-to-mouth ventilation are to be found in the Bible and literature is full of descriptions of different resuscitation methods - from flagellation and ventilation with bellows through hanging the victims upside down and compressing the chest in order to stimulate ventilation to rectal fumigation with tobacco smoke. The modern history of CPR starts with Kouwenhoven et al. who in 1960 published a paper regarding heart massage through chest compressions. Shortly after that in 1961Peter Safar presented a paradigm promoting opening the airway, performing rescue breaths and chest compressions. First CPR guidelines were published in 1966. Since that time guidelines were modified and improved numerously by two leading world expert organizations ERC (European Resuscitation Council) and AHA (American Heart Association) and published in a new version every 5 years. Currently 2010 guidelines should be obliged. In this paper authors made an attempt to present history of development of resuscitation techniques and methods and assess the influence of previous lifesaving methods on nowadays technologies, equipment and guidelines which allow to help those women and men whose life is in danger due to sudden cardiac arrest. © 2015 MEDPRESS.

The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation

PubMed Central

Fried, David A.; Leary, Marion; Smith, Douglas A.; Sutton, Robert M.; Niles, Dana; Herzberg, Daniel L.; Becker, Lance B.; Abella, Benjamin S.

2011-01-01

Objective Successful resuscitation from cardiac arrest requires the delivery of high-quality chest compressions, encompassing parameters such as adequate rate, depth, and full recoil between compressions. The lack of compression recoil (“leaning” or “incomplete recoil”) has been shown to adversely affect hemodynamics in experimental arrest models, but the prevalence of leaning during actual resuscitation is poorly understood. We hypothesized that leaning varies across resuscitation events, possibly due to rescuer and/or patient characteristics and may worsen over time from rescuer fatigue during continuous chest compressions. Methods This was an observational clinical cohort study at one academic medical center. Data were collected from adult in-hospital and Emergency Department arrest events using monitor/defibrillators that record chest compression characteristics and provide real-time feedback. Results We analyzed 112,569 chest compressions from 108 arrest episodes from 5/2007 to 2/2009. Leaning was present in 98/108 (91%) cases; 12% of all compressions exhibited leaning. Leaning varied widely across cases: 41/108 (38%) of arrest episodes exhibited <5% leaning yet 20/108 (19%) demonstrated >20% compression leaning. When evaluating blocks of continuous compressions (>120 sec), only 4/33 (12%) had an increase in leaning over time and 29/33 (88%) showed a decrease (p<0.001). Conclusions Chest compression leaning was common during resuscitation care and exhibited a wide distribution, with most leaning within a subset of resuscitations. Leaning decreased over time during continuous chest compression blocks, suggesting that either leaning may not be a function of rescuer fatiguing, or that it may have been mitigated by automated feedback provided during resuscitation episodes. PMID:21482010

Minimally invasive repair of pectus carinatum and how to deal with complications

PubMed Central

Aragone, Xavier; Blanco, Javier Borbore; Ciano, Alejandro; Abramson, Leonardo

2016-01-01

While less common than pectus excavatum, pectus carinatum is also a chest wall deformity affecting males in higher proportion than women. Patient requests for a solution of this disease occur especially during the growth spurt of puberty when this malformation becomes more obvious and difficult to conceal. Those people suffering from pectus carinatum are very likely subject to behavioral changes and negative personality impacts. By compressing the protruding anterior region of the chest wall we achieve correction of the chest contour and simultaneous lateral expansion of the depressed costochondral arches. This original technique and the procedure to apply it fit within the category of minimally invasive surgery. The compression system acts in a way similar to that of orthodontic braces. Two rectangular fixation plates are fixed to the compression strut with screws. The plates have threaded holes along a groove in the central portion, and two holes at both ends used to attach them to the ribs by means of steel wire suture. The compression strut has to be modified into a convex shape to adapt it to the particular characteristics of the patient’s malformation. This molding is done using benders designed as part of the procedure. PMID:29078492

Minimally invasive repair of pectus carinatum and how to deal with complications.

PubMed

Abramson, Horacio; Aragone, Xavier; Blanco, Javier Borbore; Ciano, Alejandro; Abramson, Leonardo

2016-01-01

While less common than pectus excavatum, pectus carinatum is also a chest wall deformity affecting males in higher proportion than women. Patient requests for a solution of this disease occur especially during the growth spurt of puberty when this malformation becomes more obvious and difficult to conceal. Those people suffering from pectus carinatum are very likely subject to behavioral changes and negative personality impacts. By compressing the protruding anterior region of the chest wall we achieve correction of the chest contour and simultaneous lateral expansion of the depressed costochondral arches. This original technique and the procedure to apply it fit within the category of minimally invasive surgery. The compression system acts in a way similar to that of orthodontic braces. Two rectangular fixation plates are fixed to the compression strut with screws. The plates have threaded holes along a groove in the central portion, and two holes at both ends used to attach them to the ribs by means of steel wire suture. The compression strut has to be modified into a convex shape to adapt it to the particular characteristics of the patient's malformation. This molding is done using benders designed as part of the procedure.

Mechanical versus manual chest compressions for cardiac arrest.

PubMed

Brooks, Steven C; Hassan, Nizar; Bigham, Blair L; Morrison, Laurie J

2014-02-27

This is the first update of the Cochrane review on mechanical chest compression devices published in 2011 (Brooks 2011). Mechanical chest compression devices have been proposed to improve the effectiveness of cardiopulmonary resuscitation (CPR). To assess the effectiveness of mechanical chest compressions versus standard manual chest compressions with respect to neurologically intact survival in patients who suffer cardiac arrest. We searched the Cochrane Central Register of Controlled Studies (CENTRAL; 2013, Issue 12), MEDLINE Ovid (1946 to 2013 January Week 1), EMBASE (1980 to 2013 January Week 2), Science Citation abstracts (1960 to 18 November 2009), Science Citation Index-Expanded (SCI-EXPANDED) (1970 to 11 January 2013) on Thomson Reuters Web of Science, biotechnology and bioengineering abstracts (1982 to 18 November 2009), conference proceedings Citation Index-Science (CPCI-S) (1990 to 11 January 2013) and clinicaltrials.gov (2 August 2013). We applied no language restrictions. Experts in the field of mechanical chest compression devices and manufacturers were contacted. We included randomised controlled trials (RCTs), cluster RCTs and quasi-randomised studies comparing mechanical chest compressions versus manual chest compressions during CPR for patients with atraumatic cardiac arrest. Two review authors abstracted data independently; disagreement between review authors was resolved by consensus and by a third review author if consensus could not be reached. The methodologies of selected studies were evaluated by a single author for risk of bias. The primary outcome was survival to hospital discharge with good neurological outcome. We planned to use RevMan 5 (Version 5.2. The Nordic Cochrane Centre) and the DerSimonian & Laird method (random-effects model) to provide a pooled estimate for risk ratio (RR) with 95% confidence intervals (95% CIs), if data allowed. Two new studies were included in this update. Six trials in total, including data from 1166 participants, were included in the review. The overall quality of included studies was poor, and significant clinical heterogeneity was observed. Only one study (N = 767) reported survival to hospital discharge with good neurological function (defined as a Cerebral Performance Category score of one or two), demonstrating reduced survival with mechanical chest compressions when compared with manual chest compressions (RR 0.41, 95% CI 0.21 to 0.79). Data from four studies demonstrated increased return of spontaneous circulation, and data from two studies demonstrated increased survival to hospital admission with mechanical chest compressions as compared with manual chest compressions, but none of the individual estimates reached statistical significance. Marked clinical heterogeneity between studies precluded any pooled estimates of effect. Evidence from RCTs in humans is insufficient to conclude that mechanical chest compressions during cardiopulmonary resuscitation for cardiac arrest are associated with benefit or harm. Widespread use of mechanical devices for chest compressions during cardiac events is not supported by this review. More RCTs that measure and account for the CPR process in both arms are needed to clarify the potential benefit to be derived from this intervention.

Continuous chest compression cardiopulmonary resuscitation training promotes rescuer self-confidence and increased secondary training: a hospital-based randomized controlled trial*.

PubMed

Blewer, Audrey L; Leary, Marion; Esposito, Emily C; Gonzalez, Mariana; Riegel, Barbara; Bobrow, Bentley J; Abella, Benjamin S

2012-03-01

Recent work suggests that delivery of continuous chest compression cardiopulmonary resuscitation is an acceptable layperson resuscitation strategy, although little is known about layperson preferences for training in continuous chest compression cardiopulmonary resuscitation. We hypothesized that continuous chest compression cardiopulmonary resuscitation education would lead to greater trainee confidence and would encourage wider dissemination of cardiopulmonary resuscitation skills compared to standard cardiopulmonary resuscitation training (30 compressions: two breaths). Prospective, multicenter randomized study. Three academic medical center inpatient wards. Adult family members or friends (≥ 18 yrs old) of inpatients admitted with cardiac-related diagnoses. In a multicenter randomized trial, family members of hospitalized patients were trained via the educational method of video self-instruction. Subjects were randomized to continuous chest compression cardiopulmonary resuscitation or standard cardiopulmonary resuscitation educational modes. Cardiopulmonary resuscitation performance data were collected using a cardiopulmonary resuscitation skill-reporting manikin. Trainee perspectives and secondary training rates were assessed through mixed qualitative and quantitative survey instruments. Chest compression performance was similar in both groups. The trainees in the continuous chest compression cardiopulmonary resuscitation group were significantly more likely to express a desire to share their training kit with others (152 of 207 [73%] vs. 133 of 199 [67%], p = .03). Subjects were contacted 1 month after initial enrollment to assess actual sharing, or "secondary training." Kits were shared with 2.0 ± 3.4 additional family members in the continuous chest compression cardiopulmonary resuscitation group vs. 1.2 ± 2.2 in the standard cardiopulmonary resuscitation group (p = .03). As a secondary result, trainees in the continuous chest compression cardiopulmonary resuscitation group were more likely to rate themselves "very comfortable" with the idea of using cardiopulmonary resuscitation skills in actual events than the standard cardiopulmonary resuscitation trainees (71 of 207 [34%] vs. 57 of 199 [28%], p = .08). Continuous chest compression cardiopulmonary resuscitation education resulted in a statistically significant increase in secondary training. This work suggests that implementation of video self-instruction training programs using continuous chest compression cardiopulmonary resuscitation may confer broader dissemination of life-saving skills and may promote rescuer comfort with newly acquired cardiopulmonary resuscitation knowledge. URL: http://clinicaltrials.gov. Unique identifier: NCT01260441.

Continuous chest compression cardiopulmonary resuscitation training promotes rescuer self-confidence and increased secondary training: A hospital-based randomized controlled trial

PubMed Central

Blewer, Audrey L.; Leary, Marion; Esposito, Emily C.; Gonzalez, Mariana; Riegel, Barbara; Bobrow, Bentley J.; Abella, Benjamin S.

2013-01-01

Objective Recent work suggests that delivery of continuous chest compression cardiopulmonary resuscitation is an acceptable layperson resuscitation strategy, although little is known about layperson preferences for cardiopulmonary resuscitation training in continuous chest compression cardiopulmonary resuscitation. We hypothesized that continuous chest compression cardiopulmonary resuscitation education would lead to greater trainee confidence and would encourage wider dissemination of cardiopulmonary resuscitation skills compared to standard cardiopulmonary resuscitation training (30 compressions: two breaths). Design Prospective, multicenter cohort study. Setting Three academic medical center inpatient wards. Subjects Adult family members or friends (≥18 yrs old) of inpatients admitted with cardiac-related diagnoses. Interventions In a multicenter randomized trial, family members of hospitalized patients were trained via the educational method of video self-instruction. Subjects were randomized to continuous chest compression cardiopulmonary resuscitation or standard cardiopulmonary resuscitation educational modes. Measurements Cardiopulmonary resuscitation performance data were collected using a cardiopulmonary resuscitation skill-reporting manikin. Trainee perspectives and secondary training rates were assessed through mixed qualitative and quantitative survey instruments. Main Results Chest compression performance was similar in both groups. The trainees in the continuous chest compression cardiopulmonary resuscitation group were significantly more likely to express a desire to share their training kit with others (152 of 207 [73%] vs. 133 of 199 [67%], p = .03). Subjects were contacted 1 month after initial enrollment to assess actual sharing, or “secondary training.” Kits were shared with 2.0 ± 3.4 additional family members in the continuous chest compression cardiopulmonary resuscitation group vs. 1.2 ± 2.2 in the standard cardiopulmonary resuscitation group (p = .03). As a secondary result, trainees in the continuous chest compression cardiopulmonary resuscitation group were more likely to rate themselves “very comfortable” with the idea of using cardiopulmonary resuscitation skills in actual events than the standard cardiopulmonary resuscitation trainees (71 of 207 [34%] vs. 57 of 199 [28%], p = .08). Conclusions Continuous chest compression cardiopulmonary resuscitation education resulted in a statistically significant increase in secondary training. This work suggests that implementation of video self-instruction training programs using continuous chest compression cardiopulmonary resuscitation may confer broader dissemination of life-saving skills and may promote rescuer comfort with newly acquired cardiopulmonary resuscitation knowledge. Clinical Trial Registration URL: http://clinicaltrials.gov. Unique identifier: NCT01260441. PMID:22080629

Long-term retention of cardiopulmonary resuscitation skills after shortened chest compression-only training and conventional training: a randomized controlled trial.

PubMed

Nishiyama, Chika; Iwami, Taku; Kitamura, Tetsuhisa; Ando, Masahiko; Sakamoto, Tetsuya; Marukawa, Seishiro; Kawamura, Takashi

2014-01-01

It is unclear how much the length of a cardiopulmonary resuscitation (CPR) training program can be reduced without ruining its effectiveness. The authors aimed to compare CPR skills 6 months and 1 year after training between shortened chest compression-only CPR training and conventional CPR training. Participants were randomly assigned to either the compression-only CPR group, which underwent a 45-minute training program consisting of chest compressions and automated external defibrillator (AED) use with personal training manikins, or the conventional CPR group, which underwent a 180-minute training program with chest compressions, rescue breathing, and AED use. Participants' resuscitation skills were evaluated 6 months and 1 year after the training. The primary outcome measure was the proportion of appropriate chest compressions 1 year after the training. A total of 146 persons were enrolled, and 63 (87.5%) in the compression-only CPR group and 56 (75.7%) in the conventional CPR group completed the 1-year evaluation. The compression-only CPR group was superior to the conventional CPR group regarding the proportion of appropriate chest compression (mean ± SD = 59.8% ± 40.0% vs. 46.3% ± 28.6%; p = 0.036) and the number of appropriate chest compressions (mean ± SD = 119.5 ± 80.0 vs. 77.2 ± 47.8; p = 0.001). Time without chest compression in the compression-only CPR group was significantly shorter than that in the conventional CPR group (mean ± SD = 11.8 ± 21.1 seconds vs. 52.9 ± 14.9 seconds; p < 0.001). The shortened compression-only CPR training program appears to help the general public retain CPR skills better than the conventional CPR training program. UMIN-CTR UMIN000001675. © 2013 by the Society for Academic Emergency Medicine.

Influence of chest compression artefact on capnogram-based ventilation detection during out-of-hospital cardiopulmonary resuscitation.

PubMed

Leturiondo, Mikel; Ruiz de Gauna, Sofía; Ruiz, Jesus M; Julio Gutiérrez, J; Leturiondo, Luis A; González-Otero, Digna M; Russell, James K; Zive, Dana; Daya, Mohamud

2018-03-01

Capnography has been proposed as a method for monitoring the ventilation rate during cardiopulmonary resuscitation (CPR). A high incidence (above 70%) of capnograms distorted by chest compression induced oscillations has been previously reported in out-of-hospital (OOH) CPR. The aim of the study was to better characterize the chest compression artefact and to evaluate its influence on the performance of a capnogram-based ventilation detector during OOH CPR. Data from the MRx monitor-defibrillator were extracted from OOH cardiac arrest episodes. For each episode, presence of chest compression artefact was annotated in the capnogram. Concurrent compression depth and transthoracic impedance signals were used to identify chest compressions and to annotate ventilations, respectively. We designed a capnogram-based ventilation detection algorithm and tested its performance with clean and distorted episodes. Data were collected from 232 episodes comprising 52 654 ventilations, with a mean (±SD) of 227 (±118) per episode. Overall, 42% of the capnograms were distorted. Presence of chest compression artefact degraded algorithm performance in terms of ventilation detection, estimation of ventilation rate, and the ability to detect hyperventilation. Capnogram-based ventilation detection during CPR using our algorithm was compromised by the presence of chest compression artefact. In particular, artefact spanning from the plateau to the baseline strongly degraded ventilation detection, and caused a high number of false hyperventilation alarms. Further research is needed to reduce the impact of chest compression artefact on capnographic ventilation monitoring. Copyright © 2017 Elsevier B.V. All rights reserved.

Optimal chest compression rate in cardiopulmonary resuscitation: a prospective, randomized crossover study using a manikin model.

PubMed

Lee, Seong Hwa; Ryu, Ji Ho; Min, Mun Ki; Kim, Yong In; Park, Maeng Real; Yeom, Seok Ran; Han, Sang Kyoon; Park, Seong Wook

2016-08-01

When performing cardiopulmonary resuscitation (CPR), the 2010 American Heart Association guidelines recommend a chest compression rate of at least 100 min, whereas the 2010 European Resuscitation Council guidelines recommend a rate of between 100 and 120 min. The aim of this study was to examine the rate of chest compression that fulfilled various quality indicators, thereby determining the optimal rate of compression. Thirty-two trainee emergency medical technicians and six paramedics were enrolled in this study. All participants had been trained in basic life support. Each participant performed 2 min of continuous compressions on a skill reporter manikin, while listening to a metronome sound at rates of 100, 120, 140, and 160 beats/min, in a random order. Mean compression depth, incomplete chest recoil, and the proportion of correctly performed chest compressions during the 2 min were measured and recorded. The rate of incomplete chest recoil was lower at compression rates of 100 and 120 min compared with that at 160 min (P=0.001). The numbers of compressions that fulfilled the criteria for high-quality CPR at a rate of 120 min were significantly higher than those at 100 min (P=0.016). The number of high-quality CPR compressions was the highest at a compression rate of 120 min, and increased incomplete recoil occurred with increasing compression rate. However, further studies are needed to confirm the results.

Impact of a feedback device on chest compression quality during extended manikin CPR: a randomized crossover study.

PubMed

Buléon, Clément; Delaunay, Julie; Parienti, Jean-Jacques; Halbout, Laurent; Arrot, Xavier; Gérard, Jean-Louis; Hanouz, Jean-Luc

2016-09-01

Chest compressions require physical effort leading to increased fatigue and rapid degradation in the quality of cardiopulmonary resuscitation overtime. Despite harmful effect of interrupting chest compressions, current guidelines recommend that rescuers switch every 2 minutes. The impact on the quality of chest compressions during extended cardiopulmonary resuscitation has yet to be assessed. We conducted randomized crossover study on manikin (ResusciAnne; Laerdal). After randomization, 60 professional emergency rescuers performed 2 × 10 minutes of continuous chest compressions with and without a feedback device (CPRmeter). Efficient compression rate (primary outcome) was defined as the frequency target reached along with depth and leaning at the same time (recorded continuously). The 10-minute mean efficient compression rate was significantly better in the feedback group: 42% vs 21% (P< .001). There was no significant difference between the first (43%) and the tenth minute (36%; P= .068) with feedback. Conversely, a significant difference was evident from the second minute without feedback (35% initially vs 27%; P< .001). The efficient compression rate difference with and without feedback was significant every minute, from the second minute onwards. CPRmeter feedback significantly improved chest compression depth from the first minute, leaning from the second minute and rate from the third minute. A real-time feedback device delivers longer effective, steadier chest compressions over time. An extrapolation of these results from simulation may allow rescuer switches to be carried out beyond the currently recommended 2 minutes when a feedback device is used. Copyright © 2016 Elsevier Inc. All rights reserved.

Quality of Basic Life Support - A Comparison between Medical Students and Paramedics.

PubMed

Körber, Maria Isabel; Köhler, Thomas; Weiss, Verena; Pfister, Roman; Michels, Guido

2016-07-01

Poor survival rates after cardiac arrest can partly be explained by poor basic life support skills in medical professionals. This study aimed to assess quality of basic life support in medical students and paramedics. We conducted a prospective observational study with 100 early medical students (group A), 100 late medical students (group B) and 100 paramedics (group C), performing a 20-minute basic life support simulation in teams of two. Average frequency and absolute number of chest compressions per minute (mean (±SD)), chest decompression (millimetres of compression remaining, mean (±SD)), hands-off-time (seconds/minute, mean (±SD)), frequency of switching positions between ventilation and chest compression (per 20 minutes) and rate of sufficient compressions (depth ≥50mm) were assessed as quality parameters of CPR. In groups A, B and C the rates of sufficiently deep chest compressions were 56%, 42% and 52%, respectively, without significant differences. Male gender and real-life CPR experience were significantly associated with deeper chest compression. Frequency and number of chest compressions were within recommended goals in at least 96% of all groups. Remaining chest compressions were 6 mm (±2), 6 mm (±2) and 5 mm (±2) with a significant difference between group A and C (p=0.017). Hands-off times were 6s/min (±1), 5s/min (±1) and 4s/min (±1), which was significantly different across all three groups. Overall, paramedics tended to show better quality of CPR compared to medical students. Though, chest compression depth as an important quality characteristic of CPR was insufficient in almost 50% of participants, even in well trained paramedics. Therefore, we suggest that an effort should be made to find better ways to educate health care professionals in BLS.

Transthoracic impedance for the monitoring of quality of manual chest compression during cardiopulmonary resuscitation.

PubMed

Zhang, Hehua; Yang, Zhengfei; Huang, Zitong; Chen, Bihua; Zhang, Lei; Li, Heng; Wu, Baoming; Yu, Tao; Li, Yongqin

2012-10-01

The quality of cardiopulmonary resuscitation (CPR), especially adequate compression depth, is associated with return of spontaneous circulation (ROSC) and is therefore recommended to be measured routinely. In the current study, we investigated the relationship between changes of transthoracic impedance (TTI) measured through the defibrillation electrodes, chest compression depth and coronary perfusion pressure (CPP) in a porcine model of cardiac arrest. In 14 male pigs weighing between 28 and 34 kg, ventricular fibrillation (VF) was electrically induced and untreated for 6 min. Animals were randomized to either optimal or suboptimal chest compression group. Optimal depth of manual compression in 7 pigs was defined as a decrease of 25% (50 mm) in anterior posterior diameter of the chest, while suboptimal compression was defined as 70% of the optimal depth (35 mm). After 2 min of chest compression, defibrillation was attempted with a 120-J rectilinear biphasic shock. There were no differences in baseline measurements between groups. All animals had ROSC after optimal compressions; this contrasted with suboptimal compressions, after which only 2 of the animals had ROSC (100% vs. 28.57%, p=0.021). The correlation coefficient was 0.89 between TTI amplitude and compression depth (p<0.001), 0.83 between TTI amplitude and CPP (p<0.001). Amplitude change of TTI was correlated with compression depth and CPP in this porcine model of cardiac arrest. The TTI measured from defibrillator electrodes, therefore has the potential to serve as an indicator to monitor the quality of chest compression and estimate CPP during CPR. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Convolution neural-network-based detection of lung structures

NASA Astrophysics Data System (ADS)

Hasegawa, Akira; Lo, Shih-Chung B.; Freedman, Matthew T.; Mun, Seong K.

1994-05-01

Chest radiography is one of the most primary and widely used techniques in diagnostic imaging. Nowadays with the advent of digital radiology, the digital medical image processing techniques for digital chest radiographs have attracted considerable attention, and several studies on the computer-aided diagnosis (CADx) as well as on the conventional image processing techniques for chest radiographs have been reported. In the automatic diagnostic process for chest radiographs, it is important to outline the areas of the lungs, the heart, and the diaphragm. This is because the original chest radiograph is composed of important anatomic structures and, without knowing exact positions of the organs, the automatic diagnosis may result in unexpected detections. The automatic extraction of an anatomical structure from digital chest radiographs can be a useful tool for (1) the evaluation of heart size, (2) automatic detection of interstitial lung diseases, (3) automatic detection of lung nodules, and (4) data compression, etc. Based on the clearly defined boundaries of heart area, rib spaces, rib positions, and rib cage extracted, one should be able to use this information to facilitate the tasks of the CADx on chest radiographs. In this paper, we present an automatic scheme for the detection of lung field from chest radiographs by using a shift-invariant convolution neural network. A novel algorithm for smoothing boundaries of lungs is also presented.

[Real-time feedback systems for improvement of resuscitation quality].

PubMed

Lukas, R P; Van Aken, H; Engel, P; Bohn, A

2011-07-01

The quality of chest compression is a determinant of survival after cardiac arrest. Therefore, the European Resuscitation Council (ERC) 2010 guidelines on resuscitation strongly focus on compression quality. Despite its impact on survival, observational studies have shown that chest compression quality is not reached by professional rescue teams. Real-time feedback devices for resuscitation are able to measure chest compression during an ongoing resuscitation attempt through a sternal sensor equipped with a motion and pressure detection system. In addition to the electrocardiograph (ECG) ventilation can be detected by transthoracic impedance monitoring. In cases of quality deviation, such as shallow chest compression depth or hyperventilation, feedback systems produce visual or acoustic alarms. Rescuers can thereby be supported and guided to the requested quality in chest compression and ventilation. Feedback technology is currently available both as a so-called stand-alone device and as an integrated feature in a monitor/defibrillator unit. Multiple studies have demonstrated sustainable enhancement in the education of resuscitation due to the use of real-time feedback technology. There is evidence that real-time feedback for resuscitation combined with training and debriefing strategies can improve both resuscitation quality and patient survival. Chest compression quality is an independent predictor for survival in resuscitation and should therefore be measured and documented in further clinical multicenter trials.

Impacts to the chest of PMHSs - Influence of impact location and load distribution on chest response.

PubMed

Holmqvist, Kristian; Svensson, Mats Y; Davidsson, Johan; Gutsche, Andreas; Tomasch, Ernst; Darok, Mario; Ravnik, Dean

2016-02-01

The chest response of the human body has been studied for several load conditions, but is not well known in the case of steering wheel rim-to-chest impact in heavy goods vehicle frontal collisions. The aim of this study was to determine the response of the human chest in a set of simulated steering wheel impacts. PMHS tests were carried out and analysed. The steering wheel load pattern was represented by a rigid pendulum with a straight bar-shaped front. A crash test dummy chest calibration pendulum was utilised for comparison. In this study, a set of rigid bar impacts were directed at various heights of the chest, spanning approximately 120mm around the fourth intercostal space. The impact energy was set below a level estimated to cause rib fracture. The analysed results consist of responses, evaluated with respect to differences in the impacting shape and impact heights on compression and viscous criteria chest injury responses. The results showed that the bar impacts consistently produced lesser scaled chest compressions than the hub; the Middle bar responses were around 90% of the hub responses. A superior bar impact provided lesser chest compression; the average response was 86% of the Middle bar response. For inferior bar impacts, the chest compression response was 116% of the chest compression in the middle. The damping properties of the chest caused the compression to decrease in the high speed bar impacts to 88% of that in low speed impacts. From the analysis it could be concluded that the bar impact shape provides lower chest criteria responses compared to the hub. Further, the bar responses are dependent on the impact location of the chest. Inertial and viscous effects of the upper body affect the responses. The results can be used to assess the responses of human substitutes such as anthropomorphic test devices and finite element human body models, which will benefit the development process of heavy goods vehicle safety systems. Copyright © 2015 Elsevier Ltd. All rights reserved.

Mechanical versus manual chest compressions for out-of-hospital cardiac arrest: a meta-analysis of randomized controlled trials

PubMed Central

Tang, Lu; Gu, Wan-Jie; Wang, Fei

2015-01-01

Recent evidence regarding mechanical chest compressions in out-of-hospital cardiac arrest (OHCA) is conflicting. The objective of this study was to perform a meta-analysis of randomized controlled trials (RCTs) to compare the effect of mechanical versus manual chest compressions on resuscitation outcomes in OHCA. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the ClinicalTrials.gov registry were searched. In total, five RCTs with 12,510 participants were included. Compared with manual chest compressions, mechanical chest compressions did not significantly improve survival with good neurological outcome to hospital discharge (relative risks (RR) 0.80, 95% CI 0.61–1.04, P = 0.10; I2 = 65%), return of spontaneous circulation (RR 1.02, 95% CI 0.95–1.09, P = 0.59; I2 = 0%), or long-term (≥6 months) survival (RR 0.96, 95% CI 0.79–1.16, P = 0.65; I2 = 16%). In addition, mechanical chest compressions were associated with worse survival to hospital admission (RR 0.94, 95% CI 0.89–1.00, P = 0.04; I2 = 0%) and to hospital discharge (RR 0.88, 95% CI 0.78–0.99, P = 0.03; I2 = 0%). Based on the current evidence, widespread use of mechanical devices for chest compressions in OHCA cannot be recommended. PMID:26503429

Comparison of Ventilation and Cardiac Compressions When Utilizing the Impact Model 730 Automatic Transport Ventilator Versus a Conventional Bag Valve With a Facemask in a Model of Adult Cadiopulmonary Arrest

DTIC Science & Technology

2005-10-25

Chest compression , Ventilation 2P251107 256Page 2 1. Introduction During the initial stages of cardiopulmonary resuscitation ( CPR ), ventilation is...a metronome to facilitate chest compression timing. Twenty-eight nurses alternated performing 4 minutes of CPR using the BVM or Impact 730 to deliver... Chest compression and ventilation rates during cardiopulmonary resuscitation : the effects of audible tone guidance. Academic Emergency Medicine

Traumatic Pancreatitis: A Rare Complication of Cardiopulmonary Resuscitation.

PubMed

Aziz, Muhammad

2017-08-17

An elderly gentleman was successfully revived after undergoing cardiopulmonary resuscitation (CPR) for cardiac arrest. Post CPR, the patient developed acute pancreatitis which was likely complication of inappropriately delivered chest compressions which caused further complications and resulted in the death of the patient. This case underlines the importance of quality chest compressions that includes correct placement of hands by the operator giving chest compressions to avoid lethal injuries to the receiver.

Life-threatening hemothorax due to azygos vein rupture after chest compression during cardiopulmonary resuscitation.

PubMed

Yang, Euiseok; Jeong, WonJoon; Lee, JunWan; Kim, SeungWhan

2014-11-01

Hemothorax is not an uncommon cardiopulmonary resuscitation(CPR)–related complication. But hemothorax related to azygos vein injury (AVI) is a rare condition following blunt chest trauma, with no report of CPR-related AVI in the literature. We present a case of azygosve in rupture in a middle-aged woman after repeated chest compression during 1 hour of CPR. She eventually presented with massive hemothorax due to azygos vein rupture diagnosed by computed tomography (CT). When faced with a patient with massive hemothorax after chest compression, azygos vein rupture should be considered as a complication.

Compressing with dominant hand improves quality of manual chest compressions for rescuers who performed suboptimal CPR in manikins.

PubMed

Wang, Juan; Tang, Ce; Zhang, Lei; Gong, Yushun; Yin, Changlin; Li, Yongqin

2015-07-01

The question of whether the placement of the dominant hand against the sternum could improve the quality of manual chest compressions remains controversial. In the present study, we evaluated the influence of dominant vs nondominant hand positioning on the quality of conventional cardiopulmonary resuscitation (CPR) during prolonged basic life support (BLS) by rescuers who performed optimal and suboptimal compressions. Six months after completing a standard BLS training course, 101 medical students were instructed to perform adult single-rescuer BLS for 8 minutes on a manikin with a randomized hand position. Twenty-four hours later, the students placed the opposite hand in contact with the sternum while performing CPR. Those with an average compression depth of less than 50 mm were considered suboptimal. Participants who had performed suboptimal compressions were significantly shorter (170.2 ± 6.8 vs 174.0 ± 5.6 cm, P = .008) and lighter (58.9 ± 7.6 vs 66.9 ± 9.6 kg, P < .001) than those who performed optimal compressions. No significant differences in CPR quality were observed between dominant and nondominant hand placements for these who had an average compression depth of greater than 50 mm. However, both the compression depth (49.7 ± 4.2 vs 46.5 ± 4.1 mm, P = .003) and proportion of chest compressions with an appropriate depth (47.6% ± 27.8% vs 28.0% ± 23.4%, P = .006) were remarkably higher when compressing the chest with the dominant hand against the sternum for those who performed suboptimal CPR. Chest compression quality significantly improved when the dominant hand was placed against the sternum for those who performed suboptimal compressions during conventional CPR. Copyright © 2015 Elsevier Inc. All rights reserved.

Application of current guidelines for chest compression depth on different surfaces and using feedback devices: a randomized cross-over study.

PubMed

Schober, P; Krage, R; Lagerburg, V; Van Groeningen, D; Loer, S A; Schwarte, L A

2014-04-01

Current cardiopulmonary resuscitation (CPR)-guidelines recommend an increased chest compression depth and rate compared to previous guidelines, and the use of automatic feedback devices is encouraged. However, it is unclear whether this compression depth can be maintained at an increased frequency. Moreover, the underlying surface may influence accuracy of feedback devices. We investigated compression depths over time and evaluated the accuracy of a feedback device on different surfaces. Twenty-four volunteers performed four two-minute blocks of CPR targeting at current guideline recommendations on different surfaces (floor, mattress, 2 backboards) on a patient simulator. Participants rested for 2 minutes between blocks. Influences of time and different surfaces on chest compression depth (ANOVA, mean [95% CI]) and accuracy of a feedback device to determine compression depth (Bland-Altman) were assessed. Mean compression depth did not reach recommended depth and decreased over time during all blocks (first block: from 42 mm [39-46 mm] to 39 mm [37-42 mm]). A two-minute resting period was insufficient to restore compression depth to baseline. No differences in compression depth were observed on different surfaces. The feedback device slightly underestimated compression depth on the floor (bias -3.9 mm), but markedly overestimated on the mattress (bias +12.6 mm). This overestimation was eliminated after correcting compression depth by a second sensor between manikin and mattress. Strategies are needed to improve chest compression depth, and more than two providers should alternate with chest compressions. The underlying surface does not necessarily adversely affect CPR performance but influences accuracy of feedback devices. Accuracy is improved by a second, posterior, sensor.

Observer performance assessment of JPEG-compressed high-resolution chest images

NASA Astrophysics Data System (ADS)

Good, Walter F.; Maitz, Glenn S.; King, Jill L.; Gennari, Rose C.; Gur, David

1999-05-01

The JPEG compression algorithm was tested on a set of 529 chest radiographs that had been digitized at a spatial resolution of 100 micrometer and contrast sensitivity of 12 bits. Images were compressed using five fixed 'psychovisual' quantization tables which produced average compression ratios in the range 15:1 to 61:1, and were then printed onto film. Six experienced radiologists read all cases from the laser printed film, in each of the five compressed modes as well as in the non-compressed mode. For comparison purposes, observers also read the same cases with reduced pixel resolutions of 200 micrometer and 400 micrometer. The specific task involved detecting masses, pneumothoraces, interstitial disease, alveolar infiltrates and rib fractures. Over the range of compression ratios tested, for images digitized at 100 micrometer, we were unable to demonstrate any statistically significant decrease (p greater than 0.05) in observer performance as measured by ROC techniques. However, the observers' subjective assessments of image quality did decrease significantly as image resolution was reduced and suggested a decreasing, but nonsignificant, trend as the compression ratio was increased. The seeming discrepancy between our failure to detect a reduction in observer performance, and other published studies, is likely due to: (1) the higher resolution at which we digitized our images; (2) the higher signal-to-noise ratio of our digitized films versus typical CR images; and (3) our particular choice of an optimized quantization scheme.

Poor chest compression quality with mechanical compressions in simulated cardiopulmonary resuscitation: a randomized, cross-over manikin study.

PubMed

Blomberg, Hans; Gedeborg, Rolf; Berglund, Lars; Karlsten, Rolf; Johansson, Jakob

2011-10-01

Mechanical chest compression devices are being implemented as an aid in cardiopulmonary resuscitation (CPR), despite lack of evidence of improved outcome. This manikin study evaluates the CPR-performance of ambulance crews, who had a mechanical chest compression device implemented in their routine clinical practice 8 months previously. The objectives were to evaluate time to first defibrillation, no-flow time, and estimate the quality of compressions. The performance of 21 ambulance crews (ambulance nurse and emergency medical technician) with the authorization to perform advanced life support was studied in an experimental, randomized cross-over study in a manikin setup. Each crew performed two identical CPR scenarios, with and without the aid of the mechanical compression device LUCAS. A computerized manikin was used for data sampling. There were no substantial differences in time to first defibrillation or no-flow time until first defibrillation. However, the fraction of adequate compressions in relation to total compressions was remarkably low in LUCAS-CPR (58%) compared to manual CPR (88%) (95% confidence interval for the difference: 13-50%). Only 12 out of the 21 ambulance crews (57%) applied the mandatory stabilization strap on the LUCAS device. The use of a mechanical compression aid was not associated with substantial differences in time to first defibrillation or no-flow time in the early phase of CPR. However, constant but poor chest compressions due to failure in recognizing and correcting a malposition of the device may counteract a potential benefit of mechanical chest compressions. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Feedback on the Rate and Depth of Chest Compressions during Cardiopulmonary Resuscitation Using Only Accelerometers

PubMed Central

Ruiz de Gauna, Sofía; González-Otero, Digna M.; Ruiz, Jesus; Russell, James K.

2016-01-01

Background Quality of cardiopulmonary resuscitation (CPR) is key to increase survival from cardiac arrest. Providing chest compressions with adequate rate and depth is difficult even for well-trained rescuers. The use of real-time feedback devices is intended to contribute to enhance chest compression quality. These devices are typically based on the double integration of the acceleration to obtain the chest displacement during compressions. The integration process is inherently unstable and leads to important errors unless boundary conditions are applied for each compression cycle. Commercial solutions use additional reference signals to establish these conditions, requiring additional sensors. Our aim was to study the accuracy of three methods based solely on the acceleration signal to provide feedback on the compression rate and depth. Materials and Methods We simulated a CPR scenario with several volunteers grouped in couples providing chest compressions on a resuscitation manikin. Different target rates (80, 100, 120, and 140 compressions per minute) and a target depth of at least 50 mm were indicated. The manikin was equipped with a displacement sensor. The accelerometer was placed between the rescuer’s hands and the manikin’s chest. We designed three alternatives to direct integration based on different principles (linear filtering, analysis of velocity, and spectral analysis of acceleration). We evaluated their accuracy by comparing the estimated depth and rate with the values obtained from the reference displacement sensor. Results The median (IQR) percent error was 5.9% (2.8–10.3), 6.3% (2.9–11.3), and 2.5% (1.2–4.4) for depth and 1.7% (0.0–2.3), 0.0% (0.0–2.0), and 0.9% (0.4–1.6) for rate, respectively. Depth accuracy depended on the target rate (p < 0.001) and on the rescuer couple (p < 0.001) within each method. Conclusions Accurate feedback on chest compression depth and rate during CPR is possible using exclusively the chest acceleration signal. The algorithm based on spectral analysis showed the best performance. Despite these encouraging results, further research should be conducted to asses the performance of these algorithms with clinical data. PMID:26930061

Corpuls cpr resuscitation device generates superior emulated flows and pressures than LUCAS II in a mechanical thorax model.

PubMed

Eichhorn, S; Mendoza Garcia, A; Polski, M; Spindler, J; Stroh, A; Heller, M; Lange, R; Krane, M

2017-06-01

The provision of sufficient chest compression is among the most important factors influencing patient survival during cardiopulmonary resuscitation (CPR). One approach to optimize the quality of chest compressions is to use mechanical-resuscitation devices. The aim of this study was to compare a new device for chest compression (corpuls cpr) with an established device (LUCAS II). We used a mechanical thorax model consisting of a chest with variable stiffness and an integrated heart chamber which generated blood flow dependent on the compression depth and waveform. The method of blood-flow generation could be changed between direct cardiac-compression mode and thoracic-pump mode. Different chest-stiffness settings and compression modes were tested to generate various blood-flow profiles. Additionally, an endurance test at high stiffness was performed to measure overall performance and compression consistency. Both resuscitation machines were able to compress the model thorax with a frequency of 100/min and a depth of 5 cm, independent of the chosen chest stiffness. Both devices passed the endurance test without difficulty. The corpuls cpr device was able to generate about 10-40% more blood flow than the LUCAS II device, depending on the model settings. In most scenarios, the corpuls cpr device also generated a higher blood pressure than the LUCAS II. The peak compression forces during CPR were about 30% higher using the corpuls cpr device than with the LUCAS II. In this study, the corpuls cpr device had improved blood flow and pressure outcomes than the LUCAS II device. Further examination in an animal model is required to prove the findings of this preliminary study.

A Feasibility Study for Measuring Accurate Chest Compression Depth and Rate on Soft Surfaces Using Two Accelerometers and Spectral Analysis

PubMed Central

Gutiérrez, J. J.; Russell, James K.

2016-01-01

Background. Cardiopulmonary resuscitation (CPR) feedback devices are being increasingly used. However, current accelerometer-based devices overestimate chest displacement when CPR is performed on soft surfaces, which may lead to insufficient compression depth. Aim. To assess the performance of a new algorithm for measuring compression depth and rate based on two accelerometers in a simulated resuscitation scenario. Materials and Methods. Compressions were provided to a manikin on two mattresses, foam and sprung, with and without a backboard. One accelerometer was placed on the chest and the second at the manikin's back. Chest displacement and mattress displacement were calculated from the spectral analysis of the corresponding acceleration every 2 seconds and subtracted to compute the actual sternal-spinal displacement. Compression rate was obtained from the chest acceleration. Results. Median unsigned error in depth was 2.1 mm (4.4%). Error was 2.4 mm in the foam and 1.7 mm in the sprung mattress (p < 0.001). Error was 3.1/2.0 mm and 1.8/1.6 mm with/without backboard for foam and sprung, respectively (p < 0.001). Median error in rate was 0.9 cpm (1.0%), with no significant differences between test conditions. Conclusion. The system provided accurate feedback on chest compression depth and rate on soft surfaces. Our solution compensated mattress displacement, avoiding overestimation of compression depth when CPR is performed on soft surfaces. PMID:27999808

[New Insights into Maternal Cardiopulmonary Resuscitation--Significance of Simulation Research and Training].

PubMed

Komasawa, Nobuyasu; Fujiwara, Shunsuke; Majima, Nozomi; Minami, Toshiaki

2015-08-01

Pregnancy-related mortality, estimated to occur in approximately 1: 50,000 deliveries, is rare in developed countries. The 2010 American Heart Association (AHA) Guidelines for Resuscitation emphasize the importance of high-quality chest compression as a key determinant of successful cardiopulmonary resuscitation. During pregnancy, the uterus can compress the inferior vena cava, impeding venous return and thereby reducing stroke volume and cardiac output. To maximize the effectiveness of chest compressions in pregnancy, the AHA guidelines recommend the 27-30 degrees left-lateral tilt (LLT) position. When CPR is performed on parturients in the LLT position, chest compressions will probably be more effective if performed with the operator standing on the left side of the patient. The videolaryngoscope Pentax-AWS Airwayscope (AWS) was found to be an effective tool for airway management during chest compressions in 27 LLT simulations, suggesting that the AWS may be a useful device for airway management during maternal resuscitation.

Accurate measurement of chest compression depth using impulse-radio ultra-wideband sensor on a mattress

PubMed Central

Kim, Yeomyung

2017-01-01

Objective We developed a new chest compression depth (CCD) measuring technology using radar and impulse-radio ultra-wideband (IR-UWB) sensor. This study was performed to determine its accuracy on a soft surface. Methods Four trials, trial 1: chest compressions on the floor using an accelerometer device; trial 2: chest compressions on the floor using an IR-UWB sensor; trial 3: chest compressions on a foam mattress using an accelerometer device; trial 4: chest compressions on a foam mattress using an IR-UWB sensor, were performed in a random order. In all the trials, a cardiopulmonary resuscitation provider delivered 50 uninterrupted chest compressions to a manikin. Results The CCD measured by the manikin and the device were as follows: 57.42 ± 2.23 and 53.92 ± 2.92 mm, respectively in trial 1 (p < 0.001); 56.29 ± 1.96 and 54.16 ± 3.90 mm, respectively in trial 2 (p < 0.001); 55.61 ± 1.57 and 103.48 ± 10.48 mm, respectively in trial 3 (p < 0.001); 57.14 ± 3.99 and 55.51 ± 3.39 mm, respectively in trial 4 (p = 0.012). The gaps between the CCD measured by the manikin and the devices (accelerometer device vs. IR-UWB sensor) on the floor were not different (3.50 ± 2.08 mm vs. 3.15 ± 2.27 mm, respectively, p = 0.136). However, the gaps were significantly different on the foam mattress (48.53 ± 5.65 mm vs. 4.10 ± 2.47 mm, p < 0.001). Conclusion The IR-UWB sensor could measure the CCD accurately both on the floor and on the foam mattress. PMID:28854262

Accurate measurement of chest compression depth using impulse-radio ultra-wideband sensor on a mattress.

PubMed

Yu, Byung Gyu; Oh, Je Hyeok; Kim, Yeomyung; Kim, Tae Wook

2017-01-01

We developed a new chest compression depth (CCD) measuring technology using radar and impulse-radio ultra-wideband (IR-UWB) sensor. This study was performed to determine its accuracy on a soft surface. Four trials, trial 1: chest compressions on the floor using an accelerometer device; trial 2: chest compressions on the floor using an IR-UWB sensor; trial 3: chest compressions on a foam mattress using an accelerometer device; trial 4: chest compressions on a foam mattress using an IR-UWB sensor, were performed in a random order. In all the trials, a cardiopulmonary resuscitation provider delivered 50 uninterrupted chest compressions to a manikin. The CCD measured by the manikin and the device were as follows: 57.42 ± 2.23 and 53.92 ± 2.92 mm, respectively in trial 1 (p < 0.001); 56.29 ± 1.96 and 54.16 ± 3.90 mm, respectively in trial 2 (p < 0.001); 55.61 ± 1.57 and 103.48 ± 10.48 mm, respectively in trial 3 (p < 0.001); 57.14 ± 3.99 and 55.51 ± 3.39 mm, respectively in trial 4 (p = 0.012). The gaps between the CCD measured by the manikin and the devices (accelerometer device vs. IR-UWB sensor) on the floor were not different (3.50 ± 2.08 mm vs. 3.15 ± 2.27 mm, respectively, p = 0.136). However, the gaps were significantly different on the foam mattress (48.53 ± 5.65 mm vs. 4.10 ± 2.47 mm, p < 0.001). The IR-UWB sensor could measure the CCD accurately both on the floor and on the foam mattress.

Effect of timing and duration of a single chest compression pause on short-term survival following prolonged ventricular fibrillation.

PubMed

Walcott, Gregory P; Melnick, Sharon B; Walker, Robert G; Banville, Isabelle; Chapman, Fred W; Killingsworth, Cheryl R; Ideker, Raymond E

2009-04-01

Pauses during chest compressions are thought to have a detrimental effect on resuscitation outcome. The Guidelines 2005 have recently eliminated the post-defibrillation pause. Previous animal studies have shown that multiple pauses of increasing duration decrease resuscitation success. We investigated the effect of varying the characteristics of a single pause near defibrillation on resuscitation outcome. Part A: 48 swine were anesthetized, fibrillated for 7min and randomized. Chest compressions were initiated for 90s followed by defibrillation and then resumption of chest compressions. Four groups were studied-G2000: 40s pause beginning 20s before, and ending 20s after defibrillation, A1: a 20s pause just before defibrillation, A2: a 20s pause ending 30s prior to defibrillation, and group A3: a 10s pause ending 30s prior to defibrillation. Part B: 12 swine (Group B) were studied with a protocol identical to Part A but with no pause in chest compressions. Primary endpoint was survival to 4h. The survival rate was significantly higher for groups A1, A2, A3, and B (5/12, 7/12, 5/12, and 5/12 survived) than for the G2000 group (0/12, p<0.05). Survival did not differ significantly among groups A1, A2, A3, and B. These results suggest that the Guidelines 2005 recommendation to omit the post-shock pulse check and immediately resume chest compressions may be an important resuscitation protocol change. However, these results also suggest that clinical maneuvers further altering a single pre-shock chest compression pause provide no additional benefit.

Effect of timing and duration of a single chest compression pause on short-term survival following prolonged ventricular fibrillation☆

PubMed Central

Walcott, Gregory P.; Melnick, Sharon B.; Walker, Robert G.; Banville, Isabelle; Chapman, Fred W.; Killingsworth, Cheryl R.; Ideker, Raymond E.

2014-01-01

Background Pauses during chest compressions are thought to have a detrimental effect on resuscitation outcome. The Guidelines 2005 have recently eliminated the post-defibrillation pause. Previous animal studies have shown that multiple pauses of increasing duration decrease resuscitation success. We investigated the effect of varying the characteristics of a single pause near defibrillation on resuscitation outcome. Methods Part A: 48 swine were anesthetized, fibrillated for 7 min and randomized. Chest compressions were initiated for 90 s followed by defibrillation and then resumption of chest compressions. Four groups were studied—G2000: 40 s pause beginning 20 s before, and ending 20 s after defibrillation, A1: a 20 s pause just before defibrillation, A2: a 20 s pause ending 30 s prior to defibrillation, and group A3: a 10 s pause ending 30 s prior to defibrillation. Part B: 12 swine (Group B) were studied with a protocol identical to Part A but with no pause in chest compressions. Primary endpoint was survival to 4 h. Results The survival rate was significantly higher for groups A1, A2, A3, and B (5/12, 7/12, 5/12, and 5/12 survived) than for the G2000 group (0/12, p < 0.05). Survival did not differ significantly among groups A1, A2, A3, and B. Conclusions These results suggest that the Guidelines 2005 recommendation to omit the post-shock pulse check and immediately resume chest compressions may be an important resuscitation protocol change. However, these results also suggest that clinical maneuvers further altering a single pre-shock chest compression pause provide no additional benefit. PMID:19185411

A simple accurate chest-compression depth gauge using magnetic coils during cardiopulmonary resuscitation

NASA Astrophysics Data System (ADS)

Kandori, Akihiko; Sano, Yuko; Zhang, Yuhua; Tsuji, Toshio

2015-12-01

This paper describes a new method for calculating chest compression depth and a simple chest-compression gauge for validating the accuracy of the method. The chest-compression gauge has two plates incorporating two magnetic coils, a spring, and an accelerometer. The coils are located at both ends of the spring, and the accelerometer is set on the bottom plate. Waveforms obtained using the magnetic coils (hereafter, "magnetic waveforms"), which are proportional to compression-force waveforms and the acceleration waveforms were measured at the same time. The weight factor expressing the relationship between the second derivatives of the magnetic waveforms and the measured acceleration waveforms was calculated. An estimated-compression-displacement (depth) waveform was obtained by multiplying the weight factor and the magnetic waveforms. Displacements of two large springs (with similar spring constants) within a thorax and displacements of a cardiopulmonary resuscitation training manikin were measured using the gauge to validate the accuracy of the calculated waveform. A laser-displacement detection system was used to compare the real displacement waveform and the estimated waveform. Intraclass correlation coefficients (ICCs) between the real displacement using the laser system and the estimated displacement waveforms were calculated. The estimated displacement error of the compression depth was within 2 mm (<1 standard deviation). All ICCs (two springs and a manikin) were above 0.85 (0.99 in the case of one of the springs). The developed simple chest-compression gauge, based on a new calculation method, provides an accurate compression depth (estimation error < 2 mm).

Retention of basic life support knowledge, self-efficacy and chest compression performance in Thai undergraduate nursing students.

PubMed

Partiprajak, Suphamas; Thongpo, Pichaya

2016-01-01

This study explored the retention of basic life support knowledge, self-efficacy, and chest compression performance among Thai nursing students at a university in Thailand. A one-group, pre-test and post-test design time series was used. Participants were 30 nursing students undertaking basic life support training as a care provider. Repeated measure analysis of variance was used to test the retention of knowledge and self-efficacy between pre-test, immediate post-test, and re-test after 3 months. A Wilcoxon signed-rank test was used to compare the difference in chest compression performance two times. Basic life support knowledge was measured using the Basic Life Support Standard Test for Cognitive Knowledge. Self-efficacy was measured using the Basic Life Support Self-Efficacy Questionnaire. Chest compression performance was evaluated using a data printout from Resusci Anne and Laerdal skillmeter within two cycles. The training had an immediate significant effect on the knowledge, self-efficacy, and skill of chest compression; however, the knowledge and self-efficacy significantly declined after post-training for 3 months. Chest compression performance after training for 3 months was positively retaining compared to the first post-test but was not significant. Therefore, a retraining program to maintain knowledge and self-efficacy for a longer period of time should be established after post-training for 3 months. Copyright © 2015 Elsevier Ltd. All rights reserved.

Efficacy of metronome sound guidance via a phone speaker during dispatcher-assisted compression-only cardiopulmonary resuscitation by an untrained layperson: a randomised controlled simulation study using a manikin.

PubMed

Park, Sang O; Hong, Chong Kun; Shin, Dong Hyuk; Lee, Jun Ho; Hwang, Seong Youn

2013-08-01

Untrained laypersons should perform compression-only cardiopulmonary resuscitation (COCPR) under a dispatcher's guidance, but the quality of the chest compressions may be suboptimal. We hypothesised that providing metronome sounds via a phone speaker may improve the quality of chest compressions during dispatcher-assisted COCPR (DA-COCPR). Untrained laypersons were allocated to either the metronome sound-guided group (MG), who performed DA-COCPR with metronome sounds (110 ticks/min), or the control group (CG), who performed conventional DA-COCPR. The participants of each group performed DA-COCPR for 4 min using a manikin with Skill-Reporter, and the data regarding chest compression quality were collected. The data from 33 cases of DA-COCPR in the MG and 34 cases in the CG were compared. The MG showed a faster compression rate than the CG (111.9 vs 96.7/min; p=0.018). A significantly higher proportion of subjects in the MG performed the DA-COCPR with an accurate chest compression rate (100-120/min) compared with the subjects in the CG (32/33 (97.0%) vs 5/34 (14.7%); p<0.0001). The mean compression depth was not different between the MG and the CG (45.9 vs 46.8 mm; p=0.692). However, a higher proportion of subjects in the MG performed shallow compressions (compression depth <38 mm) compared with subjects in the CG (median % was 69.2 vs 15.7; p=0.035). Metronome sound guidance during DA-COCPR for the untrained bystanders improved the chest compression rates, but was associated more with shallow compressions than the conventional DA-COCPR in a manikin model.

Teaching basic life support with an automated external defibrillator using the two-stage or the four-stage teaching technique.

PubMed

Bjørnshave, Katrine; Krogh, Lise Q; Hansen, Svend B; Nebsbjerg, Mette A; Thim, Troels; Løfgren, Bo

2018-02-01

Laypersons often hesitate to perform basic life support (BLS) and use an automated external defibrillator (AED) because of self-perceived lack of knowledge and skills. Training may reduce the barrier to intervene. Reduced training time and costs may allow training of more laypersons. The aim of this study was to compare BLS/AED skills' acquisition and self-evaluated BLS/AED skills after instructor-led training with a two-stage versus a four-stage teaching technique. Laypersons were randomized to either two-stage or four-stage teaching technique courses. Immediately after training, the participants were tested in a simulated cardiac arrest scenario to assess their BLS/AED skills. Skills were assessed using the European Resuscitation Council BLS/AED assessment form. The primary endpoint was passing the test (17 of 17 skills adequately performed). A prespecified noninferiority margin of 20% was used. The two-stage teaching technique (n=72, pass rate 57%) was noninferior to the four-stage technique (n=70, pass rate 59%), with a difference in pass rates of -2%; 95% confidence interval: -18 to 15%. Neither were there significant differences between the two-stage and four-stage groups in the chest compression rate (114±12 vs. 115±14/min), chest compression depth (47±9 vs. 48±9 mm) and number of sufficient rescue breaths between compression cycles (1.7±0.5 vs. 1.6±0.7). In both groups, all participants believed that their training had improved their skills. Teaching laypersons BLS/AED using the two-stage teaching technique was noninferior to the four-stage teaching technique, although the pass rate was -2% (95% confidence interval: -18 to 15%) lower with the two-stage teaching technique.

Tracheal intubation using Macintosh and 2 video laryngoscopes with and without chest compressions.

PubMed

Kim, Young-Min; Kim, Ji-Hoon; Kang, Hyung-Goo; Chung, Hyun Soo; Yim, Hyeon-Woo; Jeong, Seung-Hee

2011-07-01

The aim of the study was to compare the time taken for intubation (TTI) using the Macintosh and 2 video laryngoscopes (VLs) (GlideScope [GVL]; Saturn Biomedical System, Burnaby, British Columbia, Canada, and Airway Scope [AWS]; Pentax, Tokyo, Japan) with and without chest compressions by experienced intubators in a mannequin model. This was a randomized crossover study. Twenty-two experienced physicians who have limited experience in the VLs participated in the study. The TTI using 3 laryngoscopes with and without compressions were compared. Median TTI difference between 2 conditions was only significant in the AWS (1.64 seconds; P = .01). There were no significant differences in the TTI between the Macintosh and the GVL or the AWS during compressions. In a mannequin model, the Macintosh or the GVL was not affected by chest compressions. The TTI using the AWS was delayed by compressions but not clinically significant. Considering the lack of experience, 2 VLs may be useful adjuncts for intubation by experienced intubators during chest compressions. Copyright © 2011 Elsevier Inc. All rights reserved.

[Effects of real-time audiovisual feedback on secondary-school students' performance of chest compressions].

PubMed

Abelairas-Gómez, Cristian; Rodríguez-Núñez, Antonio; Vilas-Pintos, Elisardo; Prieto Saborit, José Antonio; Barcala-Furelos, Roberto

2015-06-01

To describe the quality of chest compressions performed by secondary-school students trained with a realtime audiovisual feedback system. The learners were 167 students aged 12 to 15 years who had no prior experience with cardiopulmonary resuscitation (CPR). They received an hour of instruction in CPR theory and practice and then took a 2-minute test, performing hands-only CPR on a child mannequin (Prestan Professional Child Manikin). Lights built into the mannequin gave learners feedback about how many compressions they had achieved and clicking sounds told them when compressions were deep enough. All the learners were able to maintain a steady enough rhythm of compressions and reached at least 80% of the targeted compression depth. Fewer correct compressions were done in the second minute than in the first (P=.016). Real-time audiovisual feedback helps schoolchildren aged 12 to 15 years to achieve quality chest compressions on a mannequin.

Cold aortic flush and chest compressions enable good neurologic outcome after 15 mins of ventricular fibrillation in cardiac arrest in pigs.

PubMed

Janata, Andreas; Weihs, Wolfgang; Schratter, Alexandra; Bayegan, Keywan; Holzer, Michael; Frossard, Martin; Sipos, Wolfgang; Springler, Gregor; Schmidt, Peter; Sterz, Fritz; Losert, Udo M; Laggner, Anton N; Kochanek, Patrick M; Behringer, Wilhelm

2010-08-01

The induction of deep cerebral hypothermia via ice-cold saline aortic flush during prolonged ventricular fibrillation cardiac arrest, followed by hypothermic stasis and delayed resuscitation (emergency preservation and resuscitation), improved neurologic outcome after cardiac arrest in pigs, as compared to conventional resuscitation. We hypothesized that emergency preservation and resuscitation with chest compressions would further improve outcome in the same model. Prospective experimental study. University research laboratory. : Twenty-four female, large, white breed pigs (27-37 kg). Fifteen minutes of ventricular fibrillation cardiac arrest were followed by 20 mins of resuscitation with chest compressions (control, n = 8), deep cerebral hypothermia via 200 mL/kg 4 degrees C saline aortic flush and hypothermic stasis (emergency preservation and resuscitation, n = 8), and emergency preservation and resuscitation combined with chest compressions (emergency preservation and resuscitation plus chest compressions, n = 8). At 35 mins after cardiac arrest, cardiopulmonary bypass was initiated, followed by defibrillation. Mild hypothermia was continued for 20 hrs. Pigs were evaluated after 9 days using a neurologic deficit (neurologic deficit score: 100% = brain dead; 0%-10% = normal) and an overall performance category score (overall performance category score: 1 = normal; 2 = slightly handicapped; 3 = severely handicapped; 4 = comatose; 5 = dead/brain dead). Brain temperature decreased from 38.5 degrees C to 15.3 degrees C +/- 3.3 degrees C in the emergency preservation and resuscitation group, and to 11.3 degrees C +/- 1.2 degrees C in the emergency preservation and resuscitation plus chest compressions group. In the control group, restoration of spontaneous circulation was achieved in four out of eight pigs, and one survived to 9 days. In the emergency preservation and resuscitation group, restoration of spontaneous circulation was achieved in seven out of eight pigs and five survived; in the emergency preservation and resuscitation plus chest compressions group, all had restoration of spontaneous circulation and seven survived (restoration of spontaneous circulation, p = .08). Neurologic outcome for (median and interquartile range) the control group included overall performance category score of 3, neurologic deficit score of 45%; for the emergency preservation and resuscitation group, overall performance category score was 3 (2-5) and neurologic deficit score was 45% (36; 50) and in the emergency preservation and resuscitation plus chest compressions group, overall performance category score was 2 (1-3) and neurologic deficit score was 13% (5; 21) (overall performance category score, p = .04; neurologic deficit score emergency preservation and resuscitation vs. emergency preservation and resuscitation plus chest compressions, p = .003). Emergency preservation and resuscitation by deep cerebral hypothermia combined with chest compressions during prolonged cardiac arrest in pigs are feasible and improve neurologic outcome.

Bystander fatigue and CPR quality by older bystanders: a randomized crossover trial comparing continuous chest compressions and 30:2 compressions to ventilations.

PubMed

Liu, Shawn; Vaillancourt, Christian; Kasaboski, Ann; Taljaard, Monica

2016-11-01

This study sought to measure bystander fatigue and cardiopulmonary resuscitation (CPR) quality after five minutes of CPR using the continuous chest compression (CCC) versus the 30:2 chest compression to ventilation method in older lay persons, a population most likely to perform CPR on cardiac arrest victims. This randomized crossover trial took place at three tertiary care hospitals and a seniors' center. Participants were aged ≥55 years without significant physical limitations (frailty score ≤3/7). They completed two 5-minute CPR sessions (using 30:2 and CCC) on manikins; sessions were separated by a rest period. We used concealed block randomization to determine CPR method order. Metronome feedback maintained a compression rate of 100/minute. We measured heart rate (HR), mean arterial pressure (MAP), and Borg Exertion Scale. CPR quality measures included total number of compressions and number of adequate compressions (depth ≥5 cm). Sixty-three participants were enrolled: mean age 70.8 years, female 66.7%, past CPR training 60.3%. Bystander fatigue was similar between CPR methods: mean difference in HR -0.59 (95% CI -3.51-2.33), MAP 1.64 (95% CI -0.23-3.50), and Borg 0.46 (95% CI 0.07-0.84). Compared to 30:2, participants using CCC performed more chest compressions (480.0 v. 376.3, mean difference 107.7; p<0.0001) and more adequate chest compressions (381.5 v. 324.9, mean difference. 62.0; p=0.0001), although good compressions/minute declined significantly faster with the CCC method (p=0.0002). CPR quality decreased significantly faster when performing CCC compared to 30:2. However, performing CCC produced more adequate compressions overall with a similar level of fatigue compared to the 30:2 method.

Corpuls CPR Generates Higher Mean Arterial Pressure Than LUCAS II in a Pig Model of Cardiac Arrest.

PubMed

Eichhorn, S; Mendoza, A; Prinzing, A; Stroh, A; Xinghai, L; Polski, M; Heller, M; Lahm, H; Wolf, E; Lange, R; Krane, M

2017-01-01

According to the European Resuscitation Council guidelines, the use of mechanical chest compression devices is a reasonable alternative in situations where manual chest compression is impractical or compromises provider safety. The aim of this study is to compare the performance of a recently developed chest compression device (Corpuls CPR) with an established system (LUCAS II) in a pig model. Methods . Pigs ( n = 5/group) in provoked ventricular fibrillation were left untreated for 5 minutes, after which 15 min of cardiopulmonary resuscitation was performed with chest compressions. After 15 min, defibrillation was performed every 2 min if necessary, and up to 3 doses of adrenaline were given. If there was no return of spontaneous circulation after 25 min, the experiment was terminated. Coronary perfusion pressure, carotid blood flow, end-expiratory CO 2 , regional oxygen saturation by near infrared spectroscopy, blood gas, and local organ perfusion with fluorescent labelled microspheres were measured at baseline and during resuscitation. Results . Animals treated with Corpuls CPR had significantly higher mean arterial pressures during resuscitation, along with a detectable trend of greater carotid blood flow and organ perfusion. Conclusion . Chest compressions with the Corpuls CPR device generated significantly higher mean arterial pressures than compressions performed with the LUCAS II device.

Corpuls CPR Generates Higher Mean Arterial Pressure Than LUCAS II in a Pig Model of Cardiac Arrest

PubMed Central

Mendoza, A.; Prinzing, A.; Stroh, A.; Xinghai, L.; Polski, M.; Heller, M.; Lahm, H.; Wolf, E.; Lange, R.; Krane, M.

2017-01-01

According to the European Resuscitation Council guidelines, the use of mechanical chest compression devices is a reasonable alternative in situations where manual chest compression is impractical or compromises provider safety. The aim of this study is to compare the performance of a recently developed chest compression device (Corpuls CPR) with an established system (LUCAS II) in a pig model. Methods. Pigs (n = 5/group) in provoked ventricular fibrillation were left untreated for 5 minutes, after which 15 min of cardiopulmonary resuscitation was performed with chest compressions. After 15 min, defibrillation was performed every 2 min if necessary, and up to 3 doses of adrenaline were given. If there was no return of spontaneous circulation after 25 min, the experiment was terminated. Coronary perfusion pressure, carotid blood flow, end-expiratory CO2, regional oxygen saturation by near infrared spectroscopy, blood gas, and local organ perfusion with fluorescent labelled microspheres were measured at baseline and during resuscitation. Results. Animals treated with Corpuls CPR had significantly higher mean arterial pressures during resuscitation, along with a detectable trend of greater carotid blood flow and organ perfusion. Conclusion. Chest compressions with the Corpuls CPR device generated significantly higher mean arterial pressures than compressions performed with the LUCAS II device. PMID:29392137

Effect of 3basic life support training programs in future primary school teachers. A quasi-experimental design.

PubMed

Navarro-Patón, R; Freire-Tellado, M; Basanta-Camiño, S; Barcala-Furelos, R; Arufe-Giraldez, V; Rodriguez-Fernández, J E

2018-05-01

To evaluate the learning of basic life support (BLS) measures on the part of laypersons after 3different teaching programs. A quasi-experimental before-after study involving a non-probabilistic sample without a control group was carried out. Primary school teacher students from the University of Santiago (Spain). A total of 124 students (68.8% women and 31.2% men) aged 20-39 years (M=22.23; SD=3.79), with no previous knowledge of BLS, were studied. Three teaching programs were used: a traditional course, an audio-visual approach and feedback devices. Chest compressions as sole cardiopulmonary resuscitation skill evaluation: average compression depth, compression rate, chest recoil percentage and percentage of correct compressions. Automated external defibrillator: time needed to apply a shock before and after the course. There were significant differences in the results obtained after 2minutes of chest compressions, depending on the training program received, with feedback devices having a clear advantage referred to average compression depth (p<0.001), compression rate (p<0.001), chest recoil percentage (p<0.001) and percentage of correct compressions (p<0.001). Regarding automated external defibrillator, statistically significant differences were found in T after (p=0.025). The teaching course using feedback devices obtained the best results in terms of the quality of chest compressions, followed by the traditional course and audio-visual approach. These favorable results were present in both men and women. All 3teaching methods reached the goal of reducing defibrillation time. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Does Video Laryngoscopy Offer Advantages over Direct Laryngoscopy during Cardiopulmonary Resuscitation?

PubMed

Saraçoğlu, Ayten; Bezen, Olgaç; Şengül, Türker; Uğur, Egin Hüsnü; Şener, Sibel; Yüzer, Fisun

2015-08-01

Interruption of chest compressions should be minimized because of its negative effects on survival. This randomized, controlled, cross-over study aimed to analyze the effectiveness of Macintosh, Miller, McCoy and McGrath laryngoscopes during with or without chest compressions in the scope of a simulated cardiopulmonary resuscitation scenario. The time required for successful tracheal intubation, number of attempts, dental trauma severity and the need for optimization manoeuvres were recorded during cardiopulmonary resuscitation with and without chest compressions. The experience with computer games during the last 10 years were asked to the participants and recorded. McCoy laryngoscope yielded the shortest time for successful tracheal intubation both in the presence of and without chest compressions. During the use of McCoy laryngoscopes, fewer tracheal intubation attempts, lower incidence of dental trauma and lower visual analogue scale scores on the ease of intubation were recorded. Participants who are experienced computer game players using Macintosh, McCoy and McGrath achieved successful tracheal intubation in a significantly shorter time during resuscitation without chest compressions. Dental trauma incidence and number of tracheal intubation attempts did not show any significant difference between the four laryngoscopes being related to the rate of playing computer games. McGrath video laryngoscopes do not appear to have advantages over direct laryngoscopes for securing a smooth and successful tracheal intubation during rhythmic chest compressions. We believe that as McCoy laryngoscope provided tracheal intubation in a shorter time and with fewer attempts, this laryngoscope may increase the success rate of resuscitation.

The effects of music on the cardiac resuscitation education of nursing students.

PubMed

Tastan, Sevinc; Ayhan, Hatice; Unver, Vesile; Cinar, Fatma Ilknur; Kose, Gulsah; Basak, Tulay; Cinar, Orhan; Iyigun, Emine

2017-03-01

The purpose of this study is to examine the effects of music on the appropriate performance of the rate and depth of chest compression for nursing students. This randomized controlled study was conducted in the School of Nursing in Turkey between November 2014 and January 2015. The study's participants were second-year nursing school students with no previous formal cardiac resuscitation training (n=77). Participants were randomly assigned to one of two groups: an intervention group with music and a control group without music. During practical training, the intervention group performed chest compressions with music. The outcomes of this study were collected twice. The first evaluation was conducted one day after CPR education, and the second evaluation was conducted six weeks after the initial training. The first evaluation shows that the participants in the intervention group had an average rate of 107.33±7.29 chest compressions per minute, whereas the rate for the control group was 121.47±12.91. The second evaluation shows that the rates of chest compression for the intervention and control groups were 106.24±8.72 and 100.71±9.54, respectively. The results of this study show that a musical piece enables students to remember the ideal rhythm for chest compression. Performing chest compression with music can easily be integrated into CPR education because it does not require additional technology and is cheap. Copyright © 2016 Elsevier Ltd. All rights reserved.

A randomised control trial of prompt and feedback devices and their impact on quality of chest compressions--a simulation study.

PubMed

Yeung, Joyce; Davies, Robin; Gao, Fang; Perkins, Gavin D

2014-04-01

This study aims to compare the effect of three CPR prompt and feedback devices on quality of chest compressions amongst healthcare providers. A single blinded, randomised controlled trial compared a pressure sensor/metronome device (CPREzy), an accelerometer device (Phillips Q-CPR) and simple metronome on the quality of chest compressions on a manikin by trained rescuers. The primary outcome was compression depth. Secondary outcomes were compression rate, proportion of chest compressions with inadequate depth, incomplete release and user satisfaction. The pressure sensor device improved compression depth (37.24-43.64 mm, p=0.02), the accelerometer device decreased chest compression depth (37.38-33.19 mm, p=0.04) whilst the metronome had no effect (39.88 mm vs. 40.64 mm, p=0.802). Compression rate fell with all devices (pressure sensor device 114.68-98.84 min(-1), p=0.001, accelerometer 112.04-102.92 min(-1), p=0.072 and metronome 108.24 min(-1) vs. 99.36 min(-1), p=0.009). The pressure sensor feedback device reduced the proportion of compressions with inadequate depth (0.52 vs. 0.24, p=0.013) whilst the accelerometer device and metronome did not have a statistically significant effect. Incomplete release of compressions was common, but unaffected by the CPR feedback devices. Users preferred the accelerometer and metronome devices over the pressure sensor device. A post hoc study showed that de-activating the voice prompt on the accelerometer device prevented the deterioration in compression quality seen in the main study. CPR feedback devices vary in their ability to improve performance. In this study the pressure sensor device improved compression depth, whilst the accelerometer device reduced it and metronome had no effect. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Suppression of the cardiopulmonary resuscitation artefacts using the instantaneous chest compression rate extracted from the thoracic impedance.

PubMed

Aramendi, E; Ayala, U; Irusta, U; Alonso, E; Eftestøl, T; Kramer-Johansen, J

2012-06-01

To demonstrate that the instantaneous chest compression rate can be accurately estimated from the transthoracic impedance (TTI), and that this estimated rate can be used in a method to suppress cardiopulmonary resuscitation (CPR) artefacts. A database of 372 records, 87 shockable and 285 non-shockable, from out-of-hospital cardiac arrest episodes, corrupted by CPR artefacts, was analysed. Each record contained the ECG and TTI obtained from the defibrillation pads and the compression depth (CD) obtained from a sternal CPR pad. The chest compression rates estimated using TTI and CD were compared. The CPR artefacts were then filtered using the instantaneous chest compression rates estimated from the TTI or CD signals. The filtering results were assessed in terms of the sensitivity and specificity of the shock advice algorithm of a commercial automated external defibrillator. The correlation between the mean chest compression rates estimated using TTI or CD was r=0.98 (95% confidence interval, 0.97-0.98). The sensitivity and specificity after filtering using CD were 95.4% (88.4-98.6%) and 87.0% (82.6-90.5%), respectively. The sensitivity and specificity after filtering using TTI were 95.4% (88.4-98.6%) and 86.3% (81.8-89.9%), respectively. The instantaneous chest compression rate can be accurately estimated from TTI. The sensitivity and specificity after filtering are similar to those obtained using the CD signal. Our CPR suppression method based exclusively on signals acquired through the defibrillation pads is as accurate as methods based on signals obtained from CPR feedback devices. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Efficacy of chest compressions directed by end-tidal CO2 feedback in a pediatric resuscitation model of basic life support.

PubMed

Hamrick, Jennifer L; Hamrick, Justin T; Lee, Jennifer K; Lee, Benjamin H; Koehler, Raymond C; Shaffner, Donald H

2014-04-14

End-tidal carbon dioxide (ETCO2) correlates with systemic blood flow and resuscitation rate during cardiopulmonary resuscitation (CPR) and may potentially direct chest compression performance. We compared ETCO2-directed chest compressions with chest compressions optimized to pediatric basic life support guidelines in an infant swine model to determine the effect on rate of return of spontaneous circulation (ROSC). Forty 2-kg piglets underwent general anesthesia, tracheostomy, placement of vascular catheters, ventricular fibrillation, and 90 seconds of no-flow before receiving 10 or 12 minutes of pediatric basic life support. In the optimized group, chest compressions were optimized by marker, video, and verbal feedback to obtain American Heart Association-recommended depth and rate. In the ETCO2-directed group, compression depth, rate, and hand position were modified to obtain a maximal ETCO2 without video or verbal feedback. After the interval of pediatric basic life support, external defibrillation and intravenous epinephrine were administered for another 10 minutes of CPR or until ROSC. Mean ETCO2 at 10 minutes of CPR was 22.7±7.8 mm Hg in the optimized group (n=20) and 28.5±7.0 mm Hg in the ETCO2-directed group (n=20; P=0.02). Despite higher ETCO2 and mean arterial pressure in the latter group, ROSC rates were similar: 13 of 20 (65%; optimized) and 14 of 20 (70%; ETCO2 directed). The best predictor of ROSC was systemic perfusion pressure. Defibrillation attempts, epinephrine doses required, and CPR-related injuries were similar between groups. The use of ETCO2-directed chest compressions is a novel guided approach to resuscitation that can be as effective as standard CPR optimized with marker, video, and verbal feedback.

Cardiopulmonary Resuscitation in Lunar and Martian Gravity Fields

NASA Technical Reports Server (NTRS)

Sarkar, Subhajit

2004-01-01

Cardiopulmonary resuscitation is required training for all astronauts. No studies thus far have investigated how chest compressions may be affected in lunar and Martian gravities. Therefore a theoretical quantitative study was performed. The maximum downward force an unrestrained person can apply is mg N (g(sub Earth) = 9.78 ms(sup -2), g(sub moon) = 1.63 ms(sup -2), g(sub Mars) = 3.69 ms(sup -2). Tsitlik et a1 (Critical Care Medicine, 1983) described the human sternal elastic force-displacement relationship (compliance) by: F = betaD(sub s) + gammaD(sub s)(sup 2) (beta = 54.9 plus or minus 29.4 Ncm(sup -1) and gamma = 10.8 plus or minus 4.1 Ncm(sup -2)). Maximum forces in the 3 gravitational fields produced by 76 kg (US population mean), 41 kg and 93 kg (masses derived from the limits for astronaut height), produced solutions for compression depth using Tsitlik equations for chests of: mean compliance (beta = 54.9, gamma = 10.8), low compliance (beta = 84.3, gamma = 14.9) and high compliance (beta = 25.5, gamma = 6.7). The mass for minimum adequate adult compression, 3.8 cm (AHA guidelines), was also calculated. 76 kg compresses the mean compliance chest by: Earth, 6.1 cm, Mars, 3.2 cm, Moon, 1.7 cm. In lunar gravity, the high compliance chest is compressed only 3.2 cm by 93 kg, 120 kg being required for 3.8 cm. In Martian gravity, on the mean chest, 93 kg compresses 3.6 cm; 99 kg is required for 3.8 cm. On Mars, the high compliance chest is compressed 4.8 cm with 76 kg, 5.5 cm with 93 kg, with 52 kg required for 3.8 cm.

[Resuscitation - Basic Life Support in adults and application of automatic external defibrillators].

PubMed

Bohn, Andreas; Seewald, Stephan; Wnent, Jan

2016-03-01

Witnesses of a sudden cardiac arrest play a key-role in resuscitation. Lay-persons should therefore be trained to recognize that a collapsed person who is not breathing at all or breathing normally might suffer from cardiac arrest. Information of professional emergency medical staff by lay-persons and their initiation of cardio-pulmonary-resuscitation-measures are of great importance for cardiac-arrest victims. Ambulance-dispatchers have to support lay-rescuers via telephone. This support includes the localisation of the nearest Automatic External Defibrillator (AED). Presentation of agonal breathing or convulsions due to brain-hypoxia need to be recognized as potential early signs of cardiac arrest. In any case of cardiac arrest chest-compressions need to be started. There is insufficiant data to recommend "chest-compression-only"-CPR as being equally sufficient as cardio-pulmonary-resuscitation including ventilation. Rescuers trained in ventilation should therefore combine compressions and ventilations at a 30:2-ratio. Movement of the chest is being used as a sign of sufficient ventilation. High-quality chest-compressions of at least 5 cm of depth, not exceeding 6 cm, are recommended at a ratio of 100-120 chest conpressions/min. Interruption of chest-compression should be avoided. At busy public places AED should be available to enable lay-rescuers to apply early defibrillation. © Georg Thieme Verlag Stuttgart · New York.

Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

PubMed

Suzuki, Kodai; Inoue, Shigeaki; Morita, Seiji; Watanabe, Nobuo; Shintani, Ayumi; Inokuchi, Sadaki; Ogura, Shinji

2016-01-01

Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions. This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching. In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1%) underwent emergency resuscitative thoracotomy and 893 (64.9%) received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P < 0.001) and 28 d after arrival (1.2% vs. 6.0%, respectively, P < 0.001). Multivariable generalized mixed-effects regression analysis with and without a propensity score-matched dataset revealed that the odds ratio for an unfavorable survival rate after 24 h was lower for emergency resuscitative thoracotomy than for closed-chest compressions (P < 0.001). Emergency resuscitative thoracotomy was independently associated with decreased odds of a favorable survival rate compared to closed-chest compressions.

Role of dominant versus non-dominant hand position during uninterrupted chest compression CPR by novice rescuers: a randomized double-blind crossover study.

PubMed

Nikandish, Reza; Shahbazi, Sharbanoo; Golabi, Sedigheh; Beygi, Najimeh

2008-02-01

Previous research has suggested improved quality of chest compressions when the dominant hand was in contact with the sternum. However, the study was in health care professionals and during conventional chest compression-ventilation CPR. The aim of this study was to test the hypothesis, in null form, that the quality of external chest compressions (ECC) in novice rescuers during 5min of uninterrupted chest compression CPR (UCC-CPR) is independent of the hand in contact with the sternum. Confirmation of the hypothesis would allow the use of either hand by the novice rescuers during UCC-CPR. Fifty-nine first year public heath students participated in this randomised double-blind crossover study. After completion of a standard adult BLS course, they performed single rescuer adult UCC-CPR for 5 min on a recording Resusci Anne. One week later they changed the hand of contact with the sternum while performing ECC. The quality of ECC was recorded by the skill meter for the dominant and non-dominant hand during 5 min ECC. The total number of correct chest compressions in the dominant hand group (DH), mean 183+/-152, was not statistically different from the non-dominant hand group (NH), mean 152+/-135 (P=0.09). The number of ECC with inadequate depth in the DH group, mean 197+/-174 and NH group, mean 196+/-173 were comparable (P=0.1). The incidence of ECC exceeding the recommended depth in the DH group, mean 51+/-110 and NH group, mean 32+/-75 were comparable (P=0.1). Although there is a trend to increased incidence of correct chest compressions with positioning the dominant hand in contact with the sternum, it does not reach statistical significance during UCC-CPR by the novice rescuers for 5 min.

Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study.

PubMed

Zimmerman, Elise; Cohen, Naiomi; Maniaci, Vincenzo; Pena, Barbara; Lozano, Juan Manuel; Linares, Marc

2015-11-01

Determine whether the use of a metronome improves chest compression rate and depth during cardiopulmonary resuscitation (CPR) on a pediatric manikin. A prospective, simulation-based, crossover, randomized controlled trial was conducted. Participants included pediatric residents, fellows, nurses, and medical students who were randomly assigned to perform chest compressions on a pediatric manikin with and without an audible metronome. Each participant performed 2 rounds of 2 minutes of chest compressions separated by a 15-minute break. A total of 155 participants performed 2 rounds of chest compressions (74 with the metronome on during the first round and 81 with the metronome on during the second round of CPR). There was a significant improvement in the mean percentage of compressions delivered within an adequate rate (90-100 compressions per minute) with the metronome on compared with off (72% vs 50%; mean difference [MD] 22%; 95% confidence interval [CI], 15% to 29%). No significant difference was noted in the mean percentage of compressions within acceptable depth (38-51 mm) (72% vs 70%; MD 2%; 95% CI, -2% to 6%). The metronome had a larger effect among medical students (73% vs 55%; MD 18%; 95% CI, 8% to 28%) and pediatric residents and fellows (84% vs 48%; MD 37%; 95% CI, 27% to 46%) but not among pediatric nurses (46% vs 48%; MD -3%; 95% CI, -19% to 14%). The rate of chest compressions during CPR can be optimized by the use of a metronome. These findings will help medical professionals comply with the American Heart Association guidelines. Copyright © 2015 by the American Academy of Pediatrics.

A randomized control hands-on defibrillation study-Barrier use evaluation.

PubMed

Wampler, David; Kharod, Chetan; Bolleter, Scotty; Burkett, Alison; Gabehart, Caitlin; Manifold, Craig

2016-06-01

Chest compressions and defibrillation are the only therapies proven to increase survival in cardiac arrest. Historically, rescuers must remove hands to shock, thereby interrupting chest compressions. This hands-off time results in a zero blood flow state. Pauses have been associated with poorer neurological recovery. This was a blinded randomized control cadaver study evaluating the detection of defibrillation during manual chest compressions. An active defibrillator was connected to the cadaver in the sternum-apex configuration. The sham defibrillator was not connected to the cadaver. Subjects performed chest compressions using 6 barrier types: barehand, single and double layer nitrile gloves, firefighter gloves, neoprene pad, and a manual chest compression/decompression device. Randomized defibrillations (10 per barrier type) were delivered at 30 joules (J) for bare hand and 360J for all other barriers. After each shock, the subject indicated degree of sensation on a VAS scale. Ten subjects participated. All subjects detected 30j shocks during barehand compressions, with only 1 undetected real shock. All barriers combined totaled 500 shocks delivered. Five (1%) active shocks were detected, 1(0.2%) single layer of Nitrile, 3(0.6%) with double layer nitrile, and 1(0.2%) with the neoprene barrier. One sham shock was reported with the single layer nitrile glove. No shocks were detected with fire gloves or compression decompression device. All shocks detected barely perceptible (0.25(±0.05)cm on 10cm VAS scale). Nitrile gloves and neoprene pad prevent (99%) responder's detection of defibrillation of a cadaver. Fire gloves and compression decompression device prevented detection. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial.

PubMed

Smereka, Jacek; Kasiński, Mariusz; Smereka, Adam; Ładny, Jerzy R; Szarpak, Łukasz

2017-01-01

The aetiology of sudden cardiac arrest in infants is different from that in adults, with respiratory failure, sudden infant death syndrome, and drowning being the primary causes in the former. According to the European Resuscitation Council (ERC) and American Heart Association (AHA) recommendations, the quality of chest compressions (CC) is a key element affecting the effectiveness of cardiopulmonary resuscitation (CPR). The current ERC and AHA guidelines recommend the 'two-finger technique' (TFT) or 'two-thumb encircling hands technique' (TTHT) for external CCs during infant CPR. The aim of the randomised crossover manikin trial was to assess the CC quality during simulated resuscitation in infants performed by paramedics. A prospective, randomised, crossover, single-centre study was conducted between June and August 2016. The study material consisted of 120 fully trained and licensed paramedics (39 females, 32.5%) with a minimum of five years of professional experience (mean 7.5 ± 4.8 years) in emergency medicine (mean age, 30.5 ± 5.5 years). The participants performed CCs using three techniques: TFT (the rescuer compresses the sternum with the tips of two fingers); TTHT; and the 'new two-thumb technique' (nTTT). The novel method of CCs in an infant consists of using two thumbs directed at the angle of 90 degrees to the chest while closing the fingers of both hands in a fist. The median CC rate when using the TFT, the TTHT, and nTTT methods varied and amounted to 134 min-1 vs. 126 min-1 vs. 114 min-1, respectively. There was a statistically significant difference in the median CC frequency between TFT and TTHT (p < 0.001), TFT and nTTT (p < 0.001), and between TTHT and nTTT (p < 0.001). The highest percentage of compressions with the frequency recommended by the ERC guidelines (100-120 min-1) was achieved by the study participants only with the nTTT. The median CC depth during the TFT was 28 mm (interquartile range [IQR] 27-30 mm) and was significantly lower than in the static TTHT (40.5 [IQR 39-41] mm; p < 0.001) and nTTT (40 [IQR 39-41] mm; p < 0.001). The percentage of adequate depth CCs was correctly obtained with TTHT and nTTT. The largest proportion of total decompression of the chest was observed with the nTTT technique (96 [IQR 96-98] %), followed by TFT (95.5 [IQR 85.5-99] %) and TTHT (5 [IQR 3-7] %). In all scenarios, the correct placement of the CC point was achieved in more than 90% of cases. Our novel infant CC method provides the highest percentage of CCs with the frequency recommended by the ERC guidelines as compared with standard techniques. It also allows optimal CC depth.

Chest compression quality management and return of spontaneous circulation: a matched-pair registry study.

PubMed

Lukas, Roman-Patrik; Gräsner, Jan Thorsten; Seewald, Stephan; Lefering, Rolf; Weber, Thomas Peter; Van Aken, Hugo; Fischer, Matthias; Bohn, Andreas

2012-10-01

Investigating the effects of any intervention during cardiac arrest remains difficult. The ROSC after cardiac arrest score was introduced to facilitate comparison of rates of return of spontaneous circulation (ROSC) between different ambulance services. To study the influence of chest compression quality management (including training, real-time feedback devices, and debriefing) in comparison with conventional cardiopulmonary resuscitation (CPR), a matched-pair analysis was conducted using data from the German Resuscitation Registry, with the calculated ROSC after cardiac arrest score as the baseline. Matching for independent ROSC after cardiac arrest score variables yielded 319 matched cases from the study period (January 2007-March 2011). The score predicted a 45% ROSC rate for the matched pairs. The observed ROSC increased significantly with chest compression quality management, to 52% (P=0.013; 95% CI, 46-57%). No significant differences were seen in the conventional CPR group (47%; 95% CI, 42-53%). The difference between the observed ROSC rates was not statistically significant. Chest compression quality management leads to significantly higher ROSC rates than those predicted by the prognostic score (ROSC after cardiac arrest score). Matched-pair analysis shows that with conventional CPR, the observed ROSC rate was not significantly different from the predicted rate. Analysis shows a trend toward a higher ROSC rate for chest compression quality management in comparison with conventional CPR. It is unclear whether a single aspect of chest compression quality management or the combination of training, real-time feedback, and debriefing contributed to this result. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

[Automatic mechanical chest compression during helicopter transportation].

PubMed

Kyrval, Helle S; Ahmad, Khalil

2010-11-15

We describe a case story with a drowned, hypothermic trauma patient treated with an automatic mechanical chest compression device during helicopter transportation to a trauma center. After falling from a 25 meter high bridge into 2 °C water, she was rescued lifeless 17 minutes later. Advanced life support was initiated. During transport by a rescue helicopter, chest compressions were effectively provided by Lund University Cardiopulmonary Assist System (LUCAS). Upon arrival to a trauma centre approx. 60 minutes later, the patient was treated with extracorporal circulation and rewarmed. She was eventually discharged to her home with minor loss of cerebral function.

Simplified dispatch-assisted CPR instructions outperform standard protocol.

PubMed

Dias, J A; Brown, T B; Saini, D; Shah, R C; Cofield, S S; Waterbor, J W; Funkhouser, E; Terndrup, T E

2007-01-01

Dispatch-assisted chest compressions only CPR (CC-CPR) has gained widespread acceptance, and recent research suggests that increasing the proportion of compression time during CPR may increase survival from out-of-hospital cardiac arrest. We created a simplified CC-CPR protocol to reduce time to start chest compressions and to increase the proportion of time spent delivering chest compressions. This simplified protocol was compared to a published protocol, Medical Priority Dispatch System (MPDS) Version 11.2, recommended by the National Academies of Emergency Dispatch. Subjects were randomized to the MPDS v11.2 protocol or a simplified protocol. Data was recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions for both protocols. Outcomes included chest compression rate, depth, hand position, full release, overall proportion of compressions without error, time to start of CPR and total hands-off chest time. Proportions were analyzed by Wilcoxon's Rank Sum tests and time variables with Welch ANOVA and Wilcoxon's Rank Sum test. All tests used a two-sided alpha-level of 0.05. One hundred and seventeen subjects were randomized prospectively, 58 to the standard protocol and 59 to the simplified protocol. The average age of subjects in both groups was 25 years old. For both groups, the compression rate was equivalent (104 simplified versus 94 MPDS, p = 0.13), as was the proportion with total release (1.0 simplified versus 1.0 MPDS, p = 0.09). The proportion to the correct depth was greater in the simplified protocol (0.31 versus 0.03, p < 0.01), as was the proportion of compressions done without error (0.05 versus 0.0, p = 0.16). Time to start of chest compressions and total hands-off chest time were better in the simplified protocol (start time 60.9s versus 78.6s, p < 0.0001; hands-off chest time 69 s versus 95 s, p < 0.0001). The proportion with correct hand position, however, was worse in the simplified protocol (0.35 versus 0.84, p < 0.01). The simplified protocol was as good as, or better than the MPDS v11.2 protocol in every aspect studied except hand position, and the simplified protocol resulted in significant time savings. The protocol may need modification to ensure correct hand position. Time savings and improved quality of CPR achieved by the new set of instructions could be important in strengthening critical links in the cardiac chain of survival.

Chest compressions in newborn animal models: A review.

PubMed

Solevåg, Anne Lee; Cheung, Po-Yin; Lie, Helene; O'Reilly, Megan; Aziz, Khalid; Nakstad, Britt; Schmölzer, Georg Marcus

2015-11-01

Much of the knowledge about the optimal way to perform chest compressions (CC) in newborn infants is derived from animal studies. The objective of this review was to identify studies of CC in newborn term animal models and review the evidence. We also provide an overview of the different models. MEDLINE, EMBASE and CINAHL, until September 29th 2014. Study eligibility criteria and interventions: term newborn animal models where CC was performed. Based on 419 retrieved studies from MEDLINE and 502 from EMBASE, 28 studies were included. No additional studies were identified in CINAHL. Most of the studies were performed in pigs after perinatal transition without long-term follow-up. The models differed widely in methodological aspects, which limits the possibility to compare and synthesize findings. Studies uncommonly reported the method for randomization and allocation concealment, and a limited number were blinded. Only the evidence in favour of the two-thumb encircling hands technique for performing CC, a CC to ventilation ratio of 3:1; and that air can be used for ventilation during CC; was supported by more than one study. Animal studies should be performed and reported with the same rigor as in human randomized trials. Good transitional and survival models are needed to further increase the strength of the evidence derived from animal studies of newborn chest compressions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A Comparison of Chest Compression Quality Delivered During On-Scene and Ground Transport Cardiopulmonary Resuscitation

PubMed Central

Russi, Christopher S.; Myers, Lucas A.; Kolb, Logan J.; Lohse, Christine M.; Hess, Erik P.; White, Roger D.

2016-01-01

Introduction American Heart Association (AHA) guidelines recommend cardiopulmonary resuscitation (CPR) chest compressions 1.5 to 2 inches (3.75–5 cm) deep at 100 to 120 per minute. Recent studies demonstrated that manual CPR by emergency medical services (EMS) personnel is substandard. We hypothesized that transport CPR quality is significantly worse than on-scene CPR quality. Methods We analyzed adult patients receiving on-scene and transport chest compressions from nine EMS sites across Minnesota and Wisconsin from May 2008 to July 2010. Two periods were analyzed: before and after visual feedback. CPR data were collected and exported with the Zoll M series monitor and a sternally placed accelerometer measuring chest compression rate and depth. We compared compression data with 2010 AHA guidelines and Zoll RescueNet Code Review software. CPR depth and rate were “above (deep),” “in,” or “below (shallow)” the target range according to AHA guidelines. We paired on-scene and transport data for each patient; paired proportions were compared with the nonparametric Wilcoxon signed rank test. Results In the pre-feedback period, we analyzed 105 of 140 paired cases (75.0%); in the post-feedback period, 35 of 140 paired cases (25.0%) were analyzed. The proportion of correct depths during on-scene compressions (median, 41.9%; interquartile range [IQR], 16.1–73.1) was higher compared to the paired transport proportion (median, 8.7%; IQR, 2.7–48.9). Proportions of on-scene median correct rates and transport median correct depths did not improve in the post-feedback period. Conclusion Transport chest compressions are significantly worse than on-scene compressions. Implementation of visual real-time feedback did not affect performance. PMID:27625733

The effect of compressor-administered defibrillation on peri-shock pauses in a simulated cardiac arrest scenario.

PubMed

Glick, Joshua; Lehman, Erik; Terndrup, Thomas

2014-03-01

Coordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest. The purpose of this study was to determine whether defibrillation provided by the provider performing chest compressions led to a decrease in peri-shock pauses as compared to defibrillation administered by a second provider, in a simulated cardiac arrest scenario. This was a randomized, controlled study measuring pauses in chest compressions for defibrillation in a simulated cardiac arrest model. We approached hospital providers with current CPR certification for participation between July, 2011 and October, 2011. Volunteers were randomized to control (facilitator-administered defibrillation) or experimental (compressor-administered defibrillation) groups. All participants completed one minute of chest compressions on a mannequin in a shockable rhythm prior to administration of defibrillation. We measured and compared pauses for defibrillation in both groups. Out of 200 total participants, we analyzed data from 197 defibrillations. Compressor-initiated defibrillation resulted in a significantly lower pre-shock hands-off time (0.57 s; 95% CI: 0.47-0.67) compared to facilitator-initiated defibrillation (1.49 s; 95% CI: 1.35-1.64). Furthermore, compressor-initiated defibrillation resulted in a significantly lower peri-shock hands-off time (2.77 s; 95% CI: 2.58-2.95) compared to facilitator-initiated defibrillation (4.25 s; 95% CI: 4.08-4.43). Assigning the responsibility for shock delivery to the provider performing compressions encourages continuous compressions throughout the charging period and decreases total time spent off the chest. However, as this was a simulation-based study, clinical implementation is necessary to further evaluate these potential benefits.

Trial of Continuous or Interrupted Chest Compressions during CPR.

PubMed

Nichol, Graham; Leroux, Brian; Wang, Henry; Callaway, Clifton W; Sopko, George; Weisfeldt, Myron; Stiell, Ian; Morrison, Laurie J; Aufderheide, Tom P; Cheskes, Sheldon; Christenson, Jim; Kudenchuk, Peter; Vaillancourt, Christian; Rea, Thomas D; Idris, Ahamed H; Colella, Riccardo; Isaacs, Marshal; Straight, Ron; Stephens, Shannon; Richardson, Joe; Condle, Joe; Schmicker, Robert H; Egan, Debra; May, Susanne; Ornato, Joseph P

2015-12-03

During cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest, the interruption of manual chest compressions for rescue breathing reduces blood flow and possibly survival. We assessed whether outcomes after continuous compressions with positive-pressure ventilation differed from those after compressions that were interrupted for ventilations at a ratio of 30 compressions to two ventilations. This cluster-randomized trial with crossover included 114 emergency medical service (EMS) agencies. Adults with non-trauma-related cardiac arrest who were treated by EMS providers received continuous chest compressions (intervention group) or interrupted chest compressions (control group). The primary outcome was the rate of survival to hospital discharge. Secondary outcomes included the modified Rankin scale score (on a scale from 0 to 6, with a score of ≤3 indicating favorable neurologic function). CPR process was measured to assess compliance. Of 23,711 patients included in the primary analysis, 12,653 were assigned to the intervention group and 11,058 to the control group. A total of 1129 of 12,613 patients with available data (9.0%) in the intervention group and 1072 of 11,035 with available data (9.7%) in the control group survived until discharge (difference, -0.7 percentage points; 95% confidence interval [CI], -1.5 to 0.1; P=0.07); 7.0% of the patients in the intervention group and 7.7% of those in the control group survived with favorable neurologic function at discharge (difference, -0.6 percentage points; 95% CI, -1.4 to 0.1, P=0.09). Hospital-free survival was significantly shorter in the intervention group than in the control group (mean difference, -0.2 days; 95% CI, -0.3 to -0.1; P=0.004). In patients with out-of-hospital cardiac arrest, continuous chest compressions during CPR performed by EMS providers did not result in significantly higher rates of survival or favorable neurologic function than did interrupted chest compressions. (Funded by the National Heart, Lung, and Blood Institute and others; ROC CCC ClinicalTrials.gov number, NCT01372748.).

An investigation of thrust, depth and the impedance cardiogram as measures of cardiopulmonary resuscitation efficacy in a porcine model of cardiac arrest.

PubMed

Howe, Andrew; O'Hare, Peter; Crawford, Paul; Delafont, Bruno; McAlister, Olibhear; Di Maio, Rebecca; Clutton, Eddie; Adgey, Jennifer; McEneaney, David

2015-11-01

Optimising the depth and rate of applied chest compressions following out of hospital cardiac arrest is crucial in maintaining end organ perfusion and improving survival. The impedance cardiogram (ICG) measured via defibrillator pads produces a characteristic waveform during chest compressions with the potential to provide feedback on cardiopulmonary resuscitation (CPR) and enhance performance. The objective of this pre-clinical study was to investigate the relationship between mechanical and physiological markers of CPR efficacy in a porcine model and examine the strength of correlation between the ICG amplitude, compression depth and end-tidal CO2 (ETCO2). Two experiments were performed using 24 swine (12 per experiment). For experiment 1, ventricular fibrillation (VF) was induced and mechanical CPR commenced at varying thrusts (0-60 kg) for 2 min intervals. Chest compression depth was recorded using a Philips QCPR device with additional recording of invasive physiological parameters: systolic blood pressure, ETCO2, cardiac output and carotid flow. For experiment 2, VF was induced and mechanical CPR commenced at varying depths (0-5 cm) for 2 min intervals. The ICG was recorded via defibrillator pads attached to the animal's sternum and connected to a Heartsine 500 P defibrillator. ICG amplitude, chest compression depth, systolic blood pressure and ETCO2 were recorded during each cycle. In both experiments the within-animal correlation between the measured parameters was assessed using a mixed effect model. In experiment 1 moderate within-animal correlations were observed between physiological parameters and compression depth (r=0.69-0.77) and thrust (r=0.66-0.82). A moderate correlation was observed between compression depth and thrust (r=0.75). In experiment 2 a strong within-animal correlation and moderate overall correlations were observed between ICG amplitude and compression depth (r=0.89, r=0.79) and ETCO2 (r=0.85, r=0.64). In this porcine model of induced cardiac arrest moderate within animal correlations were observed between mechanical and physiological markers of chest compression efficacy demonstrating the challenge in utilising a single mechanical metric to quantify chest compression efficacy. ICG amplitude demonstrated strong within animal correlations with compression depth and ETCO2 suggesting its potential utility to provide CPR feedback in the out of hospital setting to improve performance. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Football Equipment Removal Improves Chest Compression and Ventilation Efficacy.

PubMed

Mihalik, Jason P; Lynall, Robert C; Fraser, Melissa A; Decoster, Laura C; De Maio, Valerie J; Patel, Amar P; Swartz, Erik E

2016-01-01

Airway access recommendations in potential catastrophic spine injury scenarios advocate for facemask removal, while keeping the helmet and shoulder pads in place for ensuing emergency transport. The anecdotal evidence to support these recommendations assumes that maintaining the helmet and shoulder pads assists inline cervical stabilization and that facial access guarantees adequate airway access. Our objective was to determine the effect of football equipment interference on performing chest compressions and delivering adequate ventilations on patient simulators. We hypothesized that conditions with more football equipment would decrease chest compression and ventilation efficacy. Thirty-two certified athletic trainers were block randomized to participate in six different compression conditions and six different ventilation conditions using human patient simulators. Data for chest compression (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of adequate compressions) and ventilation (total ventilations, mean ventilation volume, and percentage of ventilations delivering adequate volume) conditions were analyzed across all conditions. The fully equipped athlete resulted in the lowest mean compression depth (F5,154 = 22.82; P < 0.001; Effect Size = 0.98) and delivery of adequate compressions (F5,154 = 15.06; P < 0.001; Effect Size = 1.09) compared to all other conditions. Bag-valve mask conditions resulted in delivery of significantly higher mean ventilation volumes compared to all 1- or 2-person pocketmask conditions (F5,150 = 40.05; P < 0.001; Effect Size = 1.47). Two-responder ventilation scenarios resulted in delivery of a greater number of total ventilations (F5,153 = 3.99; P = 0.002; Effect Size = 0.26) and percentage of adequate ventilations (F5,150 = 5.44; P < 0.001; Effect Size = 0.89) compared to one-responder scenarios. Non-chinstrap conditions permitted greater ventilation volumes (F3,28 = 35.17; P < 0.001; Effect Size = 1.78) and a greater percentage of adequate volume (F3,28 = 4.85; P = 0.008; Effect Size = 1.12) compared to conditions with the chinstrap buckled or with the chinstrap in place but not buckled. Chest compression and ventilation delivery are compromised in equipment-intense conditions when compared to conditions whereby equipment was mostly or entirely removed. Emergency medical personnel should remove the helmet and shoulder pads from all football athletes who require cardiopulmonary resuscitation, while maintaining appropriate cervical spine stabilization when injury is suspected. Further research is needed to confirm our findings supporting full equipment removal for chest compression and ventilation delivery.

Interdisciplinary ICU Cardiac Arrest Debriefing Improves Survival Outcomes

PubMed Central

Wolfe, Heather; Zebuhr, Carleen; Topjian, Alexis A.; Nishisaki, Akira; Niles, Dana E.; Meaney, Peter A.; Boyle, Lori; Giordano, Rita T.; Davis, Daniela; Priestley, Margaret; Apkon, Michael; Berg, Robert A.; Nadkarni, Vinay M.; Sutton, Robert M.

2014-01-01

Objective In-hospital cardiac arrest is an important public health problem. High-quality resuscitation improves survival but is difficult to achieve. Our objective is to evaluate the effectiveness of a novel, interdisciplinary, postevent quantitative debriefing program to improve survival outcomes after in-hospital pediatric chest compression events. Design, Setting, and Patients Single-center prospective interventional study of children who received chest compressions between December 2008 and June 2012 in the ICU. Interventions Structured, quantitative, audiovisual, interdisciplinary debriefing of chest compression events with front-line providers. Measurements and Main Results Primary outcome was survival to hospital discharge. Secondary outcomes included survival of event (return of spontaneous circulation for ≥ 20 min) and favorable neurologic outcome. Primary resuscitation quality outcome was a composite variable, termed “excellent cardiopulmonary resuscitation,” prospectively defined as a chest compression depth ≥ 38 mm, rate ≥ 100/min, ≤ 10% of chest compressions with leaning, and a chest compression fraction > 90% during a given 30-second epoch. Quantitative data were available only for patients who are 8 years old or older. There were 119 chest compression events (60 control and 59 interventional). The intervention was associated with a trend toward improved survival to hospital discharge on both univariate analysis (52% vs 33%, p = 0.054) and after controlling for confounders (adjusted odds ratio, 2.5; 95% CI, 0.91–6.8; p = 0.075), and it significantly increased survival with favorable neurologic outcome on both univariate (50% vs 29%, p = 0.036) and multivariable analyses (adjusted odds ratio, 2.75; 95% CI, 1.01–7.5; p = 0.047). Cardiopulmonary resuscitation epochs for patients who are 8 years old or older during the debriefing period were 5.6 times more likely to meet targets of excellent cardiopulmonary resuscitation (95% CI, 2.9–10.6; p < 0.01). Conclusion Implementation of an interdisciplinary, postevent quantitative debriefing program was significantly associated with improved cardiopulmonary resuscitation quality and survival with favorable neurologic outcome. (Crit Care Med 2014; XX:00–00) PMID:24717462

Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study.

PubMed

Gundersen, Kenneth; Kvaløy, Jan Terje; Kramer-Johansen, Jo; Steen, Petter Andreas; Eftestøl, Trygve

2009-02-06

One of the factors that limits survival from out-of-hospital cardiac arrest is the interruption of chest compressions. During ventricular fibrillation and tachycardia the electrocardiogram reflects the probability of return of spontaneous circulation associated with defibrillation. We have used this in the current study to quantify in detail the effects of interrupting chest compressions. From an electrocardiogram database we identified all intervals without chest compressions that followed an interval with compressions, and where the patients had ventricular fibrillation or tachycardia. By calculating the mean-slope (a predictor of the return of spontaneous circulation) of the electrocardiogram for each 2-second window, and using a linear mixed-effects statistical model, we quantified the decline of mean-slope with time. Further, a mapping from mean-slope to probability of return of spontaneous circulation was obtained from a second dataset and using this we were able to estimate the expected development of the probability of return of spontaneous circulation for cases at different levels. From 911 intervals without chest compressions, 5138 analysis windows were identified. The results show that cases with the probability of return of spontaneous circulation values 0.35, 0.1 and 0.05, 3 seconds into an interval in the mean will have probability of return of spontaneous circulation values 0.26 (0.24-0.29), 0.077 (0.070-0.085) and 0.040(0.036-0.045), respectively, 27 seconds into the interval (95% confidence intervals in parenthesis). During pre-shock pauses in chest compressions mean probability of return of spontaneous circulation decreases in a steady manner for cases at all initial levels. Regardless of initial level there is a relative decrease in the probability of return of spontaneous circulation of about 23% from 3 to 27 seconds into such a pause.

Cardiopulmonary resuscitation update.

PubMed

Reynolds, Joshua C; Bond, Michael C; Shaikh, Sanober

2012-02-01

Cardiopulmonary resuscitation (CPR) is vital therapy in cardiac arrest care by lay and trained rescuers. Chest compressions are the key component of CPR. Ventilation and airway management should be secondary to high-quality and continuous chest compressions in patients receiving CPR. Only after the patient has had return of spontaneous circulation or completed a cycle of CPR with defibrillation (if appropriate) should attempts at securing an advanced airway be made. Even then, interruptions of chest compressions should be minimized to maintain cardiocerebral perfusion and increase survival. Finally, the ventilation rate should be no more than 8 to 10 breaths per minute. Copyright © 2012 Elsevier Inc. All rights reserved.

Clinical assessment of heart chamber size and valve motion during cardiopulmonary resuscitation by two-dimensional echocardiography.

PubMed

Rich, S; Wix, H L; Shapiro, E P

1981-09-01

It has been generally accepted that enhanced blood flow during closed-chest CPR is generated from compression of the heart between the sternum and the spine. To visualize the heart during closed-chest massage, we performed two-dimensional echocardiography (2DE) during resuscitation efforts in four patients who had cardiac arrest. 2DE analysis showed that (1) the LV internal dimensions did not change appreciably with chest compression; (2) the mitral and aortic valves were open simultaneously during the compression phase; (3) blood flow into the right heart, as evidenced by saline bubble contrast, occurred during the relaxation phase; and (4) compression of the right ventricle and LA occurred in varying amounts in all patients. We conclude that stroke volume from the heart during CPR does not result from compression of the LV. Rather, CPR-induced improved cardiocirculatory dynamics appear to be principally the result of changes in intrathoracic pressure created by sternal compression.

Open chest cardiac massage offers no benefit over closed chest compressions in patients with traumatic cardiac arrest.

PubMed

Bradley, Matthew J; Bonds, Brandon W; Chang, Luke; Yang, Shiming; Hu, Peter; Li, Hsiao-Chi; Brenner, Megan L; Scalea, Thomas M; Stein, Deborah M

2016-11-01

Open chest cardiac massage (OCCM) is a commonly performed procedure after traumatic cardiac arrest (TCA). OCCM has been reported to be superior to closed chest compressions (CCC) in animal models and in non-TCA. The purpose of this study is to prospectively compare OCCM versus CCC in TCA using end-tidal carbon dioxide (ETCO2), the criterion standard for determining the effectiveness of chest compressions and detection of return of spontaneous circulation (ROSC), as the surrogate for cardiac output and marker for adequacy of resuscitation. This prospective observational study enrolled patients over a 9-month period directly presenting to a level 1 trauma center after TCA. Continuous high-resolution ETCO2 measurements were collected every 6 seconds for periods of CCC and OCCM, respectively. Patients receiving CCC only were compared with patients receiving CCC followed by OCCM. Student's t tests were used to compare ETCO2 within and between groups. Thirty-three patients were enrolled (16 OCCM, 17 CCC-only). Mean time of CCC before OCCM was 66 seconds. Within the OCCM group, final, peak, mean, and median ETCO2 levels significantly increased when comparing the initial CCC period to the OCCM interval. Using a time-matched comparison, significant increases were observed in the final and peak but not mean and median values when comparing the first minute of CCC to the remaining time in the CCC-only group. However, when periods of OCCM were compared with equivalent periods of CCC-only, there were no differences in the initial, final, peak, mean, or median ETCO2 values. Correspondingly, no difference in rates of ROSC was observed between groups (OCCM 23.5% vs. CCC 38.9%; p = 0.53). Although we could not control for confounders, we found no significant improvement in ETCO2 or ROSC with OCCM. With newer endovascular techniques for aortic occlusion, thoracotomy solely for performing OCCM provides no benefit over CCC. Therapeutic study, level III.

[Laryngeal Tube Position Shift after Chest Compression: Comparison of Fixation Methods Using Durapore Tape, Multipore Tape, or a Neck Tape].

PubMed

Seno, Hisayo; Komasawa, Nobuyasu; Fujiwara, Shunsuke; Miyazaki, Shinichiro; Tatsumi, Shinichi; Minami, Toshiaki

2015-05-01

The laryngeal tube (LT ; Smiths Medical, Minnesota, U. S. A) is an inflatable supraglottic device for emergency airway management such as during chest compression, the instability after insertion remains a problem. We investigated the effectiveness of three fixation methods of LT using a manikin and automated chest compressor. After 10-minute chest compression, LT without fixation was shifted by 0.4 ± 0.1 cm, which was greater than with Durapore tape (0.2 ± 0.1 cm), Multipore tape (0.2 ± 0.1 cm), or a neck tape (0.1 ± 0.1 cm). The shift of the position was smaller with neck tape fixation compared to Durapore or Multipore tape fixation. A fixation neck tape may be useful in stabilizing the inserted position of LT during cardiopulmonary resuscitation.

The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation.

PubMed

Abelairas-Gómez, Cristian; Barcala-Furelos, Roberto; Szarpak, Łukasz; García-García, Óscar; Paz-Domínguez, Álvaro; López-García, Sergio; Rodríguez-Núñez, Antonio

2017-01-01

Providing high-quality chest compressions and rescue breaths are key elements in the effectiveness of cardio-pulmonary resuscitation. To investigate the effects of a strength training programme on the quality of prolonged basic cardiopulmonary resuscitation on a manikin. This was a quasi-experimental trial. Thirty-nine participants with prior basic life support knowledge were randomised to an experimental or control group. They then performed a test of 10 min of chest compressions and mouth-to-mouth ventilation on manikins equipped with a skill reporter tool (baseline or test 1). The experimental group participated in a four-week strength training programme focused on the muscles involved in chest compressions. Both groups were subsequently tested again (test 2). After training, the experimental group significantly increased the mean depth of compression (53.7 ± 2.3 mm vs. 49.9 ± 5.9 mm; p = 0.003) and the correct compression fraction (68.2 ± 21.0% vs. 46.4 ± 29.1%; p = 0.004). Trained subjects maintained chest compression quality over time better than the control group. The mean tidal volume delivered was higher in the experimental than in the control group (701.5 ± 187.0 mL vs. 584.8 ± 113.6 mL; p = 0.040) and above the current resuscitation guidelines. In test 2, the percentage of rescue breaths with excessive volume was higher in the experi-mental group than in the controls (31.5 ± 19.6% vs. 15.6 ± 13.0%; p = 0.007). A simple strength training programme has a significant impact on the quality of chest compressions and its maintenance over time. Additional training is needed to avoid over-ventilation of potential patients.

Randomised crossover trial of rate feedback and force during chest compressions for paediatric cardiopulmonary resuscitation.

PubMed

Gregson, Rachael Kathleen; Cole, Tim James; Skellett, Sophie; Bagkeris, Emmanouil; Welsby, Denise; Peters, Mark John

2017-05-01

To determine the effect of visual feedback on rate of chest compressions, secondarily relating the forces used. Randomised crossover trial. Tertiary teaching hospital. Fifty trained hospital staff. A thin sensor-mat placed over the manikin's chest measured rate and force. Rescuers applied compressions to the same paediatric manikin for two sessions. During one session they received visual feedback comparing their real-time rate with published guidelines. Primary: compression rate. Secondary: compression and residual forces. Rate of chest compressions (compressions per minute (compressions per minute; cpm)) varied widely (mean (SD) 111 (13), range 89-168), with a fourfold difference in variation during session 1 between those receiving and not receiving feedback (108 (5) vs 120 (20)). The interaction of session by feedback order was highly significant, indicating that this difference in mean rate between sessions was 14 cpm less (95% CI -22 to -5, p=0.002) in those given feedback first compared with those given it second. Compression force (N) varied widely (mean (SD) 306 (94); range 142-769). Those receiving feedback second (as opposed to first) used significantly lower force (adjusted mean difference -80 (95% CI -128 to -32), p=0.002). Mean residual force (18 N, SD 12, range 0-49) was unaffected by the intervention. While visual feedback restricted excessive compression rates to within the prescribed range, applied force remained widely variable. The forces required may differ with growth, but such variation treating one manikin is alarming. Feedback technologies additionally measuring force (effort) could help to standardise and define effective treatments throughout childhood. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation.

PubMed

Gates, Simon; Lall, Ranjit; Quinn, Tom; Deakin, Charles D; Cooke, Matthew W; Horton, Jessica; Lamb, Sarah E; Slowther, Anne-Marie; Woollard, Malcolm; Carson, Andy; Smyth, Mike; Wilson, Kate; Parcell, Garry; Rosser, Andrew; Whitfield, Richard; Williams, Amanda; Jones, Rebecca; Pocock, Helen; Brock, Nicola; Black, John Jm; Wright, John; Han, Kyee; Shaw, Gary; Blair, Laura; Marti, Joachim; Hulme, Claire; McCabe, Christopher; Nikolova, Silviya; Ferreira, Zenia; Perkins, Gavin D

2017-03-01

Mechanical chest compression devices may help to maintain high-quality cardiopulmonary resuscitation (CPR), but little evidence exists for their effectiveness. We evaluated whether or not the introduction of Lund University Cardiopulmonary Assistance System-2 (LUCAS-2; Jolife AB, Lund, Sweden) mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest (OHCA). Evaluation of the LUCAS-2 device as a routine ambulance service treatment for OHCA. Pragmatic, cluster randomised trial including adults with non-traumatic OHCA. Ambulance dispatch staff and those collecting the primary outcome were blind to treatment allocation. Blinding of the ambulance staff who delivered the interventions and reported initial response to treatment was not possible. We also conducted a health economic evaluation and a systematic review of all trials of out-of-hospital mechanical chest compression. Four UK ambulance services (West Midlands, North East England, Wales and South Central), comprising 91 urban and semiurban ambulance stations. Clusters were ambulance service vehicles, which were randomly assigned (approximately 1 : 2) to the LUCAS-2 device or manual CPR. Patients were included if they were in cardiac arrest in the out-of-hospital environment. Exclusions were patients with cardiac arrest as a result of trauma, with known or clinically apparent pregnancy, or aged < 18 years. Patients received LUCAS-2 mechanical chest compression or manual chest compressions according to the first trial vehicle to arrive on scene. Survival at 30 days following cardiac arrest; survival without significant neurological impairment [Cerebral Performance Category (CPC) score of 1 or 2]. We enrolled 4471 eligible patients (1652 assigned to the LUCAS-2 device and 2819 assigned to control) between 15 April 2010 and 10 June 2013. A total of 985 (60%) patients in the LUCAS-2 group received mechanical chest compression and 11 (< 1%) patients in the control group received LUCAS-2. In the intention-to-treat analysis, 30-day survival was similar in the LUCAS-2 (104/1652, 6.3%) and manual CPR groups [193/2819, 6.8%; adjusted odds ratio (OR) 0.86, 95% confidence interval (CI) 0.64 to 1.15]. Survival with a CPC score of 1 or 2 may have been worse in the LUCAS-2 group (adjusted OR 0.72, 95% CI 0.52 to 0.99). No serious adverse events were noted. The systematic review found no evidence of a survival advantage if mechanical chest compression was used. The health economic analysis showed that LUCAS-2 was dominated by manual chest compression. There was substantial non-compliance in the LUCAS-2 arm. For 272 out of 1652 patients (16.5%), mechanical chest compression was not used for reasons that would not occur in clinical practice. We addressed this issue by using complier average causal effect analyses. We attempted to measure CPR quality during the resuscitation attempts of trial participants, but were unable to do so. There was no evidence of improvement in 30-day survival with LUCAS-2 compared with manual compressions. Our systematic review of recent randomised trials did not suggest that survival or survival without significant disability may be improved by the use of mechanical chest compression. The use of mechanical chest compression for in-hospital cardiac arrest, and in specific circumstances (e.g. transport), has not yet been evaluated. Current Controlled Trials ISRCTN08233942. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 21, No. 11. See the NIHR Journals Library website for further project information.

GPU-accelerated compressed-sensing (CS) image reconstruction in chest digital tomosynthesis (CDT) using CUDA programming

NASA Astrophysics Data System (ADS)

Choi, Sunghoon; Lee, Haenghwa; Lee, Donghoon; Choi, Seungyeon; Shin, Jungwook; Jang, Woojin; Seo, Chang-Woo; Kim, Hee-Joung

2017-03-01

A compressed-sensing (CS) technique has been rapidly applied in medical imaging field for retrieving volumetric data from highly under-sampled projections. Among many variant forms, CS technique based on a total-variation (TV) regularization strategy shows fairly reasonable results in cone-beam geometry. In this study, we implemented the TV-based CS image reconstruction strategy in our prototype chest digital tomosynthesis (CDT) R/F system. Due to the iterative nature of time consuming processes in solving a cost function, we took advantage of parallel computing using graphics processing units (GPU) by the compute unified device architecture (CUDA) programming to accelerate our algorithm. In order to compare the algorithmic performance of our proposed CS algorithm, conventional filtered back-projection (FBP) and simultaneous algebraic reconstruction technique (SART) reconstruction schemes were also studied. The results indicated that the CS produced better contrast-to-noise ratios (CNRs) in the physical phantom images (Teflon region-of-interest) by factors of 3.91 and 1.93 than FBP and SART images, respectively. The resulted human chest phantom images including lung nodules with different diameters also showed better visual appearance in the CS images. Our proposed GPU-accelerated CS reconstruction scheme could produce volumetric data up to 80 times than CPU programming. Total elapsed time for producing 50 coronal planes with 1024×1024 image matrix using 41 projection views were 216.74 seconds for proposed CS algorithms on our GPU programming, which could match the clinically feasible time ( 3 min). Consequently, our results demonstrated that the proposed CS method showed a potential of additional dose reduction in digital tomosynthesis with reasonable image quality in a fast time.

[At what age can children perform effective cardiopulmonary resuscitation? - Effectiveness of cardiopulmonary resuscitation skills among primary school children].

PubMed

Bánfai, Bálint; Pandur, Attila; Pék, Emese; Csonka, Henrietta; Betlehem, József

2017-01-01

In cardiac arrest life can be saved by bystanders. Our aim was to determine at what age can schoolchildren perform correct cardiopulmonary resuscitation. 164 schoolchildren (age 7-14) were involved in the study. A basic life support training consisted of 45 minutes education in small groups (8-10 children). They were tested during a 2-minute-long continuous cardiopulmonary resuscitation scenario using the "AMBU CPR Software". Average depth of chest compression was 44.07 ± 12.6 mm. 43.9% of participants were able to do effective chest compressions. Average ventilation volume was 0.17 ± 0.31 liter. 12.8% of participants were able to ventilate effectively the patient. It was significant correlation between the chest compression depth (p<0.001) and ventilation (p<0.001) and the children's age, weight, height and BMI. Primary school children are able to learn cardiopulmonary resuscitation. The ability to do effective chest compressions and ventilation depended on the children's physical capability. Orv. Hetil., 2017, 158(4), 147-152.

Quality of cardio-pulmonary resuscitation (CPR) during paediatric resuscitation training: time to stop the blind leading the blind.

PubMed

Arshid, Muhammad; Lo, Tsz-Yan Milly; Reynolds, Fiona

2009-05-01

Recent evidence suggested that the quality of cardio-pulmonary resuscitation (CPR) during adult advanced life support training was suboptimal. This study aimed to assess the CPR quality of a paediatric resuscitation training programme, and to determine whether it was sufficiently addressed by the trainee team leaders during training. CPR quality of 20 consecutive resuscitation scenario training sessions was audited prospectively using a pre-designed proforma. A consultant intensivist and a senior nurse who were also Advanced Paediatric Life Support (APLS) instructors assessed the CPR quality which included ventilation frequency, chest compression rate and depth, and any unnecessary interruption in chest compressions. Team leaders' response to CPR quality and elective change of compression rescuer during training were also recorded. Airway patency was not assessed in 13 sessions while ventilation rate was too fast in 18 sessions. Target compression rate was not achieved in only 1 session. The median chest compression rate was 115 beats/min. Chest compressions were too shallow in 10 sessions and were interrupted unnecessarily in 13 sessions. More than 50% of training sessions did not have elective change of the compression rescuer. 19 team leaders failed to address CPR quality during training despite all team leaders being certified APLS providers. The quality of CPR performance was suboptimal during paediatric resuscitation training and team leaders-in-training had little awareness of this inadequacy. Detailed CPR quality assessment and feedback should be integrated into paediatric resuscitation training to ensure optimal performance in real life resuscitations.

Comparison of chest compressions in the standing position beside a bed at knee level and the kneeling position: a non-randomised, single-blind, cross-over trial.

PubMed

Oh, Je Hyeok; Kim, Chan Woong; Kim, Sung Eun; Lee, Sang Jin; Lee, Dong Hoon

2014-07-01

When rescuers perform cardiopulmonary resuscitation (CPR) from a standing position, the height at which chest compressions are carried out is raised. To determine whether chest compressions delivered on a bed adjusted to rescuer's knee height are as effective as those delivered on the floor. A total of 20 fourth-year medical students participated in the study. The students performed chest compressions for 2 min each on a manikin lying on the floor (test 1) and on a manikin lying on a bed (test 2). The average compression rate (ACR) and the average compression depth (ACD) were compared between the two tests. The ACR was not significantly different between tests 1 and 2 (120.1 to 132.9  vs 115.7 to 131.2 numbers/min, 95% CI, p=0.324). The ACD was also not significantly different between tests 1 and 2 (51.2 to 56.6 vs 49.4 to 55.7 mm, 95% CI, p=0.058). The results suggest that there may be no significant differences in compression rate and depth between CPR performed on manikins placed on the floor and those placed at a rescuer's knee height. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Mask leak increases and minute ventilation decreases when chest compressions are added to bag ventilation in a neonatal manikin model.

PubMed

Tracy, Mark B; Shah, Dharmesh; Hinder, Murray; Klimek, Jan; Marceau, James; Wright, Audrey

2014-05-01

To determine changes in respiratory mechanics when chest compressions are added to mask ventilation, as recommended by the International Liaison Committee on Resuscitation (ILCOR) guidelines for newborn infants. Using a Laerdal Advanced Life Support leak-free baby manikin and a 240-mL self-inflating bag, 58 neonatal staff members were randomly paired to provide mask ventilation, followed by mask ventilation with chest compressions with a 1:3 ratio, for two minutes each. A Florian respiratory function monitor was used to measure respiratory mechanics, including mask leak. The addition of chest compressions to mask ventilation led to a significant reduction in inflation rate, from 63.9 to 32.9 breaths per minute (p < 0.0001), mean airway pressure reduced from 7.6 to 4.9 cm H2 O (p < 0.001), minute ventilation reduced from 770 to 451 mL/kg/min (p < 0.0001), and there was a significant increase in paired mask leak of 6.8% (p < 0.0001). Adding chest compressions to mask ventilation, in accordance with the ILCOR guidelines, in a manikin model is associated with a significant reduction in delivered ventilation and increase in mask leak. If similar findings occur in human infants needing an escalation in resuscitation, there is a potential risk of either delay in recovery or inadequate response to resuscitation. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Using Simulation as an Investigational Methodology to Explore the Impact of Technology on Team Communication and Patient Management: A Pilot Evaluation of the Effect of an Automated Compression Device.

PubMed

Gittinger, Matthew; Brolliar, Sarah M; Grand, James A; Nichol, Graham; Fernandez, Rosemarie

2017-06-01

This pilot study used a simulation-based platform to evaluate the effect of an automated mechanical chest compression device on team communication and patient management. Four-member emergency department interprofessional teams were randomly assigned to perform manual chest compressions (control, n = 6) or automated chest compressions (intervention, n = 6) during a simulated cardiac arrest with 2 phases: phase 1 baseline (ventricular tachycardia), followed by phase 2 (ventricular fibrillation). Patient management was coded using an Advanced Cardiovascular Life Support-based checklist. Team communication was categorized in the following 4 areas: (1) teamwork focus; (2) huddle events, defined as statements focused on re-establishing situation awareness, reinforcing existing plans, and assessing the need to adjust the plan; (3) clinical focus; and (4) profession of team member. Statements were aggregated for each team. At baseline, groups were similar with respect to total communication statements and patient management. During cardiac arrest, the total number of communication statements was greater in teams performing manual compressions (median, 152.3; interquartile range [IQR], 127.6-181.0) as compared with teams using an automated compression device (median, 105; IQR, 99.5-123.9). Huddle events were more frequent in teams performing automated chest compressions (median, 4.0; IQR, 3.1-4.3 vs. 2.0; IQR, 1.4-2.6). Teams randomized to the automated compression intervention had a delay to initial defibrillation (median, 208.3 seconds; IQR, 153.3-222.1 seconds) as compared with control teams (median, 63.2 seconds; IQR, 30.1-397.2 seconds). Use of an automated compression device may impact both team communication and patient management. Simulation-based assessments offer important insights into the effect of technology on healthcare teams.

Performance of cardiopulmonary resuscitation during prolonged basic life support in military medical university students: A manikin study.

PubMed

Wang, Juan; Zhuo, Chao-Nan; Zhang, Lei; Gong, Yu-Shun; Yin, Chang-Lin; Li, Yong-Qin

2015-01-01

The quality of chest compressions can be significantly improved after training of rescuers according to the latest national guidelines of China. However, rescuers may be unable to maintain adequate compression or ventilation throughout a response of average emergency medical services because of increased rescuer fatigue. In the present study, we evaluated the performance of cardiopulmonary resuscitation (CPR) in training of military medical university students during a prolonged basic life support (BLS). A 3-hour BLS training was given to 120 military medical university students. Six months after the training, 115 students performed single rescuer BLS on a manikin for 8 minutes. The qualities of chest compressions as well as ventilations were assessed. The average compression depth and rate were 53.7±5.3 mm and 135.1±15.7 compressions per minute respectively. The proportion of chest compressions with appropriate depth was 71.7%±28.4%. The average ventilation volume was 847.2±260.4 mL and the proportion of students with adequate ventilation was 63.5%. Compared with male students, significantly lower compression depth (46.7±4.8 vs. 54.6±4.8 mm, P<0.001) and adequate compression rate (35.5%±26.5% vs. 76.1%±25.1%, P<0.001) were observed in female students. CPR was found to be related to gender, body weight, and body mass index of students in this study. The quality of chest compressions was well maintained in male students during 8 minutes of conventional CPR but declined rapidly in female students after 2 minutes according to the latest national guidelines. Physical fitness and rescuer fatigue did not affect the quality of ventilation.

Performance of cardiopulmonary resuscitation during prolonged basic life support in military medical university students: A manikin study

PubMed Central

Wang, Juan; Zhuo, Chao-nan; Zhang, Lei; Gong, Yu-shun; Yin, Chang-lin; Li, Yong-qin

2015-01-01

BACKGROUND: The quality of chest compressions can be significantly improved after training of rescuers according to the latest national guidelines of China. However, rescuers may be unable to maintain adequate compression or ventilation throughout a response of average emergency medical services because of increased rescuer fatigue. In the present study, we evaluated the performance of cardiopulmonary resuscitation (CPR) in training of military medical university students during a prolonged basic life support (BLS). METHODS: A 3-hour BLS training was given to 120 military medical university students. Six months after the training, 115 students performed single rescuer BLS on a manikin for 8 minutes. The qualities of chest compressions as well as ventilations were assessed. RESULTS: The average compression depth and rate were 53.7±5.3 mm and 135.1±15.7 compressions per minute respectively. The proportion of chest compressions with appropriate depth was 71.7%±28.4%. The average ventilation volume was 847.2±260.4 mL and the proportion of students with adequate ventilation was 63.5%. Compared with male students, significantly lower compression depth (46.7±4.8 vs. 54.6±4.8 mm, P<0.001) and adequate compression rate (35.5%±26.5% vs. 76.1%±25.1%, P<0.001) were observed in female students. CONCLUSIONS: CPR was found to be related to gender, body weight, and body mass index of students in this study. The quality of chest compressions was well maintained in male students during 8 minutes of conventional CPR but declined rapidly in female students after 2 minutes according to the latest national guidelines. Physical fitness and rescuer fatigue did not affect the quality of ventilation. PMID:26401177

Forced expiratory technique, directed cough, and autogenic drainage.

PubMed

Fink, James B

2007-09-01

In health, secretions produced in the respiratory tract are cleared by mucociliary transport, cephalad airflow bias, and cough. In disease, increased secretion viscosity and volume, dyskinesia of the cilia, and ineffective cough combine to reduce secretion clearance, leading to increased risk of infection. In obstructive lung disease these conditions are further complicated by early collapse of airways, due to airway compression, which traps both gas and secretions. Techniques have been developed to optimize expiratory flow and promote airway clearance. Directed cough, forced expiratory technique, active cycle of breathing, and autogenic drainage are all more effective than placebo and comparable in therapeutic effects to postural drainage; they require no special equipment or care-provider assistance for routine use. Researchers have suggested that standard chest physical therapy with active cycle of breathing and forced expiratory technique is more effective than chest physical therapy alone. Evidence-based reviews have suggested that, though successful adoption of techniques such as autogenic drainage may require greater control and training, patients with long-term secretion management problems should be taught as many of these techniques as they can master for adoption in their therapeutic routines.

[Protective effect of erythropoietin on brain tissue in rats with cardiopulmonary resuscitation after asphyxia].

PubMed

Chunling, Ji; Hourong, Zhou; Xiulin, Yang; Qian, Zhang; Yuhui, Yuan; Jia, Huang

2015-12-01

To study the protective effect of erythropoietin (EPO) on brain tissue with cardiac arrest-cardiopulmonary resuscitation (CA-CPR) and its mechanism. 120 male Sprague-Dawley (SD) rats were randomly divided into three groups (each n = 40), namely: sham group, routine chest compression group, and conventional chest compression + EPO group (EPO group). The rats in each group were subdivided into CA and 6, 12, 24, 48 hours after restoration of spontaneous circulation (ROSC) five subgroups (each n = 8). The model of CA was reproduced according to the Hendrickx classical asphyxia method followed by routine chest compression, and the rats in sham group only underwent anesthesia, tracheostomy intubation and venous-puncture without asphyxia and CPR. The rats in EPO group were given the routine chest compression + EPO 5 kU/kg (2 mL/kg) after CA. Blood sample was collected at different time points of intervention for the determination the content of serum S100 β protein by enzyme linked immunosorbent assay (ELISA). All the rats were sacrificed at the corresponding time points, and the hippocampus was harvested for the calculation of the number of S100 β protein positive cells, and to examine the pathological changes and their scores at 24 hours after ROSC by light microscopy. With prolongation of ROSC time, the serum levels of S100 β protein (µg/L) in the routine chose compression group and the EPO group were significantly elevated, peaking at 24 hours (compared with CA: 305.7 ± 29.2 vs. 44.4 ± 6.2 in routine chest compression group, and 276.7 ± 28.9 vs. 44.7 ± 5.6 in the EPO group, both P < 0.05), followed by a fall. The levels of S100 β protein at each time point after ROSC in EPO group were significanthy lower than those of the routine chest compression group (83.2 ± 7.5 vs. 114.3 ± 15.3 at 6 hours, 123.9 ± 20.2 vs. 184.9 ± 22.2 at 12 hours, 276.7 ± 28.9 vs. 305.7 ± 29.2 at 24 hours, 256.3 ± 26.6 vs. 283.2 ± 23.6 at 48 hours, all P < 0.05). With the prolongation of ROSC time, the S100 β protein positive cell number in brain (cells/HP) in the routine chest compression group and the EPO group was significantly increased, peaking at 24 hours (compared with CA: 14.3 ± 2.2 vs. 6.7 ± 0.7 in the routine chest compression group, 11.3 ± 1.3 vs. 6.8 ± 0.9 in the EPO group, both P < 0.05), then it began to fall. The S100 β protein positive cell number in brain at each time point after ROSC in the EPO group was significantly lower than that of the routine chest compression group (7.0 ± 0.9 vs. 7.9 ± 1.9 at 6 hours, 8.4 ± 1.1 vs. 10.2 ± 2.2 at 12 hours, 11.3 ± 1.3 vs. 14.3 ± 2.2 at 24 hours, 8.3 ± 0.8 vs. 10.8 ± 2.0 at 48 hours, all P < 0.05). Under the light microscope, a serious brain cortex injury was found after reproduction of the model, and the degree of injury was reduced after EPO intervention. The pathological score at 24 hours after ROSC in EPO group was lower than that of routine chest compression group (3.83 ± 0.73 vs. 4.17 ± 0.75, P < 0.05). The S100 β protein level in serum and brain tissue was increased early in asphyxia CA-CPR rats. EPO intervention can reduce the expression of S100 protein and reduce the degree of brain injury.

Deep-seated intramuscular lipoma penetrates the intercostal muscle

PubMed Central

Hwang, Jinwook; Min, Byoung-Ju; Shin, Jae Seung

2015-01-01

Deep-seated intramuscular lipomas are rare, and most exhibit an infiltrating behavior. This study reports serial radiographs of a lipoma in chest wall muscles which penetrated the intercostal muscle for a 6-year period. Although this lipoma did not involve the parietal pleura, it compressed lung. To the authors’ knowledge, the present study is the first report to show the growth of a deep-seated chest wall lipoma into the thoracic cavity through serial radiographs. We consider the surgical treatment is needed before deep-seated intramuscular chest wall lipoma compress intrathoracic structures. PMID:26623127

Two-Thumb Encircling Technique Over the Head of Patients in the Setting of Lone Rescuer Infant CPR Occurred During Ambulance Transfer: A Crossover Simulation Study.

PubMed

Jo, Choong Hyun; Cho, Gyu Chong; Lee, Chang Hee

2017-07-01

The purpose of this study was to determine if the over-the-head 2-thumb encircling technique (OTTT) provides better overall quality of cardiopulmonary resuscitation compared with conventional 2-finger technique (TFT) for a lone rescuer in the setting of infant cardiac arrest in ambulance. Fifty medical emergency service students were voluntarily recruited to perform lone rescuer infant cardiopulmonary resuscitation for 2 minutes on a manikin simulating a 3-month-old baby in an ambulance. Participants who performed OTTT sat over the head of manikins to compress the chest using a 2-thumb encircling technique and provide bag-valve mask ventilations, whereas those who performed TFT sat at the side of the manikins to compress using 2-fingers and provide pocket-mask ventilations. Mean hands-off time was not significantly different between OTTT and TFT (7.6 ± 1.1 seconds vs 7.9 ± 1.3 seconds, P = 0.885). Over-the-head 2-thumb encircling technique resulted in greater depth of compression (42.6 ± 1.4 mm vs 41.0 ± 1.4 mm, P < 0.001) and faster rate of compressions (114.4 ± 8.0 per minute vs 112.2 ± 8.2 per minute, P = 0.019) than TFT. Over-the-head 2-thumb encircling technique resulted in a smaller fatigue score than TFT (1.7 ± 1.5 vs 2.5 ± 1.6, P < 0.001). In addition, subjects reported that compression, ventilation, and changing compression to ventilation were easier in OTTT than in TFT. The use of OTTT may be a suitable alternative to TFT in the setting of cardiac arrest of infants during ambulance transfer.

Transthoracic impedance used to evaluate performance of cardiopulmonary resuscitation during out of hospital cardiac arrest.

PubMed

Stecher, Frederik S; Olsen, Jan-Aage; Stickney, Ronald E; Wik, Lars

2008-12-01

There is a need to measure cardiopulmonary resuscitation (CPR) in order to document whether ambulance personnel follow CPR guidelines. Our goal was to do this using defibrillator technology based on changes in transthoracic impedance (TTI) produced by chest compressions and ventilations. 122 incidents of out-of-hospital cardiac arrest between May 2003 and February 2004 were analysed based on data recorded from defibrillators in Oslo EMS. New software was used to analyze chest compressions and ventilations based on changes in thoracic impedance between the defibrillator pads, as well as ECG and other event data. In total, 25+/-14% (varying from 76% to 3%) of the time chest compressions were not performed on patients without spontaneous circulation (NFR=No Flow Ratio). When adjusting for time spent on analysis of ECG, pulse check and defibrillation, NFR was 20+/-13% (varying from 70% to 3%). Mean compressions delivered per minute was 87+/-16 and the compression rate during active compressions was 117+/-9min(-1). Individual variation was 31-117min(-1) (mean) and 95-144min(-1) (active periods). A mean of 14+/-3ventilations/min was recorded, varying from 8 to 26min(-1). Compared with the rest of the episode, the first 5min had a significantly higher proportion of time without chest compressions; 30+/-17% (p<0.001) and significantly lower mean compression and ventilation rates; 80+/-19min(-1) and 12+/-4min(-1), respectively (p<0.001 in both cases). Core CPR values can be measured from TTI signals by using a standard defibrillator and new software. NFR was 25% (20% adjusted) with great rescuer variability.

Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial.

PubMed

Sullivan, Nancy J; Duval-Arnould, Jordan; Twilley, Marida; Smith, Sarah P; Aksamit, Deborah; Boone-Guercio, Pam; Jeffries, Pamela R; Hunt, Elizabeth A

2015-01-01

Traditional American Heart Association (AHA) cardiopulmonary resuscitation (CPR) curriculum focuses on teams of two performing quality chest compressions with rescuers on their knees but does not include training specific to In-Hospital Cardiac Arrests (IHCA), i.e. patient in hospital bed with large resuscitation teams and sophisticated technology available. A randomized controlled trial was conducted with the primary goal of evaluating the effectiveness and ideal frequency of in-situ training on time elapsed from call for help to; (1) initiation of chest compressions and (2) successful defibrillation in IHCA. Non-intensive care unit nurses were randomized into four groups: standard AHA training (C) and three groups that participated in 15 min in-situ IHCA training sessions every two (2M), three (3M) or six months (6M). Curriculum included specific choreography for teams to achieve immediate chest compressions, high chest compression fractions and rapid defibrillation while incorporating use of a backboard, stepstool. More frequent training was associated with decreased median (IQR) seconds to: starting compressions: [C: 33(25-40) vs. 6M: 21(15-26) vs. 3M: 14(10-20) vs. 2M: 13(9-20); p < 0.001]; and defibrillation: [C: 157(140-254) vs. 6M: 138(107-158) vs. 3M: 115(101-119) vs. 2M: 109(98-129); p < 0.001]. A composite outcome of key priorities, compressions within 20s, defibrillation within 180 s and use of a backboard, revealed improvement with more frequent training sessions: [C:5%(1/18) vs. 6M: 23%(4/17) vs. 3M: 56%(9/16) vs. 2M: 73%(11/15); p < 0.001]. Results revealed short in-situ training sessions conducted every 3 months are effective in improving timely initiation of chest compressions and defibrillation in IHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Instructions to "put the phone down" do not improve the quality of bystander initiated dispatcher-assisted cardiopulmonary resuscitation.

PubMed

Brown, Todd B; Saini, Devashish; Pepper, Tracy; Mirza, Muzna; Nandigam, Hari Krishna; Kaza, Niroop; Cofield, Stacey S

2008-02-01

The quality of early bystander CPR appears important in maximizing survival. This trial tests whether explicit instructions to "put the phone down" improve the quality of bystander initiated dispatch-assisted CPR. In a randomized, double-blinded, controlled trial, subjects were randomized to a modified version of the Medical Priority Dispatch System (MPDS) version 11.2 protocol or a simplified protocol, each with or without instruction to "put the phone down" during CPR. Data were recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions. Primary outcome measures included chest compression rate, depth, and the proportion of compressions without error, with correct hand position, adequate depth, and total release. Time was measured in two distinct ways: time required for initiation of CPR and total amount of time hands were off the chest during CPR. Proportions were analyzed by Wilcoxon rank sum tests and time variables with ANOVA. All tests used a two-sided alpha-level of 0.05. Two hundred and fifteen subjects were randomized-107 in the "put the phone down" instruction group and 108 in the group without "put the phone down" instructions. The groups were comparable across demographic and experiential variables. The additional instruction to "put the phone down" had no effect on the proportion of compressions administered without error, with the correct depth, and with the correct hand position. Likewise, "put the phone down" did not affect the average compression depth, the average compression rate, the total hands-off-chest time, or the time to initiate chest compressions. A statistically significant, yet trivial, effect was found in the proportion of compressions with total release of the chest wall. Instructions to "put the phone down" had no effect on the quality of bystander initiated dispatcher-assisted CPR in this trial.

Cardiorespiratory interactions and blood flow generation during cardiac arrest and other states of low blood flow.

PubMed

Sigurdsson, Gardar; Yannopoulos, Demetris; McKnite, Scott H; Lurie, Keith G

2003-06-01

Recent advances in cardiopulmonary resuscitation have shed light on the importance of cardiorespiratory interactions during shock and cardiac arrest. This review focuses on recently published studies that evaluate factors that determine preload during chest compression, methods that can augment preload, and the detrimental effects of hyperventilation and interrupting chest compressions. Refilling of the ventricles, so-called ventricular preload, is diminished during cardiovascular collapse and resuscitation from cardiac arrest. In light of the potential detrimental effects and challenges of large-volume fluid resuscitations, other methods have increasing importance. During cardiac arrest, active decompression of the chest and impedance of inspiratory airflow during the recoil of the chest work by increasing negative intrathoracic pressure and, hence, increase refilling of the ventricles and increase cardiac preload, with improvement in survival. Conversely, increased frequency of ventilation has detrimental effects on coronary perfusion pressure and survival rates in cardiac arrest and severe shock. Prolonged interruption of chest compressions for delivering single-rescuer ventilation or analyzing rhythm before shock delivery is associated with decreased survival rate. Cardiorespiratory interactions are of profound importance in states of cardiovascular collapse in which increased negative intrathoracic pressure during decompression of the chest has a favorable effect and increased intrathoracic pressure with ventilation has a detrimental effect on survival rate.

Comparison of blind intubation through the I-gel and ILMA Fastrach by nurses during cardiopulmonary resuscitation: a manikin study.

PubMed

Melissopoulou, Theodora; Stroumpoulis, Konstantinos; Sampanis, Michail A; Vrachnis, Nikolaos; Papadopoulos, Georgios; Chalkias, Athanasios; Xanthos, Theodoros

2014-01-01

To investigate whether nursing staff can successfully use the I-gel and the intubating laryngeal mask Fastrach (ILMA) during cardiopulmonary resuscitation. Although tracheal intubation is considered to be the optimal method for securing the airway during cardiopulmonary resuscitation, laryngoscopy requires a high level of skill. Forty five nurses inserted the I-gel and the ILMA in a manikin, with continuous and without chest compressions. Mean intubation times for the ILMA and I-gel without chest compressions were 20.60 ± 3.27 and 18.40 ± 3.26 s, respectively (p < 0.0005). ILMA proved more successful than the I-gel regardless of compressions. Continuation of compressions caused a prolongation in intubation times for both the I-gel (p < 0.0005) and the ILMA (p < 0.0005). In this mannequin study, nursing staff can successfully intubate using the I-gel and the ILMA as conduits with comparable success rates, regardless of whether chest compressions are interrupted or not. Copyright © 2014 Elsevier Inc. All rights reserved.

Compression asphyxia in upright suspended position.

PubMed

Tumram, Nilesh Keshav; Ambade, Vipul Namdeorao; Dixit, Pradeep Gangadhar

2014-06-01

In compression asphyxia, the respiration is prevented by external pressure on the body. It is usually due to external force compressing the trunk due to heavy weight over chest/abdomen and is associated with internal injuries. In the present case, the victim was suspended in an upright position owing to wedging of the chest and the abdomen in the gap between 2 parallel bridges undergoing construction. There was neither any heavy weight over the body, nor was any external force applied over the trunk. Moreover, there was neither any severe blunt force injury nor any significant pathological natural disease contributing to the cause of death. The body was wedged in the gap between 2 static hard surfaces. The victim was unable to extricate himself from the position owing to impairment of cognitive responses and coordination due to influence of alcohol. The victim died as a result of "static" asphyxia due to compression of the chest and the abdomen. Compression asphyxia in upright suspended position under this circumstance is very rare and not reported previously to the best of our knowledge.

The primacy of basics in advanced life support.

PubMed

Chamberlain, Douglas; Frenneaux, Michael; Fletcher, David

2009-06-01

The standards required for optimal effect of chest compressions and the degree to which most practice falls short of ideal have not been widely appreciated. This review highlights some of the important data now available and offers a haemodynamic explanation that broadens current concepts. New techniques have permitted a detailed examination of how compressions are performed in practice. The implications of recent experimental work adds a new imperative to the need for improvement. In addition to highlighting the need for improved training and audit, the greater understanding of mechanisms in resuscitation suggest that guidelines for management of adult cardiac arrest of presumed cardiac origin need further revision and simplification.

Effectiveness and feasibility of assistant push on improvement of chest compression quality: a crossover study.

PubMed

Choi, Sung Soo; Yun, Seong-Woo; Lee, Byung Kook; Jeung, Kyung Woon; Song, Kyoung Hwan; Lee, Chang-Hee; Park, Jung Soo; Jeong, Ji Yeon; Shin, Sang Yeol

2015-03-01

To improve the quality of chest compression (CC), we developed the assistant-push method, whereby the second rescuer pushes the back of the chest compressor during CC. We investigated the effectiveness and feasibility of assistant push in achieving and maintaining the CC quality. This was a randomized crossover trial in which 41 subjects randomly performed both of standard CC (single-rescuer group) and CC with instructor-driven assistant push (assistant-push group) in different order. Each session of CC was performed for 2 minutes using a manikin. Subjects were also assigned to both roles of chest compressor and assistant and together performed CC with subject-driven assistant push. Depth of CC, compression to recoil ratio, duty cycle, and rate of incomplete recoil were quantified. The mean depth of CC (57.0 [56.0-59.0] vs 55.0 [49.5-57.5], P < .001) was significantly deeper, and the compression force (33.8 [29.3-36.4] vs 23.3 [20.4-25.3], P < .001) was stronger in the assistant-push group. The ratio of compression to recoil, duty cycle, and rate of incomplete chest recoil were comparable between the 2 groups. The CC depth in the single-rescuer group decreased significantly every 30 seconds, whereas in the assistant-push group, it was comparable at 60- and 90-second time points (P = .004). The subject assistant-push group performed CCs at a depth comparable with that of the instructor assistant-push group. The assistant-push method improved the depth of CC and attenuated its decline, eventually helping maintain adequate CC depth over time. Subjects were able to feasibly learn assistant push and performed effectively. Copyright © 2014 Elsevier Inc. All rights reserved.

Helicopter-based in-water resuscitation with chest compressions: a pilot study.

PubMed

Winkler, Bernd E; Hartig, Frank; DuCanto, James; Koch, Andreas; Georgieff, Michael; Lungwitz, Yannick P; Muth, Claus-Martin

2015-07-01

Drowning is a relevant worldwide cause of severe disability and death. The delay of ventilations and chest compressions is a crucial problem in drowning victims. Hence, a novel helicopter-based ALS rescue concept with in-water ventilation and chest compressions was evaluated. Cardio pulmonary resuscitation (CPR) and vascular access were performed in a self-inflating Heliboat platform in an indoor wave pool using the Fastrach intubating laryngeal mask, the Oxylator resuscitator, Lund University Cardiopulmonary Assist System (LUCAS) chest compression device and EZ-IO intraosseous power drill. The time requirement and physical exertion on a Visual Analogue Scale (VAS) were compared between a procedure without waves and with moderate swell. Measurement of the elapsed time of the various stages of the procedure did not reveal significant differences between calm water and swell: Ventilation was initiated after 02:48 versus 03:02 and chest compression after 04:20 versus 04:18 min; the intraosseous cannulisation was completed after 05:59 versus 06:30 min after a simulated jump off the helicopter. The attachment of the LUCAS to the mannequin and the intraosseous cannulisation was rated significantly more demanding on the VAS during swell conditions. CPR appears to be possible when performed in a rescue platform with special equipment. The novel helicopter-based strategy appears to enable the rescuers to initiate CPR in an appropriate length of time and with an acceptable amount of physical exertion for the divers. The time for the helicopter to reach the patient will have to be very short to minimise neurological damage in the drowning victim. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The effects of flipped learning for bystander cardiopulmonary resuscitation on undergraduate medical students.

PubMed

Nakanishi, Taizo; Goto, Tadahiro; Kobuchi, Taketsune; Kimura, Tetsuya; Hayashi, Hiroyuki; Tokuda, Yasuharu

2017-12-22

To compare bystander cardiopulmonary resuscitation skills retention between conventional learning and flipped learning for first-year medical students. A post-test only control group design. A total of 108 participants were randomly assigned to either the conventional learning or flipped learning. The primary outcome measures of time to the first chest compression and the number of total chest compressions during a 2-minute test period 6 month after the training were assessed with the Mann-Whitney U test. Fifty participants (92.6%) in the conventional learning group and 45 participants (83.3%) in the flipped learning group completed the study. There were no statistically significant differences 6 months after the training in the time to the first chest compression of 33.0 seconds (interquartile range, 24.0-42.0) for the conventional learning group and 31.0 seconds (interquartile range, 25.0-41.0) for the flipped learning group (U=1171.0, p=0.73) or in the number of total chest compressions of 101.5 (interquartile range, 90.8-124.0) for the conventional learning group and 104.0 (interquartile range, 91.0-121.0) for the flipped learning group (U=1083.0, p=0.75). The 95% confidence interval of the difference between means of the number of total chest compressions 6 months after the training did not exceed a clinically important difference defined a priori. There were no significant differences between the conventional learning group and the flipped learning group in our main outcomes. Flipped learning might be comparable to conventional learning, and seems a promising approach which requires fewer resources and enables student-centered learning without compromising the acquisition of CPR skills.

How effectively can young people perform dispatcher-instructed cardiopulmonary resuscitation without training?

PubMed

Beard, Matthew; Swain, Andrew; Dunning, Andrew; Baine, Julie; Burrowes, Corey

2015-05-01

Survival from out-of-hospital cardiac arrest is increased by bystander cardiopulmonary resuscitation (CPR). Bystander performance can be improved when CPR instructions are delivered by a calltaker at the Emergency Communications Centre. Little is known about a young person's ability to understand these instructions and perform CPR correctly. We assessed the ability of a group of untrained young people to effectively apply these directions to an adult resuscitation manikin. 87 youngsters aged 7-15 years with no previous training in CPR were separately equipped with a mobile phone and an adult assessment manikin. They phoned the emergency number (111) and were automatically diverted to a senior emergency medical dispatcher (EMD). The EMD delivered resuscitation instructions which complied fully with Medical Priority Dispatch System (version 12.1). Performance was monitored using a Laerdal Computerised Skill Reporting System. Average compression depth increased with age from 10.3 mm to 30 mm for 8 and 15 year olds respectively. 100 compressions per minute was achieved in youngsters aged 10 years and older but the rate fatigued over time and improved after interruption for two ventilations. Those aged 11 years and older consistently compressed the chest from 31 mm to 50mm. Only one participant could successfully ventilate the manikin by mouth-to-mouth. This study demonstrates that untrained youngsters should perform compression-only CPR. From 11 years of age, they can effectively perform dispatcher-directed CPR by compressing the chest at an appropriate rate and depth. However, their technique benefits from formal training. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Quality of closed chest compression on a manikin in ambulance vehicles and flying helicopters with a real time automated feedback.

PubMed

Havel, Christof; Schreiber, Wolfgang; Trimmel, Helmut; Malzer, Reinhard; Haugk, Moritz; Richling, Nina; Riedmüller, Eva; Sterz, Fritz; Herkner, Harald

2010-01-01

Automated verbal and visual feedback improves quality of resuscitation in out-of-hospital cardiac arrest and was proven to increase short-term survival. Quality of resuscitation may be hampered in more difficult situations like emergency transportation. Currently there is no evidence if feedback devices can improve resuscitation quality during different modes of transportation. To assess the effect of real time automated feedback on the quality of resuscitation in an emergency transportation setting. Randomised cross-over trial. Medical University of Vienna, Vienna Municipal Ambulance Service and Helicopter Emergency Medical Service Unit (Christophorus Flugrettungsverein) in September 2007. European Resuscitation Council (ERC) certified health care professionals performing CPR in a flying helicopter and in a moving ambulance vehicle on a manikin with human-like chest properties. CPR sessions, with real time automated feedback as the intervention and standard CPR without feedback as control. Quality of chest compression during resuscitation. Feedback resulted in less deviation from ideal compression rate 100 min(-1) (9+/-9 min(-1), p<0.0001) with this effect becoming steadily larger over time. Applied work was less in the feedback group compared to controls (373+/-448 cm x compression; p<0.001). Feedback did not influence ideal compression depth significantly. There was some indication of a learning effect of the feedback device. Real time automated feedback improves certain aspects of CPR quality in flying helicopters and moving ambulance vehicles. The effect of feedback guidance was most pronounced for chest compression rate. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Up-Down Hand Position Switch May Delay the Fatigue of Non-Dominant Hand Position Rescuers and Improve Chest Compression Quality during Cardiopulmonary Resuscitation: A Randomized Crossover Manikin Study

PubMed Central

Xu, Bing; Wang, Huang-Lei; Xiong, Dan; Sheng, Li-Pin; Yang, Qi-Sheng; Jiang, Shan; Xu, Peng; Chen, Zhi-Qiao; Zhao, Yan

2015-01-01

Previous studies have shown improved external chest compression (ECC) quality and delayed rescuer fatigue when the dominant hand (DH) was in contact with the sternum. However, many rescuers prefer placing the non-dominant hand (NH) in contact with the sternum during ECC. We aimed to investigate the effects of up-down hand position switch on the quality of ECC and the fatigue of rescuers during cardiopulmonary resuscitation (CPR). After completion of a review of the standard adult basic life support (BLS) course, every candidate performed 10 cycles of single adult CPR twice on an adult manikin with either a constant hand position (CH) or a switched hand position (SH) in random order at 7-day intervals. The rescuers’ general characteristics, hand positions, physiological signs, fatigue appearance and ECC qualities were recorded. Our results showed no significant differences in chest compression quality for the DH position rescuers between the CH and SH sessions (p>0.05, resp.). And also no significant differences were found for Borg score (p = 0.437) or cycle number (p = 0.127) of fatigue appearance after chest compressions between the two sessions. However, for NH position rescuers, the appearance of fatigue was delayed (p = 0.046), with a lower Borg score in the SH session (12.67 ± 2.03) compared to the CH session (13.33 ± 1.95) (p = 0.011). Moreover, the compression depth was significantly greater in the SH session (39.3 ± 7.2 mm) compared to the CH session (36.3 ± 8.1 mm) (p = 0.015). Our data suggest that the up-down hand position switch during CPR may delay the fatigue of non-dominant hand position rescuers and improve the quality of chest compressions. PMID:26267353

[Pulmonary atelectasis in patients with neurological or muscular disease; gravity-related lung compression by the heart and intra-abdominal organs on persistent supine position].

PubMed

Toyoshima, Mitsuo; Maeoka, Yukinori; Kawahara, Hitoshi; Maegaki, Yoshihiro; Ohno, Kousaku

2006-11-01

We report 10 cases of pulmonary atelectasis diagnosed by chest computed tomography in patients with neurological or muscular disease. Atelectasis was frequently seen in hypotonic patients who could not roll over on their own. The atelectases located mostly in the dorsal bronchopulmonary segments, adjacent to the heart or diaphragm. Atelectasis diminished in two patients after they became able to roll themselves over. Gravity-related lung compression by the heart and intra-abdominal organs on persistent supine position can cause pulmonary atelectasis in patients with neurological or muscular disease who can not roll over by their own power. To confirm that the prone position reduces compression of the lungs, chest computed tomography was performed in both the supine and the prone position in three patients. Sagittal images with three-dimensional computed tomographic reconstruction revealed significant sternad displacements of the heart and caudal displacements of the dorsal portion of the diaphragm on prone position compared with supine position. The prone position, motor exercises for rolling over, and biphasic cuirass ventilation are effective in reducing gravity-related lung compression. Some patients with intellectual disabilities were also able to cooperate in chest physiotherapy. Chest physiotherapy is useful in preventing atelectasis in patients with neurological or muscular disease.

Profound Obstructive Hypotension From Prone Positioning Documented by Transesophageal Echocardiography in a Patient With Scoliosis: A Case Report.

PubMed

Abcejo, Arnoley S; Diaz Soto, Juan; Castoro, Courtney; Armour, Sarah; Long, Timothy R

2017-08-01

In a healthy 12-year-old female with scoliosis, prone positioning resulted in pressor-refractory cardiovascular collapse. Resumption of supine position immediately improved hemodynamics. Intraoperative transesophageal echocardiography (TEE) revealed a collapsed left atrium and biventricular failure. Repeat prone positioning resulted in a recurrence of hypotension. However, hemodynamic stabilization was restored and maintained by repositioning chest pads caudally. The patient successfully underwent a 6-hour scoliosis repair without perioperative morbidity. With this case, we aim to: (1) reintroduce awareness of this mechanical obstructive cause of reversible hypotension; (2) highlight the use of intraoperative TEE during prone hemodynamic collapse; and (3) suggest an alternative prone positioning technique if chest compression results in hemodynamic instability.

Evaluation of the robustness of the preprocessing technique improving reversible compressibility of CT images: Tested on various CT examinations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jeon, Chang Ho; Kim, Bohyoung; Gu, Bon Seung

2013-10-15

Purpose: To modify the preprocessing technique, which was previously proposed, improving compressibility of computed tomography (CT) images to cover the diversity of three dimensional configurations of different body parts and to evaluate the robustness of the technique in terms of segmentation correctness and increase in reversible compression ratio (CR) for various CT examinations.Methods: This study had institutional review board approval with waiver of informed patient consent. A preprocessing technique was previously proposed to improve the compressibility of CT images by replacing pixel values outside the body region with a constant value resulting in maximizing data redundancy. Since the technique wasmore » developed aiming at only chest CT images, the authors modified the segmentation method to cover the diversity of three dimensional configurations of different body parts. The modified version was evaluated as follows. In randomly selected 368 CT examinations (352 787 images), each image was preprocessed by using the modified preprocessing technique. Radiologists visually confirmed whether the segmented region covers the body region or not. The images with and without the preprocessing were reversibly compressed using Joint Photographic Experts Group (JPEG), JPEG2000 two-dimensional (2D), and JPEG2000 three-dimensional (3D) compressions. The percentage increase in CR per examination (CR{sub I}) was measured.Results: The rate of correct segmentation was 100.0% (95% CI: 99.9%, 100.0%) for all the examinations. The median of CR{sub I} were 26.1% (95% CI: 24.9%, 27.1%), 40.2% (38.5%, 41.1%), and 34.5% (32.7%, 36.2%) in JPEG, JPEG2000 2D, and JPEG2000 3D, respectively.Conclusions: In various CT examinations, the modified preprocessing technique can increase in the CR by 25% or more without concerning about degradation of diagnostic information.« less

Cardiac compression due to gastric volvulus: an unusual cause of chest pain.

PubMed

Brown, Alex; Austin, David; Kanakala, Venkatesh

2017-05-22

A 42-year-old man was admitted to coronary care for assessment with severe retrosternal chest pain. Echocardiography showed significant external compression of the left atrium. A subsequent CT scan revealed him to have a large hiatus hernia, with most of his stomach herniating into his thorax causing left atrial compression and gastric volvulus. He subsequently underwent successful emergency decompression of the gastric volvulus and repair of his hiatus hernia. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Revolving back to the basics in cardiopulmonary resuscitation.

PubMed

Roppolo, L P; Wigginton, J G; Pepe, P E

2009-05-01

Since the 1970s, most of the research and debate regarding interventions for cardiopulmonary arrest have focused on advanced life support (ALS) therapies and early defibrillation strategies. During the past decade, however, international guidelines for cardiopulmonary resuscitation (CPR) have not only emphasized the concept of uninterrupted chest compressions, but also improvements in the timing, rate and quality of those compressions. In essence, it has been a ''revolution'' in resuscitation medicine in terms of ''coming full circle'' to the 1960s when basic CPR was first developed. Recent data have indicated the need for minimally-interrupted chest compressions with an accompanying emphasis toward removing rescue ventilation altogether in sudden cardiac arrest, at least in the few minutes after a sudden unheralded collapse. In other studies, transient delays in defibrillation attempts and ALS interventions are even recommended so that basic CPR can be prioritized to first restore and maintain better coronary artery perfusion. New devices have now been developed to modify, in real-time, the performance of basic CPR, during both training and an actual resuscitative effort. Several new adjuncts have been created to augment chest compressions or enhance venous return and evolving technology may now be able to identify ventricular fibrillation (VF) without interrupting chest compressions. A renewed focus on widespread CPR training for the average person has also returned to center stage with ground-breaking training initiatives including validated video-based adult learning courses that can reliably teach and enable long term retention of basic CPR skills and automated external defibrillator (AED) use.

Volume and tissue composition preserving deformation of breast CT images to simulate breast compression in mammographic imaging

NASA Astrophysics Data System (ADS)

Han, Tao; Chen, Lingyun; Lai, Chao-Jen; Liu, Xinming; Shen, Youtao; Zhong, Yuncheng; Ge, Shuaiping; Yi, Ying; Wang, Tianpeng; Shaw, Chris C.

2009-02-01

Images of mastectomy breast specimens have been acquired with a bench top experimental Cone beam CT (CBCT) system. The resulting images have been segmented to model an uncompressed breast for simulation of various CBCT techniques. To further simulate conventional or tomosynthesis mammographic imaging for comparison with the CBCT technique, a deformation technique was developed to convert the CT data for an uncompressed breast to a compressed breast without altering the breast volume or regional breast density. With this technique, 3D breast deformation is separated into two 2D deformations in coronal and axial views. To preserve the total breast volume and regional tissue composition, each 2D deformation step was achieved by altering the square pixels into rectangular ones with the pixel areas unchanged and resampling with the original square pixels using bilinear interpolation. The compression was modeled by first stretching the breast in the superior-inferior direction in the coronal view. The image data were first deformed by distorting the voxels with a uniform distortion ratio. These deformed data were then deformed again using distortion ratios varying with the breast thickness and re-sampled. The deformation procedures were applied in the axial view to stretch the breast in the chest wall to nipple direction while shrinking it in the mediolateral to lateral direction re-sampled and converted into data for uniform cubic voxels. Threshold segmentation was applied to the final deformed image data to obtain the 3D compressed breast model. Our results show that the original segmented CBCT image data were successfully converted into those for a compressed breast with the same volume and regional density preserved. Using this compressed breast model, conventional and tomosynthesis mammograms were simulated for comparison with CBCT.

Tracheal intubation during pediatric cardiopulmonary resuscitation: A videography-based assessment in an emergency department resuscitation room.

PubMed

Donoghue, Aaron; Hsieh, Ting-Chang; Nishisaki, Akira; Myers, Sage

2016-02-01

To describe procedural characteristics of tracheal intubation (TI) during cardiopulmonary resuscitation (CPR) in a pediatric emergency department, and to characterize interruptions in CPR associated with TI performance. Retrospective single center case series. Resuscitations in a pediatric ED are videorecorded for quality improvement. Children who underwent TI while receiving chest compressions were eligible for inclusion. Intubations done by methods other than direct laryngoscopy were excluded. Background data included patient age and training background of intubator. Data on intubation attempts (success, laryngoscopy time) and chest compressions (interruptions, duration of pauses) were collected. Between December 2012 and February 2014, 32 patients had 59 TI attempts performed during CPR. Overall first attempt success at TI was 15/32 (47%); a median of 2 attempts were made per patient (range 1 to 4). Median laryngoscopy time was 47s (range 8-115s). 32/59 (54%) TI attempts had an associated interruption in CPR; the median interruption duration was 25s (range 3-64s). TI attempts without interruption in CPR were successful in 20/32 (63%) compared to 11/27 (41%) when CPR was paused (p=0.09). Laryngoscopy time was not significantly different between TI attempts with (47±21s) and without (47±26s; p=0.2) interruptions in compressions. 25/32 (78%) of pauses exceeded 10s in duration. TI during pediatric CPR results in significant interruptions in chest compressions. Procedural outcomes were not significantly different between attempts with and without compressions paused. In children receiving CPR, TI should be performed without pausing chest compressions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Histological Changes in the Thyroid Gland in Cases of Infant and Early Childhood Asphyxia-A Preliminary Study.

PubMed

Byard, Roger W; Bellis, Maria

2016-05-01

A retrospective blinded study of thyroid gland histology was undertaken in 50 infants and young children aged from 1 to 24 months. Deaths were due to (i) suffocation (N = 7), hanging (4), wedging (3), and chest and/or neck compression (4), and (ii) SIDS (20), noncervical trauma (7), organic disease, (4) and drug toxicity (1). In the asphyxia group (N = 18), thyroid gland congestion ranged from 0 to 3+ with 39% of cases (7/18) having moderate/marked congestion. In three cases, focal aggregates of red blood cells (blood islands) were observed within the intrafollicular colloid. These deaths involved chest compression, chest and/or neck compression, and crush asphyxia in a vehicle accident, and all had facial petechiae. Only 22% of the 32 control cases (7/32) had moderate/marked congestion with no blood islands being identified (p < 0.05). Blood islands within the thyroid gland may be caused by congestion associated with crushing or compression and may provide supportive evidence for this diagnosis. © 2016 American Academy of Forensic Sciences.

Resuscitator’s perceptions and time for corrective ventilation steps during neonatal resuscitation☆

PubMed Central

Sharma, Vinay; Lakshminrusimha, Satyan; Carrion, Vivien; Mathew, Bobby

2016-01-01

Background The 2010 neonatal resuscitation program (NRP) guidelines incorporate ventilation corrective steps (using the mnemonic – MRSOPA) into the resuscitation algorithm. The perception of neonatal providers, time taken to perform these maneuvers or the effectiveness of these additional steps has not been evaluated. Methods Using two simulated clinical scenarios of varying degrees of cardiovascular compromise –perinatal asphyxia with (i) bradycardia (heart rate – 40 min−1) and (ii) cardiac arrest, 35 NRP certified providers were evaluated for preference to performing these corrective measures, the time taken for performing these steps and time to onset of chest compressions. Results The average time taken to perform ventilation corrective steps (MRSOPA) was 48.9 ± 21.4 s. Providers were less likely to perform corrective steps and proceed directly to endotracheal intubation in the scenario of cardiac arrest as compared to a state of bradycardia. Cardiac compressions were initiated significantly sooner in the scenario of cardiac arrest 89 ± 24 s as compared to severe bradycardia 122 ± 23 s, p < 0.0001. There were no differences in the time taken to initiation of chest compressions between physicians or mid-level care providers or with the level of experience of the provider. Conclusions Effective ventilation of the lungs with corrective steps using a mask is important in most cases of neonatal resuscitation. Neonatal resuscitators prefer early endotracheal intubation and initiation of chest compressions in the presence of asystolic cardiac arrest. Corrective ventilation steps can potentially postpone initiation of chest compressions and may delay return of spontaneous circulation in the presence of severe cardiovascular compromise. PMID:25796996

Toward the modeling of mucus draining from human lung: role of airways deformation on air-mucus interaction

PubMed Central

Mauroy, Benjamin; Flaud, Patrice; Pelca, Dominique; Fausser, Christian; Merckx, Jacques; Mitchell, Barrett R.

2015-01-01

Chest physiotherapy is an empirical technique used to help secretions to get out of the lung whenever stagnation occurs. Although commonly used, little is known about the inner mechanisms of chest physiotherapy and controversies about its use are coming out regularly. Thus, a scientific validation of chest physiotherapy is needed to evaluate its effects on secretions. We setup a quasi-static numerical model of chest physiotherapy based on thorax and lung physiology and on their respective biophysics. We modeled the lung with an idealized deformable symmetric bifurcating tree. Bronchi and their inner fluids mechanics are assumed axisymmetric. Static data from the literature is used to build a model for the lung's mechanics. Secretions motion is the consequence of the shear constraints apply by the air flow. The input of the model is the pressure on the chest wall at each time, and the output is the bronchi geometry and air and secretions properties. In the limit of our model, we mimicked manual and mechanical chest physiotherapy techniques. We show that for secretions to move, air flow has to be high enough to overcome secretion resistance to motion. Moreover, the higher the pressure or the quicker it is applied, the higher is the air flow and thus the mobilization of secretions. However, pressures too high are efficient up to a point where airways compressions prevents air flow to increase any further. Generally, the first effects of manipulations is a decrease of the airway tree hydrodynamic resistance, thus improving ventilation even if secretions do not get out of the lungs. Also, some secretions might be pushed deeper into the lungs; this effect is stronger for high pressures and for mechanical chest physiotherapy. Finally, we propose and tested two a dimensional numbers that depend on lung properties and that allow to measure the efficiency and comfort of a manipulation. PMID:26300780

Quality of resuscitation: flight attendants in an airplane simulator use a new mechanical resuscitation device--a randomized simulation study.

PubMed

Fischer, Henrik; Neuhold, Stephanie; Hochbrugger, Eva; Steinlechner, Barbara; Koinig, Herbert; Milosevic, Ljubisa; Havel, Christof; Frantal, Sophie; Greif, Robert

2011-04-01

Cardiopulmonary resuscitation (CPR) during flight is challenging and has to be sustained for long periods. In this setting a mechanical-resuscitation-device (MRD) might improve performance. In this study we compared the quality of resuscitation of trained flight attendants practicing either standard basic life support (BLS) or using a MRD in a cabin-simulator. Prospective, open, randomized and crossover simulation study. Study participants, competent in standard BLS were trained to use the MRD to deliver both chest compressions and ventilation. 39 teams of two rescuers resuscitated a manikin for 12 min in random order, standard BLS or mechanically assisted resuscitation. Primary outcome was "absolute hands-off time" (sum of all periods during which no hand was placed on the chest minus ventilation time). Various parameters describing the quality of chest compression and ventilation were analysed as secondary outcome parameters. Use of the MRD led to significantly less "absolute hands-off time" (164±33 s vs. 205±42 s, p<0.001). The quality of chest compression was comparable among groups, except for a higher compression rate in the standard BLS group (123±14 min(-1) vs. 95±11 min(-1), p<0.001). Tidal volume was higher in the standard BLS group (0.48±0.14 l vs. 0.34±0.13 l, p<0.001), but we registered fewer gastric inflations in the MRD group (0.4±0.3% vs. 16.6±16.9%, p<0.001). Using the MRD resulted in significantly less "absolute hands-off time", but less effective ventilation. The translation of higher chest compression rate into better outcome, as shown in other studies previously, has to be investigated in another human outcome study. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

A feasibility study of cerebral oximetry during in-hospital mechanical and manual cardiopulmonary resuscitation*.

PubMed

Parnia, Sam; Nasir, Asad; Ahn, Anna; Malik, Hanan; Yang, Jie; Zhu, Jiawen; Dorazi, Francis; Richman, Paul

2014-04-01

A major hurdle limiting the ability to improve the quality of resuscitation has been the lack of a noninvasive real-time detection system capable of monitoring the quality of cerebral and other organ perfusion, as well as oxygen delivery during cardiopulmonary resuscitation. Here, we report on a novel system of cerebral perfusion targeted resuscitation. An observational study evaluating the role of cerebral oximetry (Equanox; Nonin, Plymouth, MI, and Invos; Covidien, Mansfield, MA) as a real-time marker of cerebral perfusion and oxygen delivery together with the impact of an automated mechanical chest compression system (Life Stat; Michigan Instruments, Grand Rapids, MI) on oxygen delivery and return of spontaneous circulation following in-hospital cardiac arrest. Tertiary medical center. In-hospital cardiac arrest patients (n = 34). Cerebral oximetry provided real-time information regarding the quality of perfusion and oxygen delivery. The use of automated mechanical chest compression device (n = 12) was associated with higher regional cerebral oxygen saturation compared with manual chest compression device (n = 22) (53.1% ± 23.4% vs 24% ± 25%, p = 0.002). There was a significant difference in mean regional cerebral oxygen saturation (median % ± interquartile range) in patients who achieved return of spontaneous circulation (n = 15) compared with those without return of spontaneous circulation (n = 19) (47.4% ± 21.4% vs 23% ± 18.42%, p < 0.001). After controlling for patients achieving return of spontaneous circulation or not, significantly higher mean regional cerebral oxygen saturation levels during cardiopulmonary resuscitation were observed in patients who were resuscitated using automated mechanical chest compression device (p < 0.001). The integration of cerebral oximetry into cardiac arrest resuscitation provides a novel noninvasive method to determine the quality of cerebral perfusion and oxygen delivery to the brain. The use of automated mechanical chest compression device during in-hospital cardiac arrest may lead to improved oxygen delivery and organ perfusion.

Closed-loop controller for chest compressions based on coronary perfusion pressure: a computer simulation study.

PubMed

Wang, Chunfei; Zhang, Guang; Wu, Taihu; Zhan, Ningbo; Wang, Yaling

2016-03-01

High-quality cardiopulmonary resuscitation contributes to cardiac arrest survival. The traditional chest compression (CC) standard, which neglects individual differences, uses unified standards for compression depth and compression rate in practice. In this study, an effective and personalized CC method for automatic mechanical compression devices is provided. We rebuild Charles F. Babbs' human circulation model with a coronary perfusion pressure (CPP) simulation module and propose a closed-loop controller based on a fuzzy control algorithm for CCs, which adjusts the CC depth according to the CPP. Compared with a traditional proportion-integration-differentiation (PID) controller, the performance of the fuzzy controller is evaluated in computer simulation studies. The simulation results demonstrate that the fuzzy closed-loop controller results in shorter regulation time, fewer oscillations and smaller overshoot than traditional PID controllers and outperforms the traditional PID controller for CPP regulation and maintenance.

Compression asphyxia from a human pyramid.

PubMed

Tumram, Nilesh Keshav; Ambade, Vipul Namdeorao; Biyabani, Naushad

2015-12-01

In compression asphyxia, respiration is stopped by external forces on the body. It is usually due to an external force compressing the trunk such as a heavy weight on the chest or abdomen and is associated with internal injuries. In present case, the victim was trapped and crushed under the falling persons from a human pyramid formation for a "Dahi Handi" festival. There was neither any severe blunt force injury nor any significant pathological natural disease contributing to the cause of death. The victim was unable to remove himself from the situation because his cognitive responses and coordination were impaired due to alcohol intake. The victim died from asphyxia due to compression of his chest and abdomen. Compression asphyxia resulting from the collapse of a human pyramid and the dynamics of its impact force in these circumstances is very rare and is not reported previously to the best of our knowledge. © The Author(s) 2015.

Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: A systematic review and meta-analysis.

PubMed

Talikowska, Milena; Tohira, Hideo; Finn, Judith

2015-11-01

To conduct a systematic review and meta-analysis to determine whether cardiopulmonary resuscitation (CPR) quality, as indicated by parameters such as chest compression depth, compression rate and compression fraction, is associated with patient survival from cardiac arrest. Five databases were searched (MEDLINE, Embase, CINAHL, Scopus and Cochrane) as well as the grey literature (MedNar). To satisfy inclusion criteria, studies had to document human cases of in- or out-of hospital cardiac arrest where CPR quality had been recorded using an automated device and linked to patient survival. Where indicated (I(2)<75%), meta-analysis was undertaken to examine the relationship between individual CPR quality parameters and either survival to hospital discharge (STHD) or return of spontaneous circulation (ROSC). Database searching yielded 8,842 unique citations, resulting in the inclusion of 22 relevant articles. Thirteen were included in the meta-analysis. Chest compression depth was significantly associated with STHD (mean difference (MD) between survivors and non-survivors 2.59 mm, 95% CI: 0.71, 4.47); and with ROSC (MD 0.99 mm, 95% CI: 0.04, 1.93). Within the range of approximately 100-120 compressions per minute (cpm), compression rate was significantly associated with STHD; survivors demonstrated a lower mean compression rate than non-survivors (MD -1.17 cpm, 95% CI: -2.21, -0.14). Compression fraction could not be examined by meta-analysis due to high heterogeneity, however a higher fraction appeared to be associated with survival in cases with a shockable initial rhythm. Chest compression depth and rate were associated with survival outcomes. More studies with consistent reporting of data are required for other quality parameters. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Development and evaluation of a novel lossless image compression method (AIC: artificial intelligence compression method) using neural networks as artificial intelligence.

PubMed

Fukatsu, Hiroshi; Naganawa, Shinji; Yumura, Shinnichiro

2008-04-01

This study was aimed to validate the performance of a novel image compression method using a neural network to achieve a lossless compression. The encoding consists of the following blocks: a prediction block; a residual data calculation block; a transformation and quantization block; an organization and modification block; and an entropy encoding block. The predicted image is divided into four macro-blocks using the original image for teaching; and then redivided into sixteen sub-blocks. The predicted image is compared to the original image to create the residual image. The spatial and frequency data of the residual image are compared and transformed. Chest radiography, computed tomography (CT), magnetic resonance imaging, positron emission tomography, radioisotope mammography, ultrasonography, and digital subtraction angiography images were compressed using the AIC lossless compression method; and the compression rates were calculated. The compression rates were around 15:1 for chest radiography and mammography, 12:1 for CT, and around 6:1 for other images. This method thus enables greater lossless compression than the conventional methods. This novel method should improve the efficiency of handling of the increasing volume of medical imaging data.

A novel educational outreach approach to teach Hands-Only Cardiopulmonary Resuscitation to the public.

PubMed

Chang, Mary P; Gent, Lana M; Sweet, Merrilee; Potts, Jerry; Ahtone, Jeral; Idris, Ahamed H

2017-07-01

The American Heart Association set goals in 2010 to train 20 million people annually in cardiopulmonary resuscitation and to double bystander response by 2020. These ambitious goals are difficult to achieve without new approaches. The main objective is to evaluate a new approach to cardiopulmonary resuscitation instruction using a self-instructional kiosk to teach Hands-Only CPR to people at a busy international airport. This is a prospective, observational study evaluating a new approach to teach Hands-Only CPR to the public from July 2013 to February 2016. The American Heart Association developed a Hands-Only CPR Kiosk for this project. We assessed the number of participants who viewed the instructional video and practiced chest compressions as well as the quality metrics of the chest compressions. In a 32-month period, there were 23478 visits to the Hands-Only CPR Kiosk and 9006 test sessions; of those practice sessions, 26.2% achieved correct chest compression rate, 60.2% achieved correct chest compression depth, and 63.5% had the correct hand position. There is noticeable public interest in learning Hands-Only CPR by using an airport kiosk and an airport is an opportune place to engage a layperson in learning Hands-Only CPR. The average quality of Hands-Only CPR by the public needs improvement and adding kiosks to other locations in the airport could reach more people and could be replicated in other major airports in the United States. Copyright © 2017 Elsevier B.V. All rights reserved.

Code Team Training: Demonstrating Adherence to AHA Guidelines During Pediatric Code Blue Activations.

PubMed

Stewart, Claire; Shoemaker, Jamie; Keller-Smith, Rachel; Edmunds, Katherine; Davis, Andrew; Tegtmeyer, Ken

2017-10-16

Pediatric code blue activations are infrequent events with a high mortality rate despite the best effort of code teams. The best method for training these code teams is debatable; however, it is clear that training is needed to assure adherence to American Heart Association (AHA) Resuscitation Guidelines and to prevent the decay that invariably occurs after Pediatric Advanced Life Support training. The objectives of this project were to train a multidisciplinary, multidepartmental code team and to measure this team's adherence to AHA guidelines during code simulation. Multidisciplinary code team training sessions were held using high-fidelity, in situ simulation. Sessions were held several times per month. Each session was filmed and reviewed for adherence to 5 AHA guidelines: chest compression rate, ventilation rate, chest compression fraction, use of a backboard, and use of a team leader. After the first study period, modifications were made to the code team including implementation of just-in-time training and alteration of the compression team. Thirty-eight sessions were completed, with 31 eligible for video analysis. During the first study period, 1 session adhered to all AHA guidelines. During the second study period, after alteration of the code team and implementation of just-in-time training, no sessions adhered to all AHA guidelines; however, there was an improvement in percentage of sessions adhering to ventilation rate and chest compression rate and an improvement in median ventilation rate. We present a method for training a large code team drawn from multiple hospital departments and a method of assessing code team performance. Despite subjective improvement in code team positioning, communication, and role completion and some improvement in ventilation rate and chest compression rate, we failed to consistently demonstrate improvement in adherence to all guidelines.

Even Four Minutes of Poor Quality of CPR Compromises Outcome in a Porcine Model of Prolonged Cardiac Arrest

PubMed Central

Li, Heng; Zhang, Lei; Yang, Zhengfei; Huang, Zitong; Chen, Bihua; Li, Yongqin; Yu, Tao

2013-01-01

Objective. Untrained bystanders usually delivered suboptimal chest compression to victims who suffered from cardiac arrest in out-of-hospital settings. We therefore investigated the hemodynamics and resuscitation outcome of initial suboptimal quality of chest compressions compared to the optimal ones in a porcine model of cardiac arrest. Methods. Fourteen Yorkshire pigs weighted 30 ± 2 kg were randomized into good and poor cardiopulmonary resuscitation (CPR) groups. Ventricular fibrillation was electrically induced and untreated for 6 mins. In good CPR group, animals received high quality manual chest compressions according to the Guidelines (25% of animal's anterior-posterior thoracic diameter) during first two minutes of CPR compared with poor (70% of the optimal depth) compressions. After that, a 120-J biphasic shock was delivered. If the animal did not acquire return of spontaneous circulation, another 2 mins of CPR and shock followed. Four minutes later, both groups received optimal CPR until total 10 mins of CPR has been finished. Results. All seven animals in good CPR group were resuscitated compared with only two in poor CPR group (P < 0.05). The delayed optimal compressions which followed 4 mins of suboptimal compressions failed to increase the lower coronary perfusion pressure of five non-survival animals in poor CPR group. Conclusions. In a porcine model of prolonged cardiac arrest, even four minutes of initial poor quality of CPR compromises the hemodynamics and survival outcome. PMID:24364028

Delivery of cardiopulmonary resuscitation in the microgravity environment

NASA Technical Reports Server (NTRS)

Barratt, M. R.; Billica, R. D.

1992-01-01

The microgravity environment presents several challenges for delivering effective cardiopulmonary resuscitation (CPR). Chest compressions must be driven by muscular force rather than by the weight of the rescuer's upper torso. Airway stabilization is influenced by the neutral body posture. Rescuers will consist of crew members of varying sizes and degrees of physical deconditioning from space flight. Several methods of CPR designed to accommodate these factors were tested in the one G environment, in parabolic flight, and on a recent shuttle flight. Methods: Utilizing study participants of varying sizes, different techniques of CPR delivery were evaluated using a recording CPR manikin to assess adequacy of compressive force and frequency. Under conditions of parabolic flight, methods tested included conventional positioning of rescuer and victim, free floating 'Heimlich type' compressions, straddling the patient with active and passive restraints, and utilizing a mechanical cardiac compression assist device (CCAD). Multiple restrain systems and ventilation methods were also assessed. Results: Delivery of effective CPR was possible in all configurations tested. Reliance on muscular force alone was quickly fatiguing to the rescuer. Effectiveness of CPR was dependent on technique, adequate restraint of the rescuer and patient, and rescuer size and preference. Free floating CPR was adequate but rapidly fatiguing. The CCAD was able to provide adequate compressive force but positioning was problematic. Conclusions: Delivery of effective CPR in microgravity will be dependent on adequate resuer and patient restraint, technique, and rescuer size and preference. Free floating CPR may be employed as a stop gap method until patient restraint is available. Development of an adequate CCAD would be desirable to compensate for the effects of deconditioning.

Peyton's 4-Steps-Approach in comparison: Medium-term effects on learning external chest compression – a pilot study

PubMed Central

Münster, Tobias; Stosch, Christoph; Hindrichs, Nina; Franklin, Jeremy; Matthes, Jan

2016-01-01

Introduction: The external chest compression is a very important skill required to maintain a minimum of circulation during cardiac arrest until further medical procedures can be taken. Peyton’s 4-Steps-Approach is one method of skill training, the four steps being: Demonstration, Deconstruction, Comprehension and Execution. Based on CPR skill training, this method is widely, allegedly predominantly used, although there are insufficient studies on Peyton’s 4-Steps-Approach for skill training in CPR in comparison with other methods of skill training. In our study, we compared the medium- term effects on learning external chest compression with a CPR training device in three different groups: PEY (Peyton’s 4-Steps-Approach), PMOD (Peyton’s 4-Steps-Approach without Step 3) and STDM, the standard model, according to the widely spread method “see one, do one” (this is equal to Peyton’s step 1 and 3). Material and Methods: This prospective and randomised pilot study took place during the summer semester of 2009 at the SkillsLab and Simulation Centre of the University of Cologne (Kölner interprofessionelles Skills Lab und Simulationszentrum - KISS). The subjects were medical students (2nd and 3rd semester). They volunteered for the study and were randomised in three parallel groups, each receiving one of the teaching methods mentioned above. One week and 5/6 months after the intervention, an objective, structured single assessment was taken. Compression rate, compression depth, correct compressions, and the sum of correct checklist items were recorded. Additionally, we compared cumulative percentages between the groups based on the correct implementation of the resuscitation guidelines during that time. Results: The examined sample consisted of 134 subjects (68% female; age 22±4; PEY: n=62; PMOD: n=31; STDM: n=41). There was no difference between the groups concerning age, gender, pre-existing experience in CPR or time of last CPR course. The only significant difference between the groups was the mean compression rate (bpm): Group 1 (PEY) with 99±17 bpm, Group 2 (PMOD) with 101±16 bpm and Group 3 (STDM) with 90±16 bpm (p=0,007 for Group 3 vs. Group 1 and Group 3 vs. Group 2, Mann-Whitney- U-Test). We observed no significant differences between the groups after the second assessment. Conclusion: Our study showed that there are no essential differences in external chest compression during CPR performed by medical students dependent on the teaching method (Peyton vs. “Non-Peyton”) implemented with regard to the medium-term effects. The absence of benefits could possibly be due to the simplicity of external chest compression. PMID:27579360

50% duty cycle may be inappropriate to achieve a sufficient chest compression depth when cardiopulmonary resuscitation is performed by female or light rescuers.

PubMed

Lee, Chang Jae; Chung, Tae Nyoung; Bae, Jinkun; Kim, Eui Chung; Choi, Sung Wook; Kim, Ok Jun

2015-03-01

Current guidelines for cardiopulmonary resuscitation recommend chest compressions (CC) during 50% of the duty cycle (DC) in part because of the ease with which individuals may learn to achieve it with practice. However, no consideration has been given to a possible interaction between DC and depth of CC, which has been the subject of recent study. Our aim was to determine if 50% DC is inappropriate to achieve sufficient chest compression depth for female and light rescuers. Previously collected CC data, performed by senior medical students guided by metronome sounds with various down-stroke patterns and rates, were included in the analysis. Multiple linear regression analysis was performed to determine the association between average compression depth (ACD) with average compression rate (ACR), DC, and physical characteristics of the performers. Expected ACD was calculated for various settings. DC, ACR, body weight, male sex, and self-assessed physical strength were significantly associated with ACD in multivariate analysis. Based on our calculations, with 50% of DC, only men with ACR of 140/min or faster or body weight over 74 kg with ACR of 120/min can achieve sufficient ACD. A shorter DC is independently correlated with deeper CC during simulated cardiopulmonary resuscitation. The optimal DC recommended in current guidelines may be inappropriate for achieving sufficient CD, especially for female or lighter-weight rescuers.

Google Glass for Residents Dealing With Pediatric Cardiopulmonary Arrest: A Randomized, Controlled, Simulation-Based Study.

PubMed

Drummond, David; Arnaud, Cécile; Guedj, Romain; Duguet, Alexandre; de Suremain, Nathalie; Petit, Arnaud

2017-02-01

To determine whether real-time video communication between the first responder and a remote intensivist via Google Glass improves the management of a simulated in-hospital pediatric cardiopulmonary arrest before the arrival of the ICU team. Randomized controlled study. Children's hospital at a tertiary care academic medical center. Forty-two first-year pediatric residents. Pediatric residents were evaluated during two consecutive simulated pediatric cardiopulmonary arrests with a high-fidelity manikin. During the second evaluation, the residents in the Google Glass group were allowed to seek help from a remote intensivist at any time by activating real-time video communication. The residents in the control group were asked to provide usual care. The main outcome measures were the proportion of time for which the manikin received no ventilation (no-blow fraction) or no compression (no-flow fraction). In the first evaluation, overall no-blow and no-flow fractions were 74% and 95%, respectively. During the second evaluation, no-blow and no-flow fractions were similar between the two groups. Insufflations were more effective (p = 0.04), and the technique (p = 0.02) and rate (p < 0.001) of chest compression were more appropriate in the Google Glass group than in the control group. Real-time video communication between the first responder and a remote intensivist through Google Glass did not decrease no-blow and no-flow fractions during the first 5 minutes of a simulated pediatric cardiopulmonary arrest but improved the quality of the insufflations and chest compressions provided.

A Review of Compression, Ventilation, Defibrillation, Drug Treatment, and Targeted Temperature Management in Cardiopulmonary Resuscitation

PubMed Central

Pan, Jian; Zhu, Jian-Yong; Kee, Ho Sen; Zhang, Qing; Lu, Yuan-Qiang

2015-01-01

Objective: Important studies of cardiopulmonary resuscitation (CPR) techniques influence the development of new guidelines. We systematically reviewed the efficacy of some important studies of CPR. Data Sources: The data analyzed in this review are mainly from articles included in PubMed and EMBASE, published from 1964 to 2014. Study Selection: Original articles and critical reviews about CPR techniques were selected for review. Results: The survival rate after out-of-hospital cardiac arrest (OHCA) is improving. This improvement is associated with the performance of uninterrupted chest compressions and simple airway management procedures during bystander CPR. Real-time feedback devices can be used to improve the quality of CPR. The recommended dose, timing, and indications for adrenaline (epinephrine) use may change. The appropriate target temperature for targeted temperature management is still unclear. Conclusions: New studies over the past 5 years have evaluated various aspects of CPR in OHCA. Some of these studies were high-quality randomized controlled trials, which may help to improve the scientific understanding of resuscitation techniques and result in changes to CPR guidelines. PMID:25673462

Cystic Fibrosis Chest X-Ray Findings: A Teaching Analog

DTIC Science & Technology

2008-07-01

lung volume. There are five specific types of atelectasis: obstructive, compressive, cicatrization , post-operative and adhesive. Obstructive...commonly, a pleural lesion or mass can cause impact on the neighboring lung tissue causing compression of the alveoli in that area. Cicatrization ...Lymphoma Atelectasis Obstructive Compressive Pneumothorax Pleural Effusion Pleural Lesion Cicatrization Radiation Severe Pneumonia Adhesive

The uniform chest compression depth of 50 mm or greater recommended by current guidelines is not appropriate for all adults.

PubMed

Lee, Soo Hoon; Kim, Dong Hoon; Kang, Tae-Sin; Kang, Changwoo; Jeong, Jin Hee; Kim, Seong Chun; Kim, Dong Seob

2015-08-01

This study was conducted to evaluate the appropriateness of the chest compression (CC) depth recommended in the current guidelines and simulated external CCs, and to characterize the optimal CC depth for an adult by body mass index (BMI). Adult patients who underwent chest computed tomography as a screening test for latent pulmonary diseases in the health care center were enrolled in this study. We calculated the internal anteroposterior (AP) diameter (IAPD) and external AP diameter (EAPD) of the chest across BMIs (<18.50, 18.50-24.99, 25.00-29.99, and ≥30.00 kg/m(2)) for simulated CC depth. We also calculated the residual chest depths less than 20 mm for simulated CC depth. There was a statistically significant difference in the chest EAPD and IAPD measured at the lower half of the sternum for each BMI groups (EAPD: R(2) = 0.638, P < .001; IAPD: R(2) = 0.297, P < .001). For one-half external AP CC, 100% of the patients, regardless of BMI, had a calculated residual internal chest depth less than 20 mm. For one-fourth external AP CC, no patients had a calculated residual internal chest depth less than 20 mm. For one-third external AP CC, only 6.48% of the patients had a calculated residual internal chest depth less than 20 mm. It is not appropriate that the current CC depth (≥50 mm), expressed only as absolute measurement without a fraction of the depth of the chest, is applied uniformly in all adults. In addition, in terms of safety and efficacy, simulated CC targeting approximately between one-third and one-fourth EAPD CC depth might be appropriate. Copyright © 2015 Elsevier Inc. All rights reserved.

Improvement in Trainees' Attitude and Resuscitation Quality With Repeated Cardiopulmonary Resuscitation Training: Cross-Sectional Simulation Study.

PubMed

Kim, Jong Won; Lee, Jeong Hun; Lee, Kyeong Ryong; Hong, Dae Young; Baek, Kwang Je; Park, Sang O

2016-08-01

This study investigated the effect of increasing numbers of training sessions in cardiopulmonary resuscitation (CPR) on trainees' attitude and CPR quality. Cardiopulmonary resuscitation training for hospital employees was held every year from 2006 to 2010. Participants were recruited among the trainees in 2010. The trainees' attitudes toward CPR were surveyed by questionnaire, and the quality of their CPR was measured using 5-cycle 30:2 CPR on a manikin. Participants were categorized according to the number of consecutive CPR training sessions as T1 (only 2010), T2 (2009 and 2010), T3 (from 2008 to 2010) and T4-5 (from 2006 or 2007 to 2010). The trainee attitude and CPR quality were compared among the 4 groups. Of 923 CPR trainees, 267 were enrolled in the study. There was significant increase in willingness to start CPR and confidence in chest compression and mouth-to-mouth ventilation (MTMV) with increasing number of CPR training sessions attended (especially for ≥ 3 sessions). There was a significant increase in mean compression depth and decrease in percentage of chest compressions with depth of less than 38 mm in the T3 and T4-5 compared with the T1 and T2. No-flow time decreased significantly, and the percentage of MTMV with visible chest rise increased, as the number of training sessions increased. Repeated CPR training improved trainees' attitude and CPR quality. Because the number of training sessions increased (≥3), the willingness to start CPR and the confidence in skills increased significantly, and chest compression depth, no-flow time, and MTMV improved.

The Efficacy of LUCAS in Prehospital Cardiac Arrest Scenarios: A Crossover Mannequin Study.

PubMed

Gyory, Robert A; Buchle, Scott E; Rodgers, David; Lubin, Jeffrey S

2017-04-01

High-quality cardiopulmonary resuscitation (CPR) is critical for successful cardiac arrest outcomes. Mechanical devices may improve CPR quality. We simulated a prehospital cardiac arrest, including patient transport, and compared the performance of the LUCAS™ device, a mechanical chest compression-decompression system, to manual CPR. We hypothesized that because of the movement involved in transporting the patient, LUCAS would provide chest compressions more consistent with high-quality CPR guidelines. We performed a crossover-controlled study in which a recording mannequin was placed on the second floor of a building. An emergency medical services (EMS) crew responded, defibrillated, and provided either manual or LUCAS CPR. The team transported the mannequin through hallways and down stairs to an ambulance and drove to the hospital with CPR in progress. Critical events were manually timed while the mannequin recorded data on compressions. Twenty-three EMS providers participated. Median time to defibrillation was not different for LUCAS compared to manual CPR (p=0.97). LUCAS had a lower median number of compressions per minute (112/min vs. 125/min; IQR = 102-128 and 102-126 respectively; p<0.002), which was more consistent with current American Heart Association CPR guidelines, and percent adequate compression rate (71% vs. 40%; IQR = 21-93 and 12-88 respectively; p<0.002). In addition, LUCAS had a higher percent adequate depth (52% vs. 36%; IQR = 25-64 and 29-39 respectively; p<0.007) and lower percent total hands-off time (15% vs. 20%; IQR = 10-22 and 15-27 respectively; p<0.005). LUCAS performed no differently than manual CPR in median compression release depth, percent fully released compressions, median time hands off, or percent correct hand position. In our simulation, LUCAS had a higher rate of adequate compressions and decreased total hands-off time as compared to manual CPR. Chest compression quality may be better when using a mechanical device during patient movement in prehospital cardiac arrest patient.

The capability of professional- and lay-rescuers to estimate the chest compression-depth target: a short, randomized experiment.

PubMed

van Tulder, Raphael; Laggner, Roberta; Kienbacher, Calvin; Schmid, Bernhard; Zajicek, Andreas; Haidvogel, Jochen; Sebald, Dieter; Laggner, Anton N; Herkner, Harald; Sterz, Fritz; Eisenburger, Philip

2015-04-01

In CPR, sufficient compression depth is essential. The American Heart Association ("at least 5cm", AHA-R) and the European Resuscitation Council ("at least 5cm, but not to exceed 6cm", ERC-R) recommendations differ, and both are hardly achieved. This study aims to investigate the effects of differing target depth instructions on compression depth performances of professional and lay-rescuers. 110 professional-rescuers and 110 lay-rescuers were randomized (1:1, 4 groups) to estimate the AHA-R or ERC-R on a paper sheet (given horizontal axis) using a pencil and to perform chest compressions according to AHA-R or ERC-R on a manikin. Distance estimation and compression depth were the outcome variables. Professional-rescuers estimated the distance according to AHA-R in 19/55 (34.5%) and to ERC-R in 20/55 (36.4%) cases (p=0.84). Professional-rescuers achieved correct compression depth according to AHA-R in 39/55 (70.9%) and to ERC-R in 36/55 (65.4%) cases (p=0.97). Lay-rescuers estimated the distance correctly according to AHA-R in 18/55 (32.7%) and to ERC-R in 20/55 (36.4%) cases (p=0.59). Lay-rescuers yielded correct compression depth according to AHA-R in 39/55 (70.9%) and to ERC-R in 26/55 (47.3%) cases (p=0.02). Professional and lay-rescuers have severe difficulties in correctly estimating distance on a sheet of paper. Professional-rescuers are able to yield AHA-R and ERC-R targets likewise. In lay-rescuers AHA-R was associated with significantly higher success rates. The inability to estimate distance could explain the failure to appropriately perform chest compressions. For teaching lay-rescuers, the AHA-R with no upper limit of compression depth might be preferable. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Chest compression rate measurement from smartphone video.

PubMed

Engan, Kjersti; Hinna, Thomas; Ryen, Tom; Birkenes, Tonje S; Myklebust, Helge

2016-08-11

Out-of-hospital cardiac arrest is a life threatening situation where the first person performing cardiopulmonary resuscitation (CPR) most often is a bystander without medical training. Some existing smartphone apps can call the emergency number and provide for example global positioning system (GPS) location like Hjelp 113-GPS App by the Norwegian air ambulance. We propose to extend functionality of such apps by using the built in camera in a smartphone to capture video of the CPR performed, primarily to estimate the duration and rate of the chest compression executed, if any. All calculations are done in real time, and both the caller and the dispatcher will receive the compression rate feedback when detected. The proposed algorithm is based on finding a dynamic region of interest in the video frames, and thereafter evaluating the power spectral density by computing the fast fourier transform over sliding windows. The power of the dominating frequencies is compared to the power of the frequency area of interest. The system is tested on different persons, male and female, in different scenarios addressing target compression rates, background disturbances, compression with mouth-to-mouth ventilation, various background illuminations and phone placements. All tests were done on a recording Laerdal manikin, providing true compression rates for comparison. Overall, the algorithm is seen to be promising, and it manages a number of disturbances and light situations. For target rates at 110 cpm, as recommended during CPR, the mean error in compression rate (Standard dev. over tests in parentheses) is 3.6 (0.8) for short hair bystanders, and 8.7 (6.0) including medium and long haired bystanders. The presented method shows that it is feasible to detect the compression rate of chest compressions performed by a bystander by placing the smartphone close to the patient, and using the built-in camera combined with a video processing algorithm performed real-time on the device.

Echocardiographic image of an active human heart

NASA Technical Reports Server (NTRS)

2003-01-01

Echocardiographic images provide quick, safe images of the heart as it beats. While a state-of-the art echocardiograph unit is part of the Human Research Facility on International Space Station, quick transmission of images and data to Earth is a challenge. NASA is developing techniques to improve the echocardiography available to diagnose sick astronauts as well as study the long-term effects of space travel on their health. Echocardiography uses ultrasound, generated in a sensor head placed against the patient's chest, to produce images of the structure of the heart walls and valves. However, ultrasonic imaging creates an enormous volume of data, up to 220 million bits per second. This can challenge ISS communications as well as Earth-based providers. Compressing data for rapid transmission back to Earth can degrade the quality of the images. Researchers at the Cleveland Clinic Foundation are working with NASA to develop compression techniques that meet imaging standards now used on the Internet and by the medical community, and that ensure that physicians receive quality diagnostic images.

42 CFR 37.44 - Approval of radiographic facilities that use digital radiography systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... image acquisition, digitization, processing, compression, transmission, display, archiving, and... quality digital chest radiographs by submitting to NIOSH digital radiographic image files of a test object... digital radiographic image files from six or more sample chest radiographs that are of acceptable quality...

42 CFR 37.44 - Approval of radiographic facilities that use digital radiography systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... image acquisition, digitization, processing, compression, transmission, display, archiving, and... quality digital chest radiographs by submitting to NIOSH digital radiographic image files of a test object... digital radiographic image files from six or more sample chest radiographs that are of acceptable quality...

Metastatic spinal cord compression from basal cell carcinoma of the skin treated with surgical decompression and vismodegib: case report and review of Hedgehog signalling pathway inhibition in advanced basal cell carcinoma.

PubMed

McGrane, J; Carswell, S; Talbot, T

2017-01-01

We report a case of a 66-year-old man with locally advanced and metastatic basal cell carcinoma (BCC) causing spinal cord compression, which was treated with spinal surgery and subsequent vismodegib. The patient presented with a large fungating chest wall lesion and a metastasis in T8 that was causing cord compression. He had neurosurgical decompression of the T8 lesion and fixation of the spine. Punch biopsy from the fungating chest wall lesion showed a BCC with some malignant squamous differentiation (basosquamous). Histopathological examination of the metastatic lesion in T8 at the time of surgical decompression identified features identical to the punch biopsy. The patient was referred to the oncology clinic for adjuvant treatment. In light of his metastatic disease and the large area over his chest wall that could not fully be covered by radiotherapy, he was treated with the novel oral Hedgehog signalling pathway (HHSP) inhibitor vismodegib, which led to marked improvement. © 2016 British Association of Dermatologists.

A Rat Model of Ventricular Fibrillation and Resuscitation by Conventional Closed-chest Technique

PubMed Central

Lamoureux, Lorissa; Radhakrishnan, Jeejabai; Gazmuri, Raúl J.

2015-01-01

A rat model of electrically-induced ventricular fibrillation followed by cardiac resuscitation using a closed chest technique that incorporates the basic components of cardiopulmonary resuscitation in humans is herein described. The model was developed in 1988 and has been used in approximately 70 peer-reviewed publications examining a myriad of resuscitation aspects including its physiology and pathophysiology, determinants of resuscitability, pharmacologic interventions, and even the effects of cell therapies. The model featured in this presentation includes: (1) vascular catheterization to measure aortic and right atrial pressures, to measure cardiac output by thermodilution, and to electrically induce ventricular fibrillation; and (2) tracheal intubation for positive pressure ventilation with oxygen enriched gas and assessment of the end-tidal CO2. A typical sequence of intervention entails: (1) electrical induction of ventricular fibrillation, (2) chest compression using a mechanical piston device concomitantly with positive pressure ventilation delivering oxygen-enriched gas, (3) electrical shocks to terminate ventricular fibrillation and reestablish cardiac activity, (4) assessment of post-resuscitation hemodynamic and metabolic function, and (5) assessment of survival and recovery of organ function. A robust inventory of measurements is available that includes – but is not limited to – hemodynamic, metabolic, and tissue measurements. The model has been highly effective in developing new resuscitation concepts and examining novel therapeutic interventions before their testing in larger and translationally more relevant animal models of cardiac arrest and resuscitation. PMID:25938619

50% duty cycle may be inappropriate to achieve a sufficient chest compression depth when cardiopulmonary resuscitation is performed by female or light rescuers

PubMed Central

Lee, Chang Jae; Chung, Tae Nyoung; Bae, Jinkun; Kim, Eui Chung; Choi, Sung Wook; Kim, Ok Jun

2015-01-01

Objective Current guidelines for cardiopulmonary resuscitation recommend chest compressions (CC) during 50% of the duty cycle (DC) in part because of the ease with which individuals may learn to achieve it with practice. However, no consideration has been given to a possible interaction between DC and depth of CC, which has been the subject of recent study. Our aim was to determine if 50% DC is inappropriate to achieve sufficient chest compression depth for female and light rescuers. Methods Previously collected CC data, performed by senior medical students guided by metronome sounds with various down-stroke patterns and rates, were included in the analysis. Multiple linear regression analysis was performed to determine the association between average compression depth (ACD) with average compression rate (ACR), DC, and physical characteristics of the performers. Expected ACD was calculated for various settings. Results DC, ACR, body weight, male sex, and self-assessed physical strength were significantly associated with ACD in multivariate analysis. Based on our calculations, with 50% of DC, only men with ACR of 140/min or faster or body weight over 74 kg with ACR of 120/min can achieve sufficient ACD. Conclusion A shorter DC is independently correlated with deeper CC during simulated cardiopulmonary resuscitation. The optimal DC recommended in current guidelines may be inappropriate for achieving sufficient CD, especially for female or lighter-weight rescuers. PMID:27752567

The influence of scenario-based training and real-time audiovisual feedback on out-of-hospital cardiopulmonary resuscitation quality and survival from out-of-hospital cardiac arrest.

PubMed

Bobrow, Bentley J; Vadeboncoeur, Tyler F; Stolz, Uwe; Silver, Annemarie E; Tobin, John M; Crawford, Scott A; Mason, Terence K; Schirmer, Jerome; Smith, Gary A; Spaite, Daniel W

2013-07-01

We assess whether an initiative to optimize out-of-hospital provider cardiopulmonary resuscitation (CPR) quality is associated with improved CPR quality and increased survival from out-of-hospital cardiac arrest. This was a before-after study of consecutive adult out-of-hospital cardiac arrest. Data were obtained from out-of-hospital forms and defibrillators. Phase 1 included 18 months with real-time audiovisual feedback disabled (October 2008 to March 2010). Phase 2 included 16 months (May 2010 to September 2011) after scenario-based training of 373 professional rescuers and real-time audiovisual feedback enabled. The effect of interventions on survival to hospital discharge was assessed with multivariable logistic regression. Multiple imputation of missing data was used to analyze the effect of interventions on CPR quality. Analysis included 484 out-of-hospital cardiac arrest patients (phase 1 232; phase 2 252). Median age was 68 years (interquartile range 56-79); 66.5% were men. CPR quality measures improved significantly from phase 1 to phase 2: Mean chest compression rate decreased from 128 to 106 chest compressions per minute (difference -23 chest compressions; 95% confidence interval [CI] -26 to -19 chest compressions); mean chest compression depth increased from 1.78 to 2.15 inches (difference 0.38 inches; 95% CI 0.28 to 0.47 inches); median chest compression fraction increased from 66.2% to 83.7% (difference 17.6%; 95% CI 15.0% to 20.1%); median preshock pause decreased from 26.9 to 15.5 seconds (difference -11.4 seconds; 95% CI -15.7 to -7.2 seconds), and mean ventilation rate decreased from 11.7 to 9.5/minute (difference -2.2/minute; 95% CI -3.9 to -0.5/minute). All-rhythms survival increased from phase 1 to phase 2 (20/231, 8.7% versus 35/252, 13.9%; difference 5.2%; 95% CI -0.4% to 10.8%), with an adjusted odds ratio of 2.72 (95% CI 1.15 to 6.41), controlling for initial rhythm, witnessed arrest, age, minimally interrupted cardiac resuscitation protocol compliance, and provision of therapeutic hypothermia. Witnessed arrests/shockable rhythms survival was 26.3% (15/57) for phase 1 and 55.6% (20/36) for phase 2 (difference 29.2%; 95% CI 9.4% to 49.1%). Implementation of resuscitation training combined with real-time audiovisual feedback was independently associated with improved CPR quality, an increase in survival, and favorable functional outcomes after out-of-hospital cardiac arrest. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

A randomised crossover comparison of mouth-to-face-shield ventilation and mouth-to-pocket-mask ventilation by surf lifeguards in a manikin.

PubMed

Adelborg, K; Bjørnshave, K; Mortensen, M B; Espeseth, E; Wolff, A; Løfgren, B

2014-07-01

Thirty surf lifeguards (mean (SD) age: 25.1 (4.8) years; 21 male, 9 female) were randomly assigned to perform 2 × 3 min of cardiopulmonary resuscitation on a manikin using mouth-to-face-shield ventilation (AMBU LifeKey) and mouth-to-pocket-mask ventilation (Laerdal Pocket Mask). Interruptions in chest compressions, effective ventilation (visible chest rise) ratio, tidal volume and inspiratory time were recorded. Interruptions in chest compressions per cycle were increased with mouth-to-face-shield ventilation (mean (SD) 8.6 (1.7) s) compared with mouth-to-pocket-mask ventilation (6.9 (1.2) s, p < 0.0001). The proportion of effective ventilations was less using mouth-to-face-shield ventilation (199/242 (82%)) compared with mouth-to-pocket-mask ventilation (239/240 (100%), p = 0.0002). Tidal volume was lower using mouth-to-face-shield ventilation (mean (SD) 0.36 (0.20) l) compared with mouth-to-pocket-mask ventilation (0.45 (0.20) l, p = 0.006). No differences in inspiratory times were observed between mouth-to-face-shield ventilation and mouth-to-pocket-mask ventilation. In conclusion, mouth-to-face-shield ventilation increases interruptions in chest compressions, reduces the proportion of effective ventilations and decreases delivered tidal volumes compared with mouth-to-pocket-mask ventilation. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Hemodynamic directed cardiopulmonary resuscitation improves short-term survival from ventricular fibrillation cardiac arrest.

PubMed

Friess, Stuart H; Sutton, Robert M; Bhalala, Utpal; Maltese, Matthew R; Naim, Maryam Y; Bratinov, George; Weiland, Theodore R; Garuccio, Mia; Nadkarni, Vinay M; Becker, Lance B; Berg, Robert A

2013-12-01

During cardiopulmonary resuscitation, adequate coronary perfusion pressure is essential for establishing return of spontaneous circulation. Current American Heart Association guidelines recommend standardized interval administration of epinephrine for patients in cardiac arrest. The objective of this study was to compare short-term survival using a hemodynamic directed resuscitation strategy versus chest compression depth-directed cardiopulmonary resuscitation in a porcine model of cardiac arrest. Randomized interventional study. Preclinical animal laboratory. Twenty-four 3-month-old female swine. After 7 minutes of ventricular fibrillation, pigs were randomized to receive one of three resuscitation strategies: 1) Hemodynamic directed care (coronary perfusion pressure-20): chest compressions with depth titrated to a target systolic blood pressure of 100 mm Hg and titration of vasopressors to maintain coronary perfusion pressure greater than 20 mm Hg; 2) Depth 33 mm: target chest compression depth of 33 mm with standard American Heart Association epinephrine dosing; or 3) Depth 51 mm: target chest compression depth of 51 mm with standard American Heart Association epinephrine dosing. All animals received manual cardiopulmonary resuscitation guided by audiovisual feedback for 10 minutes before first shock. Forty-five-minute survival was higher in the coronary perfusion pressure-20 group (8 of 8) compared to depth 33 mm (1 of 8) or depth 51 mm (3 of 8) groups; p equals to 0.002. Coronary perfusion pressures were higher in the coronary perfusion pressure-20 group compared to depth 33 mm (p = 0.004) and depth 51 mm (p = 0.006) and in survivors compared to nonsurvivors (p < 0.01). Total epinephrine dosing and defibrillation attempts were not different. Hemodynamic directed resuscitation targeting coronary perfusion pressures greater than 20 mm Hg during 10 minutes of cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest improves short-term survival, when compared to resuscitation with depth of compressions guided to 33 mm or 51 mm and standard American Heart Association vasopressor dosing.

Quality of audio-assisted versus video-assisted dispatcher-instructed bystander cardiopulmonary resuscitation: A systematic review and meta-analysis.

PubMed

Lin, Yu-You; Chiang, Wen-Chu; Hsieh, Ming-Ju; Sun, Jen-Tang; Chang, Yi-Chung; Ma, Matthew Huei-Ming

2018-02-01

This study aimed to conduct a systematic review and meta-analysis comparing the effect of video-assistance and audio-assistance on quality of dispatcher-instructed cardiopulmonary resuscitation (DI-CPR) for bystanders. Five databases were searched, including PubMed, Cochrane library, Embase, Scopus and NIH clinical trial, to find randomized control trials published before June 2017. Qualitative analysis and meta-analysis were undertaken to examine the difference between the quality of video-instructed and audio-instructed dispatcher-instructed bystander CPR. The database search yielded 929 records, resulting in the inclusion of 9 relevant articles in this study. Of these, 6 were included in the meta-analysis. Initiation of chest compressions was slower in the video-instructed group than in the audio-instructed group (median delay 31.5 s; 95% CI: 10.94-52.09). The difference in the number of chest compressions per minute between the groups was 19.9 (95% CI: 10.50-29.38) with significantly faster compressions in the video-instructed group than in the audio-instructed group (104.8 vs. 80.6). The odds ratio (OR) for correct hand positioning was 0.8 (95% CI: 0.53-1.30) when comparing the audio-instructed and video-instructed groups. The differences in chest compression depth (mm) and time to first ventilation (seconds) between the video-instructed group and audio-instructed group were 1.6 mm (95% CI: -8.75, 5.55) and 7.5 s (95% CI: -56.84, 71.80), respectively. Video-instructed DI-CPR significantly improved the chest compression rate compared to the audio-instructed method, and a trend for correctness of hand position was also observed. However, this method caused a delay in the commencement of bystander-initiated CPR in the simulation setting. Copyright © 2017 Elsevier B.V. All rights reserved.

Relative effectiveness of dominant versus non-dominant hand position for rescuer's side of approach during chest compressions between right-handed and left-handed novice rescuers.

PubMed

You, Je Sung; Kim, Hoon; Park, Jung Soo; Baek, Kyung Min; Jang, Mun Sun; Lee, Hye Sun; Chung, Sung Phil; Kim, SeungWhan

2015-03-01

The major components affecting high quality cardiopulmonary resuscitation (CPR) have been defined as the ability of the rescuer, hand position, position of the rescuer and victim, depth and rate of chest compressions, and fatigue. Until now, there have been no studies on dominant versus non-dominant hand position and the rescuer's side of approach. This study was designed to evaluate the effectiveness of hand position and approach side on the quality of CPR between right-handed (RH) and left-handed (LH) novice rescuers. 44 health science university students with no previous experience of basic life support (BLS) volunteered for the study. We divided volunteers into two groups by handedness. Adult BLS was performed on a manikin for 2 min in each session. The sequences were randomly performed on the manikin's left side of approach (Lap) with the rescuer's left hand in contact with the sternum (Lst), Lap/Rst, Rap/Lst and Rap/Rst. We compared the quality of chest compressions between the RH and LH groups according to predetermined positions. A significant decrease in mean compression depth between the two groups was only observed when rescuers performed in the Rap/Lst scenario, regardless of hand dominance. The frequency of correct hand placement also significantly decreased in the Lap/Rst position for the LH group. The performance of novice rescuers during chest compressions is influenced by the position of the dominant hand and the rescuer's side of approach. In CPR training and real world situations, a novice rescuer, regardless of handedness, should consider hand positions for contacting the sternum identical to the side of approach after approaching from the nearest and most accessible side, for optimal CPR performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effect of socioemotional stress on the quality of cardiopulmonary resuscitation during advanced life support in a randomized manikin study.

PubMed

Bjørshol, Conrad Arnfinn; Myklebust, Helge; Nilsen, Kjetil Lønne; Hoff, Thomas; Bjørkli, Cato; Illguth, Eirik; Søreide, Eldar; Sunde, Kjetil

2011-02-01

The aim of this study was to evaluate whether socioemotional stress affects the quality of cardiopulmonary resuscitation during advanced life support in a simulated manikin model. A randomized crossover trial with advanced life support performed in two different conditions, with and without exposure to socioemotional stress. The study was conducted at the Stavanger Acute Medicine Foundation for Education and Research simulation center, Stavanger, Norway. Paramedic teams, each consisting of two paramedics and one assistant, employed at Stavanger University Hospital, Stavanger, Norway. A total of 19 paramedic teams performed advanced life support twice in a randomized fashion, one control condition without socioemotional stress and one experimental condition with exposure to socioemotional stress. The socioemotional stress consisted of an upset friend of the simulated patient who was a physician, spoke a foreign language, was unfamiliar with current Norwegian resuscitation guidelines, supplied irrelevant clinical information, and repeatedly made doubts about the paramedics' resuscitation efforts. Aural distractions were supplied by television and cell telephone. The primary outcome was the quality of cardiopulmonary resuscitation: chest compression depth, chest compression rate, time without chest compressions (no-flow ratio), and ventilation rate after endotracheal intubation. As a secondary outcome, the socioemotional stress impact was evaluated through the paramedics' subjective workload, frustration, and feeling of realism. There were no significant differences in chest compression depth (39 vs. 38 mm, p = .214), compression rate (113 vs. 116 min⁻¹, p = .065), no-flow ratio (0.15 vs. 0.15, p = .618), or ventilation rate (8.2 vs. 7.7 min⁻¹, p = .120) between the two conditions. There was a significant increase in the subjective workload, frustration, and feeling of realism when the paramedics were exposed to socioemotional stress. In this advanced life support manikin study, the presence of socioemotional stress increased the subjective workload, frustration, and feeling of realism, without affecting the quality of cardiopulmonary resuscitation.

Mobile phone-assisted basic life support augmented with a metronome.

PubMed

Paal, Peter; Pircher, Iris; Baur, Thomas; Gruber, Elisabeth; Strasak, Alexander M; Herff, Holger; Brugger, Hermann; Wenzel, Volker; Mitterlechner, Thomas

2012-09-01

Basic life support (BLS) performed by lay rescuers is poor. We developed software for mobile phones augmented with a metronome to improve BLS. To assess BLS in lay rescuers with or without software assistance. Medically untrained volunteers were randomized to run through a cardiac arrest scenario with ("assisted BLS") or without ("non-assisted BLS") the aid of a BLS software program installed on a mobile phone. Sixty-four lay rescuers were enrolled in the "assisted BLS" and 77 in the "non-assisted BLS" group. The "assisted BLS" when compared to the "non-assisted BLS" group, achieved a higher overall score (19.2 ± 7.5 vs. 12.9 ± 5.7 credits; p < 0.001). Moreover, the "assisted BLS" when compared to the "non-assisted" group checked (64% vs. 27%) and protected themselves more often from environmental risks (70% vs. 39%); this group also called more often for help (56% vs. 27%), opened the upper airway (78% vs. 16%), and had more correct chest compressions rates (44% ± 38% vs. 14% ± 28%; all p < 0.001). However, the "assisted BLS" when compared to the "non-assisted BLS" group, was slower in calling the dispatch center (113.6 ± 86.4 vs. 54.1 ± 45.1 s; p < 0.001) and starting chest compressions (165.3 ± 93.3 vs. 87.1 ± 53.2 s; p < 0.001). "Assisted BLS" augmented by a metronome resulted in a higher overall score and a better chest compression rate when compared to "non-assisted BLS." However, in the "assisted BLS" group, time to call the dispatch center and to start chest compressions was longer. In both groups, lay persons did not ventilate satisfactorily during this cardiac arrest scenario. Copyright © 2012 Elsevier Inc. All rights reserved.

Simulation-based Randomized Comparative Assessment of Out-of-Hospital Cardiac Arrest Resuscitation Bundle Completion by Emergency Medical Service Teams Using Standard Life Support or an Experimental Automation-assisted Approach.

PubMed

Choi, Bryan; Asselin, Nicholas; Pettit, Catherine C; Dannecker, Max; Machan, Jason T; Merck, Derek L; Merck, Lisa H; Suner, Selim; Williams, Kenneth A; Jay, Gregory D; Kobayashi, Leo

2016-12-01

Effective resuscitation of out-of-hospital cardiac arrest (OHCA) patients is challenging. Alternative resuscitative approaches using electromechanical adjuncts may improve provider performance. Investigators applied simulation to study the effect of an experimental automation-assisted, goal-directed OHCA management protocol on EMS providers' resuscitation performance relative to standard protocols and equipment. Two-provider (emergency medical technicians (EMT)-B and EMT-I/C/P) teams were randomized to control or experimental group. Each team engaged in 3 simulations: baseline simulation (standard roles); repeat simulation (standard roles); and abbreviated repeat simulation (reversed roles, i.e., basic life support provider performing ALS tasks). Control teams used standard OHCA protocols and equipment (with high-performance cardiopulmonary resuscitation training intervention); for second and third simulations, experimental teams performed chest compression, defibrillation, airway, pulmonary ventilation, vascular access, medication, and transport tasks with goal-directed protocol and resuscitation-automating devices. Videorecorders and simulator logs collected resuscitation data. Ten control and 10 experimental teams comprised 20 EMT-B's; 1 EMT-I, 8 EMT-C's, and 11 EMT-P's; study groups were not fully matched. Both groups suboptimally performed chest compressions and ventilations at baseline. For their second simulations, control teams performed similarly except for reduced on-scene time, and experimental teams improved their chest compressions (P=0.03), pulmonary ventilations (P<0.01), and medication administration (P=0.02); changes in their performance of chest compression, defibrillation, airway, and transport tasks did not attain significance against control teams' changes. Experimental teams maintained performance improvements during reversed-role simulations. Simulation-based investigation into OHCA resuscitation revealed considerable variability and improvable deficiencies in small EMS teams. Goal-directed, automation-assisted OHCA management augmented select resuscitation bundle element performance without comprehensive improvement.

Perception of CPR quality: Influence of CPR feedback, Just-in-Time CPR training and provider role.

PubMed

Cheng, Adam; Overly, Frank; Kessler, David; Nadkarni, Vinay M; Lin, Yiqun; Doan, Quynh; Duff, Jonathan P; Tofil, Nancy M; Bhanji, Farhan; Adler, Mark; Charnovich, Alex; Hunt, Elizabeth A; Brown, Linda L

2015-02-01

Many healthcare providers rely on visual perception to guide cardiopulmonary resuscitation (CPR), but little is known about the accuracy of provider perceptions of CPR quality. We aimed to describe the difference between perceived versus measured CPR quality, and to determine the impact of provider role, real-time visual CPR feedback and Just-in-Time (JIT) CPR training on provider perceptions. We conducted secondary analyses of data collected from a prospective, multicenter, randomized trial of 324 healthcare providers who participated in a simulated cardiac arrest scenario between July 2012 and April 2014. Participants were randomized to one of four permutations of: JIT CPR training and real-time visual CPR feedback. We calculated the difference between perceived and measured quality of CPR and reported the proportion of subjects accurately estimating the quality of CPR within each study arm. Participants overestimated achieving adequate chest compression depth (mean difference range: 16.1-60.6%) and rate (range: 0.2-51%), and underestimated chest compression fraction (0.2-2.9%) across all arms. Compared to no intervention, the use of real-time feedback and JIT CPR training (alone or in combination) improved perception of depth (p<0.001). Accurate estimation of CPR quality was poor for chest compression depth (0-13%), rate (5-46%) and chest compression fraction (60-63%). Perception of depth is more accurate in CPR providers versus team leaders (27.8% vs. 7.4%; p=0.043) when using real-time feedback. Healthcare providers' visual perception of CPR quality is poor. Perceptions of CPR depth are improved by using real-time visual feedback and with prior JIT CPR training. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Haemodynamic effects of adrenaline (epinephrine) depend on chest compression quality during cardiopulmonary resuscitation in pigs.

PubMed

Pytte, Morten; Kramer-Johansen, Jo; Eilevstjønn, Joar; Eriksen, Morten; Strømme, Taevje A; Godang, Kristin; Wik, Lars; Steen, Petter Andreas; Sunde, Kjetil

2006-12-01

Adrenaline (epinephrine) is used during cardiopulmonary resuscitation (CPR) based on animal experiments without supportive clinical data. Clinically CPR was reported recently to have much poorer quality than expected from international guidelines and what is generally done in laboratory experiments. We have studied the haemodynamic effects of adrenaline during CPR with good laboratory quality and with quality simulating clinical findings and the feasibility of monitoring these effects through VF waveform analysis. After 4 min of cardiac arrest, followed by 4 min of basic life support, 14 pigs were randomised to ClinicalCPR (intermittent manual chest compressions, compression-to-ventilation ratio 15:2, compression depth 30-38 mm) or LabCPR (continuous mechanical chest compressions, 12 ventilations/min, compression depth 45 mm). Adrenaline 0.02 mg/kg was administered 30 s thereafter. Plasma adrenaline concentration peaked earlier with LabCPR than with ClinicalCPR, median (range), 90 (30, 150) versus 150 (90, 270) s (p = 0.007), respectively. Coronary perfusion pressure (CPP) and cortical cerebral blood flow (CCBF) increased and femoral blood flow (FBF) decreased after adrenaline during LabCPR (mean differences (95% CI) CPP 17 (6, 29) mmHg (p = 0.01), FBF -5.0 (-8.8, -1.2) ml min(-1) (p = 0.02) and median difference CCBF 12% of baseline (p = 0.04)). There were no significant effects during ClinicalCPR (mean differences (95% CI) CPP 4.7 (-3.2, 13) mmHg (p = 0.2), FBF -0.2 (-4.6, 4.2) ml min(-1)(p = 0.9) and CCBF 3.6 (-1.8, 9.0)% of baseline (p = 0.15)). Slope VF waveform analysis reflected changes in CPP. Adrenaline improved haemodynamics during laboratory quality CPR in pigs, but not with quality simulating clinically reported CPR performance.

A simulation tool to study high-frequency chest compression energy transfer mechanisms and waveforms for pulmonary disease applications.

PubMed

O'Clock, George D; Lee, Yong Wan; Lee, Jongwon; Warwick, Warren J

2010-07-01

High-frequency chest compression (HFCC) can be used as a therapeutic intervention to assist in the transport and clearance of mucus and enhance water secretion for cystic fibrosis patients. An HFCC pump-vest and half chest-lung simulation, with 23 lung generations, has been developed using inertance, compliance, viscous friction relationships, and Newton's second law. The simulation has proven to be useful in studying the effects of parameter variations and nonlinear effects on HFCC system performance and pulmonary system response. The simulation also reveals HFCC waveform structure and intensity changes in various segments of the pulmonary system. The HFCC system simulation results agree with measurements, indicating that the HFCC energy transport mechanism involves a mechanically induced pulsation or vibration waveform with average velocities in the lung that are dependent upon small air displacements over large areas associated with the vest-chest interface. In combination with information from lung physiology, autopsies and a variety of other lung modeling efforts, the results of the simulation can reveal a number of therapeutic implications.

Traumatic asphyxia.

PubMed

Montes-Tapia, Fernando; Barreto-Arroyo, Itzel; Cura-Esquivel, Idalia; Rodríguez-Taméz, Antonio; de la O-Cavazos, Manuel

2014-02-01

Traumatic asphyxia is a rare condition in children that usually occurs after severe compression to the chest or abdomen. We report 3 cases in patients 18, 20, and 36 months of age who presented signs and symptoms of traumatic asphyxia after car accidents. Two clinical features were consistent in all 3 patients: multiple petechiae on the face and bulbar conjunctival hemorrhage; 2 patients had facial cyanosis, and 1 had facial edema.In children, the number of clinical manifestations that should be evident to diagnose traumatic asphyxia has not been ascertained. However, in any history of trauma with compression of the chest or abdomen and signs of increased intravenous craniocervical pressure, traumatic asphyxia should be suspected.

The evaluation of upper body muscle activity during the performance of external chest compressions in simulated hypogravity

NASA Astrophysics Data System (ADS)

Krygiel, Rebecca G.; Waye, Abigail B.; Baptista, Rafael Reimann; Heidner, Gustavo Sandri; Rehnberg, Lucas; Russomano, Thais

2014-04-01

BACKGROUND: This original study evaluated the electromyograph (EMG) activity of four upper body muscles: triceps brachii, erector spinae, upper rectus abdominis, and pectoralis major, while external chest compressions (ECCs) were performed in simulated Martian hypogravity using a Body Suspension Device, counterweight system, and standard full body cardiopulmonary resuscitation (CPR) mannequin. METHOD: 20 young, healthy male subjects were recruited. One hundred compressions divided into four sets, with roughly six seconds between each set to indicate 'ventilation', were performed within approximately a 1.5 minute protocol. Chest compression rate, depth and number were measured along with the subject's heart rate (HR) and rating of perceived exertion (RPE). RESULTS: All mean values were used in two-tailed t-tests using SPSS to compare +1 Gz values (control) versus simulated hypogravity values. The AHA (2005) compression standards were maintained in hypogravity. RPE and HR increased by 32% (p < 0.001) and 44% (p = 0.002), respectively, when ECCs were performed during Mars simulation, in comparison to +1 Gz. In hypogravity, the triceps brachii showed significantly less activity (p < 0.001) when compared with the other three muscles studied. The comparison of all the other muscles showed no difference at +1 Gz or in hypogravity. CONCLUSIONS: This study was among the first of its kind, however several limitations were faced which hopefully will not exist in future studies. Evaluation of a great number of muscles will allow space crews to focus on specific strengthening exercises within their current training regimes in case of a serious cardiac event in hypogravity.

Is there any alternative to standard chest compression techniques in infants? A randomized manikin trial of the new "2-thumb-fist" option.

PubMed

Ladny, Jerzy R; Smereka, Jacek; Rodríguez-Núñez, Antonio; Leung, Steve; Ruetzler, Kurt; Szarpak, Lukasz

2018-02-01

Pediatric cardiac arrest is a fatal emergent condition that is associated with high mortality, permanent neurological injury, and is a socioeconomic burden at both the individual and national levels. The aim of this study was to test in an infant manikin a new chest compression (CC) technique ("2 thumbs-fist" or nTTT) in comparison with standard 2-finger (TFT) and 2-thumb-encircling hands techniques (TTEHT). This was prospective, randomized, crossover manikin study. Sixty-three nurses who performed a randomized sequence of 2-minute continuous CC with the 3 techniques in random order. Simulated systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), and pulse pressures (PP, SBP-DBP) in mm Hg were measured. The nTTT resulted in a higher median SBP value (69 [IQR, 63-74] mm Hg) than TTEHT (41.5 [IQR, 39-42] mm Hg), (P < .001) and TFT (26.5 [IQR, 25.5-29] mm Hg), (P <.001). The simulated median value of DBP was 20 (IQR, 19-20) mm Hg with nTTT, 18 (IQR, 17-19) mm Hg with TTEHT and 23.5 (IQR, 22-25.5) mm Hg with TFT. DBP was significantly higher with TFT than with TTEHT (P <.001), as well as with TTEHT than nTTT (P <.001). Median values of simulated MAP were 37 (IQR, 34.5-38) mm Hg with nTTT, 26 (IQR, 25-26) mm Hg with TTEHT and 24.5 (IQR,23.5-26.5) mm Hg with TFT. A statistically significant difference was noticed between nTTT and TFT (P <.001), nTTT and TTEHT (P <.001), and between TTEHT and TFT (P <.001). Sixty-one subjects (96.8%) preferred the nTTT over the 2 standard methods. The new nTTT technique achieved higher SBP and MAP compared to the standard CC techniques in our infant manikin model. nTTT appears to be a suitable alternative or complementary to the TFT and TTEHT.

Active cycle of breathing technique for cystic fibrosis.

PubMed

Mckoy, Naomi A; Wilson, Lisa M; Saldanha, Ian J; Odelola, Olaide A; Robinson, Karen A

2016-07-05

People with cystic fibrosis experience chronic airway infections as a result of mucus build up within the lungs. Repeated infections often cause lung damage and disease. Airway clearance therapies aim to improve mucus clearance, increase sputum production, and improve airway function. The active cycle of breathing technique (also known as ACBT) is an airway clearance method that uses a cycle of techniques to loosen airway secretions including breathing control, thoracic expansion exercises, and the forced expiration technique. This is an update of a previously published review. To compare the clinical effectiveness of the active cycle of breathing technique with other airway clearance therapies in cystic fibrosis. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of last search: 25 April 2016. Randomised or quasi-randomised controlled clinical studies, including cross-over studies, comparing the active cycle of breathing technique with other airway clearance therapies in cystic fibrosis. Two review authors independently screened each article, abstracted data and assessed the risk of bias of each study. Our search identified 62 studies, of which 19 (440 participants) met the inclusion criteria. Five randomised controlled studies (192 participants) were included in the meta-analysis; three were of cross-over design. The 14 remaining studies were cross-over studies with inadequate reports for complete assessment. The study size ranged from seven to 65 participants. The age of the participants ranged from six to 63 years (mean age 22.33 years). In 13 studies, follow up lasted a single day. However, there were two long-term randomised controlled studies with follow up of one to three years. Most of the studies did not report on key quality items, and therefore, have an unclear risk of bias in terms of random sequence generation, allocation concealment, and outcome assessor blinding. Due to the nature of the intervention, none of the studies blinded participants or the personnel applying the interventions. However, most of the studies reported on all planned outcomes, had adequate follow up, assessed compliance, and used an intention-to-treat analysis.Included studies compared the active cycle of breathing technique with autogenic drainage, airway oscillating devices, high frequency chest compression devices, conventional chest physiotherapy, and positive expiratory pressure. Preference of technique varied: more participants preferred autogenic drainage over the active cycle of breathing technique; more preferred the active cycle of breathing technique over airway oscillating devices; and more were comfortable with the active cycle of breathing technique versus high frequency chest compression. No significant difference was seen in quality of life, sputum weight, exercise tolerance, lung function, or oxygen saturation between the active cycle of breathing technique and autogenic drainage or between the active cycle of breathing technique and airway oscillating devices. There was no significant difference in lung function and the number of pulmonary exacerbations between the active cycle of breathing technique alone or in conjunction with conventional chest physiotherapy. All other outcomes were either not measured or had insufficient data for analysis. There is insufficient evidence to support or reject the use of the active cycle of breathing technique over any other airway clearance therapy. Five studies, with data from eight different comparators, found that the active cycle of breathing technique was comparable with other therapies in outcomes such as participant preference, quality of life, exercise tolerance, lung function, sputum weight, oxygen saturation, and number of pulmonary exacerbations. Longer-term studies are needed to more adequately assess the effects of the active cycle of breathing technique on outcomes important for people with cystic fibrosis such as quality of life and preference.

Optimizing Survival Outcomes For Adult Patients With Nontraumatic Cardiac Arrest.

PubMed

Jung, Julianna

2016-10-01

Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm. Management of cardiac arrest in circumstances such as pregnancy, pulmonary embolism, opioid overdose and other toxicologic causes, hypothermia, and coronary ischemia are also reviewed.

Cardiovascular causes of airway compression.

PubMed

Kussman, Barry D; Geva, Tal; McGowan, Francis X

2004-01-01

Compression of the paediatric airway is a relatively common and often unrecognized complication of congenital cardiac and aortic arch anomalies. Airway obstruction may be the result of an anomalous relationship between the tracheobronchial tree and vascular structures (producing a vascular ring) or the result of extrinsic compression caused by dilated pulmonary arteries, left atrial enlargement, massive cardiomegaly, or intraluminal bronchial obstruction. A high index of suspicion of mechanical airway compression should be maintained in infants and children with recurrent respiratory difficulties, stridor, wheezing, dysphagia, or apnoea unexplained by other causes. Prompt diagnosis is required to avoid death and minimize airway damage. In addition to plain chest radiography and echocardiography, diagnostic investigations may consist of barium oesophagography, magnetic resonance imaging (MRI), computed tomography, cardiac catheterization and bronchoscopy. The most important recent advance is MRI, which can produce high quality three-dimensional reconstruction of all anatomic elements allowing for precise anatomic delineation and improved surgical planning. Anaesthetic technique will depend on the type of vascular ring and the presence of any congenital heart disease or intrinsic lesions of the tracheobronchial tree. Vascular rings may be repaired through a conventional posterolateral thoracotomy, or utilizing video-assisted thoracoscopic surgery (VATS) or robotic endoscopic surgery. Persistent airway obstruction following surgical repair may be due to residual compression, secondary airway wall instability (malacia), or intrinsic lesions of the airway. Simultaneous repair of cardiac defects and vascular tracheobronchial compression carries a higher risk of morbidity and mortality.

A tourniquet assisted cardiopulmonary resuscitation augments myocardial perfusion in a porcine model of cardiac arrest.

PubMed

Yang, Zhengfei; Tang, David; Wu, Xiaobo; Hu, Xianwen; Xu, Jiefeng; Qian, Jie; Yang, Min; Tang, Wanchun

2015-01-01

During cardiopulmonary resuscitation (CPR), myocardial blood flow generated by chest compression rarely exceeds 35% of its normal level. Cardiac output generated by chest compression decreases gradually with the prolongation of cardiac arrest and resuscitation. Early studies have demonstrated that myocardial blood flow during CPR is largely dependent on peripheral vascular resistance. In this study, we investigated the effects of chest compression in combination with physical control of peripheral vascular resistance assisted by tourniquets on myocardial blood flow during CPR. Ventricular fibrillation was induced and untreated for 7 min in ten male domestic pigs weighing between 33 and 37 kg. The animals were then randomized to receive CPR alone or a tourniquet assisted CPR (T-CPR). In the CPR alone group, chest compression was performed by a miniaturized mechanical chest compressor. In the T-CPR group, coincident with the start of resuscitation, the thin elastic tourniquets were wrapped around the four limbs from the distal end to the proximal part. After 2 min of CPR, epinephrine (20 μg/kg) was administered via the femoral vein. After 5 min of CPR, defibrillation was attempted by a single 150 J shock. If resuscitation was not successful, CPR was resumed for 2 min before the next defibrillation. The protocol was continued until successful resuscitation or for a total of 15 min. Five minutes after resuscitation, the elastic tourniquets were removed. The resuscitated animals were observed for 2h. T-CPR generated significantly greater coronary perfusion pressure, end-tidal carbon dioxide and carotid blood flow. There was no difference in both intrathoracic positive and negative pressures between the two groups. All animals were successfully resuscitated with a single shock in both groups. There were no significant changes in hemodynamics observed in the animals treated in the T-CPR group before-and-after the release of tourniquets at post-resuscitation 5 min. T-CPR improves myocardial and cerebral perfusion during CPR. It may provide a new and convenient method for augmenting myocardial and cerebral blood flow during CPR. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The 2015 Resuscitation Council of Asia (RCA) guidelines on adult basic life support for lay rescuers.

PubMed

Chung, Sung Phil; Sakamoto, Tetsuya; Lim, Swee Han; Ma, Mathew Huei-Ming; Wang, Tzong-Luen; Lavapie, Francis; Krisanarungson, Sopon; Nonogi, Hiroshi; Hwang, Sung Oh

2016-08-01

This paper introduces adult basic life support (BLS) guidelines for lay rescuers of the resuscitation council of Asia (RCA) developed for the first time. The RCA BLS guidelines for lay rescuers have been established by expert consensus among BLS Guidelines Taskforce of the RCA on the basis of the 2015 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science with Treatment Recommendations. The RCA recommends compression-only CPR for lay rescuers and emphasizes high-quality CPR with chest compression depth of approximately 5cm and chest compression rate of 100-120min(-1). Role of emergency medical dispatchers in helping lay rescuers recognize cardiac arrest and perform CPR is also emphasized. The RCA guidelines will contribute to help Asian countries establish and implement their own CPR guidelines in the context of their domestic circumstances. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Human occupants in low-speed frontal sled tests: effects of pre-impact bracing on chest compression, reaction forces, and subject acceleration.

PubMed

Kemper, Andrew R; Beeman, Stephanie M; Madigan, Michael L; Duma, Stefan M

2014-01-01

The purpose of this study was to investigate the effects of pre-impact bracing on the chest compression, reaction forces, and accelerations experienced by human occupants during low-speed frontal sled tests. A total of twenty low-speed frontal sled tests, ten low severity (∼2.5g, Δv=5 kph) and ten medium severity (∼5g, Δv=10 kph), were performed on five 50th-percentile male human volunteers. Each volunteer was exposed to two impulses at each severity, one relaxed and the other braced prior to the impulse. A 59-channel chestband, aligned at the nipple line, was used to quantify the chest contour and anterior-posterior sternum deflection. Three-axis accelerometer cubes were attached to the sternum, 7th cervical vertebra, and sacrum of each subject. In addition, three linear accelerometers and a three-axis angular rate sensor were mounted to a metal mouthpiece worn by each subject. Seatbelt tension load cells were attached to the retractor, shoulder, and lap portions of the standard three-point driver-side seatbelt. In addition, multi-axis load cells were mounted to each interface between the subject and the test buck to quantify reaction forces. For relaxed tests, the higher test severity resulted in significantly larger peak values for all resultant accelerations, all belt forces, and three resultant reaction forces (right foot, seatpan, and seatback). For braced tests, the higher test severity resulted in significantly larger peak values for all resultant accelerations, and two resultant reaction forces (right foot and seatpan). Bracing did not have a significant effect on the occupant accelerations during the low severity tests, but did result in a significant decrease in peak resultant sacrum linear acceleration during the medium severity tests. Bracing was also found to significantly reduce peak shoulder and retractor belt forces for both test severities, and peak lap belt force for the medium test severity. In contrast, bracing resulted in a significant increase in the peak resultant reaction force for the right foot and steering column at both test severities. Chest compression due to belt loading was observed for all relaxed subjects at both test severities, and was found to increase significantly with increasing severity. Conversely, chest compression due to belt loading was essentially eliminated during the braced tests for all but one subject, who sustained minor chest compression due to belt loading during the medium severity braced test. Overall, the data from this study illustrate that muscle activation has a significant effect on the biomechanical response of human occupants in low-speed frontal impacts.

In patients with extensive subcutaneous emphysema, which technique achieves maximal clinical resolution: infraclavicular incisions, subcutaneous drain insertion or suction on in situ chest drain?

PubMed

Johnson, Charles H N; Lang, Sommer A; Bilal, Haris; Rammohan, Kandadai S

2014-06-01

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'In patients with extensive subcutaneous emphysema, which technique achieves maximal clinical resolution: infraclavicular incisions, subcutaneous drain insertion or suction on in situ chest drain?'. Altogether more than 200 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Subcutaneous emphysema is usually a benign, self-limiting condition only requiring conservative management. Interventions are useful in the context of severe patient discomfort, respiratory distress or persistent air leak. In the absence of any comparative study, it is not possible to choose definitively between infraclavicular incisions, drain insertion and increasing suction on an in situ drain as the best method for managing severe subcutaneous emphysema. All the three techniques described have been shown to provide effective relief. Increasing suction on a chest tube already in situ provided rapid relief in patients developing SE following pulmonary resection. A retrospective study showed resolution in 66%, increasing to 98% in those who underwent video-assisted thoracic surgery with identification and closure of the leak. Insertion of a drain into the subcutaneous tissue also provided rapid sustained relief. Several studies aided drainage by using regular compressive massage. Infraclavicular incisions were also shown to provide rapid relief, but were noted to be more invasive and carried the potential for cosmetic defect. No major complications were illustrated. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Finite element comparison of human and Hybrid III responses in a frontal impact.

PubMed

Danelson, Kerry A; Golman, Adam J; Kemper, Andrew R; Gayzik, F Scott; Clay Gabler, H; Duma, Stefan M; Stitzel, Joel D

2015-12-01

The improvement of finite element (FE) Human Body Models (HBMs) has made them valuable tools for investigating restraint interactions compared to anthropomorphic test devices (ATDs). The objective of this study was to evaluate the effect of various combinations of safety restraint systems on the sensitivity of thoracic injury criteria using matched ATD and Human Body Model (HBM) simulations at two crash severities. A total of seven (7) variables were investigated: 3-point belt with two (2) load limits, frontal airbag, knee bolster airbag, a buckle pretensioner, and two (2) delta-v's - 40kph and 50kph. Twenty four (24) simulations were conducted for the Hybrid III ATD FE model and repeated with a validated HBM for 48 total simulations. Metrics tested in these conditions included sternum deflection, chest acceleration, chest excursion, Viscous Criteria (V*C) criteria, pelvis acceleration, pelvis excursion, and femur forces. Additionally, chest band deflection and rib strain distribution were measured in the HBM for additional restraint condition discrimination. The addition of a frontal airbag had the largest effect on the occupant chest metrics with an increase in chest compression and acceleration but a decrease in excursion. While the THUMS and Hybrid III occupants demonstrated the same trend in the chest compression measurements, there were conflicting results in the V*C, acceleration, and displacement metrics. Similarly, the knee bolster airbag had the largest effect on the pelvis with a decrease in acceleration and excursion. With a knee bolster airbag the simulated occupants gave conflicting results, the THUMS had a decrease in femur force and the ATD had an increase. Preferential use of dummies or HBM's is not debated; however, this study highlights the ability of HBM metrics to capture additional chest response metrics. Copyright © 2015 Elsevier Ltd. All rights reserved.

Retention of Cardiopulmonary Resuscitation Skills by Medical Students.

ERIC Educational Resources Information Center

Fossel, Michael; And Others

1983-01-01

A study of preclinical medical students' cardiopulmonary resuscitation (CPR) skills showed students had a very recent CPR course had a significantly lower failure rate than those with courses one or two years previously. The most frequent errors were in chest compression rate and inability to adhere to the single-rescuer compression-to-ventilation…

A multicenter observer performance study of 3D JPEG2000 compression of thin-slice CT.

PubMed

Erickson, Bradley J; Krupinski, Elizabeth; Andriole, Katherine P

2010-10-01

The goal of this study was to determine the compression level at which 3D JPEG2000 compression of thin-slice CTs of the chest and abdomen-pelvis becomes visually perceptible. A secondary goal was to determine if residents in training and non-physicians are substantially different from experienced radiologists in their perception of compression-related changes. This study used multidetector computed tomography 3D datasets with 0.625-1-mm thickness slices of standard chest, abdomen, or pelvis, clipped to 12 bits. The Kakadu v5.2 JPEG2000 compression algorithm was used to compress and decompress the 80 examinations creating four sets of images: lossless, 1.5 bpp (8:1), 1 bpp (12:1), and 0.75 bpp (16:1). Two randomly selected slices from each examination were shown to observers using a flicker mode paradigm in which observers rapidly toggled between two images, the original and a compressed version, with the task of deciding whether differences between them could be detected. Six staff radiologists, four residents, and six PhDs experienced in medical imaging (from three institutions) served as observers. Overall, 77.46% of observers detected differences at 8:1, 94.75% at 12:1, and 98.59% at 16:1 compression levels. Across all compression levels, the staff radiologists noted differences 64.70% of the time, the resident's detected differences 71.91% of the time, and the PhDs detected differences 69.95% of the time. Even mild compression is perceptible with current technology. The ability to detect differences does not equate to diagnostic differences, although perception of compression artifacts could affect diagnostic decision making and diagnostic workflow.

The superiority of the two-thumb over the two-finger technique for single-rescuer infant cardiopulmonary resuscitation.

PubMed

Lee, Sang Yoon; Hong, Jun Young; Oh, Je Hyeok; Son, Sun-Han

2017-03-21

The two-finger technique (TFT) using the index-middle fingers of the right hand (TFT-R23) was recently confirmed to produce deeper chest compression depth (CCD) compared with the TFT using any other fingers. This study was carried out to confirm whether the TFT-R23 would be as effective as the two-thumb technique (TTT). In addition, individual finger strengths were measured to identify the reasons why the TTT and TFT-R23 produced deeper CCD than any other methods. This prospective randomized cross-over trial compared TTT with TFT-R23. A total of 37 doctors conducted 2 min single-rescuer cardiopulmonary resuscitation using TTT and TFT-R23 in a random order using a 3-month-old sized infant manikin laid on the floor. The chest compression to ventilation ratio was set to 15 : 2. In addition, finger strengths were measured using a pinch meter. The actual CCD of the TTT was significantly deeper than that of the TFT-R23 (41.3±1.3 vs. 39.8±1.5 mm, P<0.001). Although the hands-off time of the TTT was significantly longer than that of the TFT-R23 (55.6±5.7 vs. 53.6±5.8 s, P=0.002), the mean difference was only 2.0±3.7 s (95% confidence interval: 0.755-3.245). The finger strength of the TTT was significantly higher than that of TFT-R23 (23.8±10.1 vs. 13.7±5.1 kg, P<0.001). The TTT produced deeper CCD compared with that of the TFT-R23 because the finger strength of the TTT was significantly higher than that of the TFT-R23.

Chest compression rate feedback based on transthoracic impedance.

PubMed

González-Otero, Digna M; Ruiz de Gauna, Sofía; Ruiz, Jesus; Daya, Mohamud R; Wik, Lars; Russell, James K; Kramer-Johansen, Jo; Eftestøl, Trygve; Alonso, Erik; Ayala, Unai

2015-08-01

Quality of cardiopulmonary resuscitation (CPR) is an important determinant of survival from cardiac arrest. The use of feedback devices is encouraged by current resuscitation guidelines as it helps rescuers to improve quality of CPR performance. To determine the feasibility of a generic algorithm for feedback related to chest compression (CC) rate using the transthoracic impedance (TTI) signal recorded through the defibrillation pads. We analysed 180 episodes collected equally from three different emergency services, each one using a unique defibrillator model. The new algorithm computed the CC-rate every 2s by analysing the TTI signal in the frequency domain. The obtained CC-rate values were compared with the gold standard, computed using the compression force or the ECG and TTI signals when the force was not recorded. The accuracy of the CC-rate, the proportion of alarms of inadequate CC-rate, chest compression fraction (CCF) and the mean CC-rate per episode were calculated. Intervals with CCs were detected with a mean sensitivity and a mean positive predictive value per episode of 96.3% and 97.0%, respectively. Estimated CC-rate had an error below 10% in 95.8% of the time. Mean percentage of accurate alarms per episode was 98.2%. No statistical differences were found between the gold standard and the estimated values for any of the computed metrics. We developed an accurate algorithm to calculate and provide feedback on CC-rate using the TTI signal. This could be integrated into automated external defibrillators and help improve the quality of CPR in basic-life-support settings. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Association Between Left Atrial Compression And Atrial Fibrillation: A Case Presentation And A Short Review Of Literature.

PubMed

Ahmed, Niloy; Carlos, Morales-Mangual; Moshe, Gunsburg; Yitzhak, Rosen

2016-01-01

This case report describes a patient who developed palpitations and chest pain and was found to be in atrial fibrillation, which was likely due to the presence of an extra-cardiac mass. This was compressing the left atrium. The mass was related to small cell carcinoma, which decreased significantly in size after chemotherapy. Resolution of the atrial fibrillation correlated temporally with reduction in the size of the mass and alleviation of the left atrial compression.

Evaluation of related factors and the outcome in cardiac arrest resuscitation at Thammasat Emergency Department.

PubMed

Amnuaypattanapon, Kumpol; Udomsubpayakul, Umaporn

2010-12-01

In the present study, we aimed to define the factors contributing to patient survival after treatment by cardiopulmonary resuscitation (CPR) following cardiac arrest. Retrospective analysis was performed on cardiac arrest patients (n=138) who had CPR in the emergency department (ED) at Thammasat University hospital from 2007-2009. Logistic regression was used to analyze factors that related to the sustained return of spontaneous circulation (ROSC) for 20 minutes, survival until discharge, and survival up to 1 month post discharge. The sustained ROSC was 22.5%, survival to discharge 5.6%, and survival from discharge to 1 month 3.6%. Significant factors related to sustained ROSC was the location of cardiac arrest, the cause of arrest, shockable rhythm with defibrillation, the time until chest compression, and CPR duration. The factor influencing survival to discharge was chest compression performed within 15 minutes after cardiac arrest (p = 0.048). No factor however could be attributed to survivability up to 1 month following discharge. Our findings attribute six factors associated to ROSC including the location of arrest, the cause of cardiac arrest, initial cardiac rhythm, shockable rhythm with defibrillation, the time until chest compression and CPR duration. Statistically, resuscitation performed within 15 minutes of cardiac arrest increases the survivability of patients until discharge. However no factors could be related to the percentage of patients surviving up to 1 month post discharge.

Simulated life-threatening emergency during robot-assisted surgery.

PubMed

Huser, Anna-Sophia; Müller, Dirk; Brunkhorst, Violeta; Kannisto, Päivi; Musch, Michael; Kröpfl, Darko; Groeben, Harald

2014-06-01

With the increasing use of robot-assisted techniques for urologic and gynecologic surgery in patients with severe comorbidities, the risk of a critical incidence during surgery increases. Due to limited access to the patient the start of effective measures to treat a life-threatening emergency could be delayed. Therefore, we tested the management of an acute emergency in an operating room setting with a full-size simulator in six complete teams. A full-size simulator (ISTAN, Meti, CA), modified to hold five trocars, was placed in a regular operating room and connected to a robotic system. Six teams (each with three nurses, one anesthesiologist, two urologists or gynecologists) were introduced to the scenario. Subsequently, myocardial fibrillation occurred. Time to first chest compression, removal of the robot, first defibrillation, and stabilization of circulation were obtained. After 7 weeks the simulation was repeated. The time to the start of chest compressions, removal of the robotic system, and first defibrillation were significantly improved at the second simulation. Time for restoration of stable circulation was improved from 417 ± 125 seconds to 224 ± 37 seconds (P=0.0054). Unexpected delays occurred during the first simulation because trocars had been removed from the patient but not from the robot, thus preventing the robot to be moved. Following proper training, resuscitation can be started within seconds. A repetition of the simulation significantly improved time for all steps of resuscitation. An emergency simulation of a multidisciplinary team in a real operating room setting can be strongly recommended.

CPR performance in the presence of audiovisual feedback or football shoulder pads.

PubMed

Tanaka, Shota; Rodrigues, Wayne; Sotir, Susan; Sagisaka, Ryo; Tanaka, Hideharu

2017-01-01

The initiation of cardiopulmonary resuscitation (CPR) can be complicated by the use of protective equipment in contact sports, and the rate of success in resuscitating the patient depends on the time from incident to start of CPR. The aim of our study was to see if (1) previous training, (2) the presence of audiovisual feedback and (3) the presence of football shoulder pads (FSP) affected the quality of chest compressions. Six basic life support certified athletic training students (BLS-ATS), six basic life support certified emergency medical service personnel (BLS-EMS) and six advanced cardiac life support certified emergency medical service personnel (ACLS-EMS) participated in a crossover manikin study. A quasi-experimental repeated measures design was used to measure the chest compression depth (cm), rate (cpm), depth accuracy (%) and rate accuracy (%) on four different conditions by using feedback and/or FSP. Real CPR Help manufactured by ZOLL (Chelmsford, Massachusetts, USA) was used for the audiovisual feedback. Three participants from each group performed 2 min of chest compressions at baseline first, followed by compressions with FSP, with feedback and with both FSP and feedback (FSP+feedback). The other three participants from each group performed compressions at baseline first, followed by compressions with FSP+feedback, feedback and FSP. CPR performance did not differ between the groups at baseline (median (IQR), BLS-ATS: 5.0 (4.4-6.1) cm, 114(96-131) cpm; BLS-EMS: 5.4 (4.1-6.4) cm, 112(99-131) cpm; ACLS-EMS: 6.4 (5.7-6.7) cm, 138(113-140) cpm; depth p=0.10, rate p=0.37). A statistically significant difference in the percentage of depth accuracy was found with feedback (median (IQR), 13.8 (0.9-49.2)% vs 69.6 (32.3-85.8)%; p=0.0002). The rate accuracy was changed from 17.1 (0-80.7)% without feedback to 59.2 (17.3-74.3)% with feedback (p=0.50). The use of feedback was effective for depth accuracy, especially in the BLS-ATS group, regardless of the presence of FSP (median (IQR), 22.0 (7.3-36.2)% vs 71.3 (35.4-86.5)%; p=0.0002). The use of audiovisual feedback positively affects the quality of the depth of CPR. Both feedback and FSP do not alter the rate measurements. Medically trained personnel are able to deliver the desired depth regardless of the presence of FSP even though shallower chest compressions depth can be seen in CPR with FSP. A feedback device must be introduced into the athletic training settings.

CPR performance in the presence of audiovisual feedback or football shoulder pads

PubMed Central

Tanaka, Shota; Rodrigues, Wayne; Sotir, Susan; Sagisaka, Ryo; Tanaka, Hideharu

2017-01-01

Objective The initiation of cardiopulmonary resuscitation (CPR) can be complicated by the use of protective equipment in contact sports, and the rate of success in resuscitating the patient depends on the time from incident to start of CPR. The aim of our study was to see if (1) previous training, (2) the presence of audiovisual feedback and (3) the presence of football shoulder pads (FSP) affected the quality of chest compressions. Methods Six basic life support certified athletic training students (BLS-ATS), six basic life support certified emergency medical service personnel (BLS-EMS) and six advanced cardiac life support certified emergency medical service personnel (ACLS-EMS) participated in a crossover manikin study. A quasi-experimental repeated measures design was used to measure the chest compression depth (cm), rate (cpm), depth accuracy (%) and rate accuracy (%) on four different conditions by using feedback and/or FSP. Real CPR Help manufactured by ZOLL (Chelmsford, Massachusetts, USA) was used for the audiovisual feedback. Three participants from each group performed 2 min of chest compressions at baseline first, followed by compressions with FSP, with feedback and with both FSP and feedback (FSP+feedback). The other three participants from each group performed compressions at baseline first, followed by compressions with FSP+feedback, feedback and FSP. Results CPR performance did not differ between the groups at baseline (median (IQR), BLS-ATS: 5.0 (4.4–6.1) cm, 114(96–131) cpm; BLS-EMS: 5.4 (4.1–6.4) cm, 112(99–131) cpm; ACLS-EMS: 6.4 (5.7–6.7) cm, 138(113–140) cpm; depth p=0.10, rate p=0.37). A statistically significant difference in the percentage of depth accuracy was found with feedback (median (IQR), 13.8 (0.9–49.2)% vs 69.6 (32.3–85.8)%; p=0.0002). The rate accuracy was changed from 17.1 (0–80.7)% without feedback to 59.2 (17.3–74.3)% with feedback (p=0.50). The use of feedback was effective for depth accuracy, especially in the BLS-ATS group, regardless of the presence of FSP (median (IQR), 22.0 (7.3–36.2)% vs 71.3 (35.4–86.5)%; p=0.0002). Conclusions The use of audiovisual feedback positively affects the quality of the depth of CPR. Both feedback and FSP do not alter the rate measurements. Medically trained personnel are able to deliver the desired depth regardless of the presence of FSP even though shallower chest compressions depth can be seen in CPR with FSP. A feedback device must be introduced into the athletic training settings. PMID:28761704

CPR - child (1 to 8 years old)

MedlinePlus

Rescue breathing and chest compressions - child; Resuscitation - cardiopulmonary - child; Cardiopulmonary resuscitation - child ... take care of children should learn infant and child CPR if they have not already. See www. ...

The specific effect of metronome guidance on the quality of one-person cardiopulmonary resuscitation and rescuer fatigue.

PubMed

Chung, Tae Nyoung; Kim, Sun Wook; You, Je Sung; Cho, Young Soon; Chung, Sung Phil; Park, Incheol; Kim, Seung Ho

2012-12-01

Metronome guidance is a simple and economic feedback method of guiding cardiopulmonary resuscitation (CPR). It has been proven for its usefulness in regulating the rate of chest compression and ventilation, but it is not yet clear how metronome use may affect compression depth or rescuer fatigue. The aim of this study was to assess the specific effect that metronome guidance has on the quality of CPR and rescuer fatigue. One-person CPRs were performed by senior medical students on Resusci Anne® manikins (Laerdal, Stavanger, Norway) with personal-computer skill-reporting systems. Half of the students performed CPR with metronome guidance and the other half without. CPR performance data, duration, and before-after trial differences in mean arterial pressure (MAP) and heart rate (HR) were compared between groups. Average compression depth (ACD) of the first five cycles, compression rate, no-flow fraction, and ventilation count were significantly lower in the metronome group (p=0.028, < 0.001, 0.001, and 0.041, respectively). Total CPR duration, total work (ACD × total compression count), and the before-after trial differences of the MAP and HR did not differ between the two groups. Metronome guidance is associated with lower chest compression depth of the first five cycles, while shortening the no-flow fraction and the ventilation count in a simulated one-person CPR model. Metronome guidance does not have an obvious effect of intensifying rescuer fatigue. Copyright © 2012 Elsevier Inc. All rights reserved.

[A first step to teaching basic life support in schools: Training the teachers].

PubMed

Pichel López, María; Martínez-Isasi, Santiago; Barcala-Furelos, Roberto; Fernández-Méndez, Felipe; Vázquez Santamariña, David; Sánchez-Santos, Luis; Rodríguez-Nuñez, Antonio

2017-12-07

Teachers may have an essential role in basic life support (BLS) training in schoolchildren. However, few data are available about their BLS learning abilities. To quantitatively assess the quality of BLS when performed by school teachers after a brief and simple training program. A quasi-experimental study with no control group, and involving primary and secondary education teachers from four privately managed and public funded schools was conducted in 3 stages: 1st. A knowledge test, 2nd: BLS training, and 3rd: Performance test. Training included a 40minutes lecture and 80minutes hands-on session with the help feedback on the quality of the chest compressions. A total of 81 teachers were included, of which 60.5% were women. After training, the percentage of subjects able to perform the BLS sequence rose from 1.2% to 46% (P<.001). Chest compression quality also improved significantly in terms of: correct hands position (97.6 vs. 72.3%; P<.001), mean depth (48.1 vs. 38.8mm; P<.001), percentage that reached recommended depth (46.5 vs. 21.5%; P<.001), percentage of adequate decompression (78.7 vs. 61.2%; P<.05), and percentage of compressions delivered at recommended rate (64.2 vs. 26.9%; P<.001). After and brief and simple training program, teachers of privately managed public funded schools were able to perform the BLS sequence and to produce chest compressions with a quality similar to that obtained by staff with a duty to assist cardiac arrest victims. The ability of schoolteachers to deliver good-quality BLS is a pre-requisite to be engaged in BLS training for schoolchildren. Copyright © 2017. Publicado por Elsevier España, S.L.U.

A comparison between over-the-head and lateral cardiopulmonary resuscitation with a single rescuer by bag-valve mask

PubMed Central

Nasiri, Ebrahim; Nasiri, Reza

2014-01-01

Context: mask fixation in the lateral position is difficult during CPR. Aim: the aim of this study is to compare the lateral CPR for the use of bag-valve mask by single paramedic rescuer as well as over-the-head CPR on the chest compression and ventilation on the manikin. Settings and Design: Mazandaran University of Medical Sciences. The design of this study was a randomized cross-over trial. Methods: participants learned a standardized theoretical introduction CPR according to the 2010 guidelines. The total number of chest compressions per two minutes was measured. Total number of correct and wrong ventilation per two minutes was evaluated. Statistical Analysis: we used Wilcoxon signed-rank test to analyze the non-normally distributed data in dependence groups A. P-value of more than 0.05 was considered to show statistical significance. Results: there were 100 participants (45 women and 55 men) who participated in the study from September to March, 2011. The compression and ventilation rate in lateral CPR was lower than OTH CPR. Around 51% of participants had correct chest compression rate more than 90 beats per minute in lateral CPR and 65% of them had equal or more than ten correct ventilations per minute. Conclusions: in conclusion, this study confirmed that in a simulated CPR model over-the-head position CPR led to a better BLS than the lateral position CPR by a single paramedic student with a BVM device. We also concluded that by this new BVM fixation method on the face of the patients in the lateral position CPR can be a good alternative over-the-head mask fixation by a single trained rescuer. PMID:24665237

The compressed breast during mammography and breast tomosynthesis: in vivo shape characterization and modeling

NASA Astrophysics Data System (ADS)

Rodríguez-Ruiz, Alejandro; Agasthya, Greeshma A.; Sechopoulos, Ioannis

2017-09-01

To characterize and develop a patient-based 3D model of the compressed breast undergoing mammography and breast tomosynthesis. During this IRB-approved, HIPAA-compliant study, 50 women were recruited to undergo 3D breast surface imaging with structured light (SL) during breast compression, along with simultaneous acquisition of a tomosynthesis image. A pair of SL systems were used to acquire 3D surface images by projecting 24 different patterns onto the compressed breast and capturing their reflection off the breast surface in approximately 12-16 s. The 3D surface was characterized and modeled via principal component analysis. The resulting surface model was combined with a previously developed 2D model of projected compressed breast shapes to generate a full 3D model. Data from ten patients were discarded due to technical problems during image acquisition. The maximum breast thickness (found at the chest-wall) had an average value of 56 mm, and decreased 13% towards the nipple (breast tilt angle of 5.2°). The portion of the breast not in contact with the compression paddle or the support table extended on average 17 mm, 18% of the chest-wall to nipple distance. The outermost point along the breast surface lies below the midline of the total thickness. A complete 3D model of compressed breast shapes was created and implemented as a software application available for download, capable of generating new random realistic 3D shapes of breasts undergoing compression. Accurate characterization and modeling of the breast curvature and shape was achieved and will be used for various image processing and clinical tasks.

Metronome improves compression and ventilation rates during CPR on a manikin in a randomized trial.

PubMed

Kern, Karl B; Stickney, Ronald E; Gallison, Leanne; Smith, Robert E

2010-02-01

We hypothesized that a unique tock and voice metronome could prevent both suboptimal chest compression rates and hyperventilation. A prospective, randomized, parallel design study involving 34 pairs of paid firefighter/emergency medical technicians (EMTs) performing two-rescuer CPR using a Laerdal SkillReporter Resusci Anne manikin with and without metronome guidance was performed. Each CPR session consisted of 2 min of 30:2 CPR with an unsecured airway, then 4 min of CPR with a secured airway (continuous compressions at 100 min(-1) with 8-10 ventilations/min), repeated after the rescuers switched roles. The metronome provided "tock" prompts for compressions, transition prompts between compressions and ventilations, and a spoken "ventilate" prompt. During CPR with a bag/valve/mask the target compression rate of 90-110 min(-1) was achieved in 5/34 CPR sessions (15%) for the control group and 34/34 sessions (100%) for the metronome group (p<0.001). An excessive ventilation rate was not observed in either the metronome or control group during CPR with a bag/valve/mask. During CPR with a bag/endotracheal tube, the target of both a compression rate of 90-110 min(-1) and a ventilation rate of 8-11 min(-1) was achieved in 3/34 CPR sessions (9%) for the control group and 33/34 sessions (97%) for the metronome group (p<0.001). Metronome use with the secured airway scenario significantly decreased the incidence of over-ventilation (11/34 EMT pairs vs. 0/34 EMT pairs; p<0.001). A unique combination tock and voice prompting metronome was effective at directing correct chest compression and ventilation rates both before and after intubation. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

[Effects of a voice metronome on compression rate and depth in telephone assisted, bystander cardiopulmonary resuscitation: an investigator-blinded, 3-armed, randomized, simulation trial].

PubMed

van Tulder, Raphael; Roth, Dominik; Krammel, Mario; Laggner, Roberta; Schriefl, Christoph; Kienbacher, Calvin; Lorenzo Hartmann, Alexander; Novosad, Heinz; Constantin Chwojka, Christof; Havel, Christoph; Schreiber, Wolfgang; Herkner, Harald

2015-01-01

We investigated the effect on compression rate and depth of a conventional metronome and a voice metronome in simulated telephone-assisted, protocol-driven bystander Cardiopulmonary resucitation (CPR) compared to standard instruction. Thirty-six lay volunteers performed 10 minutes of compression-only CPR in a prospective, investigator-blinded, 3-arm study on a manikin. Participants were randomized either to standard instruction ("push down firmly, 5 cm"), a regular metronome pacing 110 beats per minute (bpm), or a voice metronome continuously prompting "deep-deepdeep- deeper" at 110 bpm. The primary outcome was deviation from the ideal chest compression target range (50 mm compression depth x 100 compressions per minute x 10 minutes = 50 m). Secondary outcomes were CPR quality measures (compression and leaning depth, rate, no-flow times) and participants' related physiological response (heart rate, blood pressure and nine hole peg test and borg scales score). We used a linear regression model to calculate effects. The mean (SD) deviation from the ideal target range (50 m) was -11 (9) m in the standard group, -20 (11) m in the conventional metronome group (adjusted difference [95%, CI], 9.0 [1.2-17.5 m], P=.03), and -18 (9) m in the voice metronome group (adjusted difference, 7.2 [-0.9-15.3] m, P=.08). Secondary outcomes (CPR quality measures and physiological response of participants to CPR performance) showed no significant differences. Compared to standard instruction, the conventional metronome showed a significant negative effect on the chest compression target range. The voice metronome showed a non-significant negative effect and therefore cannot be recommended for regular use in telephone-assisted CPR.

Modern BLS, dispatch and AED concepts.

PubMed

Koster, Rudolph W

2013-09-01

Basic Life Support has changed significantly over the last 15 years. Evidence-based changes in recommendations involved compression rate, compression depth and the ratio between compressions and ventilations. There is much evidence that early basic life support increases the probability of survival two- to three-fold. Recognition of a cardiac arrest remains challenging for witness and dispatcher. Educating the public in basic life support and recognition of cardiac arrest are key factors in improving survival of cardiac arrest. The large differences in survival between countries and regions clearly indicate that education and implementation must be high on the agenda in each community. Dispatchers play an increasingly important role in the process, both in rapid recognition of the cardiac arrest as well as giving telephone guidance to those bystanders that had not followed a training in basic life support. Those instructions should only instruct to deliver chest compressions. For those who have been trained in BLS and who are willing to give full CPR, should administer ventilations and chest compressions according to the guidelines. The AED plays a key role in early management of cardiac arrest and can substantially contribute to better survival. Logistics of placement of AEDs and the optimal way to bring AEDs to a victim require much more efforts, especially for victims in residential area's, where the great majority of cases of cardiac arrest occur. Copyright © 2013 Elsevier Ltd. All rights reserved.

Pectus carinatum.

PubMed

Coelho, Marlos de Souza; Guimarães, Paulo de Souza Fonseca

2007-01-01

Among the deformities of the thoracic wall,pectus carinatum has not received the same attention as has pectus excavatum. Few pulmonologists, pediatricians, and thoracic surgeons are aware of the approaches to treating this condition. As a consequence, patients with pectus carinatum are not referred for treatment. This deformity, with an incidence of 1:1000 teenagers, is oligosymptomatic. However, for aesthetic and emotional reasons, it accounts for a large number of medical appointments. Such patients are introverted and do not engage in physical activities, since they are unwilling to expose their chest, which also discourages them from going to the beach or to swimming pools. The diagnosis is clinical and visual, and details are obtained through chest X-rays and computed tomography. The treatment is based on a well-known organogram that summarizes orthopedic and surgical procedures. Dynamic compression, combined with physical exercises, is indicated for teenagers with flexible thorax in inferior and lateral pectus carinatum, with limited indication for those with superior pectus carinatum. For individuals of any age with rigid thorax, surgery is indicated for aesthetic reasons. Among the techniques described, the modified sternum chondroplasty stands out due to the excellent aesthetic results achieved.

Tricuspid valve chordal rupture due to airbag injury and review of pathophysiological mechanisms.

PubMed

Thekkudan, Joyce; Luckraz, Heyman; Ng, Alex; Norell, Mike

2012-09-01

Blunt trauma to the chest is associated with significant morbidity and mortality. The latter is usually due to an aortic transection, whereas the former is related to myocardial contusion, cardiac valve injury, coronary artery disruption and intracardiac shunts due to the formation of septal defects. The main mechanisms causing these injuries are due to the sudden deceleration force and compression within the chest cavity. Moreover, there is also the sudden increase in intravascular pressure due to a mechanical compression effect and a hormonal adrenergic surge during the event. We report a case of a tricuspid valve injury caused by the deployment of the airbag during a high-speed impact car accident and the subsequent damage to the tricuspid valve chordal mechanism. The patient's management and the pathophysiological mechanisms involved in the injury are reviewed.

Mechanical CPR: Who? When? How?

PubMed

Poole, Kurtis; Couper, Keith; Smyth, Michael A; Yeung, Joyce; Perkins, Gavin D

2018-05-29

In cardiac arrest, high quality cardiopulmonary resuscitation (CPR) is a key determinant of patient survival. However, delivery of effective chest compressions is often inconsistent, subject to fatigue and practically challenging.Mechanical CPR devices provide an automated way to deliver high-quality CPR. However, large randomised controlled trials of the routine use of mechanical devices in the out-of-hospital setting have found no evidence of improved patient outcome in patients treated with mechanical CPR, compared with manual CPR. The limited data on use during in-hospital cardiac arrest provides preliminary data supporting use of mechanical devices, but this needs to be robustly tested in randomised controlled trials.In situations where high-quality manual chest compressions cannot be safely delivered, the use of a mechanical device may be a reasonable clinical approach. Examples of such situations include ambulance transportation, primary percutaneous coronary intervention, as a bridge to extracorporeal CPR and to facilitate uncontrolled organ donation after circulatory death.The precise time point during a cardiac arrest at which to deploy a mechanical device is uncertain, particularly in patients presenting in a shockable rhythm. The deployment process requires interruptions in chest compression, which may be harmful if the pause is prolonged. It is recommended that use of mechanical devices should occur only in systems where quality assurance mechanisms are in place to monitor and manage pauses associated with deployment.In summary, mechanical CPR devices may provide a useful adjunct to standard treatment in specific situations, but current evidence does not support their routine use.

Junior physician skill and behaviour in resuscitation: a simulation study.

PubMed

Høyer, Christian Bjerre; Christensen, Erika F; Eika, Berit

2009-02-01

Physicians are expected to manage their role as teamleader during resuscitation. During inter-hospital transfer the physician has the highest medical credentials on a small team. The aim of this study was to describe physician behaviour as teamleaders in a simulated cardiac arrest during inter-hospital transfer. Our goal was to pinpoint deficits in knowledge and skill integration and make recommendations for improvements in education. An ambulance was the framework for the simulation; the scenario a patient with acute coronary syndrome suffering ventricular fibrillation during transportation. Physicians (graduation age < or =5 years) working in internal medicine departments in Denmark were studied. The ambulance crew was instructed to be passive to clarify the behaviour of the physicians. 72 physicians were studied. Chest compressions were initiated in 71 cases, ventilation and defibrillation in 72. The median times for arrival of the driver in the patient cabin, initiation of ventilation and chest compressions, and first defibrillation were all less than 1min. Medication was administered in 63/72 simulations (88%), after a median time of 210 s. Adrenaline was the preferred initial drug administered (58/63, 92%). Tasks delegated were ventilations, chest compressions, defibrillation, and administration of medication (97%, 92%, 42%, and 10% of cases, respectively). Junior physicians performed well with respect to the treatment given and the delegation of tasks. However, variations in the time of initiation it took for each treatment indicated lack of leadership skills. It is imperative that the education of physicians includes training in leadership.

High-quality cardiopulmonary resuscitation.

PubMed

Nolan, Jerry P

2014-06-01

The quality of cardiopulmonary resuscitation (CPR) impacts on outcome after cardiac arrest. This review will explore the factors that contribute to high-quality CPR and the metrics that can be used to monitor performance. A recent consensus statement from North America defined five key components of high-quality CPR: minimizing interruptions in chest compressions, providing compressions of adequate rate and depth, avoiding leaning on the chest between compressions, and avoiding excessive ventilation. Studies have shown that real-time feedback devices improve the quality of CPR and, in one before-and-after study, outcome from out-of-hospital cardiac arrest. There is evidence for increasing survival rates following out-of-hospital cardiac arrest and this is associated with increasing rates of bystander CPR. The quality of CPR provided by healthcare professionals can be improved with real-time feedback devices. The components of high-quality CPR and the metrics that can be measured and fed back to healthcare professionals have been defined by expert consensus. In the future, real-time feedback based on the physiological responses to CPR may prove more effective.

Coronary perfusion pressure and compression quality in maternal cardiopulmonary resuscitation in supine and left-lateral tilt positions: A prospective, crossover study using mannequins and swine models.

PubMed

Dohi, Satoshi; Ichizuka, Kiyotake; Matsuoka, Ryu; Seo, Kohei; Nagatsuka, Masaaki; Sekizawa, Akihiko

2017-09-01

The risk of maternal and fetal mortality is high if cardiopulmonary arrest occurs during pregnancy. To assess the best position for maternal cardiopulmonary resuscitation (CPR), a prospective randomized crossover study was undertaken, involving basic life support mannequin-based simulation (BLS-MS) and a swine model of pulseless electrical activity (an unstable cardiac state) incorporating a fetal mannequin (PEA-FM). The BLS-MS (performed by certified rescuers) served to evaluate the quality of chest compressions in 30° left lateral tilt (LLT) and supine positions. Based on a 5-point scale, each rescuer subjectively graded their experience. The PEA-FM model was used to compare coronary perfusion pressure readings during CPR in supine, supine with left uterine displacement, 30° LLT, and 30° right lateral tilt positions. Compression rate and correctness of hand position, compression depth, and recoil were measures of compression quality (BLS-MS). Compared with LLT position, supine position enabled correct hand position (rate: 0.99 vs 0.88; p<0.05) and compression depth (rate: 0.76 vs 0.36; p<0.001) significantly more often. Moreover, BLS-MS rescuers found chest compressions significantly easier to perform with the mannequin in supine (vs LLT) position (difficulty score: 1.75 vs 3.95; p<0.001). In the PEA-FM study arm, supine position with left uterine displacement and right lateral tilt positions had the highest and lowest recorded coronary perfusion pressure readings, respectively. Supine position with left uterine displacement is optimal for maternal CPR. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Viewing an ultra-brief chest compression only video improves some measures of bystander CPR performance and responsiveness at a mass gathering event.

PubMed

Beskind, Daniel L; Stolz, Uwe; Thiede, Rebecca; Hoyer, Riley; Robertson, Whitney; Brown, Jeffrey; Ludgate, Melissa; Tiutan, Timothy; Shane, Romy; McMorrow, Deven; Pleasants, Michael; Kern, Karl B; Panchal, Ashish R

2017-09-01

CPR training at mass gathering events is an important part of health initiatives to improve cardiac arrest survival. However, it is unclear whether training lay bystanders using an ultra-brief video at a mass gathering event improves CPR quality and responsiveness. To determine if showing a chest-compression only (CCO) Ultra-Brief Video (UBV) at a mass gathering event is effective in teaching lay bystanders CCO-CPR. Prospective control trial in adults (age >18) who attended either a women's University of Arizona or a men's Phoenix Suns basketball game. Participants were evaluated using a standardized cardiac arrest scenario with Laerdal Skillreporter™ mannequins. CPR responsiveness (calling 911, time to calling 911, starting compressions within two minutes) and quality (compression rate, depth, hands-off time) were assessed for participants and data collected at Baseline and Post-intervention. Different participants were tested before and after the exposure of the UBV. Data were analyzed via the intention to treat principle using logistic regression for binary outcomes and median regression for continuous outcomes, controlling for clustering by venue. A total of 96 people were consented (Baseline=45; Post intervention=51). CPR responsiveness post intervention improved with faster time to calling 911 (s) and time to starting compressions (sec). Likewise, CPR quality improved with deeper compressions and improved hands-off time. Showing a UBV at a mass gathering sporting event is associated with improved CPR responsiveness and performance for lay bystanders. This data provides further support for the use of mass media interventions. Copyright © 2017 Elsevier B.V. All rights reserved.

Capnography and chest wall impedance algorithms for ventilation detection during cardiopulmonary resuscitation

PubMed Central

Edelson, Dana P.; Eilevstjønn, Joar; Weidman, Elizabeth K.; Retzer, Elizabeth; Vanden Hoek, Terry L.; Abella, Benjamin S.

2009-01-01

Objective Hyperventilation is both common and detrimental during cardiopulmonary resuscitation (CPR). Chest wall impedance algorithms have been developed to detect ventilations during CPR. However, impedance signals are challenged by noise artifact from multiple sources, including chest compressions. Capnography has been proposed as an alternate method to measure ventilations. We sought to assess and compare the adequacy of these two approaches. Methods Continuous chest wall impedance and capnography were recorded during consecutive in-hospital cardiac arrests. Algorithms utilizing each of these data sources were compared to a manually determined “gold standard” reference ventilation rate. In addition, a combination algorithm, which utilized the highest of the impedance or capnography values in any given minute, was similarly evaluated. Results Data were collected from 37 cardiac arrests, yielding 438 min of data with continuous chest compressions and concurrent recording of impedance and capnography. The manually calculated mean ventilation rate was 13.3±4.3/min. In comparison, the defibrillator’s impedance-based algorithm yielded an average rate of 11.3±4.4/min (p=0.0001) while the capnography rate was 11.7±3.7/min (p=0.0009). There was no significant difference in sensitivity and positive predictive value between the two methods. The combination algorithm rate was 12.4±3.5/min (p=0.02), which yielded the highest fraction of minutes with respiratory rates within 2/min of the reference. The impedance signal was uninterpretable 19.5% of the time, compared with 9.7% for capnography. However, the signals were only simultaneously non-interpretable 0.8% of the time. Conclusions Both the impedance and capnography-based algorithms underestimated the ventilation rate. Reliable ventilation rate determination may require a novel combination of multiple algorithms during resuscitation. PMID:20036047

[Basic life support in pediatrics].

PubMed

Calvo Macías, A; Manrique Martínez, I; Rodríguez Núñez, A; López-Herce Cid, J

2006-09-01

Basic life support (BLS) is the combination of maneuvers that identifies the child in cardiopulmonary arrest and initiates the substitution of respiratory and circulatory function, without the use of technical adjuncts, until the child can receive more advanced treatment. BLS includes a sequence of steps or maneuvers that should be performed sequentially: ensuring the safety of rescuer and child, assessing unconsciousness, calling for help, positioning the victim, opening the airway, assessing breathing, ventilating, assessing signs of circulation and/or central arterial pulse, performing chest compressions, activating the emergency medical service system, and checking the results of resuscitation. The most important changes in the new guidelines are the compression: ventilation ratio and the algorithm for relieving foreign body airway obstruction. A compression/ ventilation ratio of 30:2 will be recommended for lay rescuers of infants, children and adults. Health professionals will use a compression: ventilation ratio of 15:2 for infants and children. If the health professional is alone, he/she may also use a ratio of 30:2 to avoid fatigue. In the algorithm for relieving foreign body airway obstruction, when the child becomes unconscious, the maneuvers will be similar to the BLS sequence with chest compressions (functioning as a deobstruction procedure) and ventilation, with reassessment of the mouth every 2 min to check for a foreign body, and evaluation of breathing and the presence of vital signs. BLS maneuvers are easy to learn and can be performed by anyone with adequate training. Therefore, BLS should be taught to all citizens.

[Influence of chest physiotherapy on gastro-œsophageal reflux in children].

PubMed

Reychler, G; Jacques, L; Arnold, D; Scheers, I; Smets, F; Sokal, E; Stephenne, X

2015-05-01

Chest physiotherapy is regularly prescribed for children, particularly in cystic fibrosis. Gastro-oesophageal reflux is common in this disease and is associated with certain chest physiotherapy manoeuvres. To evaluate the influence of two chest physiotherapy techniques on gastro-oesophageal reflux in children. Twenty-nine children were investigated by routine pHmetry. During the examination, they performed two chest physiotherapy manoeuvres in a seated position for 10 minutes each with a 5 minutes rest between them. The two manoeuvres used were a slow expiration technique (ELPr) and positive expiratory pressure (PEP). It was a prospective study and the order of manoeuvres was randomised. The pH traces were analysed blindly when all the studies had been completed. In the sample, 21% of children had gastro-oesophageal reflux during the physiotherapy session. No relationship was found between reflux during physiotherapy and pathological reflux (P=0.411) nor the physiotherapy technique used (P=0.219). The use of these two chest physiotherapy techniques in children in a seated position can produce gastro-oesophageal reflux. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

An Interventional Quality Improvement Study to Assess the Compliance to Cardiopulmonary Resuscitation Documentation in an Indian Teaching Hospital

PubMed Central

Nevrekar, Viraj; Panda, Prasan Kumar; Wig, Naveet; Pandey, R. M.; Agarwal, Praveen; Biswas, Ashutosh

2017-01-01

Background: Cardiopulmonary resuscitation (CPR) should be performed as per the international guidelines; however, compliance to these guidelines is difficult to assess. This study was conducted to determine the compliance to American Heart Association (2010) guideline on CPR documentation by among resident physicians before and after resident training (two arms). Methods: This pre–postinterventional quality improvement study was conducted in a referral center, North India. Data of hospitalized in-hospital CPR patients were collected in the form of quality indicators (checklists) as defined by the guideline and compared between two arms of before–after resident training. Residents were given appropriate training in CPR technique as per the guideline. The compliance of CPR documentation was assessed pre- and post-intervention. Results: The baseline arm compliance of various components of CPR documentation was low. The postintervention arm compliances of all components significantly increased (baseline, 2.5% to postintervention, 15.11%, P = 0.03). Individual components assessed were documentation of assessment of responsiveness (65% to 77.9%, P = 0.19), assessment of breathing (37.5% to 58.1%, P = 0.03), assessment of carotid pulse (62.5% to 79%, P = 0.05), rate of chest compressions (20% to 39.5%, P = 0.04), airway management (62.5% to 82.5%, P = 0.02), and compressions to breaths ratio (12.5% to 31.4%, P = 0.02). Documentation of chest compression rate compared to nondocumentation (12 of 42 vs. 11 of 84, P = 0.04) was independently associated with a higher rate of return of spontaneous circulation. The study however did not show any survival benefits. Conclusions: This study establishes that the compliance to CPR documentation is poor as assessed by CPR documentation content and quality, which improves after physician training, but not up to the mark level (100%) that may be due to busy Indian hospital settings and human behavioral factors. Due to ethical constraints of live CPR assessment, this document checklist approach may be considered as an internal quality assessment method for CPR compliance. Furthermore, correct instruction in CPR technique along with proper documentation of the procedure is required, followed up with periodic re-education during the residency period and beyond. PMID:29279637

Mechanics of airway and alveolar collapse in human breath-hold diving.

PubMed

Fitz-Clarke, John R

2007-11-15

A computational model of the human respiratory tract was developed to study airway and alveolar compression and re-expansion during deep breath-hold dives. The model incorporates the chest wall, supraglottic airway, trachea, branched airway tree, and elastic alveoli assigned time-dependent surfactant properties. Total lung collapse with degassing of all alveoli is predicted to occur around 235 m, much deeper than estimates for aquatic mammals. Hysteresis of the pressure-volume loop increases with maximum diving depth due to progressive alveolar collapse. Reopening of alveoli occurs stochastically as airway pressure overcomes adhesive and compressive forces on ascent. Surface area for gas exchange vanishes at collapse depth, implying that the risk of decompression sickness should reach a plateau beyond this depth. Pulmonary capillary transmural stresses cannot increase after local alveolar collapse. Consolidation of lung parenchyma might provide protection from capillary injury or leakage caused by vascular engorgement due to outward chest wall recoil at extreme depths.

Review of Chest Deflection Measurement Techniques and Transducers

DOT National Transportation Integrated Search

1978-06-01

A summary is presented of measurement techniques and transducers that have been used, or are presently available and exhibit potential for use in the measurement of dynamic chest deflection. Various techniques and transducers are evaluated for their ...

Neurogenic Thoracic Outlet Syndrome Caused by Vascular Compression of the Brachial Plexus: A Report of Two Cases

PubMed Central

Hanna, Amgad; Bodden, Larry O'Neil; Siebiger, Gabriel R. L.

2018-01-01

Thoracic outlet syndrome (TOS) is caused by compression of the brachial plexus and/or subclavian vessels as they pass through the cervicothoracobrachial region, exiting the chest. There are three main types of TOS: neurogenic TOS, arterial TOS, and venous TOS. Neurogenic TOS accounts for approximately 95% of all cases, and it is usually caused by physical trauma (posttraumatic etiology), chronic repetitive motion (functional etiology), or bone or muscle anomalies (congenital etiology). We present two cases in which neurogenic TOS was elicited by vascular compression of the inferior portion of the brachial plexus. PMID:29497457

Ten-year experience with the muscle split technique, bioabsorbable plates, and postoperative bracing for correction of pectus carinatum: the Innsbruck protocol.

PubMed

Del Frari, Barbara; Schwabegger, Anton H

2011-06-01

We reviewed further clinical experience with our approach for pectus carinatum repair: modified surgical approach of pectoralis muscle split technique, bioabsorbable plates with screws, and postoperative compressive brace. From April 2000 to February 2010, 55 patients underwent pectus carinatum repair at our department with modifications of conventional Ravitch repair. There were 14 female and 41 male patients, mean age of 19.3 years at the onset of treatment. Postoperative treatment involved fitting of a lightweight, patient-controlled chest brace. Average follow-up was 13.7 months. Patient satisfaction was excellent for 40 patients (72.7%) and good for the remaining 15 (27.3%); aesthetic appearance was excellent for 37 patients (67.3%) and good for the remaining 18 (32.7%). Postoperative evaluation was objective measurement with a thorax caliper and clinical examination. No major perioperative complications were observed. Postoperative complications were mild recurrence of deformity (n = 3) and persistent, mild, single costal cartilage protrusion (n = 2). No patient had palpable plates or screws, and there was no material breakdown. The combination of muscle split technique and absorbable osteosynthesis represents an alternative in pectus carinatum repair. The pectoralis muscle split technique allows early patient mobilization and rehabilitation. Bioabsorbable plates get completely absorbed, avoiding second operation, and chest brace provides postoperative immobilization of the anterior thoracic wall during healing and avoids development of hypertrophic scars. Our combined approach to the correction of pectus carinatum deformities yields predominantly excellent esthetic results, with low morbidity, low costs, and less invasiveness, leading to high patient satisfaction. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Occupant thorax response variations due to arm position and restraint systems in side impact crash scenarios.

PubMed

Gierczycka, Donata; Cronin, Duane S

2017-09-01

Recent epidemiological studies have identified that thoracic side airbags may vary in efficacy to reduce injury severity in side impact crash scenarios, while previous experimental and epidemiological studies have presented contrasting results. This study aimed to quantify the variations in occupant response in side impact conditions using a human body computational model integrated with a full vehicle model. The model was analyzed for a Moving Deformable Barrier side impact at 61km/h to assess two pre-crash arm positions, the incorporation of a seatbelt, and a thorax air bag on thorax response. The occupant response was evaluated using chest compression, the viscous criterion and thoracic spinal curvature. The arm position accounted for largest changes in the thorax response (106%) compared to the presence of the airbag and seatbelt systems (75%). It was also noted that the results were dependant on the method and location of thorax response measurement and this should be investigated further. Assessment using lateral displacement of the thoracic spine correlated positively with chest compression and Viscous Criterion, with the benefit of evaluating whole thorax response and provides a useful metric to compare occupant response for different side impact safety systems. The thoracic side airbag was found to increase the chest compression for the driving arm position (+70%), and reduced the injury metrics for the vertical arm position (-17%). This study demonstrated the importance of occupant arm position on variability in thoracic response, and provides insight for future design and optimization of side impact safety systems. Copyright © 2017 Elsevier Ltd. All rights reserved.

An innovative design for cardiopulmonary resuscitation manikins based on a human-like thorax and embedded flow sensors.

PubMed

Thielen, Mark; Joshi, Rohan; Delbressine, Frank; Bambang Oetomo, Sidarto; Feijs, Loe

2017-03-01

Cardiopulmonary resuscitation manikins are used for training personnel in performing cardiopulmonary resuscitation. State-of-the-art cardiopulmonary resuscitation manikins are still anatomically and physiologically low-fidelity designs. The aim of this research was to design a manikin that offers high anatomical and physiological fidelity and has a cardiac and respiratory system along with integrated flow sensors to monitor cardiac output and air displacement in response to cardiopulmonary resuscitation. This manikin was designed in accordance with anatomical dimensions using a polyoxymethylene rib cage connected to a vertebral column from an anatomical female model. The respiratory system was composed of silicon-coated memory foam mimicking lungs, a polyvinylchloride bronchus and a latex trachea. The cardiovascular system was composed of two sets of latex tubing representing the pulmonary and aortic arteries which were connected to latex balloons mimicking the ventricles and lumped abdominal volumes, respectively. These balloons were filled with Life/form simulation blood and placed inside polyether foam. The respiratory and cardiovascular systems were equipped with flow sensors to gather data in response to chest compressions. Three non-medical professionals performed chest compressions on this manikin yielding data corresponding to force-displacement while the flow sensors provided feedback. The force-displacement tests on this manikin show a desirable nonlinear behaviour mimicking chest compressions during cardiopulmonary resuscitation in humans. In addition, the flow sensors provide valuable data on the internal effects of cardiopulmonary resuscitation. In conclusion, scientifically designed and anatomically high-fidelity designs of cardiopulmonary resuscitation manikins that embed flow sensors can improve physiological fidelity and provide useful feedback data.

Comparison of effectiveness of class lecture versus workshop-based teaching of basic life support on acquiring practice skills among the health care providers

PubMed Central

Karim, Habib Md. Reazaul; Yunus, Md.; Bhattacharyya, Prithwis; Ahmed, Ghazal

2016-01-01

Background: Basic life support (BLS) is an integral part of emergency medical care. Studies have shown poor knowledge of it among health care providers who are usually taught BLS by lecture-based teachings in classes. Objectives: This study is designed to assess the effectiveness of class lecture versus workshop-based teaching of BLS on acquiring the practice skills on mannequin. Methods: After ethical approval and informed consent from the participants, the present study was conducted among the health care providers. Participants were grouped in lecture-based class teaching and workshop-based teaching. They were then asked to practice BLS on mannequin (Resusci Anne with QCPR) and evaluated as per performance parameters based on American Heart Association BLS. Statistical analyses are done by Fisher's exact t-test using GraphPad INSTAT software and P < 0.05 is taken as significant. Results: There were 55 participants in lecture-based teaching and 50 in workshop-based teaching group. There is no statistical difference in recognition of arrest, checking pulse, and starting chest compression (P > 0.05). Though more than 83% of lecture-based teaching group has started chest compression as compared 96% of workshop group; only 49% of the participants of lecture-based group performed quality chest compression as compared to 82% of other group (P = 0.0005). The workshop group also performed better bag mask ventilation and defibrillation (P < 0.0001). Conclusion: Workshop-based BLS teaching is more effective and lecture-based class teaching better is replaced in medical education curriculum. PMID:27308252

Quality of dispatch-assisted cardiopulmonary resuscitation by lay rescuers following a standard protocol in Japan: an observational simulation study.

PubMed

Asai, Hideki; Fukushima, Hidetada; Bolstad, Francesco; Okuchi, Kazuo

2018-04-01

Bystander cardiopulmonary resuscitation (CPR) is essential for improving the outcomes of sudden cardiac arrest patients. It has been reported that dispatch-assisted CPR (DACPR) accounts for more than half of the incidence of CPR undertaken by bystanders. Its quality, however, can be suboptimal. We aimed to measure the quality of DACPR using a simulation study. We recruited laypersons at a shopping mall and measured the quality of CPR carried out in our simulation. Dispatchers provided instruction in accordance with the standard DACPR protocol in Japan. Twenty-three laypersons (13 with CPR training experience within the past 2 years and 10 with no training experience) participated in this study. The median chest compression rate and depth were 106/min and 33 mm, respectively. The median time interval from placing the 119 call to the start of chest compressions was 119 s. No significant difference was found between the groups with and without training experience. However, subjects with training experience more frequently placed their hands correctly on the manikin (84.6% versus 40.0%; P = 0.026). Twelve participants (52.2%, seven in trained and five in untrained group) interrupted chest compressions for 3-18 s, because dispatchers asked if the patient started breathing or moving. This current simulation study showed that the quality of DACPR carried out by lay rescuers can be less than optimal in terms of depth, hand placement, and minimization of pauses. Further studies are required to explore better DACPR instruction methods to help lay rescuers perform CPR with optimal quality.

Comparison of effectiveness of class lecture versus workshop-based teaching of basic life support on acquiring practice skills among the health care providers.

PubMed

Karim, Habib Md Reazaul; Yunus, Md; Bhattacharyya, Prithwis; Ahmed, Ghazal

2016-01-01

Basic life support (BLS) is an integral part of emergency medical care. Studies have shown poor knowledge of it among health care providers who are usually taught BLS by lecture-based teachings in classes. This study is designed to assess the effectiveness of class lecture versus workshop-based teaching of BLS on acquiring the practice skills on mannequin. After ethical approval and informed consent from the participants, the present study was conducted among the health care providers. Participants were grouped in lecture-based class teaching and workshop-based teaching. They were then asked to practice BLS on mannequin (Resusci Anne with QCPR) and evaluated as per performance parameters based on American Heart Association BLS. Statistical analyses are done by Fisher's exact t-test using GraphPad INSTAT software and P < 0.05 is taken as significant. There were 55 participants in lecture-based teaching and 50 in workshop-based teaching group. There is no statistical difference in recognition of arrest, checking pulse, and starting chest compression (P > 0.05). Though more than 83% of lecture-based teaching group has started chest compression as compared 96% of workshop group; only 49% of the participants of lecture-based group performed quality chest compression as compared to 82% of other group (P = 0.0005). The workshop group also performed better bag mask ventilation and defibrillation (P < 0.0001). Workshop-based BLS teaching is more effective and lecture-based class teaching better is replaced in medical education curriculum.

Pediatric Out-of-Hospital Cardiac Arrest Characteristics and Their Association With Survival and Neurobehavioral Outcome.

PubMed

Meert, Kathleen L; Telford, Russell; Holubkov, Richard; Slomine, Beth S; Christensen, James R; Dean, J Michael; Moler, Frank W

2016-12-01

To investigate relationships between cardiac arrest characteristics and survival and neurobehavioral outcome among children recruited to the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial. Secondary analysis of Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial data. Thirty-six PICUs in the United States and Canada. All children (n = 295) had chest compressions for greater than or equal to 2 minutes, were comatose, and required mechanical ventilation after return of circulation. Neurobehavioral function was assessed using the Vineland Adaptive Behavior Scales, Second Edition at baseline (reflecting prearrest status) and 12 months postarrest. U.S. norms for Vineland Adaptive Behavior Scales, Second Edition scores are 100 (mean) ± 15 (SD). Higher scores indicate better functioning. Outcomes included 12-month survival and 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70. Cardiac etiology of arrest, initial arrest rhythm of ventricular fibrillation/tachycardia, shorter duration of chest compressions, compressions not required at hospital arrival, fewer epinephrine doses, and witnessed arrest were associated with greater 12-month survival and 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70. Weekend arrest was associated with lower 12-month survival. Body habitus was associated with 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70; underweight children had better outcomes, and obese children had worse outcomes. On multivariate analysis, acute life threatening event/sudden unexpected infant death, chest compressions more than 30 minutes, and weekend arrest were associated with lower 12-month survival; witnessed arrest was associated with greater 12-month survival. Acute life threatening event/sudden unexpected infant death, other respiratory causes of arrest except drowning, other/unknown causes of arrest, and compressions more than 30 minutes were associated with lower 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70. Many factors are associated with survival and neurobehavioral outcome among children who are comatose and require mechanical ventilation after out-of-hospital cardiac arrest. These factors may be useful for identifying children at risk for poor outcomes, and for improving prevention and resuscitation strategies.

First North American 50 cc Total Artificial Heart Experience: Conversion from a 70 cc Total Artificial Heart.

PubMed

Khalpey, Zain; Kazui, Toshinobu; Ferng, Alice S; Connell, Alana; Tran, Phat L; Meyer, Mark; Rawashdeh, Badi; Smith, Richard G; Sweitzer, Nancy K; Friedman, Mark; Lick, Scott; Slepian, Marvin J; Copeland, Jack G

2016-01-01

The 70 cc total artificial heart (TAH) has been utilized as bridge to transplant (BTT) for biventricular failure. However, the utilization of 70 cc TAH has been limited to large patients for the low output from the pulmonary as well as systemic vein compression after chest closure. Therefore, the 50 cc TAH was developed by SynCardia (Tucson, AZ) to accommodate smaller chest cavity. We report the first TAH exchange from a 70 to 50 cc due to a fit difficulty. The patient failed to be closed with a 70 cc TAH, although the patient met the conventional 70 cc TAH fit criteria. We successfully closed the chest with a 50 cc TAH.

Eccentric mastectomy and zigzag periareolar incision for gynecomastia.

PubMed

Tu, Lung-Chen; Tung, Kwang-Yi; Chen, Heng-Chang; Huang, Wen-Chen; Hsiao, Hung-Tao

2009-07-01

Gynecomastia is enlargement of the male breast caused by gland proliferation. Surgery is performed for symptom relief or for cosmetic reasons. The authors used a modified operative procedure, then evaluated the results and safety. Between 2001 and 2005, 22 men (median age, 26 years; range, 13-63 years) with gynecomastia underwent surgery. The operative procedure included a zigzag periareolar skin incision, eccentric subcutaneous mastectomy, and liposuction, with postoperative compression. All the patients were satisfied with the results of the surgery, which produced a chest contour resembling a normal male chest rather than simply a smaller breast. The only complication was a hematoma. One patient was found to have breast cancer. The normal male chest contour can be restored by the described method of eccentric subcutaneous mastectomy.

Male chest enhancement: pectoral implants.

PubMed

Benito-Ruiz, J; Raigosa, J M; Manzano-Surroca, M; Salvador, L

2008-01-01

The authors present their experience with the pectoral muscle implant for male chest enhancement in 21 patients. The markings and technique are thoroughly described. The implants used were manufactured and custom made. The candidates for implants comprised three groups: group 1 (18 patients seeking chest enhancement), group 2 (1 patient with muscular atrophy), and group 3 (2 patients with muscular injuries). Because of the satisfying results obtained, including significant enhancement of the chest contour and no major complications, this technique is used for an increasing number of male cosmetic surgeries.

Comparison of continuous compression with regular ventilations versus 30:2 compressions-ventilations strategy during mechanical cardiopulmonary resuscitation in a porcine model of cardiac arrest.

PubMed

Yang, Zhengfei; Liu, Qingyu; Zheng, Guanghui; Liu, Zhifeng; Jiang, Longyuan; Lin, Qing; Chen, Rui; Tang, Wanchun

2017-09-01

A compression-ventilation (C:V) ratio of 30:2 is recommended for adult cardiopulmonary resuscitation (CPR) by the current American Heart Association (AHA) guidelines. However, continuous chest compression (CCC) is an alternative strategy for CPR that minimizes interruption especially when an advanced airway exists. In this study, we investigated the effects of 30:2 mechanical CPR when compared with CCC in combination with regular ventilation in a porcine model. Sixteen male domestic pigs weighing 39±2 kg were utilized. Ventricular fibrillation was induced and untreated for 7 min. The animals were then randomly assigned to receive CCC combined with regular ventilation (CCC group) or 30:2 CPR (VC group). Mechanical chest compression was implemented with a miniaturized mechanical chest compressor. At the same time of beginning of precordial compression, the animals were mechanically ventilated at a rate of 10 breaths-per-minute in the CCC group or with a 30:2 C:V ratio in the VC group. Defibrillation was delivered by a single 150 J shock after 5 min of CPR. If failed to resuscitation, CPR was resumed for 2 min before the next shock. The protocol was stopped if successful resuscitation or at a total of 15 min. The resuscitated animals were observed for 72 h. Coronary perfusion pressure, end-tidal carbon dioxide and carotid blood flow in the VC group were similar to those achieved in the CCC group during CPR. No significant differences were observed in arterial blood gas parameters between two groups at baseline, VF 6 min, CPR 4 min and 30, 120 and 360 min post-resuscitation. Although extravascular lung water index of both groups significantly increased after resuscitation, no distinct difference was found between CCC and VC groups. All animals were successfully resuscitated and survived for 72 h with favorable neurologic outcomes in both groups. However, obviously more numbers of rib fracture were observed in CCC animals in comparison with VC animals. There was no difference in hemodynamic efficacy and gas exchange during and after resuscitation, therefore identical 72 h survival with intact neurologic function was observed in both VC and CCC groups. However, the incidence of rib fracture increases during the mechanical CPR strategy of CCC combined with regular ventilations.

[European Resuscitation Council guidelines for resuscitation 2010].

PubMed

Hunyadi-Anticević, Silvija; Colak, Zeljko; Funtak, Ines Lojna; Lukić, Anita; Filipović-Grcić, Boris; Tomljanović, Branka; Kniewald, Hrvoje; Protić, Alen; Pandak, Tatjana; Poljaković, Zdravka; Canadija, Marino

2011-01-01

All rescuers trained or not, should provide chest compressions to victims of cardiac arrest. The aim should be to push to a depth of at least 5 cm at a rate of at least 100 compressions per minute, to allow full chest recoil, and to minimise interruptions in chest compressions. Trained rescuers should also provide ventilations with a compression-ventilation ratio of 30:2. ELECTRICAL THERAPIES: Much greater emphasis on minimising the duration of the pre-shock and post-shock pauses; the continuation of compressions during charging of the defibrillator is recommended. Further development of AED programmes is encouraged. ADULT ADVANCED LIFE SUPPORT: Increased emphasis on high-quality chest compressions throughout any ALS intervention paused briefly only to enable specific interventions. Removal of the recommendation for a pre-specified period of cardiopulmonary resuscitation before out-of-hospital defibrillation following cardiac arrest unwitnessed by the EMS. The role of precordial thump is de-emphasized. Delivery of drugs via a tracheal tube is no longer recommended, drugs should be given by the intraosseous (IO) route. Atropine is no longer recommended for routine use in asystole or pulseless electrical activity. Reduced emphasis on early tracheal intubation unless achieved by highly skilled individuals with minimal interruptions in chest compressions. Increased emphasis on the use of capnography. Recognition of potential harm caused by hyperoxaemia. Revision of the recommendation of glucose control. Use of therapeutic hypothermia to include comatose survivors of cardiac arrest associated initially with shockable rhythms, as well as non-shockable rhythms, with a lower level of evidence acknowledged for the latter. INITIAL MANAGEMENT OF ACUTE CORONARY SYNDROMES: The term non-ST-elevation myocardial infarction-acute coronary syndrome (non-STEMI-ACS) has been introduced for both NSTEMI and unstable angina pectoris. Primary PCI (PPCI) is the preferred reperfusion strategy provided it is performed in a timely manner by an experienced team. Non-steroidal anti-inflammatory drugs should be avoided, as well as routine use of intravenous beta-blockers; oxygen is to be given only to those patients with hypoxaemia, breathlessness or pulmonary congestion. PAEDIATRIC LIFE SUPPORT: The decision to begin resuscitation must be taken in less than 10 seconds. Lay rescuers should be taught to use a ratio of 30 compressions to 2 ventilations, rescuers with a duty to respond should learn and use a 15:2 ratio; however, they can use the 30:2 compression-ventilation ratio if they are alone. Ventilation remains a very important component of resuscitation in asphyxial arrest. The emphasis is on achieving quality compressions with the rate of at least 100 but not greater than 120 per minute, with minimal interruptions. AEDs are safe and successful when used in children older than 1 year. A single shock strategy using a non-escalating dose of 4 J/kg is recommended for defibrillation in children. Cuffed tubes can be used safely in infants and young children. Monitoring exhaled carbon dioxide (CO2), ideally by capnography, is recommended during resuscitation. RESUSCITATION OF BABIES AT BIRTH: For uncompromised babies, a delay in cord clamping of at least one minute from the complete delivery is now recommended. For term infants, air should be used fro resuscitation at birth. For preterm babies less than 32 weeks gestation blended oxygen and air should be given judiciously and its use guided by pulse oximetry. Preterm babies of less than 28 weeks gestation should be completely covered in a plastic wrap up to their necks, without drying, immediately after birth. The recommended compression: ventilation ratio remains at 3:1 for newborn resuscitation. Attempts to aspirate meconium from the nose and mouth of the unborn baby, while the head is still on the perineum, are not recommended. If adrenaline is given the n the intravenous route is recommended using a dose of 10-30 microg/kg. Newly born infants born at term or near-term with moderate to severe hypoxic-ischaemic encephalopathy should be treated with therapeutic hypothermia. PRINCIPLES OF EDUCATION IN RESUSCITATION: The aim is to ensure that learners acquire and retain skill and knowledge that will enable them to act correctly in actual cardiac arrest and improve patient outcome. Short video/computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered as an effective alternative to instructor-led basic life support (BLS and AED) courses. Ideally all citizens should be trained in standard CPR that includes compressions and ventilations. Basic and advanced life support knowledge and skills deteriorate in as little as three to six months. CPR prompt or feedback devices improve CPR skill acquisition and retention.

Electrophysiology of Muscle Fatigue in Cardiopulmonary Resuscitation on Manikin Model.

PubMed

Cobo-Vázquez, Carlos; De Blas, Gemma; García-Canas, Pablo; Del Carmen Gasco-García, María

2018-01-01

Cardiopulmonary resuscitation requires the provider to adopt positions that could be dangerous for his or her spine, specifically affecting the muscles and ligaments in the lumbar zone and the scapular spinal muscles. Increased fatigue caused by muscular activity during the resuscitation could produce a loss of quality and efficacy, resulting in compromising resuscitation. The aim of this study was to evaluate the maximum time a rescuer can perform uninterrupted chest compressions correctly without muscle fatigue. This pilot study was performed at Universidad Complutense de Madrid (Spain) with the population recruited following CONSORT 2010 guidelines. From the 25 volunteers, a total of 14 students were excluded because of kyphoscoliosis (4), lumbar muscle pain (1), anti-inflammatory treatment (3), or not reaching 80% of effective chest compressions during the test (6). Muscle activity at the high spinal and lumbar (L5) muscles was assessed using electromyography while students performed continuous chest compressions on a ResusciAnne manikin. The data from force exerted were analyzed according to side and muscle groups using Student's t test for paired samples. The influence of time, muscle group, and side was analyzed by multivariate analyses ( p ≤ .05). At 2 minutes, high spinal muscle activity (right: 50.82 ± 9.95; left: 57.27 ± 20.85 μV/ms) reached the highest values. Activity decreased at 5 and 15 minutes. At 2 minutes, L5 activity (right: 45.82 ± 9.09; left: 48.91 ± 10.02 μV/ms) reached the highest values. After 5 minutes and at 15 minutes, activity decreased. Fatigue occurred bilaterally and time was the most important factor. Fatigue began at 2 minutes. Rescuers exert muscular countervailing forces in order to maintain effective compressions. This imbalance of forces could determine the onset of poor posture, musculoskeletal pain, and long-term injuries in the rescuer.

Chest compression during sustained inflation versus 3:1 chest compression:ventilation ratio during neonatal cardiopulmonary resuscitation: a randomised feasibility trial.

PubMed

Schmölzer, Georg M; O Reilly, Megan; Fray, Caroline; van Os, Sylvia; Cheung, Po-Yin

2017-10-07

Current neonatal resuscitation guidelines recommend 3:1 compression:ventilation (C:V) ratio. Recently, animal studies reported that continuous chest compressions (CC) during a sustained inflation (SI) significantly improved return of spontaneous circulation (ROSC). The approach of CC during SI (CC+SI) has not been examined in the delivery room during neonatal resuscitation. It is a feasibility study to compare CC+SI versus 3:1 C:V ratio during neonatal resuscitation in the delivery room. We hypothesised that during neonatal resuscitation, CC+SI will reduce the time to ROSC. Our aim was to examine if CC+SI reduces ROSC compared with 3:1 C:V CPR in preterm infants <33 weeks of gestation. Randomised feasibility trial. Once CC was indicated all eligible infants were immediately and randomly allocated to either CC+SI group or 3:1 C:V group. A sequentially numbered, brown, sealed envelope contained a folded card box with the treatment allocation was opened by the clinical team at the start of CC. Infants in the CC+SI group received CC at a rate of 90/min during an SI with a duration of 20 s (CC+SI). After 20 s, the SI was interrupted for 1 s and the next SI was started for another 20 s until ROSC. Infants in the '3:1 group' received CC using 3:1 C:V ratio until ROSC. Overall the mean (SD) time to ROSC was significantly shorter in the CC+SI group with 31 (9) s compared with 138 (72) s in the 3:1 C:V group (p=0.011). CC+SI is feasible in the delivery room. Clinicaltrials.gov NCT02083705, pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A flexible pressure sensor could correctly measure the depth of chest compression on a mattress.

PubMed

Minami, Kouichiro; Kokubo, Yota; Maeda, Ichinosuke; Hibino, Shingo

2016-05-01

Feedback devices are used to improve the quality of chest compression (CC). However, reports have noted that accelerometers substantially overestimate depth when cardiopulmonary resuscitation (CPR) is performed on a soft surface. Here, we determined whether a flexible pressure sensor could correctly evaluate the depth CC performed on a mannequin placed on a mattress. Chest compression was performed 100 times/min by a compression machine on the floor or a mattress, and the depth of CC was monitored using a flexible pressure sensor (Shinnosukekun) and CPRmeter(™). The depth of machine-performed CC was consistently 5cm. We compared data from the feedback sensor with the true depth of CC using dual real-time auto feedback system that incorporated an infrared camera (CPR evolution(™)). On the floor, the true depth of CC was 5.0±0.0cm (n=100), or identical to the depth of CC performed by the machine. The Shinnosukekun(™) measured a mean (±SD) CC depth of 5.0±0.1cm (n=100), and the CPRmeter(™) measured a depth of 5.0±0.2cm (n=100). On the mattress, the true depth of CC was 4.4±0.0cm (n=100). The Shinnosukekun(™) measured a mean CC depth of 4.4±0.0cm (n=100), and the CPRmeter(™) measured a depth of 4.7±0.1cm (n=100). The data of CPRmeter(™) were overestimated (P<.0001 between the true depth and the CPRmeter(™)-measured depth). The Shinnosukekun(™) could correctly measure the depth of CC on a mattress. According to our present results, the flexible pressure sensor could be a useful feedback system for CC performed on a soft surface. Copyright © 2016 Elsevier Inc. All rights reserved.

Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

PubMed Central

Matos, António P.; Mascarenhas, Vasco; Herédia, Vasco

2014-01-01

Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall. PMID:25295188

Multidetector computer tomography: evaluation of blunt chest trauma in adults.

PubMed

Palas, João; Matos, António P; Mascarenhas, Vasco; Herédia, Vasco; Ramalho, Miguel

2014-01-01

Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

Evaluation of the Boussignac Cardiac arrest device (B-card) during cardiopulmonary resuscitation in an animal model.

PubMed

Moore, Johanna C; Lamhaut, Lionel; Hutin, Alice; Dodd, Kenneth W; Robinson, Aaron E; Lick, Michael C; Salverda, Bayert J; Hinke, Mason B; Labarere, José; Debaty, Guillaume; Segal, Nicolas

2017-10-01

The purpose of this study was to examine continuous oxygen insufflation (COI) in a swine model of cardiac arrest. The primary hypothesis was COI during standard CPR (S-CPR) should result in higher intrathoracic pressure (ITP) during chest compression and lower ITP during decompression versus S-CPR alone. These changes with COI were hypothesized to improve hemodynamics. The second hypothesis was that changes in ITP with S-CPR+COI would result in superior hemodynamics compared with active compression decompression (ACD) + impedance threshold device (ITD) CPR, as this method primarily lowers ITP during chest decompression. After 6min of untreated ventricular fibrillation, S-CPR was initiated in 8 female swine for 4min, then 3min of S-CPR+COI, then 3min of ACD+ITD CPR, then 3min of S-CPR+COI. ITP and hemodynamics were continuously monitored. During S-CPR+COI, ITP was always positive during the CPR compression and decompression phases. ITP compression values with S-CPR+COI versus S-CPR alone were 5.5±3 versus 0.2±2 (p<0.001) and decompression values were 2.8±2 versus -1.3±2 (p<0.001), respectively. With S-CPR+COI versus ACD+ITD the ITP compression values were 5.5±3 versus 1.5±2 (p<0.01) and decompression values were 2.8±2 versus -4.7±3 (p<0.001), respectively. COI during S-CPR created a continuous positive pressure in the airway during both the compression and decompression phase of CPR. At no point in time did COI generate a negative intrathoracic pressures during CPR in this swine model of cardiac arrest. Copyright © 2017 Elsevier B.V. All rights reserved.

Utility of a simple lighting device to improve chest compressions learning.

PubMed

González-Calvete, L; Barcala-Furelos, R; Moure-González, J D; Abelairas-Gómez, C; Rodríguez-Núñez, A

2017-11-01

The recommendations on cardiopulmonary resuscitation (CPR) emphasize the quality of the manoeuvres, especially chest compressions (CC). Audiovisual feedback devices could improve the quality of the CC during CPR. The aim of this study was to evaluate the usefulness of a simple lighting device as a visual aid during CPR on a mannequin. Twenty-two paediatricians who attended an accredited paediatric CPR course performed, in random order, 2min of CPR on a mannequin without and with the help of a simple lighting device, which flashes at a frequency of 100 cycles per minute. The following CC variables were analyzed using a validated compression quality meter (CPRmeter ® ): depth, decompression, rate, CPR time and percentage of compressions. With the lighting device, participants increased average quality (60.23±54.50 vs. 79.24±9.80%; P=.005), percentage in target depth (48.86±42.67 vs. 72.95±20.25%; P=.036) and rate (35.82±37.54 vs. 67.09±31.95%; P=.024). A simple light device that flashes at the recommended frequency improves the quality of CC performed by paediatric residents on a mannequin. The usefulness of this CPR aid system should be assessed in real patients. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

A 5-year experience with a minimally invasive technique for pectus carinatum repair.

PubMed

Abramson, Horacio; D'Agostino, José; Wuscovi, Sebastián

2009-01-01

This report describes a 5-year experience with a novel, minimally invasive surgical technique for treatment of pectus carinatum. From June 2002 to August 2007, 40 patients underwent operation to correct pectus carinatum by pressure applied through a curved steel bar that was placed subcutaneously anterior to the sternum, via lateral thoracic incisions. The bar is inserted through a polyvinyl chloride tube with the convexity facing posteriorly. The polyvinyl chloride tube is positioned presternally by trocar. Subperiosteal wires attach small fixation plates to the ribs laterally, and the convex bar is secured to the small fixation plates with screws applying manual pressure to the anterior chest wall until the desired configuration is achieved. The compressive elongated bar is attached to the fixation plate with screws. The average age was 14.3 years (range, 10-21 years), and 90% were male. Both symmetric and asymmetric protrusions were treated. Patients whose chest was not malleable, and whose sternum could not be brought to a desirable position with pressure from the operator's hand, were treated by the open or "Ravitch" technique. After 2 or more years, the bar, wires stitches, screws, and fixation plates were removed. Of 40 patients treated with this procedure, 20 have undergone bar removal with the following results: 10 excellent, 4 good, 4 fair, and 2 poor. Average blood loss was 15 mL. Average length of hospital stay was as follows: implant, 3.8 days; removal, 1.4 days. Patients returned to routine activity 14 days after repair. Average follow-up since primary repair is 2.49 years. In those who have had bar removal, it is 1.53 years. Complications were pneumothorax in 1 patient, treated with chest tub e suction; skin adherence in 8 cases; seroma in 6; wire breakage in 3; persistence of pain in 1; and infection in 1. Technical modifications (selecting younger patients, excluding patients with a stiff thoracic wall, submuscular insertion of the bar, stronger pericostal wire) have been associated with no complications in the last 16 cases. This experience with a new, minimally invasive technique for the treatment of pectus carinatum shows it to be safe and effective. The correction obtained was highly satisfactory with minimal complications. It should be considered in appropriate cases as an alternative to more invasive techniques.

[Development of a digital chest phantom for studies on energy subtraction techniques].

PubMed

Hayashi, Norio; Taniguchi, Anna; Noto, Kimiya; Shimosegawa, Masayuki; Ogura, Toshihiro; Doi, Kunio

2014-03-01

Digital chest phantoms continue to play a significant role in optimizing imaging parameters for chest X-ray examinations. The purpose of this study was to develop a digital chest phantom for studies on energy subtraction techniques under ideal conditions without image noise. Computed tomography (CT) images from the LIDC (Lung Image Database Consortium) were employed to develop a digital chest phantom. The method consisted of the following four steps: 1) segmentation of the lung and bone regions on CT images; 2) creation of simulated nodules; 3) transformation to attenuation coefficient maps from the segmented images; and 4) projection from attenuation coefficient maps. To evaluate the usefulness of digital chest phantoms, we determined the contrast of the simulated nodules in projection images of the digital chest phantom using high and low X-ray energies, soft tissue images obtained by energy subtraction, and "gold standard" images of the soft tissues. Using our method, the lung and bone regions were segmented on the original CT images. The contrast of simulated nodules in soft tissue images obtained by energy subtraction closely matched that obtained using the gold standard images. We thus conclude that it is possible to carry out simulation studies based on energy subtraction techniques using the created digital chest phantoms. Our method is potentially useful for performing simulation studies for optimizing the imaging parameters in chest X-ray examinations.

Traumatic asphyxia due to blunt chest trauma: a case report and literature review

PubMed Central

2012-01-01

Introduction Crush asphyxia is different from positional asphyxia, as respiratory compromise in the latter is caused by splinting of the chest and/or diaphragm, thus preventing normal chest expansion. There are only a few cases or small case series of crush asphyxia in the literature, reporting usually poor outcomes. Case presentation We present the case of a 44-year-old Caucasian man who developed traumatic asphyxia with severe thoracic injury and mild brain edema after being crushed under heavy auto vehicle mechanical parts. He remained unconscious for an unknown time. The treatment included oropharyngeal intubation and mechanical ventilation, bilateral chest tube thoracostomies, treatment of brain edema and other supportive measures. Our patient’s outcome was good. Traumatic asphyxia is generally under-reported and most authors apply supportive measures, while the final outcome seems to be dependent on the length of time of the chest compression and on the associated injuries. Conclusion Treatment for traumatic asphyxia is mainly supportive with special attention to the re-establishment of adequate oxygenation and perfusion; treatment of the concomitant injuries might also affect the final outcome. PMID:22935547

Regionally adaptive histogram equalization of the chest.

PubMed

Sherrier, R H; Johnson, G A

1987-01-01

Advances in the area of digital chest radiography have resulted in the acquisition of high-quality images of the human chest. With these advances, there arises a genuine need for image processing algorithms specific to the chest, in order to fully exploit this digital technology. We have implemented the well-known technique of histogram equalization, noting the problems encountered when it is adapted to chest images. These problems have been successfully solved with our regionally adaptive histogram equalization method. With this technique histograms are calculated locally and then modified according to both the mean pixel value of that region as well as certain characteristics of the cumulative distribution function. This process, which has allowed certain regions of the chest radiograph to be enhanced differentially, may also have broader implications for other image processing tasks.

Aspergillus epidural abscess and cord compression in a patient with aspergilloma and empyema. Survival and response to high dose systemic amphotericin therapy.

PubMed

Hendrix, W C; Arruda, L K; Platts-Mills, T A; Haworth, C S; Jabour, R; Ward, G W

1992-06-01

A 57-yr-old man with a chronic lung cavity presumed to be related to ankylosing spondylitis and/or old cavitary tuberculosis presented with hemoptysis and rapidly developed lower extremity paresis and hypoesthesia. On chest radiograph he had a left upper lobe lesion suggestive of aspergilloma combined with a large left empyema with bronchopleural fistula. Serologic analysis demonstrated precipitins and very high titer IgG antibodies to Aspergillus fumigatus antigens. Decompressive laminectomy from T1 to T5 was performed, with drainage of A. fumigatus culture-positive material from an epidural abscess compressing the spinal cord. Chest drainage was required for control of the empyema. With a total course of 3 g of intravenously administered amphotericin B, rehabilitative therapy, and chronic empyema drainage, he is now at home and ambulatory with assistance. He is also being followed by regular serum assays of IgG antibodies to Aspergillus proteins. We report the case of an apparent long-term survivor of a formerly lethal and/or nonreversible paraplegic condition. The critical factors compared with previous cases with a poor outcome would appear to be prompt neurosurgical intervention, restoration of a normal number of T-cells, effective long-term chest drainage, and high dose amphotericin treatment.

Development of a smart backboard system for real-time feedback during CPR chest compression on a soft back support surface.

PubMed

Gohier, Francis; Dellimore, Kiran; Scheffer, Cornie

2013-01-01

The quality of cardiopulmonary resuscitation (CPR) is often inconsistent and frequently fails to meet recommended guidelines. One promising approach to address this problem is for clinicians to use an active feedback device during CPR. However, one major deficiency of existing feedback systems is that they fail to account for the displacement of the back support surface during chest compression (CC), which can be important when CPR is performed on a soft surface. In this study we present the development of a real-time CPR feedback system based on an algorithm which uses force and dual-accelerometer measurements to provide accurate estimation of the CC depth on a soft surface, without assuming full chest decompression. Based on adult CPR manikin tests it was found that the accuracy of the estimated CC depth for a dual accelerometer feedback system is significantly better (7.3% vs. 24.4%) than for a single accelerometer system on soft back support surfaces, in the absence or presence of a backboard. In conclusion, the algorithm used was found to be suitable for a real-time, dual accelerometer CPR feedback application since it yielded reasonable accuracy in terms of CC depth estimation, even when used on a soft back support surface.

A traumatic asphyxia in a child.

PubMed

Nishiyama, T; Hanaoka, K

2000-11-01

Traumatic asphyxia in a child is rare and the pathophysiology is different from that occurring in an adult. We report a case of traumatic asphyxia in a child who recovered without specific treatment, even though chest and abdominal compression was severe. A three-year-old boy (14.2 kg) was run over by the rear wheel of a Jeep. He was under the tire for about three minutes and then was transferred to our hospital. When he arrived, he was lethargic with Glasgow Coma Scale of E3V4M6 (coma score of 13). He was cyanotic in his face and had a tire mark from the left shoulder to the right abdomen, petechiae on the head, face, conjunctiva and chest, oral bleeding, and facial edema. Serum concentrations of liver enzymes were increased and microhematuria was detected. However, no injuries were seen in the brain, eye, chest, or abdomen. Cyanosis disappeared in a few hours. Facial and thoracic petechiae disappeared in three days and that of the conjunctiva in five days. He was discharged from hospital on the 13th day without any disturbances. We present a three-year-old boy with traumatic asphyxia. He had no complications although he received severe thoraco-abdominal compression by a Jeep.

Protocol of a Multicenter International Randomized Controlled Manikin Study on Different Protocols of Cardiopulmonary Resuscitation for laypeople (MANI-CPR)

PubMed Central

Contri, Enrico; Burkart, Roman; Borrelli, Paola; Ferraro, Ottavia Eleonora; Tonani, Michela; Cutuli, Amedeo; Bertaia, Daniele; Iozzo, Pasquale; Tinguely, Caroline; Lopez, Daniel; Boldarin, Susi; Deiuri, Claudio; Dénéréaz, Sandrine; Dénéréaz, Yves; Terrapon, Michael; Tami, Christian; Cereda, Cinzia; Somaschini, Alberto; Cornara, Stefano; Cortegiani, Andrea

2018-01-01

Introduction Out-of-hospital cardiac arrest is one of the leading causes of death in industrialised countries. Survival depends on prompt identification of cardiac arrest and on the quality and timing of cardiopulmonary resuscitation (CPR) and defibrillation. For laypeople, there has been a growing interest on hands-only CPR, meaning continuous chest compression without interruption to perform ventilations. It has been demonstrated that intentional interruptions in hands-only CPR can increase its quality. The aim of this randomised trial is to compare three CPR protocols performed with different intentional interruptions with hands-only CPR. Methods and analysis This is a prospective randomised trial performed in eight training centres. Laypeople who passed a basic life support course will be randomised to one of the four CPR protocols in an 8 min simulated cardiac arrest scenario on a manikin: (1) 30 compressions and 2 s pause; (2) 50 compressions and 5 s pause; (3) 100 compressions and 10 s pause; (4) hands-only. The calculated sample size is 552 people. The primary outcome is the percentage of chest compression performed with correct depth evaluated by a computerised feedback system (Laerdal QCPR). Ethics and dissemination Due to the nature of the study, we obtained a waiver from the Ethics Committee (IRCCS Policlinico San Matteo, Pavia, Italy). All participants will sign an informed consent form before randomisation. The results of this study will be published in peer-reviewed journal. The data collected will also be made available in a public data repository. Trial registration number NCT02632500. PMID:29674365

9 Closed chest compressions reduce survival in a model of haemorrhage-induced traumatic cardiac arrest.

PubMed

Watts, Sarah; Smith, Jason; Gwyther, Robert; Kirkman, Emrys

2017-12-01

Closed chest compressions (CCC) are a key component of resuscitation from medical causes of cardiac arrest, but when haemorrhage, the leading cause of preventable battlefield deaths, is the likely cause there is little evidence to support their use. Resuscitation protocols for traumatic cardiac arrest (TCA) highlight the importance of addressing reversible causes, such as the administration of fluids to treat hypovolaemia. This study evaluated whether CCC were beneficial following haemorrhage-induced TCA and additionally whether resuscitation with blood improved physiological outcomes. The study was conducted with the authority of UK Animals (Scientific Procedures) Act 1986 using 39 terminally anesthetised Large White pigs (35 kg, 29-40 kg) instrumented for invasive physiological monitoring. Following instrumentation and baseline measurements, animals underwent tissue injury (captive bolt to the right thigh) and controlled haemorrhage (30% blood volume). Mean arterial blood pressure (MAP) was maintained at 45 mmHg for 60 min, followed by a further controlled haemorrhage to a MAP of 20 mmHg. As arterial blood and pulse pressures spontaneously deteriorated further over a 5 min period, the randomised resuscitation protocol was initiated as follows: CCC (n=6); IV 0.9% saline (Sal n=8); IV autologous whole blood (WB n=8); IV saline +chest compressions (Sal +CCC n=9); and IV whole blood +chest compressions (WB +CCC n=8). 3×10 ml/kg fluid boluses were administered using the Belmont Rapid Infuser (200 ml/min). CCC were performed using the LUCAS II Chest Compression System.Outcome was attainment of return of spontaneous circulation (ROSC) 15 min post-resuscitation. ROSC was categorised by MAP (MAP ≥50 mmHg=ROSC; MAP >20 <50 mmHg=partial ROSC; MAP ≤20 mmHg=dead).emermed;34/12/A866-a/F1F1F1Figure 1 RESULTS: Outcome was significantly worse in the group that received CCC compared to WB and Sal groups (6/6 dead versus 0/8 and 0/8 respectively) (p<0.0001).A significantly higher number of animals attained ROSC in WB compared to Sal group (6/8 versus 0/8 ROSC and 2/8 versus 8/8 partial ROSC respectively) (p=0.0069).There were some none significant differences between WB and WB+CCC groups (6/8 versus 5/8 ROSC, 2/8 versus 1/8 partial ROSC and 0/8 versus 2/8 dead respectively) (p=0.4411).No animals attained ROSC in the Sal and Sal+CCC groups however significantly more animals died in the Sal+CCC group (0/8 versus 0/9 ROSC, 8/8 versus 2/9 partial ROSC and 0/8 versus 7/9 dead respectively) (p=0.0023). CCC were associated with increased mortality compared to intravenous fluid resuscitation. Resuscitation with whole blood demonstrated the greatest physiological benefit as demonstrated by highest numbers of animals achieving ROSC. © 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Updated teaching techniques improve CPR performance measures: a cluster randomized, controlled trial.

PubMed

Ettl, Florian; Testori, Christoph; Weiser, Christoph; Fleischhackl, Sabine; Mayer-Stickler, Monika; Herkner, Harald; Schreiber, Wolfgang; Fleischhackl, Roman

2011-06-01

The first-aid training necessary for obtaining a drivers license in Austria has a regulated and predefined curriculum but has been targeted for the implementation of a new course structure with less theoretical input, repetitive training in cardiopulmonary resuscitation (CPR) and structured presentations using innovative media. The standard and a new course design were compared with a prospective, participant- and observer-blinded, cluster-randomized controlled study. Six months after the initial training, we evaluated the confidence of the 66 participants in their skills, CPR effectiveness parameters and correctness of their actions. The median self-confidence was significantly higher in the interventional group [IG, visual analogue scale (VAS:"0" not-confident at all,"100" highly confident):57] than in the control group (CG, VAS:41). The mean chest compression rate in the IG (98/min) was closer to the recommended 100 bpm than in the CG (110/min). The time to the first chest compression (IG:25s, CG:36s) and time to first defibrillator shock (IG:86s, CG:92s) were significantly shorter in the IG. Furthermore, the IG participants were safer in their handling of the defibrillator and started with countermeasures against developing shock more often. The management of an unconscious person and of heavy bleeding did not show a difference between the two groups even after shortening the lecture time. Motivation and self-confidence as well as skill retention after six months were shown to be dependent on the teaching methods and the time for practical training. Courses may be reorganized and content rescheduled, even within predefined curricula, to improve course outcomes. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Acute ECG changes and chest pain induced by neck motion in patients with cervical hernia--a case report.

PubMed

Güler, N; Bilge, M; Eryonucu, B; Cirak, B

2000-10-01

We report two cases of acute cervical angina and ECG changes induced by anteflexion of the head. Cervical angina is defined as chest pain that resembles true cardiac angina but originates from cervical discopathy with nerve root compression. In these patients, Prinzmetal's angina, valvular heart disease, congenital heart disease, left ventricular aneurysm, and cardiomyopathy were excluded. After all, the patient's chest pain was reproduced by anteflexion of head, at this time, their ECGs showed nonspecific ST-T changes in the inferior and anterior leads different from the basal ECG. ECG changes returned to normal when the patient's neck moved to the neutral position. To our knowledge, these are the first cases of cervical angina associated with acute ECG changes by neck motion.

Anthropomorphic breast phantoms for preclinical imaging evaluation with transmission or emission imaging

NASA Astrophysics Data System (ADS)

Tornai, Martin P.; McKinley, Randolph L.; Bryzmialkiewicz, Caryl N.; Cutler, Spencer J.; Crotty, Dominic J.

2005-04-01

With the development of several classes of dedicated emission and transmission imaging technologies utilizing ionizing radiation for improved breast cancer detection and in vivo characterization, it is extremely useful to have available anthropomorphic breast phantoms in a variety of shapes, sizes and malleability prior to clinical imaging. These anthropomorphic phantoms can be used to evaluate the implemented imaging approaches given a known quantity, the phantom, and to evaluate the variability of the measurement due to the imaging system chain. Thus, we have developed a set of fillable and incompressible breast phantoms ranging in volume from 240 to 1730mL with nipple-to-chest distances from 3.8 to 12cm. These phantoms are mountable and exchangeable on either a uniform chest plate or anthropomorphic torso phantom containing tissue equivalent bones and surface tissue. Another fillable ~700mL breast phantom with solid anterior chest plate is intentionally compressible, and can be used for direct comparisons between standard planar imaging approaches using mild-to-severe compression, partially compressed tomosynthesis, and uncompressed computed mammotomography applications. These phantoms can be filled with various fluids (water and oil based liquids) to vary the fatty tissue background composition. Shaped cellulose sponges with two cell densities are fabricated and can be added to the breasts to simulate connective tissue. Additionally, microcalcifications can be simulated by peppering slits in the sponges with oyster shell fragments. These phantoms have a utility in helping to evaluate clinical imaging paradigms with known input object parameters using basic imaging characterization, in an effort to further evaluate contemporary and next generation imaging tools. They may additionally provide a means to collect known data samples for task based optimization studies.

Video laryngoscopy vs. direct laryngoscopy: Which should be chosen for endotracheal intubation during cardiopulmonary resuscitation? A prospective randomized controlled study of experienced intubators.

PubMed

Kim, Jong Won; Park, Sang O; Lee, Kyeong Ryong; Hong, Dae Young; Baek, Kwang Je; Lee, Young Hwan; Lee, Jeong Hun; Choi, Pil Cho

2016-08-01

This study compared endotracheal intubation (ETI) performance during cardiopulmonary resuscitation (CPR) between direct laryngoscopy (DL) and video laryngoscopy (VL) (GlideScope(®)) by experienced intubators (>50 successful ETIs). This was a prospective randomized controlled study conducted in an emergency department between 2011 and 2013. Intubators who used DL or VL were randomly allocated to ETI during CPR. Data were collected from recorded video clips and rhythm sheets. The success, speed, complications, and chest compressions interruption were compared between the two devices. Total 140 ETIs by experienced intubators using DL (n=69) and VL (n=71) were analysed. There were no significant differences between DL and VL in the ETI success rate (92.8% vs. 95.8%; p=0.490), first-attempt success rate (87.0% vs. 94.4%; p=0.204), and median time to complete ETI (51 [36-67] vs. 42 [34-62]s; p=0.143). In both groups, oesophageal intubation and dental injuries seldom occurred. However, longer chest compressions interruption occurred using DL (4.0 [1.0-11.0]s) compared with VL (0.0 [0.0-1.0]s) and frequent serious no-flow (interruption>10s) occurred with DL (18/69 [26.1%]) compared with VL (0/71) (p<0.001). For highly experienced intubators (>80 successful ETIs), frequent serious no-flow occurred in DL (14/55 [25.5%] vs. 0/57 in VL). The ETI success, speed and complications during CPR did not differ significantly between the two devices for experienced intubators. However, the VL was superior in terms of completion of ETI without chest compression interruptions. Clinical Research Information Service (CRIS) in South Korea KCT0000849. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions.

PubMed

Huis In 't Veld, Maite A; Allison, Michael G; Bostick, David S; Fisher, Kiondra R; Goloubeva, Olga G; Witting, Michael D; Winters, Michael E

2017-10-01

High-quality chest compressions are a critical component of the resuscitation of patients in cardiopulmonary arrest. Point-of-care ultrasound (POCUS) is used frequently during emergency department (ED) resuscitations, but there has been limited research assessing its benefits and harms during the delivery of cardiopulmonary resuscitation (CPR). We hypothesized that use of POCUS during cardiac arrest resuscitation adversely affects high-quality CPR by lengthening the duration of pulse checks beyond the current cardiopulmonary resuscitation guidelines recommendation of 10s. We conducted a prospective cohort study of adults in cardiac arrest treated in an urban ED between August 2015 and September 2016. Resuscitations were recorded using video equipment in designated resuscitation rooms, and the use of POCUS was documented and timed. A linear mixed-effects model was used to estimate the effect of POCUS on pulse check duration. Twenty-three patients were enrolled in our study. The mean duration of pulse checks with POCUS was 21.0s (95% CI, 18-24) compared with 13.0s (95% CI, 12-15) for those without POCUS. POCUS increased the duration of pulse checks and CPR interruption by 8.4s (95% CI, 6.7-10.0 [p<0.0001]). Age, body mass index (BMI), and procedures did not significantly affect the duration of pulse checks. The use of POCUS during cardiac arrest resuscitation was associated with significantly increased duration of pulse checks, nearly doubling the 10-s maximum duration recommended in current guidelines. It is important for acute care providers to pay close attention to the duration of interruptions in the delivery of chest compressions when using POCUS during cardiac arrest resuscitation. Copyright © 2017 Elsevier B.V. All rights reserved.

Kids save lives: a six-year longitudinal study of schoolchildren learning cardiopulmonary resuscitation: Who should do the teaching and will the effects last?

PubMed

Lukas, Roman-Patrik; Van Aken, Hugo; Mölhoff, Thomas; Weber, Thomas; Rammert, Monika; Wild, Elke; Bohn, Andreas

2016-04-01

This prospective longitudinal study over 6 years compared schoolteachers and emergency physicians as resuscitation trainers for schoolchildren. It also investigated whether pupils who were trained annually for 3 years retain their resuscitation skills after the end of this study. A total of 261 pupils (fifth grade) at two German grammar schools received resuscitation training by trained teachers or by emergency physicians. The annual training events stopped after 3 years in one group and continued for 6 years in a second group. We measured knowledge about resuscitation (questionnaire), chest compression rate (min(-1)), chest compression depth (mm), ventilation rate (min(-1)), ventilation volume (mL), self-efficacy (questionnaire). Their performance was evaluated after 1, 3 and 6 years. The training events increased the pupils' knowledge and practical skills. When trained by teachers, the pupils achieved better results for knowledge (92.86% ± 8.38 vs. 90.10% ± 8.63, P=0.04) and ventilation rate (4.84/min ± 4.05 vs. 3.76/min ± 2.37, P=0.04) than when they were trained by emergency physicians. There were no differences with regard to chest compression rate, depth, ventilation volume, or self-efficacy at the end of the study. Knowledge and skills after 6 years were equivalent in the group with 6 years training compared with 3 years training. Trained teachers can provide adequate resuscitation training in schools. Health-care professionals are not mandatory for CPR training (easier for schools to implement resuscitation training). The final evaluation after 6 years showed that resuscitation skills are retained even when training is interrupted for 3 years. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Barriers to dispatcher-assisted cardiopulmonary resuscitation in Singapore.

PubMed

Ho, Andrew Fu Wah; Sim, Zariel Jiaying; Shahidah, Nur; Hao, Ying; Ng, Yih Yng; Leong, Benjamin S H; Zarinah, Siti; Teo, Winston K L; Goh, Geraldine Shu Yi; Jaafar, Hamizah; Ong, Marcus E H

2016-08-01

Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is effective in increasing bystander CPR in out-of-hospital cardiac arrests (OHCA). Singapore has recently implemented a DA-CPR program. We aimed to characterize barriers to commencement of chest compressions by callers in Singapore. We analyzed dispatch recordings of OHCA cases received by the ambulance call center between July 2012 and March 2015. Audio recordings of poor quality were excluded. Trained reviewers noted the sequential stages of the dispatcher's recognition of CPR, delivering CPR instructions and caller performing CPR. Time taken to reach these milestones was noted. Barriers to chest compressions were identified. A total of 4897 OHCA occurred during the study period, overall bystander CPR rate was 45.7%. 1885 dispatch recordings were reviewed with 1157 cases qualified for dispatcher CPR. In 1128 (97.5%) cases, the dispatcher correctly recognized the need for CPR. CPR instructions were delivered in 1056 (91.3%) cases. Of these, 1007 (87.0%) callers performed CPR to instruction. One or more barriers to chest compressions were identified in 430 (37.2%) cases. The commonest barrier identified was "could not move patient" (27%). Cases where barriers were identified were less likely to have the need for CPR recognized by the dispatcher (94.9% vs. 99.0%, p<0.001), CPR instructions given (79.3% vs. 98.3%, p<0.001) and CPR started (67.9% vs. 98.3%, p<0.001), while the time taken to reach each of these stages were significantly longer (p<0.001). Barriers were present in 37% of cases. They were associated with lower proportion of CPR started and longer delay to CPR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The impact of post-resuscitation feedback for paramedics on the quality of cardiopulmonary resuscitation.

PubMed

Bleijenberg, Eduard; Koster, Rudolph W; de Vries, Hendrik; Beesems, Stefanie G

2017-01-01

The Guidelines place emphasis on high-quality cardiopulmonary resuscitation (CPR). This study aims to measure the impact of post-resuscitation feedback on the quality of CPR as performed by ambulance personnel. Two ambulances are dispatched for suspected cardiac arrest. The crew (driver and paramedic) of the first arriving ambulance is responsible for the quality of CPR. The crew of the second ambulance establishes an intravenous access and supports the first crew. All resuscitation attempts led by the ambulance crew of the study region were reviewed by two research paramedics and structured feedback was given based on defibrillator recording with impedance signal. A 12-months period before introduction of post-resuscitation feedback was compared with a 19-months period after introduction of feedback, excluding a six months run-in interval. Quality parameters were chest compression fraction (CCF), chest compression rate, longest peri-shock pause and longest non-shock pause. In the pre-feedback period 55 cases were analyzed and 69 cases in the feedback period. Median CCF improved significantly in the feedback period (79% vs 86%, p<0.001). The mean chest compression rate was within the recommended range of 100-120/min in 87% of the cases in the pre-feedback period and in 90% of the cases in the feedback period (p=0.65). The duration of longest non-shock pause decreased significantly (40s vs 19s, p<0.001), the duration of the longest peri-shock pause did not change significantly (16s vs 13s, p=0.27). Post-resuscitation feedback improves the quality of resuscitation, significantly increasing CCF and decreasing the duration of longest non-shock pauses. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Hands-Off Time for Endotracheal Intubation during CPR Is Not Altered by the Use of the C-MAC Video-Laryngoscope Compared to Conventional Direct Laryngoscopy. A Randomized Crossover Manikin Study.

PubMed

Schuerner, Philipp; Grande, Bastian; Piegeler, Tobias; Schlaepfer, Martin; Saager, Leif; Hutcherson, Matthew T; Spahn, Donat R; Ruetzler, Kurt

2016-01-01

Sufficient ventilation and oxygenation through proper airway management is essential in patients undergoing cardio-pulmonary resuscitation (CPR). Although widely discussed, securing the airway using an endotracheal tube is considered the standard of care. Endotracheal intubation may be challenging and causes prolonged interruption of chest compressions. Videolaryngoscopes have been introduced to better visualize the vocal cords and accelerate intubation, which makes endotracheal intubation much safer and may contribute to intubation success. Therefore, we aimed to compare hands-off time and intubation success of direct laryngoscopy with videolaryngoscopy (C-MAC, Karl Storz, Tuttlingen, Germany) in a randomized, cross-over manikin study. Twenty-six anesthesia residents and twelve anesthesia consultants of the University Hospital Zurich were recruited through a voluntary enrolment. All participants performed endotracheal intubation using direct laryngoscopy and C-MAC in a random order during ongoing chest compressions. Participants were strictly advised to stop chest compression only if necessary. The median hands-off time was 1.9 seconds in direct laryngoscopy, compared to 3 seconds in the C-MAC group. In direct laryngoscopy 39 intubation attempts were recorded, resulting in an overall first intubation attempt success rate of 97%, compared to 38 intubation attempts and 100% overall first intubation attempt success rate in the C-MAC group. As a conclusion, the results of our manikin-study demonstrate that video laryngoscopes might not be beneficial compared to conventional, direct laryngoscopy in easily accessible airways under CPR conditions and in experienced hands. The benefits of video laryngoscopes are of course more distinct in overcoming difficult airways, as it converts a potential "blind intubation" into an intubation under visual control.

[Extra longtime continuous chest compression to rescue cardiopulmonary arrest: a case report and the literature review].

PubMed

Zhang, Yan; Yue, Tianxue; Sun, Kexin; Wang, Jiang; Zhu, Ruiwu

2018-05-01

The new cardiopulmonary resuscitation (CPR) guideline emphasize the importance of chest compression, which was considered as the first step to CPR. The duration for CPR is usually limited to 30 minutes. With the development of new technology and evidence-based medicine, the success of extra longtime CPR has become possible, which is of great significance to some patients with cardiac arrest (CA), but the time limit has not been determined. On February 23rd in 2016, a 76-year-old female patient with respiratory and cardiac arrest who was on the third day after transurethral resection of bladder tumor (TUR-BT) was admitted to the intensive care unit of the General Hospital of Fushun Mining Bureau. On the basis of the comprehensive treatment measures such as ventilator support ventilation, physical cooling with ice cap, 1 mg adrenaline for intravenous injection, low molecular heparin of 5 000 U for subcutaneous injection, and the continuous chest compression were carried out in a timely and effective manner for 125 minutes, which make the patient recover to sinus rhythm and her brain function recovered well without any sequelae, and follow-up of the patient in 1 year showed well. The key to success or failure of CPR depend on the patient's condition. If the patients in healthy, single cause, a good response to the resuscitation, the pulsation of the large artery can be seen now and then during the rescue, and the recovery of the spontaneous breathing, CPR should be kept on. In the process of CPR, individualized assessment of the disease progression without the 30-minute time limit, may benefit the patients in maximum. In the future clinical practice, we should actively explore more favorable evidence, so that CA patients can be rescued more.

Effect of the laryngeal tube on the no-flow-time in a simulated two rescuer basic life support setting with inexperienced users.

PubMed

Schröder, J; Bucher, M; Meyer, O

2016-09-01

Intubation with a laryngeal tube (LT) is a recommended alternative to endotracheal intubation during advanced life support (ALS). LT insertion is easy; therefore, it may also be an alternative to bag-mask ventilation (BMV) for untrained personnel performing basic life support (BLS). Data from manikin studies support the influence of LT on no-flow-time (NFT) during ALS. We performed a prospective, randomized manikin study using a two-rescuer model to compare the effects of ventilation using a LT and BMV on NFT during BLS. Participants were trained in BMV and were inexperienced in the use of a LT. There was no significant difference in total NFT with the use of a LT and BMV (LT: mean 83.1 ± 37.3 s; BMV: mean 78.7 ± 24.5 s; p = 0.313), but we found significant differences in the progression of the scenario: in the BLS-scenario, the proportion of time spent performing chest compressions was higher when BMV was used compared to when a LT was used. The quality of chest compressions and the ventilation rate did not differ significantly between the two groups. The mean tidal volume and mean minute volume were significantly larger with the use of a LT compared with the use of BMV. In conclusion, in a two-rescuer BLS scenario, NFT is longer with the use of a LT (without prior training) than with the use of BMV (with prior training). The probable reasons for this result are higher tidal volumes with the use of a LT leading to longer interruptions without chest compressions.

Effect of using a laryngeal tube on the no-flow time in a simulated, single-rescuer, basic life support setting with inexperienced users.

PubMed

Meyer, O; Bucher, M; Schröder, J

2016-03-01

The laryngeal tube (LT) is a recommended alternative to endotracheal intubation during advanced life support (ALS). Its insertion is relatively simple; therefore, it may also serve as an alternative to bag mask ventilation (BMV) for untrained personnel performing basic life support (BLS). Data support the influence of LT on the no-flow time (NFT) compared with BMV during ALS in manikin studies. We performed a manikin study to investigate the effect of using the LT for ventilation instead of BMV on the NFT during BLS in a prospective, randomized, single-rescuer study. All 209 participants were trained in BMV, but were inexperienced in using LT; each participant performed BLS during a 4-min time period. No significant difference in total NFT (LT: mean 81.1 ± 22.7 s; BMV: mean 83.2 ± 13.1 s, p = 0.414) was found; however, significant differences in the later periods of the scenario were identified. While ventilating with the LT, the proportion of chest compressions increased significantly from 67.2 to 73.2%, whereas the proportion of chest compressions increased only marginally when performing BMV. The quality of the chest compressions and the associated ventilation rate did not differ significantly. The mean tidal volume and mean minute volume were significantly lower when performing BMV. The NFT was significantly shorter in the later periods in a single-rescuer, cardiac arrest scenario when using an LT without previous training compared with BMV with previous training. A possible explanation for this result may be the complexity and workload of alternating tasks (e.g., time loss when reclining the head and positioning the mask for each ventilation during BMV).

[How to do - the chest tube drainage].

PubMed

Klopp, Michael; Hoffmann, Hans; Dienemann, Hendrik

2015-03-01

A chest tube is used to drain the contents of the pleural space to reconstitute the physiologic pressures within the pleural space and to allow the lungs to fully expand. Indications for chest tube placement include pneumothorax, hemothorax, pleural effusion, pleural empyema, and major thoracic surgery. The most appropriate site for chest tube placement is the 4th or 5th intercostal space in the mid- or anterior- axillary line. Attention to technique in placing the chest tube is vital to avoid complications from the procedure. Applying the step-by-step technique presented, placement of a chest tube is a quick and safe procedure. Complications - frequently occurring when the tube is inserted with a steel trocar - include hemothorax, dislocation, lung lacerations, and injury to organs in the thoracic or abdominal cavity." © Georg Thieme Verlag KG Stuttgart · New York.

Evaluation of chest tomosynthesis for the detection of pulmonary nodules: effect of clinical experience and comparison with chest radiography

NASA Astrophysics Data System (ADS)

Zachrisson, Sara; Vikgren, Jenny; Svalkvist, Angelica; Johnsson, Åse A.; Boijsen, Marianne; Flinck, Agneta; Månsson, Lars Gunnar; Kheddache, Susanne; Båth, Magnus

2009-02-01

Chest tomosynthesis refers to the technique of collecting low-dose projections of the chest at different angles and using these projections to reconstruct section images of the chest. In this study, a comparison of chest tomosynthesis and chest radiography in the detection of pulmonary nodules was performed and the effect of clinical experience of chest tomosynthesis was evaluated. Three senior thoracic radiologists, with more than ten years of experience of chest radiology and 6 months of clinical experience of chest tomosynthesis, acted as observers in a jackknife free-response receiver operating characteristics (JAFROC-1) study, performed on 42 patients with and 47 patients without pulmonary nodules examined with both chest tomosynthesis and chest radiography. MDCT was used as reference and the total number of nodules found using MDCT was 131. To investigate the effect of additional clinical experience of chest tomosynthesis, a second reading session of the tomosynthesis images was performed one year after the initial one. The JAFROC-1 figure of merit (FOM) was used as the principal measure of detectability. In comparison with chest radiography, chest tomosynthesis performed significantly better with regard to detectability. The observer-averaged JAFROC-1 FOM was 0.61 for tomosynthesis and 0.40 for radiography, giving a statistically significant difference between the techniques of 0.21 (p<0.0001). The observer-averaged JAFROC-1 FOM of the second reading of the tomosynthesis cases was not significantly higher than that of the first reading, indicating no improvement in detectability due to additional clinical experience of tomosynthesis.

Development and validation of an improved mechanical thorax for simulating cardiopulmonary resuscitation with adjustable chest stiffness and simulated blood flow.

PubMed

Eichhorn, Stefan; Spindler, Johannes; Polski, Marcin; Mendoza, Alejandro; Schreiber, Ulrich; Heller, Michael; Deutsch, Marcus Andre; Braun, Christian; Lange, Rüdiger; Krane, Markus

2017-05-01

Investigations of compressive frequency, duty cycle, or waveform during CPR are typically rooted in animal research or computer simulations. Our goal was to generate a mechanical model incorporating alternate stiffness settings and an integrated blood flow system, enabling defined, reproducible comparisons of CPR efficacy. Based on thoracic stiffness data measured in human cadavers, such a model was constructed using valve-controlled pneumatic pistons and an artificial heart. This model offers two realistic levels of chest elasticity, with a blood flow apparatus that reflects compressive depth and waveform changes. We conducted CPR at opposing levels of physiologic stiffness, using a LUCAS device, a motor-driven plunger, and a group of volunteers. In high-stiffness mode, blood flow generated by volunteers was significantly less after just 2min of CPR, whereas flow generated by LUCAS device was superior by comparison. Optimal blood flow was obtained via motor-driven plunger, with trapezoidal waveform. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

Measurement of absolute lung volumes by imaging techniques.

PubMed

Clausen, J

1997-10-01

In this paper, the techniques available for estimating total lung capacities from standard chest radiographs in children and infants as well as adults are reviewed. These techniques include manual measurements using ellipsoid and planimetry techniques as well as computerized systems. Techniques are also available for making radiographic lung volume measurements from portable chest radiographs. There are inadequate data in the literature to support recommending one specific technique over another. Though measurements of lung volumes by radiographic, plethysmographic, gas dilution or washout techniques result in remarkably similar mean results when groups of normal subjects are tested, in patients with disease, the results of these different basic measurement techniques can differ significantly. Computed tomographic and magnetic resonance techniques can also be used to measure absolute lung volumes and offer the theoretical advantages that the results in individual subjects are less affected by variances of thoracic shape than are measurements made using conventional chest radiographs.

Tube thoracostomy; chest tube implantation and follow up

PubMed Central

Kuhajda, Ivan; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Huang, Haidong; Li, Qiang; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Papaiwannou, Antonis; Lampaki, Sofia; Papaiwannou, Antonis; Zaric, Bojan; Branislav, Perin; Porpodis, Konstantinos

2014-01-01

Pneumothorax is an urgent medical situation that requires urgent treatment. We can divide this entity based on the etiology to primary and secondary. Chest tube implantation can be performed either in the upper chest wall or lower. Both thoracic surgeons and pulmonary physicians can place a chest tube with minimal invasive techniques. In our current work, we will demonstrate chest tube implantation to locations, methodology and tools. PMID:25337405

Availability and quality of cardiopulmonary resuscitation information for Spanish-speaking population on the Internet.

PubMed

Liu, Kirsten Y; Haukoos, Jason S; Sasson, Comilla

2014-01-01

Bystander cardiopulmonary resuscitation (CPR) is a vital link in the chain of survival for out-of-hospital cardiac arrest (OHCA); however, there are racial/ethnic disparities in the provision of bystander CPR. Approximately 32% of Hispanics perform CPR when confronted with cardiac arrest, whereas approximately 41% of non-Hispanics perform CPR. Public education, via the Internet, may be critical in improving the performance of bystander CPR among Hispanics. The objective of this study was to evaluate the availability and quality of CPR-related literature for primary Spanish-speaking individuals on the Internet. Two search engines (Google and Yahoo!) and a video-site (YouTube) were searched using the following terms: "resucitacion cardiopulmonar" and "reanimacion cardiopulmonar." Inclusion criteria were: education of CPR technique. Exclusion criteria were: instruction on pediatric CPR technique, failure to provide any instruction on CPR technique, or duplicated website. Data elements were collected on the content and quality of the websites and videos, such as assessing scene safety, verifying responsiveness, activating EMS, properly positioning hands on chest, performing accurate rate and depth of compressions. Of the 515 websites or videos screened, 116 met criteria for inclusion. The majority of websites (86%; 95% Confidence Interval [CI] 79-92%) educated viewers on traditional bystander CPR (primarily, 30:2 CPR), while only 14% (95% CI 9-21%) taught hands-only CPR. Of websites that used video (N=62), 84% were conducted in Spanish and 16% in English. The quality of CPR education was generally poor (median score of 3/6, IQR of 3.0). Only half of websites properly educated on how to check responsiveness, activate EMS and position hands on chest. Eighty-eight percent of websites failed to educate viewers on assessing scene safety. The majority of websites had improper or no education on both rate and depth of compressions (59% and 63%, respectively). Only 16% of websites included 5 or more quality markers for proper bystander CPR. A small proportion of internet resources have high quality CPR education for a Spanish-speaking population. More emphasis should be placed on improving the quality of educational resources available on the Internet for Spanish-speaking populations, and with particular emphasis on current basic life support recommendations. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

LUCAS(™)2 in Danish Search and Rescue Helicopters.

PubMed

Winther, Kasper; Bleeg, René Christian

2016-01-01

Prehospital resuscitation is often challenging. Giving uninterrupted and effective compressions is relatively impossible during transportation. In 2012, The Royal Danish Air Force received a donation of 8 mechanical chest compression devices (LUCAS(™)2; Physio-Control/Jolife AB, Lund, Sweden) to be used onboard the Danish search and rescue (SAR) helicopters. The scope of this investigation was to establish whether or not mechanical chest compression devices should be considered a necessity onboard the Danish SAR helicopters. Data were compiled from SAR medical journals. From the data collected, observations were made as to when LUCAS(™)2 was used and what diagnosis the SAR physician made. One thousand ninety missions were registered in the 24-month research period, and LUCAS(™)2 was used in 25 missions. Cardiac emergencies amounted for 25% of the missions. The Danish SAR helicopters retrieved 33 drowned/hypothermic patients during the research period, and the LUCAS(™)2 was used in 11 of the patients requiring resuscitation. The LUCAS(™)2 was frequently used during other emergencies like sudden cardiac arrest. Cardiac emergencies were the predominant type of mission. LUCAS(™)2 is now considered mandatory on Danish SAR helicopters. Copyright © 2016 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

The association between AHA CPR quality guideline compliance and clinical outcomes from out-of-hospital cardiac arrest.

PubMed

Cheskes, Sheldon; Schmicker, Robert H; Rea, Tom; Morrison, Laurie J; Grunau, Brian; Drennan, Ian R; Leroux, Brian; Vaillancourt, Christian; Schmidt, Terri A; Koller, Allison C; Kudenchuk, Peter; Aufderheide, Tom P; Herren, Heather; Flickinger, Katharyn H; Charleston, Mark; Straight, Ron; Christenson, Jim

2017-07-01

Measures of chest compression fraction (CCF), compression rate, compression depth and pre-shock pause have all been independently associated with improved outcomes from out-of-hospital (OHCA) cardiac arrest. However, it is unknown whether compliance with American Heart Association (AHA) guidelines incorporating all the aforementioned metrics, is associated with improved survival from OHCA. We performed a secondary analysis of prospectively collected data from the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database. As per the 2015 American Heart Association (AHA) guidelines, guideline compliant cardiopulmonary resuscitation (CPR) was defined as CCF >0.8, chest compression rate 100-120/minute, chest compression depth 50-60mm, and pre-shock pause <10s. Multivariable logistic regression models controlling for Utstein variables were used to assess the relationship between global guideline compliance and survival to hospital discharge and neurologically intact survival with MRS ≤3. Due to potential confounding between CPR quality metrics and cases that achieved early ROSC, we performed an a priori subgroup analysis restricted to patients who obtained ROSC after ≥10min of EMS resuscitation. After allowing for study exclusions, 19,568 defibrillator records were collected over a 4-year period ending in June 2015. For all reported models, the reference standard included all cases who did not meet all CPR quality benchmarks. For the primary model (CCF, rate, depth), there was no significant difference in survival for resuscitations that met all CPR quality benchmarks (guideline compliant) compared to the reference standard (OR 1.26; 95% CI: 0.80, 1.97). When the dataset was restricted to patients obtaining ROSC after ≥10min of EMS resuscitation (n=4,158), survival was significantly higher for those resuscitations that were guideline compliant (OR 2.17; 95% CI: 1.11, 4.27) compared to the reference standard. Similar findings were obtained for neurologically intact survival with MRS ≤3 (OR 3.03; 95% CI: 1.12, 8.20). In this observational study, compliance with AHA guidelines for CPR quality was not associated with improved outcomes from OHCA. Conversely, when restricting the cohort to those with late ROSC, compliance with guidelines was associated with improved clinical outcomes. Strategies to improve overall guideline compliance may have a significant impact on outcomes from OHCA. Copyright © 2017 Elsevier B.V. All rights reserved.

The impact of airway management on quality of cardiopulmonary resuscitation: an observational study in patients during cardiac arrest.

PubMed

Yeung, Joyce; Chilwan, Mehboob; Field, Richard; Davies, Robin; Gao, Fang; Perkins, Gavin D

2014-07-01

Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality. Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (endotracheal tube [ET] or laryngeal mask airway [LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device. One hundred patients were enrolled in the study (2008-2011). Endotracheal tube and LMA placement took similar durations (median 15.8 s (IQR 6.8-19.4) vs. LMA median 8.0s (IQR 5.5-15.9), p=0.1). The use of an advanced airway was associated with improved no flow ratios (endotracheal tube placement (n=50) improved NFR from baseline median 0.24 IQR 0.17-0.40) to 0.15 to (IQR 0.09-0.28), p=0.012; LMA (n=25) from median 0.28 (IQR 0.23-0.40) to 0.13 (IQR 0.11- 0.19), p=0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n=25) (median 0.29 (IQR 0.18-0.59) vs. median 0.26 (IQR 0.12-0.37), p=0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups. The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Why do some studies find that CPR fraction is not a predictor of survival?

PubMed

Wik, Lars; Olsen, Jan-Aage; Persse, David; Sterz, Fritz; Lozano, Michael; Brouwer, Marc A; Westfall, Mark; Souders, Chris M; Travis, David T; Herken, Ulrich R; Lerner, E Brooke

2016-07-01

An 80% chest compression fraction (CCF) during resuscitation is recommended. However, heterogeneous results in CCF studies were found during the 2015 Consensus on Science (CoS), which may be because chest compressions are stopped for a wide variety of reasons including providing lifesaving care, provider distraction, fatigue, confusion, and inability to perform lifesaving skills efficiently. The effect of confounding variables on CCF to predict cardiac arrest survival. A secondary analysis of emergency medical services (EMS) treated out-of-hospital cardiac arrest (OHCA) patients who received manual compressions. CCF (percent of time patients received compressions) was determined from electronic defibrillator files. Two Sample Wilcoxon Rank Sum or regression determined a statistical association between CCF and age, gender, bystander CPR, public location, witnessed arrest, shockable rhythm, resuscitation duration, study site, and number of shocks. Univariate and multivariate logistic regressions were used to determine CCF effect on survival. Of 2132 patients with manual compressions 1997 had complete data. Shockable rhythm (p<0.001), public location (p<0.004), treatment duration (p<0.001), and number of shocks (p<0.001) were associated with lower CCF. Univariate logistic regression found that CCF was inversely associated with survival (OR 0.07; 95% CI 0.01-0.36). Multivariate regression controlling for factors associated with survival and/or CCF found that increasing CCF was associated with survival (OR 6.34; 95% CI 1.02-39.5). CCF cannot be looked at in isolation as a predictor of survival, but in the context of other resuscitation activities. When controlling for the effects of other resuscitation activities, a higher CCF is predictive of survival. This may explain the heterogeneity of findings during the CoS review. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Protocol of a Multicenter International Randomized Controlled Manikin Study on Different Protocols of Cardiopulmonary Resuscitation for laypeople (MANI-CPR).

PubMed

Baldi, Enrico; Contri, Enrico; Burkart, Roman; Borrelli, Paola; Ferraro, Ottavia Eleonora; Tonani, Michela; Cutuli, Amedeo; Bertaia, Daniele; Iozzo, Pasquale; Tinguely, Caroline; Lopez, Daniel; Boldarin, Susi; Deiuri, Claudio; Dénéréaz, Sandrine; Dénéréaz, Yves; Terrapon, Michael; Tami, Christian; Cereda, Cinzia; Somaschini, Alberto; Cornara, Stefano; Cortegiani, Andrea

2018-04-19

Out-of-hospital cardiac arrest is one of the leading causes of death in industrialised countries. Survival depends on prompt identification of cardiac arrest and on the quality and timing of cardiopulmonary resuscitation (CPR) and defibrillation. For laypeople, there has been a growing interest on hands-only CPR, meaning continuous chest compression without interruption to perform ventilations. It has been demonstrated that intentional interruptions in hands-only CPR can increase its quality. The aim of this randomised trial is to compare three CPR protocols performed with different intentional interruptions with hands-only CPR. This is a prospective randomised trial performed in eight training centres. Laypeople who passed a basic life support course will be randomised to one of the four CPR protocols in an 8 min simulated cardiac arrest scenario on a manikin: (1) 30 compressions and 2 s pause; (2) 50 compressions and 5 s pause; (3) 100 compressions and 10 s pause; (4) hands-only. The calculated sample size is 552 people. The primary outcome is the percentage of chest compression performed with correct depth evaluated by a computerised feedback system (Laerdal QCPR). ETHICS AND DISSEMINATION: . Due to the nature of the study, we obtained a waiver from the Ethics Committee (IRCCS Policlinico San Matteo, Pavia, Italy). All participants will sign an informed consent form before randomisation. The results of this study will be published in peer-reviewed journal. The data collected will also be made available in a public data repository. NCT02632500. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The unique contribution of manual chest compression-vibrations to airflow during physiotherapy in sedated, fully ventilated children.

PubMed

Gregson, Rachael K; Shannon, Harriet; Stocks, Janet; Cole, Tim J; Peters, Mark J; Main, Eleanor

2012-03-01

This study aimed to quantify the specific effects of manual lung inflations with chest compression-vibrations, commonly used to assist airway clearance in ventilated patients. The hypothesis was that force applied during the compressions made a significant additional contribution to increases in peak expiratory flow and expiratory to inspiratory flow ratio over and above that resulting from accompanying increases in inflation volume. Prospective observational study. Cardiac and general pediatric intensive care. Sedated, fully ventilated children. Customized force-sensing mats and a commercial respiratory monitor recorded force and respiration during physiotherapy. Percentage changes in peak expiratory flow, peak expiratory to inspiratory flow ratios, inflation volume, and peak inflation pressure between baseline and manual inflations with and without compression-vibrations were calculated. Analysis of covariance determined the relative contribution of changes in pressure, volume, and force to influence changes in peak expiratory flow and peak expiratory to inspiratory flow ratio. Data from 105 children were analyzed (median age, 1.3 yrs; range, 1 wk to 15.9 yrs). Force during compressions ranged from 15 to 179 N (median, 46 N). Peak expiratory flow increased on average by 76% during compressions compared with baseline ventilation. Increases in peak expiratory flow were significantly related to increases in inflation volume, peak inflation pressure, and force with peak expiratory flow increasing by, on average, 4% for every 10% increase in inflation volume (p < .001), 5% for every 10% increase in peak inflation pressure (p = .005), and 3% for each 10 N of applied force (p < .001). By contrast, increase in peak expiratory to inspiratory flow ratio was only related to applied force with a 4% increase for each 10 N of force (p < .001). These results provide evidence of the unique contribution of compression forces in increasing peak expiratory flow and peak expiratory to inspiratory flow ratio bias over and above that related to accompanying changes from manual hyperinflations. Force generated during compression-vibrations was the single significant factor in multivariable analysis to explain the increases in expiratory flow bias. Such increases in the expiratory bias provide theoretically optimal physiological conditions for cephalad mucus movement in fully ventilated children.

Technique for repair of fractures and separations involving the cartilaginous portions of the anterior chest wall.

PubMed

Bonne, Stephanie L; Turnbull, Isaiah R; Southard, Robert E

2015-06-01

Internal fixation of the ribs has been shown in numerous studies to decrease complications following traumatic rib fractures. Anterior injuries to the chest wall causing cartilaginous fractures, although rare, can cause significant disability and can lead to a variety of complications and, therefore, pose a unique clinical problem. Here, we report the surgical technique used for four patients with internal fixation of injuries to the cartilaginous portions of the chest wall treated at our center. All patients had excellent clinical outcomes and reported improvement in symptoms, with no associated complications. Patients who have injuries to the anterior portions of the chest wall should be considered for internal fixation of the chest wall when the injuries are severe and can lead to clinical disability.

Does a minimal invasive approach reduce anterior chest wall numbness and postoperative pain in plate fixation of clavicle fractures?

PubMed

Beirer, Marc; Postl, Lukas; Crönlein, Moritz; Siebenlist, Sebastian; Huber-Wagner, Stefan; Braun, Karl F; Biberthaler, Peter; Kirchhoff, Chlodwig

2015-05-28

Fractures of the clavicle present very common injuries with a peak of incidence in young active patients. Recently published randomized clinical trials demonstrated an improved functional outcome and a lower rate of nonunions in comparison to non-operative treatment. Anterior chest wall numbness due to injury of the supraclavicular nerve and postoperative pain constitute common surgery related complications in plate fixation of displaced clavicle fractures. We recently developed a technique for mini open plating (MOP) of the clavicle to reduce postoperative numbness and pain. The purpose of this study was to analyze the size of anterior chest wall numbness and the intensity of postoperative pain in MOP in comparison to conventional open plating (COP) of clavicle fractures. 24 patients (mean age 38.2 ± 14.2 yrs.) with a displaced fracture of the clavicle (Orthopaedic Trauma Association B1.2-C1.2) surgically treated using a locking compression plate (LCP) were enrolled. 12 patients underwent MOP and another 12 patients COP. Anterior chest wall numbness was measured with a transparency grid on the second postoperative day and at the six months follow-up. Postoperative pain was evaluated using the Visual Analog Scale (VAS). Mean ratio of skin incision length to plate length was 0.61 ± 0.04 in the MOP group and 0.85 ± 0.06 in the COP group (p < 0.05). Mean ratio of the area of anterior chest wall numbness to plate length was postoperative 7.6 ± 5.9 (six months follow-up 4.7 ± 3.9) in the MOP group and 22.1 ± 19.1 (16.9 ± 14.1) in the COP group (p < 0.05). Mean VAS was 2.6 ± 1.4 points in the MOP group and 3.4 ± 1.6 points in the COP group (p = 0.20). In our study, MOP significantly reduced anterior chest wall numbness in comparison to a conventional open approach postoperative as well as at the six months follow-up. Postoperative pain tended to be lower in the MOP group, however this difference was not statistically significant. ClinicalTrials.gov NCT02247778 . Registered 21 September 2014.

Evaluation of the field relevance of several injury risk functions.

PubMed

Prasad, Priya; Mertz, Harold J; Dalmotas, Danius J; Augenstein, Jeffrey S; Diggs, Kennerly

2010-11-01

An evaluation of the four injury risk curves proposed in the NHTSA NCAP for estimating the risk of AIS>= 3 injuries to the head, neck, chest and AIS>=2 injury to the Knee-Thigh-Hip (KTH) complex has been conducted. The predicted injury risk to the four body regions based on driver dummy responses in over 300 frontal NCAP tests were compared against those to drivers involved in real-world crashes of similar severity as represented in the NASS. The results of the study show that the predicted injury risks to the head and chest were slightly below those in NASS, and the predicted risk for the knee-thigh-hip complex was substantially below that observed in the NASS. The predicted risk for the neck by the Nij curve was greater than the observed risk in NASS by an order of magnitude due to the Nij risk curve predicting a non-zero risk when Nij = 0. An alternative and published Nte risk curve produced a risk estimate consistent with the NASS estimate of neck injury. Similarly, an alternative and published chest injury risk curve produced a risk estimate that was within the bounds of the NASS estimates. No published risk curve for femur compressive load could be found that would give risk estimates consistent with the range of the NASS estimates. Additional work on developing a femur compressive load risk curve is recommended.

Cardiopulmonary resuscitation: a historical perspective leading up to the end of the 19th century.

PubMed

Ekmektzoglou, Konstantinos A; Johnson, Elizabeth O; Syros, Periklis; Chalkias, Athanasios; Kalambalikis, Lazaros; Xanthos, Theodoros

2012-01-01

Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation (CPR) was challenged, which finally led to the Enlightenment, where scholars attempted to scientifically solve the problem of sudden death. It was then that the various components of CPR (ventilation, circulation, electricity, and organization of emergency medical services) began to take shape. The 19th century gave way to hallmarks both in the ventilatory support (intubation innovations and the artificial respirator) and the open-and closed chest circulatory support. Meanwhile, novel defibrillation techniques had been employed and ventricular fibrillation described. The groundbreaking discoveries of the 20th century finally led to the scientific framework of CPR. In 1960, mouth-to-mouth resuscitation was eventually combined with chest compression and defibrillation to become CPR as we now know it. This review presents the scientific milestones behind one of medicine's most widely used fields.

Non-censored rib fracture data during frontal PMHS sled tests.

PubMed

Kemper, Andrew R; Beeman, Stephanie M; Porta, David J; Duma, Stefan M

2016-09-01

The purpose of this study was to obtain non-censored rib fracture data due to three-point belt loading during dynamic frontal post-mortem human surrogate (PMHS) sled tests. The PMHS responses were then compared to matched tests performed using the Hybrid-III 50(th) percentile male ATD. Matched dynamic frontal sled tests were performed on two male PMHSs, which were approximately 50(th) percentile height and weight, and the Hybrid-III 50(th) percentile male ATD. The sled pulse was designed to match the vehicle acceleration of a standard sedan during a FMVSS-208 40 kph test. Each subject was restrained with a 4 kN load limiting, driver-side, three-point seatbelt. A 59-channel chestband, aligned at the nipple line, was used to quantify the chest contour, anterior-posterior sternum deflection, and maximum anterior-posterior chest deflection for all test subjects. The internal sternum deflection of the ATD was quantified with the sternum potentiometer. For the PMHS tests, a total of 23 single-axis strain gages were attached to the bony structures of the thorax, including the ribs, sternum, and clavicle. In order to create a non-censored data set, the time history of each strain gage was analyzed to determine the timing of each rib fracture and corresponding timing of each AIS level (AIS = 1, 2, 3, etc.) with respect to chest deflection. Peak sternum deflection for PMHS 1 and PMHS 2 were 48.7 mm (19.0%) and 36.7 mm (12.2%), respectively. The peak sternum deflection for the ATD was 20.8 mm when measured by the chest potentiometer and 34.4 mm (12.0%) when measured by the chestband. Although the measured ATD sternum deflections were found to be well below the current thoracic injury criterion (63 mm) specified for the ATD in FMVSS-208, both PMHSs sustained AIS 3+ thoracic injuries. For all subjects, the maximum chest deflection measured by the chestband occurred to the right of the sternum and was found to be 83.0 mm (36.0%) for PMHS 1, 60.6 mm (23.9%) for PMHS 2, and 56.3 mm (20.0%) for the ATD. The non-censored rib fracture data in the current study (n = 2 PMHS) in conjunction with the non-censored rib fracture data from two previous table-top studies (n = 4 PMHS) show that AIS 3+ injury timing occurs prior to peak sternum compression, prior to peak maximum chest compression, and at lower compressions than might be suggested by current PMHS thoracic injury criteria developed using censored rib fracture data. In addition, the maximum chest deflection results showed a more reasonable correlation between deflection, rib fracture timing, and injury severity than sternum deflection. Overall, these data provide compelling empirical evidence that suggests a more conservative thoracic injury criterion could potentially be developed based on non-censored rib fracture data with additional testing performed over a wider range of subjects and loading conditions.

Effect of one-rescuer compression/ventilation ratios on cardiopulmonary resuscitation in infant, pediatric, and adult manikins.

PubMed

Srikantan, Shoba Krishnan; Berg, Robert A; Cox, Tim; Tice, Lisa; Nadkarni, Vinay M

2005-05-01

Optimal chest compression to ventilation ratio (C:V) for one-rescuer cardiopulmonary resuscitation (CPR) is not known, with current American Heart Association recommendations 3:1 for newborns, 5:1 for children, and 15:2 for adults. C:V ratios influence effectiveness of CPR, but memorizing different ratios is educationally cumbersome. We hypothesized that a 10:2 ratio might provide adequate universal application for all age arrest victims. Clinical study. Tertiary care children's hospital. Thirty-five health care providers. Thirty-five health care providers performed 5-min epochs of one-rescuer CPR at C:V ratios of 3:1, 5:1, 10:2, and 15:2 in random order on infant, pediatric, and adult manikins. Compressions were paced at 100/min by metronome. The number of effective compressions and ventilations delivered per minute was recorded by a trained basic life support instructor. Subjective assessments of fatigue (self-report) and exertion (change in rescuer pulse rate compared with baseline) were assessed. Analysis was by repeated measures analysis of variance and paired Student's t-test. Effective infant compressions per minute did not differ by C:V ratio, but ventilations per minute were greater at 3:1 vs. 5:1, 10:2, and 15:2 (p < .05). Effective pediatric compressions per minute were less at 3:1 vs. 5:1, 10:2, and 15:2 (p < .05) and not different between 5:1, 10:2, and 15:2 ratios. Effective pediatric ventilations per minute were greater at 3:1 than all other ratios and both 5:1 and 10:2 were >15:2 (p < .05). Effective adult compressions per minute were progressively greater with 3:1 vs. 5:1 vs. 10:2 vs. 15:2 (p < .05). Self-efficacy was assessed, and rescuers always subjectively rated 10:2 and 15:2 ratios as easier than 5:1 or 3:1 ratios for all manikins. Rescuer pulse change (exertion) was greater after pediatric and adult vs. infant CPR (p < .05), with no significant difference by C:V ratio. C:V ratio and manikin size have a significant influence on the number of effective compressions and ventilations delivered during ideal, metronome-paced, one-rescuer CPR. Low ratios of 3:1, 5:1, and 10:2 favor ventilation, and high ratios of 15:2 favor compression, especially in adult manikins. Rescuers subjectively preferred C:V ratios of 10:2 and 15:2 over 3:1 or 5:1. Infant CPR caused less exertion and subjective fatigue than pediatric or adult CPR technique, without significant difference by C:V ratio. We speculate that a universal 10:2 C:V ratio for one-rescuer layperson CPR is physiologically reasonable but warrants further study with particular attention to educational value and technique retention.

Treatment of atelectasis: where is the evidence?

PubMed Central

Schindler, Margrid B

2005-01-01

Lobar atelectasis is a common problem caused by a variety of mechanisms including resorption atelectasis due to airway obstruction, passive atelectasis from hypoventilation, compressive atelectsis from abdominal distension and adhesive atelectasis due to increased surface tension. However, evidence-based studies on the management of lobar atelectasis are lacking. Examination of air-bronchograms on a chest radiograph may be helpful to determine whether proximal or distal airway obstruction is involved. Chest physiotherapy, nebulised DNase and possibly fibreoptic bronchoscopy might be helpful in patients with mucous plugging of the airways. In passive and adhesive atelectasis, positive end-expiratory pressure might be a useful adjunct to treatment. PMID:16137380

Animation-assisted CPRII program as a reminder tool in achieving effective one-person-CPR performance.

PubMed

Choa, Minhong; Cho, Junho; Choi, Young Hwan; Kim, Seungho; Sung, Ji Min; Chung, Hyun Soo

2009-06-01

The objective of this study is to compare the skill retention of two groups of lay persons, six months after their last CPR training. The intervention group was provided with animation-assisted CPRII (AA-CPRII) instruction on their cellular phones, and the control group had nothing but what they learned from their previous training. This study was a single blind randomized controlled trial. The participants' last CPR trainings were held at least six months ago. We revised our CPR animation for on-site CPR instruction content emphasizing importance of chest compression. Participants were randomized into two groups, the AA-CPRII group (n=42) and the control group (n=38). Both groups performed three cycles of CPR and their performances were video recorded. These video clips were assessed by three evaluators using a checklist. The psychomotor skills were evaluated using the ResusciAnne SkillReporter. Using the 30-point scoring checklist, the AA-CPRII group had a significantly better score compared to the control group (p<0.001). Psychomotor skills evaluated with the AA-CPRII group demonstrated better performance in hand positioning (p=0.025), compression depth (p=0.035) and compression rate (p<0.001) than the control group. The AA-CPRII group resulted in better checklist scores, including chest compression rate, depth and hand positioning. Animation-assisted CPR could be used as a reminder tool in achieving effective one-person-CPR performance. By installing the CPR instruction on cellular phones and having taught them CPR with it during the training enabled participants to perform better CPR.

[Factors affecting the survival of transplants from donors after prehospital cardiac death].

PubMed

Mateos Rodríguez, Alonso Antonio; Andrés Belmonte, Amado; Del Río Gallegos, Francisco; Coll, Elisabeth

2017-06-01

To evaluate factors that influence the survival of transplanted organs from donors after prehospital cardiac death. Retrospective observational study of data collected from hospital emergency service records. Information included prehospital cardiac deaths evaluated as donors as well as patients who received transplants. Two hundred cases from 2008 through 2011 were studied. Sixty-nine potential donors (34.5%) were rejected. Three hundred organs were extracted from the remaining 131 donor cases, to yield a mean (SD) of 2.32 (0.83) transplanted organs/donor or 1.52 (1.29) organs/potential donor. One hundred fifty-two potential donors (76%) were treated with mechanical cardiopumps during transport. We detected no significant differences between cases transported with manual chest compressions and cases treated with cardiopumps regarding age (40.1 vs 43.5 years, P=.06), responder arrival times (13 min 54 s vs 12 min 54 s, P=.45), or transport times (1 h 27 min vs 1 h 32 min). However, case transported with manual chest compressions yielded significantly more kidneys (mean, 1.96/potential donor) than those transported with cardiopump compressions (mean, 1.38/potential donor) (P=.008). Eleven of the 229 kidneys harvested (4%) were not transplanted. The median (interquartile range) serum creatinine concentrations after kidney transplants at 6 and 12 months, respectively, were 1.37 (1.10-1.58) mg/dL and 1.43 (1.11-1.80) mg/dL. Our findings suggest that the use of a cardiopump reduces donor recruitment. Long-term creatinine levels are similar after transplantation of kidneys from donors transported with a cardiopump or with manual compressions.

Comparison of dual and single exposure techniques in dual-energy chest radiography.

PubMed

Ho, J T; Kruger, R A; Sorenson, J A

1989-01-01

Conventional chest radiography is the most effective tool for lung cancer detection and diagnosis; nevertheless, a high percentage of lung cancer tumors are missed because of the overlap of lung nodule image contrast with bone image contrast in a chest radiograph. Two different energy subtraction strategies, dual exposure and single exposure techniques, were studied for decomposing a radiograph into bone-free and soft tissue-free images to address this problem. For comparing the efficiency of these two techniques in lung nodule detection, the performances of the techniques were evaluated on the basis of residual tissue contrast, energy separation, and signal-to-noise ratio. The evaluation was based on both computer simulation and experimental verification. The dual exposure technique was found to be better than the single exposure technique because of its higher signal-to-noise ratio and greater residual tissue contrast. However, x-ray tube loading and patient motion are problems.

Managing a chest tube and drainage system.

PubMed

Durai, Rajaraman; Hoque, Happy; Davies, Tony W

2010-02-01

Intercostal drainage tubes (ie, chest tubes) are inserted to drain the pleural cavity of air, blood, pus, or lymph. The water-seal container connected to the chest tube allows one-way movement of air and liquid from the pleural cavity. The container should not be changed unless it is full, and the chest tube should not be clamped unnecessarily. After a chest tube is inserted, a nurse trained in chest-tube management is responsible for managing the chest tube and drainage system. This entails monitoring the chest-tube position, controlling fluid evacuation, identifying when to change or empty the containers, and caring for the tube and drainage system during patient transport. This article provides an overview of indications, insertion techniques, and management of chest tubes. Copyright 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Radiation therapy for breast cancer: Literature review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Balaji, Karunakaran, E-mail: karthik.balaji85@gmail.com; School of Advanced Sciences, VIT University, Vellore; Subramanian, Balaji

Concave shape with variable size target volume makes treatment planning for the breast/chest wall a challenge. Conventional techniques used for the breast/chest wall cancer treatment provided better sparing of organs at risk (OARs), with poor conformity and uniformity to the target volume. Advanced technologies such as intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) improve the target coverage at the cost of higher low dose volumes to OARs. Novel hybrid techniques present promising results in breast/chest wall irradiation in terms of target coverage as well as OARs sparing. Several published data compared these technologies for the benefit ofmore » the breast/chest wall with or without nodal volumes. The aim of this article is to review relevant data and identify the scope for further research in developing optimal treatment plan for breast/chest wall cancer treatment.« less

A mechanical chest compressor closed-loop controller with an effective trade-off between blood flow improvement and ribs fracture reduction.

PubMed

Zhang, Guang; Wu, Taihu; Song, Zhenxing; Wang, Haitao; Lu, Hengzhi; Wang, Yalin; Wang, Dan; Chen, Feng

2015-06-01

Chest compression (CC) is a significant emergency medical procedure for maintaining circulation during cardiac arrest. Although CC produces the necessary blood flow for patients with heart arrest, improperly deep CC will contribute significantly to the risk of chest injury. In this paper, an optimal CC closed-loop controller for a mechanical chest compressor (OCC-MCC) was developed to provide an effective trade-off between the benefit of improved blood perfusion and the risk of ribs fracture. The trade-off performance of the OCC-MCC during real automatic mechanical CCs was evaluated by comparing the OCC-MCC and the traditional mechanical CC method (TMCM) with a human circulation hardware model based on hardware simulations. A benefit factor (BF), risk factor (RF) and benefit versus risk index (BRI) were introduced in this paper for the comprehensive evaluation of risk and benefit. The OCC-MCC was developed using the LabVIEW control platform and the mechanical chest compressor (MCC) controller. PID control is also employed by MCC for effective compression depth regulation. In addition, the physiological parameters model for MCC was built based on a digital signal processor for hardware simulations. A comparison between the OCC-MCC and TMCM was then performed based on the simulation test platform which is composed of the MCC, LabVIEW control platform, physiological parameters model for MCC and the manikin. Compared with the TMCM, the OCC-MCC obtained a better trade-off and a higher BRI in seven out of a total of nine cases. With a higher mean value of cardiac output (1.35 L/min) and partial pressure of end-tidal CO2 (15.7 mmHg), the OCC-MCC obtained a larger blood flow and higher BF than TMCM (5.19 vs. 3.41) in six out of a total of nine cases. Although it is relatively difficult to maintain a stable CC depth when the chest is stiff, the OCC-MCC is still superior to the TMCM for performing safe and effective CC during CPR. The OCC-MCC is superior to the TMCM in performing safe and effective CC during CPR and can be incorporated into the current version of mechanical CC devices for high quality CPR, in both in-hospital and out-of-hospital CPR settings.

Comparison of patient specific dose metrics between chest radiography, tomosynthesis, and CT for adult patients of wide ranging body habitus

PubMed Central

Zhang, Yakun; Li, Xiang; Segars, W. Paul; Samei, Ehsan

2014-01-01

Purpose: Given the radiation concerns inherent to the x-ray modalities, accurately estimating the radiation doses that patients receive during different imaging modalities is crucial. This study estimated organ doses, effective doses, and risk indices for the three clinical chest x-ray imaging techniques (chest radiography, tomosynthesis, and CT) using 59 anatomically variable voxelized phantoms and Monte Carlo simulation methods. Methods: A total of 59 computational anthropomorphic male and female extended cardiac-torso (XCAT) adult phantoms were used in this study. Organ doses and effective doses were estimated for a clinical radiography system with the capability of conducting chest radiography and tomosynthesis (Definium 8000, VolumeRAD, GE Healthcare) and a clinical CT system (LightSpeed VCT, GE Healthcare). A Monte Carlo dose simulation program (PENELOPE, version 2006, Universitat de Barcelona, Spain) was used to mimic these two clinical systems. The Duke University (Durham, NC) technique charts were used to determine the clinical techniques for the radiographic modalities. An exponential relationship between CTDIvol and patient diameter was used to determine the absolute dose values for CT. The simulations of the two clinical systems compute organ and tissue doses, which were then used to calculate effective dose and risk index. The calculation of the two dose metrics used the tissue weighting factors from ICRP Publication 103 and BEIR VII report. Results: The average effective dose of the chest posteroanterior examination was found to be 0.04 mSv, which was 1.3% that of the chest CT examination. The average effective dose of the chest tomosynthesis examination was found to be about ten times that of the chest posteroanterior examination and about 12% that of the chest CT examination. With increasing patient average chest diameter, both the effective dose and risk index for CT increased considerably in an exponential fashion, while these two dose metrics only increased slightly for radiographic modalities and for chest tomosynthesis. Effective and organ doses normalized to mAs all illustrated an exponential decrease with increasing patient size. As a surface organ, breast doses had less correlation with body size than that of lungs or liver. Conclusions: Patient body size has a much greater impact on radiation dose of chest CT examinations than chest radiography and tomosynthesis. The size of a patient should be considered when choosing the best thoracic imaging modality. PMID:24506654

Assessing the Hemodynamic Effects of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Traumatic Cardiac Arrest When Closed Chest Compressions are Augmented by Directing the Area of Maximal Compression Over the Left Ventricle in a Swine Model (sus scrofa)

DTIC Science & Technology

2016-09-15

WHASC – Animal Final Report 18May16 1. Protocol Number: FWH200140094A 2. Type of Research: Animal Research 3. Title...6. Results: ROSC increased among standard CC animals with REBOA (33%) compared to standard CC animals without REBOA (0.0%) (p=0.04). Among...standard CC animals , aortic systolic blood pressure, right atrial systolic blood pressure and end tidal CO2 (ETCO2) increased during all time intervals of

Traumatic asphyxia: An autopsy case.

PubMed

Türkmen, Nursel; Eren, Bülent; Erkol, Zerrin

2015-01-01

Traumatic asphyxia is a form of asphyxia where respiration is prevented by external pressure on the body. A 19-year-old man was found by relatives compressed by motorboat in the garage. The death was investigated by the prosecutor; body was taken to the Morgue Department for performing autopsy. On gross physical examination; the face, neck and upper part of the chest were congested and many petechiae were observed on the conjunctivae, but not in low extremities. Autopsy macroscopic examination of lungs revealed congestion, sub pleural superficial bleeding areas. In the presented case death was reported as traumatic asphyxia by thorax compression without other lethal factors.

The cardiocerebral resuscitation protocol for treatment of out-of-hospital primary cardiac arrest.

PubMed

Ewy, Gordon A

2012-09-15

Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.

The Cardiocerebral Resuscitation protocol for treatment of out-of-hospital primary cardiac arrest

PubMed Central

2012-01-01

Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol. PMID:22980487

Minimally Invasive Repair of Pectus Carinatum.

PubMed

Yuksel, Mustafa; Lacin, Tunc; Ermerak, Nezih Onur; Sirzai, Esra Yamansavci; Sayan, Bihter

2018-03-01

The second most common deformity of the anterior chest wall, pectus carinatum, is a diverse deformity that has been largely managed using open techniques. This study reviews clinical experience with a newly designed bar for minimally invasive repair of pectus carinatum. We reviewed the records of all patients recorded in our Chest Wall Deformities Clinical Database. Between January 2006 and November 2016, minimally invasive repair of pectus carinatum was performed in 172 patients. All met the criteria of a "compression test" of 10 to 25 kg/cm 2 . The mean age was 17.3 years, and 22.7% had a positive family history of a congenital chest wall deformity. Symmetric and asymmetric deformities were treated. During our study period, we designed 4 different bar configurations and their related stabilizers. All patients are assessed every 3 to 6 months. After 2 to 3 years of follow-up, the bar and the stabilizers are removed. Of 172 patients, 97.1% tolerated the procedure very well. The operation was a mean length 76.6 minutes. Average blood loss was 40 mL. Mean hospital length of stay was 3.7 days. Complications included pneumothorax, wire breakdown/rib cut, wound infection, severe pain, skin hyperpigmentation, nickel allergy, and overcorrection leading to excavatum. Patients returned to routine activity in 10 to 14 days. With a mean follow-up of 29.8 months in bar removal patients, 130 of 172 (93.8%) reported excellent results. Minimally invasive repair of pectus carinatum with the technically modified fourth-generation bar and its securing system has advantages of low morbidity, short hospital stay, and excellent cosmetic results, even in asymmetric cases. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

a Single-Exposure Dual-Energy Computed Radiography Technique for Improved Nodule Detection and Classification in Chest Imaging

NASA Astrophysics Data System (ADS)

Zink, Frank Edward

The detection and classification of pulmonary nodules is of great interest in chest radiography. Nodules are often indicative of primary cancer, and their detection is particularly important in asymptomatic patients. The ability to classify nodules as calcified or non-calcified is important because calcification is a positive indicator that the nodule is benign. Dual-energy methods offer the potential to improve both the detection and classification of nodules by allowing the formation of material-selective images. Tissue-selective images can improve detection by virtue of the elimination of obscuring rib structure. Bone -selective images are essentially calcium images, allowing classification of the nodule. A dual-energy technique is introduced which uses a computed radiography system to acquire dual-energy chest radiographs in a single-exposure. All aspects of the dual-energy technique are described, with particular emphasis on scatter-correction, beam-hardening correction, and noise-reduction algorithms. The adaptive noise-reduction algorithm employed improves material-selective signal-to-noise ratio by up to a factor of seven with minimal sacrifice in selectivity. A clinical comparison study is described, undertaken to compare the dual-energy technique to conventional chest radiography for the tasks of nodule detection and classification. Observer performance data were collected using the Free Response Observer Characteristic (FROC) method and the bi-normal Alternative FROC (AFROC) performance model. Results of the comparison study, analyzed using two common multiple observer statistical models, showed that the dual-energy technique was superior to conventional chest radiography for detection of nodules at a statistically significant level (p < .05). Discussion of the comparison study emphasizes the unique combination of data collection and analysis techniques employed, as well as the limitations of comparison techniques in the larger context of technology assessment.

Performance of chest ultrasound in pediatric pneumonia.

PubMed

Claes, Anne-Sophie; Clapuyt, Philippe; Menten, Renaud; Michoux, Nicolas; Dumitriu, Dana

2017-03-01

The objective of this study was to evaluate the performance of ultrasound in detecting lung consolidation in children suspected of pneumonia, in comparison to the current gold standard, chest X-rays. From September 2013 to June 2014, a monocentric prospective study was performed on all children between 0 and 16 years-old, referred for chest X-ray for suspected pneumonia. Each child was examined by chest ultrasound by an examiner blinded to the chest X-ray. The presence or absence of areas of consolidation, their number and location were noted for each technique. The size of the consolidations identified only on ultrasound was compared with that of consolidations visible on both techniques. 143 children (mean age 3 years; limits between 8days and 14 years) were included. Ultrasound detected at least one area of consolidation in 44 out of 45 patients with positive X-rays. Of the 59 areas of consolidation on X-ray, ultrasound identified 54. In the 8 patients with negative X-ray, ultrasound revealed 17 areas of consolidation. The mean size of consolidations visible only on ultrasound was 9.4mm; for consolidations visible on both techniques the mean size was 26mm (p<0.0001). The sensitivity and specificity of ultrasound were calculated at 98% and 92%. PPV and NPV were 85% and 99%, respectively. Chest ultrasound is a fast, non-ionizing and feasible technique. With its high negative predictive value, it can replace X-rays in order to exclude lung consolidation in children, thus reducing radiation exposure in this population. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evaluation of Chest Ultrasound Integrated Teaching of Respiratory System Physiology to Medical Students

ERIC Educational Resources Information Center

Paganini, Matteo; Bondì, Michela; Rubini, Alessandro

2017-01-01

Ultrasound imaging is a widely used diagnostic technique, whose integration in medical education is constantly growing. The aim of this study was to evaluate chest ultrasound usefulness in teaching respiratory system physiology, students' perception of chest ultrasound integration into a traditional lecture in human physiology, and short-term…

Impact of physical fitness and biometric data on the quality of external chest compression: a randomised, crossover trial

PubMed Central

2011-01-01

Background During circulatory arrest, effective external chest compression (ECC) is a key element for patient survival. In 2005, international emergency medical organisations changed their recommended compression-ventilation ratio (CVR) from 15:2 to 30:2 to acknowledge the vital importance of ECC. We hypothesised that physical fitness, biometric data and gender can influence the quality of ECC. Furthermore, we aimed to determine objective parameters of physical fitness that can reliably predict the quality of ECC. Methods The physical fitness of 30 male and 10 female healthcare professionals was assessed by cycling and rowing ergometry (focussing on lower and upper body, respectively). During ergometry, continuous breath-by-breath ergospirometric measurements and heart rate (HR) were recorded. All participants performed two nine-minute sequences of ECC on a manikin using CVRs of 30:2 and 15:2. We measured the compression and decompression depths, compression rates and assessed the participants' perception of exhaustion and comfort. The median body mass index (BMI; male 25.4 kg/m2 and female 20.4 kg/m2) was used as the threshold for subgroup analyses of participants with higher and lower BMI. Results HR during rowing ergometry at 75 watts (HR75) correlated best with the quality of ECC (r = -0.57, p < 0.05). Participants with a higher BMI and better physical fitness performed better and showed less fatigue during ECC. These results are valid for the entire cohort, as well as for the gender-based subgroups. The compressions of female participants were too shallow and more rapid (mean compression depth was 32 mm and rate was 117/min with a CVR of 30:2). For participants with a lower BMI and higher HR75, the compression depth decreased over time, beginning after four minutes for the 15:2 CVR and after three minutes for the 30:2 CVR. Although found to be more exhausting, a CVR of 30:2 was rated as being more comfortable. Conclusion The quality of the ECC and fatigue can both be predicted by BMI and physical fitness. An evaluation focussing on the upper body may be a more valid predictor of ECC quality than cycling based tests. Our data strongly support the recommendation to relieve ECC providers after two minutes. PMID:22053981

Impact of Standardized Communication Techniques on Errors during Simulated Neonatal Resuscitation.

PubMed

Yamada, Nicole K; Fuerch, Janene H; Halamek, Louis P

2016-03-01

Current patterns of communication in high-risk clinical situations, such as resuscitation, are imprecise and prone to error. We hypothesized that the use of standardized communication techniques would decrease the errors committed by resuscitation teams during neonatal resuscitation. In a prospective, single-blinded, matched pairs design with block randomization, 13 subjects performed as a lead resuscitator in two simulated complex neonatal resuscitations. Two nurses assisted each subject during the simulated resuscitation scenarios. In one scenario, the nurses used nonstandard communication; in the other, they used standardized communication techniques. The performance of the subjects was scored to determine errors committed (defined relative to the Neonatal Resuscitation Program algorithm), time to initiation of positive pressure ventilation (PPV), and time to initiation of chest compressions (CC). In scenarios in which subjects were exposed to standardized communication techniques, there was a trend toward decreased error rate, time to initiation of PPV, and time to initiation of CC. While not statistically significant, there was a 1.7-second improvement in time to initiation of PPV and a 7.9-second improvement in time to initiation of CC. Should these improvements in human performance be replicated in the care of real newborn infants, they could improve patient outcomes and enhance patient safety. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Advantage of vein grafts for anomalous origin of a right coronary artery.

PubMed

Kansaku, Rei; Saitoh, Hirofumi; Eguchi, Shoji; Maruyama, Yukio; Ohtsuka, Hideaki; Higuchi, Kotaro

2009-03-01

A 66-year-old man with anomalous origin of the right coronary artery suffered from chest pain. The results of coronary angiography and multidetector computer tomography indicated that the proximal right coronary artery was intermittently compressed, causing the ischemia. Coronary artery bypass grafting was regarded as a reliable treatment compared with percutaneous coronary intervention or other surgeries. Because of plentiful flow of the right coronary artery, we decided to use a vein graft to avoid competitive flow. Postoperative coronary angiography revealed intact flow in both the native coronary artery and the vein graft 1 year after the surgery. The myocardial ischemia seen on scintigraphy and the chest pain had disappeared.

Outcomes of Complete Versus Partial Surgical Stabilization of Flail Chest.

PubMed

Nickerson, Terry P; Thiels, Cornelius A; Kim, Brian D; Zielinski, Martin D; Jenkins, Donald H; Schiller, Henry J

2016-01-01

Rib fractures are common after chest wall trauma. For patients with flail chest, surgical stabilization is a promising technique for reducing morbidity. Anatomical difficulties often lead to an inability to completely repair the flail chest; thus, the result is partial flail chest stabilization (PFS). We hypothesized that patients with PFS have outcomes similar to those undergoing complete flail chest stabilization (CFS). A prospectively collected database of all patients who underwent rib fracture stabilization procedures from August 2009 until February 2013 was reviewed. Abstracted data included procedural and complication data, extent of stabilization, and pulmonary function test results. Of 43 patients who underwent operative stabilization of flail chest, 23 (53%) had CFS and 20 (47%) underwent PFS. Anterior location of the fracture was the most common reason for PFS (45%). Age, sex, operative time, pneumonia, intensive care unit and hospital length of stay, and narcotic use were the same in both groups. Total lung capacity was significantly improved in the CFS group at 3 months. No chest wall deformity was appreciated on follow-up, and no patients underwent additional stabilization procedures following PFS. Despite advances in surgical technique, not all fractures are amenable to repair. There was no difference in chest wall deformity, narcotic use, or clinically significant impairment in pulmonary function tests among patients who underwent PFS compared with CFS. Our data suggest that PFS is an acceptable strategy and that extending or creating additional incisions for CFS is unnecessary.

Irrational Exuberance: Cardiopulmonary Resuscitation as Fetish.

PubMed

Rosoff, Philip M; Schneiderman, Lawrence J

2017-02-01

The Institute of Medicine and the American Heart Association have issued a "call to action" to expand the performance of cardiopulmonary resuscitation (CPR) in response to out-of-hospital cardiac arrest. Widespread advertising campaigns have been created to encourage more members of the lay public to undergo training in the technique of closed-chest compression-only CPR, based upon extolling the virtues of rapid initiation of resuscitation, untempered by information about the often distressing outcomes, and hailing the "improved" results when nonprofessional bystanders are involved. We describe this misrepresentation of CPR as a highly effective treatment as the fetishization of this valuable, but often inappropriately used, therapy. We propose that the medical profession has an ethical duty to inform the public through education campaigns about the procedure's limitations in the out-of-hospital setting and the narrow clinical indications for which it has been demonstrated to have a reasonable probability of producing favorable outcomes.

Clinical and imaging features of pulmonary artery sling in infants without significant hemodynamic changes.

PubMed

Wang, Jian-Hua; Ding, Gui-Chun; Zhang, Min-Yu; Liu, Mei; Niu, Hai-Yan

2011-10-01

Pulmonary artery sling (PAS) is a rare congenital heart anomaly and may cause unexplained respiratory symptoms in infants. Since the non-specific respiratory symptoms of PAS may lead to misdiagnosis, the aim of this study was to clarify the clinical and imaging features of this disease for timely diagnosis and treatment. Clinical histories, physical examinations and imaging studies were retrospectively evaluated in nine infants with PAS. Chest X-ray, echocardiography and contrast-enhanced computed tomography (CT) with 3-dimensional reconstructions were performed in all patients and three of them received surgical treatment. Nine cases included six males and three females with a mean age of (4.3 ± 2.8) months ranging from 2 to 11 months old. All patients had respiratory symptoms including recurrent cough, stridor and wheezing. The onset of symptoms was within 3 months in all cases and three children had symptoms only a few days after birth. The chest X-ray showed pneumonia in all cases. Contrast-enhanced CT showed the tracheal compression at different lengths in every case. The echocardiograph findings of PAS were anomalous origins of the left pulmonary artery from the posterior aspect of the right pulmonary artery. Of the 9 cases, 8 cases were diagnosed correctly by echocardiography. Of the complicated abnormalities, there were one with secundum atrial septal defect, one with patent foramen ovale and three with persistent left superior vena cava. None of them were complicated with significant blood dynamic changes. Infants with recurrent respiratory symptoms such as chronic cough, stridor and wheezing, should be examined for the possible presence of congenital pulmonary artery sling. As a noninvasive technique, echocardiography is very helpful and should be the first-choice modality for the diagnosis of pulmonary artery sling. Contrast-enhanced CT, clearly demonstrating the anatomy of pulmonary artery sling and the position and extent of trachea compression, is necessary for the final diagnosis and pre-operation evaluation.

An Image Processing Technique for Achieving Lossy Compression of Data at Ratios in Excess of 100:1

DTIC Science & Technology

1992-11-01

5 Lempel , Ziv , Welch (LZW) Compression ............... 7 Lossless Compression Tests Results ................. 9 Exact...since IBM holds the patent for this technique. Lempel , Ziv , Welch (LZW) Compression The LZW compression is related to two compression techniques known as... compression , using the input stream as data . This step is possible because the compression algorithm always outputs the phrase and character components of a

The impact of ultra-brief chest compression-only CPR video training on responsiveness, compression rate, and hands-off time interval among bystanders in a shopping mall.

PubMed

Panchal, Ashish R; Meziab, Omar; Stolz, Uwe; Anderson, Wes; Bartlett, Mitchell; Spaite, Daniel W; Bobrow, Bentley J; Kern, Karl B

2014-09-01

Recent studies have demonstrated higher-quality chest compressions (CCs) following a 60 s ultra-brief video (UBV) on compression-only CPR (CO-CPR). However, the effectiveness of UBVs as a CPR-teaching tool for lay bystanders in public venues remains unknown. Determine whether an UBV is effective in teaching laypersons CO-CPR in a public setting and if viewing leads to superior responsiveness and CPR skills. Adult lay bystanders were enrolled in a public shopping mall and randomized to: (1) Control (CTR): sat idle for 60 s; (2) UBV: watched a 60 s UBV on CO-CPR. Subjects were read a scenario detailing a sudden collapse in the mall and asked to do what they "thought was best" on a mannequin. Performance measures were recorded for 2 min: responsiveness (time to call 911 and first CCs) and CPR quality [CC depth, rate, hands-off interval (time without CC after first CC)]. One hundred subjects were enrolled. Demographics were similar between groups. UBV subjects called 911 more frequently (percent difference: 31%) and initiated CCs sooner in the arrest scenario (median difference (MD): 5 s). UBV cohort had increased CC rate (MD: 19 cpm) and decreased hands-off interval (MD: 27 s). There was no difference in CC depth. Bystanders with UBV training in a shopping mall had significantly improved responsiveness, CC rate, and decreased hands-off interval. Given the short length of training, UBV may have potential as a ubiquitous intervention for public venues to help improve bystander reaction to arrest and CO-CPR performance. Published by Elsevier Ireland Ltd.

Chest Compression With Personal Protective Equipment During Cardiopulmonary Resuscitation: A Randomized Crossover Simulation Study.

PubMed

Chen, Jie; Lu, Kai-Zhi; Yi, Bin; Chen, Yan

2016-04-01

Following a chemical, biological, radiation, and nuclear incident, prompt cardiopulmonary resuscitation (CPR) procedure is essential for patients who suffer cardiac arrest. But CPR when wearing personal protection equipment (PPE) before decontamination becomes a challenge for healthcare workers (HCW). Although previous studies have assessed the impact of PPE on airway management, there is little research available regarding the quality of chest compression (CC) when wearing PPE.A present randomized cross-over simulation study was designed to evaluate the effect of PPE on CC performance using mannequins.The study was set in one university medical center in the China.Forty anesthesia residents participated in this randomized cross-over study.Each participant performed 2 min of CC on a manikin with and without PPE, respectively. Participants were randomized into 2 groups that either performed CC with PPE first, followed by a trial without PPE after a 180-min rest, or vice versa.CPR recording technology was used to objectively quantify the quality of CC. Additionally, participants' physiological parameters and subjective fatigue score values were recorded.With the use of PPE, a significant decrease of the percentage of effective compressions (41.3 ± 17.1% with PPE vs 67.5 ± 15.6% without PPE, P < 0.001) and the percentage of adequate compressions (67.7 ± 18.9% with PPE vs 80.7 ± 15.5% without PPE, P < 0.001) were observed. Furthermore, the increases in heart rate, mean arterial pressure, and subjective fatigue score values were more obvious with the use of PPE (all P < 0.01).We found significant deterioration of CC performance in HCW with the use of a level-C PPE, which may be a disadvantage for enhancing survival of cardiac arrest.

A novel protocol for dispatcher assisted CPR improves CPR quality and motivation among rescuers-A randomized controlled simulation study.

PubMed

Rasmussen, Stinne Eika; Nebsbjerg, Mette Amalie; Krogh, Lise Qvirin; Bjørnshave, Katrine; Krogh, Kristian; Povlsen, Jonas Agerlund; Riddervold, Ingunn Skogstad; Grøfte, Thorbjørn; Kirkegaard, Hans; Løfgren, Bo

2017-01-01

Emergency dispatchers use protocols to instruct bystanders in cardiopulmonary resuscitation (CPR). Studies changing one element in the dispatcher's protocol report improved CPR quality. Whether several changes interact is unknown and the effect of combining multiple changes previously reported to improve CPR quality into one protocol remains to be investigated. We hypothesize that a novel dispatch protocol, combining multiple beneficial elements improves CPR quality compared with a standard protocol. A novel dispatch protocol was designed including wording on chest compressions, using a metronome, regular encouragements and a 10-s rest each minute. In a simulated cardiac arrest scenario, laypersons were randomized to perform single-rescuer CPR guided with the novel or the standard protocol. a composite endpoint of time to first compression, hand position, compression depth and rate and hands-off time (maximum score: 22 points). Afterwards participants answered a questionnaire evaluating the dispatcher assistance. The novel protocol (n=61) improved CPR quality score compared with the standard protocol (n=64) (mean (SD): 18.6 (1.4)) points vs. 17.5 (1.7) points, p<0.001. The novel protocol resulted in deeper chest compressions (mean (SD): 58 (12)mm vs. 52 (13)mm, p=0.02) and improved rate of correct hand position (61% vs. 36%, p=0.01) compared with the standard protocol. In both protocols hands-off time was short. The novel protocol improved motivation among rescuers compared with the standard protocol (p=0.002). Participants guided with a standard dispatch protocol performed high quality CPR. A novel bundle of care protocol improved CPR quality score and motivation among rescuers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Computerized detection of vertebral compression fractures on lateral chest radiographs: Preliminary results with a tool for early detection of osteoporosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kasai, Satoshi; Li Feng; Shiraishi, Junji

Vertebral fracture (or vertebral deformity) is a very common outcome of osteoporosis, which is one of the major public health concerns in the world. Early detection of vertebral fractures is important because timely pharmacologic intervention can reduce the risk of subsequent additional fractures. Chest radiographs are used routinely for detection of lung and heart diseases, and vertebral fractures can be visible on lateral chest radiographs. However, investigators noted that about 50% of vertebral fractures visible on lateral chest radiographs were underdiagnosed or under-reported, even when the fractures were severe. Therefore, our goal was to develop a computerized method for detectionmore » of vertebral fractures on lateral chest radiographs in order to assist radiologists' image interpretation and thus allow the early diagnosis of osteoporosis. The cases used in this study were 20 patients with severe vertebral fractures and 118 patients without fractures, as confirmed by the consensus of two radiologists. Radiologists identified the locations of fractured vertebrae, and they provided morphometric data on the vertebral shape for evaluation of the accuracy of detecting vertebral end plates by computer. In our computerized method, a curved search area, which included a number of vertebral end plates, was first extracted automatically, and was straightened so that vertebral end plates became oriented horizontally. Edge candidates were enhanced by use of a horizontal line-enhancement filter in the straightened image, and a multiple thresholding technique, followed by feature analysis, was used for identification of the vertebral end plates. The height of each vertebra was determined from locations of identified vertebral end plates, and fractured vertebrae were detected by comparison of the measured vertebral height with the expected height. The sensitivity of our computerized method for detection of fracture cases was 95% (19/20), with 1.03 (139/135) false-positive fractures per image. The accuracy of identifying vertebral end plates, marked by radiologists in a morphometric study, was 76.6% (400/522) and 70.9% (420/592) for cases used for training and those for testing, respectively. We prepared 32 additional fracture cases for a validation test, and we examined the detection accuracy of our computerized method. The sensitivity for these cases was 75% (24/32) at 1.03 (33/32) false-positive fractures per image. Our preliminary results show that the automated computerized scheme for detecting vertebral fractures on lateral chest radiographs has the potential to assist radiologists in detecting vertebral fractures.« less

Distribution of Absorbed Dose in Cone-Beam Breast Computed Tomography: A Phantom Study With Radiochromic Films

NASA Astrophysics Data System (ADS)

Russo, Paolo; Coppola, Teresa; Mettivier, Giovanni

2010-08-01

Cone-Beam Breast Computed Tomography (CBBCT) of the pendant breast with dedicated scanners is an experimental 3D X-ray imaging technique for breast cancer diagnosis under evaluation in comparison to conventional two-view 2-D mammography of the compressed breast. In CBBCT it is generally assumed that a more uniform distribution of the radiation dose to the breast volume can be obtained, with respect to mammography, at equal Mean Glandular Dose (MGD) levels. In fact, in CBBCT the X-ray beam rotates for 360 deg around the breast, while in each mammography view the breast is irradiated from one side only. Using a CBBCT laboratory scanner developed by our group, we have measured the distribution of the radiation dose in a hemi-ellipsoidal PMMA breast phantom of 14 cm diameter simulating the average uncompressed breast, using radiochromic films type XR-SP inserted at mid-plane in the phantom. The technique factors were 80 kVp (5.6 mm Al Half Value Layer), tube load in the range 23-100 mAs, for an air kerma at isocenter in the range 4.7-20 mGy, for a calculated MGD in the range 3.5-15 mGy for a 14 cm diameter breast of 50% glandularity. Results indicate that the dose decreases from the periphery to the center of the phantom, and that along a transverse profile, the relative dose variation Δ = ((edge-center)/center) is up to (25 ±4)% at a distance of 80 mm from the nipple. As for the relative dose variation along the phantom longitudinal axis, the maximum value at middle of the phantom measured is δ = ((nipple-chest wall)/chest wall) = -(15 ±4)%, indicating that the dose decreases from the chest wall toward the nipple. The values of the parameters Δ and δ depend also on the height of the X-ray tube focal spot with respect to the phantom vertex (nipple). Results are in rough agreement with similar previous determinations using thermoluminescence dosimeters.

Use of impedance threshold device in conjunction with our novel adhesive glove device for ACD-CPR does not result in additional chest decompression.

PubMed

Shih, Andre; Udassi, Sharda; Porvasnik, Stacy L; Lamb, Melissa A; Badugu, Srinivasarao; Venkata, Giridhar Kaliki; Lopez-Colon, Dalia; Haque, Ikram U; Zaritsky, Arno L; Udassi, Jai P

2013-10-01

To evaluate the hemodynamic effects of using an adhesive glove device (AGD) to perform active compression-decompression CPR (AGD-CPR) in conjunction with an impedance threshold device (ITD) in a pediatric cardiac arrest model. Controlled, randomized animal study. In this study, 18 piglets were anesthetized, ventilated, and continuously monitored. After 3min of untreated ventricular fibrillation, animals were randomized (6/group) to receive either standard CPR (S-CPR), active compression-decompression CPR via adhesive glove device (AGD-CPR) or AGD-CPR along with an ITD (AGD-CPR+ITD) for 2min at 100-120compressions/min. AGD is delivered using a fingerless leather glove with a Velcro patch on the palmer aspect and the counter Velcro patch adhered to the pig's chest. Data (mean±SD) were analyzed using one-way ANOVA with pair wise multiple comparisons to assess differences between groups. p-Value≤0.05 was considered significant. Both AGD-CPR and AGD-CPR+ITD groups produced lower intrathoracic pressure (IttP, mmHg) during decompression phase (-13.4±6.7, p=0.01 and -11.9±6.5, p=0.01, respectively) in comparison to S-CPR (-0.3±4.2). Carotid blood flow (CBF, % of baseline mL/min) was higher in AGD-CPR and AGD-CPR+ITD (respectively 64.3±47.3%, p=0.03 and 67.5±33.1%, p=0.04) as compared with S-CPR (29.1±12.5%). Coronary perfusion pressure (CPP, mmHg) was higher in AGD-CPR and AGD-CPR+ITD (respectively 19.7±4.6, p=0.04 and 25.6±12.1, p=0.02) when compared to S-CPR (9.6±9.1). There was no statistically significant difference between AGD-CPR and AGD-CPR+ITD groups with reference to intra-thoracic pressure, carotid blood flow and coronary perfusion pressure. Active compression decompression delivered by this simple and inexpensive adhesive glove device resulted in improved cerebral blood flow and coronary perfusion pressure. There was no statistically significant added effect of ITD use along with AGD-CPR on the decompression of the chest. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Patient doses from chest radiography in Victoria.

PubMed

Cardillo, I; Boal, T J; Einsiedel, P F

1997-06-01

This survey examines doses from PA chest radiography at radiology practices, private hospitals and public hospitals throughout metropolitan and country Victoria. Data were collected from 111 individual X-ray units at 86 different practices. Entrance skin doses in air were measured for exposure factors used by the centre for a 23 cm thick male chest. A CDRH LucA1 chest phantom was used when making these measurements. About half of the centres used grid technique and half used non-grid technique. There was a factor of greater than 10 difference in the entrance dose delivered between the highest dose centre and the lowest dose centre for non-grid centres; and a factor of about 5 for centres using grids. Factors contributing to the high doses recorded at some centres were identified. Guidance levels for chest radiography based on the third quartile value of the entrance doses from this survey have been recommended and compared with guidance levels recommended in other countries.

Comparison of patient specific dose metrics between chest radiography, tomosynthesis, and CT for adult patients of wide ranging body habitus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Yakun; Li, Xiang; Segars, W. Paul

2014-02-15

Purpose: Given the radiation concerns inherent to the x-ray modalities, accurately estimating the radiation doses that patients receive during different imaging modalities is crucial. This study estimated organ doses, effective doses, and risk indices for the three clinical chest x-ray imaging techniques (chest radiography, tomosynthesis, and CT) using 59 anatomically variable voxelized phantoms and Monte Carlo simulation methods. Methods: A total of 59 computational anthropomorphic male and female extended cardiac-torso (XCAT) adult phantoms were used in this study. Organ doses and effective doses were estimated for a clinical radiography system with the capability of conducting chest radiography and tomosynthesis (Definiummore » 8000, VolumeRAD, GE Healthcare) and a clinical CT system (LightSpeed VCT, GE Healthcare). A Monte Carlo dose simulation program (PENELOPE, version 2006, Universitat de Barcelona, Spain) was used to mimic these two clinical systems. The Duke University (Durham, NC) technique charts were used to determine the clinical techniques for the radiographic modalities. An exponential relationship between CTDI{sub vol} and patient diameter was used to determine the absolute dose values for CT. The simulations of the two clinical systems compute organ and tissue doses, which were then used to calculate effective dose and risk index. The calculation of the two dose metrics used the tissue weighting factors from ICRP Publication 103 and BEIR VII report. Results: The average effective dose of the chest posteroanterior examination was found to be 0.04 mSv, which was 1.3% that of the chest CT examination. The average effective dose of the chest tomosynthesis examination was found to be about ten times that of the chest posteroanterior examination and about 12% that of the chest CT examination. With increasing patient average chest diameter, both the effective dose and risk index for CT increased considerably in an exponential fashion, while these two dose metrics only increased slightly for radiographic modalities and for chest tomosynthesis. Effective and organ doses normalized to mAs all illustrated an exponential decrease with increasing patient size. As a surface organ, breast doses had less correlation with body size than that of lungs or liver. Conclusions: Patient body size has a much greater impact on radiation dose of chest CT examinations than chest radiography and tomosynthesis. The size of a patient should be considered when choosing the best thoracic imaging modality.« less

When the Battle is Lost and Won: Delayed Chest Closure After Bilateral Lung Transplantation.

PubMed

Soresi, Simona; Sabashnikov, Anton; Weymann, Alexander; Zeriouh, Mohamed; Simon, André R; Popov, Aron-Frederik

2015-10-12

In this article we summarize benefits of delayed chest closure strategy in lung transplantation, addressing indications, different surgical techniques, and additional perioperative treatment. Delayed chest closure seems to be a valuable and safe strategy in managing patients with various conditions after lung transplantation, such as instable hemodynamics, need for high respiratory pressures, coagulopathy, and size mismatch. Therefore, this approach should be considered in lung transplant centers to give patients time to recover before the chest is closed.

[Sleeve resection of right main bronchus for posttraumatic bronchial stenosis].

PubMed

Bobocea, Andrei Cristian; Matache, Radu; Codreşi, Mihaela; Bolca, Ciprian; Cordoş, Ioan

2011-01-01

Tracheobronchial disruption is one of the most severe injuries caused by blunt chest trauma. A high index of clinical suspicion and accurate interpretation of radiological findings are necessary for prompt surgical intervention with primary repair of the airway. Delays in treatment increases the risk of partial to complete bronchial stenosis. A 21 years old male was admitted to our hospital following a workplace accident. A chest radiograph showed bilateral pneumothorax, cephalic and mediastinal emphysema. Chest tubes were placed on each side, with full pulmonary expansion and remission of emphysema. Minimal lesions of the right main bronchus were found at fiberoptic bronchoscopy. Daily chest X-rays showed an uncomplicated recovery. A stenosis was suspected due to right lung pneumonia evolving under specific antibiotherapy. Right main bronchus posttraumatic stricture was diagnosed by fiberoptic bronchoscopy. He underwent a right lateral thoracotomy with sleeve resection of stenotic bronchi. Control bronchoscopy reveals main bronchus widely patent with untraceable suture line. Main bronchus rupture in blunt chest trauma is an additive effect of chest wall compression between two solid surfaces, traction on the carina and sudden increase in intraluminal pressure. Symptoms may vary: soft air leak, pneumothorax or limited mediastinal emphysema. Bronchoscopy should be performed immediately or when available. Granulation tissue leads to progressive bronchial obstruction, with distal infection and permanent parenchymal damage. Sleeve resection of the stenosed segment is the treatment of choice and restores fully the lung function. Rupture of main bronchus is a complication of blunt chest trauma. Flexible bronchoscopy is useful and reliable for early diagnosis of traumatic tracheobronchial injuries. Delayed diagnosis can lead to lung parenchyma alteration due to retrostenotic pneumonia. Resection and end-to-end anastomosis is the key of successful in these cases.

Effective doses to patients undergoing thoracic computed tomography examinations.

PubMed

Huda, W; Scalzetti, E M; Roskopf, M

2000-05-01

The purpose of this study was to investigate how x-ray technique factors and effective doses vary with patient size in chest CT examinations. Technique factors (kVp, mAs, section thickness, and number of sections) were recorded for 44 patients who underwent a routine chest CT examination. Patient weights were recorded together with dimensions and mean Hounsfield unit values obtained from representative axial CT images. The total mass of directly irradiated patient was modeled as a cylinder of water to permit the computation of the mean patient dose and total energy imparted for each chest CT examination. Computed values of energy imparted during the chest CT examination were converted into effective doses taking into account the patient weight. Patient weights ranged from 4.5 to 127 kg, and half the patients in this study were children under 18 years of age. All scans were performed at 120 kVp with a 1 s scan time. The selected tube current showed no correlation with patient weight (r2=0.06), indicating that chest CT examination protocols do not take into account for the size of the patient. Energy imparted increased with increasing patient weight, with values of energy imparted for 10 and 70 kg patients being 85 and 310 mJ, respectively. The effective dose showed an inverse correlation with increasing patient weight, however, with values of effective dose for 10 and 70 kg patients being 9.6 and 5.4 mSv, respectively. Current CT technique factors (kVp/mAs) used to perform chest CT examinations result in relatively high patient doses, which could be reduced by adjusting technique factors based on patient size.

Three-dimensional automatic computer-aided evaluation of pleural effusions on chest CT images

NASA Astrophysics Data System (ADS)

Bi, Mark; Summers, Ronald M.; Yao, Jianhua

2011-03-01

The ability to estimate the volume of pleural effusions is desirable as it can provide information about the severity of the condition and the need for thoracentesis. We present here an improved version of an automated program to measure the volume of pleural effusions using regular chest CT images. First, the lungs are segmented using region growing, mathematical morphology, and anatomical knowledge. The visceral and parietal layers of the pleura are then extracted based on anatomical landmarks, curve fitting and active contour models. The liver and compressed tissues are segmented out using thresholding. The pleural space is then fitted to a Bezier surface which is subsequently projected onto the individual two-dimensional slices. Finally, the volume of the pleural effusion is quantified. Our method was tested on 15 chest CT studies and validated against three separate manual tracings. The Dice coefficients were 0.74+/-0.07, 0.74+/-0.08, and 0.75+/-0.07 respectively, comparable to the variation between two different manual tracings.

Chest CT in children: anesthesia and atelectasis.

PubMed

Newman, Beverley; Krane, Elliot J; Gawande, Rakhee; Holmes, Tyson H; Robinson, Terry E

2014-02-01

There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain reliable and reproducible high-quality, motion-free chest CT images in children.

The effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation.

PubMed

Bousarri, Mitra Payami; Shirvani, Yadolah; Agha-Hassan-Kashani, Saeed; Nasab, Nouredin Mousavi

2014-05-01

In patients undergoing mechanical ventilation, mucus production and secretion is high as a result of the endotracheal tube. Because endotracheal suction in these patients is essential, chest physiotherapy techniques such as expiratory rib cage compression before endotracheal suctioning can be used as a means to facilitate mobilizing and removing airway secretion and improving alveolar ventilation. As one of the complications of mechanical ventilation and endotracheal suctioning is decrease of cardiac output, this study was carried out to determine the effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation. This study was a randomized clinical trial with a crossover design. The study subjects included 50 mechanically ventilated patients, hospitalized in intensive care wards of Valiasr and Mousavi hospitals in Zanjan, Iran. Subjects were selected by consecutive sampling and randomly allocated to groups 1 and 2. The patients received endotracheal suctioning with or without rib cage compression, with a minimum of 3 h interval between the two interventions. Expiratory rib cage compression was performed for 5 min before endotracheal suctioning. Vital signs were measured 5 min before and 15 and 25 min after endotracheal suctioning. Data were recorded on a data recording sheet. Data were analyzed using paired t-tests. There were statistically significant differences in the means of vital signs measured 5 min before with 15 and 25 min after endotracheal suctioning with rib cage compression (P < 0. 01). There was no significant difference in the means of diastolic pressure measured 25 min after with baseline in this stage). But on the reverse mode, there was a significant difference between the means of pulse and respiratory rate 15 min after endotracheal suctioning and the baseline values (P < 0.002). This effect continued up to 25 min after endotracheal suctioning just for respiratory rate (P = 0.016). Moreover, there were statistically significant differences in the means of vital signs measured 5 min before and 15 min after endotracheal suctioning between the two methods (P ≤ 0001). Findings showed that expiratory rib cage compression before endotracheal suctioning improves the vital signs to normal range in patients under mechanical ventilation. More studies are suggested on performing expiratory rib cage compression before endotracheal suctioning in patients undergoing mechanical ventilation.

High-speed reconstruction of compressed images

NASA Astrophysics Data System (ADS)

Cox, Jerome R., Jr.; Moore, Stephen M.

1990-07-01

A compression scheme is described that allows high-definition radiological images with greater than 8-bit intensity resolution to be represented by 8-bit pixels. Reconstruction of the images with their original intensity resolution can be carried out by means of a pipeline architecture suitable for compact, high-speed implementation. A reconstruction system is described that can be fabricated according to this approach and placed between an 8-bit display buffer and the display's video system thereby allowing contrast control of images at video rates. Results for 50 CR chest images are described showing that error-free reconstruction of the original 10-bit CR images can be achieved.

A study of the complications of small bore 'Seldinger' intercostal chest drains.

PubMed

Davies, Helen E; Merchant, Shairoz; McGown, Anne

2008-06-01

Use of small bore chest drains (<14F), inserted via the Seldinger technique, has increased globally over the last few years. They are now used as first line interventions in most acute medical situations when thoracostomy is required. Limited data are available on the associated complications. In this study, the frequency of complications associated with 12F chest drains, inserted using the Seldinger technique, was quantified. A retrospective case note audit was performed of consecutive patients requiring pleural drainage over a 12-month period. One hundred consecutive small bore Seldinger (12F) chest drain insertions were evaluated. Few serious complications occurred. However, 21% of the chest drains were displaced ('fell out') and 9% of the drains became blocked. This contributed to high morbidity rates, with 13% of patients requiring repeat pleural procedures. The frequency of drain blockage in pleural effusion was reduced by administration of regular normal saline drain flushes (odds ratio for blockage in flushed drains compared with non-flushed drains 0.04, 95% CI: 0.01-0.37, P < 0.001). Regular chest drain flushes are advocated in order to reduce rates of drain blockage, and further studies are needed to determine optimal fixation strategies that may reduce associated patient morbidity.

High frequency chest wall compression and carbon dioxide elimination in obstructed dogs.

PubMed

Gross, D; Vartian, V; Minami, H; Chang, H K; Zidulka, A

1984-01-01

High frequency chest wall compression (HFCWC) was studied as a method of assisting ventilation in six spontaneously breathing anesthetized dogs. Under a constant level of anesthesia, the dogs became hypercapneic after airflow obstruction was created by metal beads inserted in the airways. HFCWC was achieved by a piston pump rapidly oscillating the pressure in a modified double blood pressure cuff wrapped around the lower thorax. Thirty minute periods of spontaneous ventilation were alternated with thirty minute periods of spontaneous breathing plus HFCWC at 3, 5 or 8 Hz. The superimposition of HFCWC to spontaneous ventilation resulted in little change in the PaO2. The PaCO2, however, was reduced in every case from a mean of 6.55 +/- 0.59 to 4.72 +/- 0.32 kPa at 3 Hz (p less than 0.05), 6.92 +/- 0.57 to 3.9 +/- 0.45 kPa at 5 Hz (p less than 0.01) and 7.10 +/- 0.65 to 4.56 +/- 0.59 kPa at 8 Hz (p less than 0.05). This occurred despite a decrease in spontaneous minute ventilation. We conclude that HFCWC can assist in elimination of CO2 in obstructed spontaneous breathing dogs with hypercapnea.

Comprehensive cardiopulmonary life support (CCLS) for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital

PubMed Central

Garg, Rakesh; Ahmed, Syed Moied; Kapoor, Mukul Chandra; Rao, SSC Chakra; Mishra, Bibhuti Bhusan; Kalandoor, M Venkatagiri; Singh, Baljit; Divatia, Jigeeshu Vasishtha

2017-01-01

The cardiopulmonary resuscitation (CPR) guideline of comprehensive cardiopulmonary life support (CCLS) for management of the patient with cardiopulmonary arrest in adults provides an algorithmic step-wise approach for optimal outcome of the patient inside the hospital by trained medics and paramedics. This guideline has been developed considering the infrastructure of healthcare delivery system in India. This is based on evidence in the international and national literature. In the absence of data from the Indian population, the extrapolation has been made from international data, discussed with Indian experts and modified accordingly to ensure their applicability in India. The CCLS guideline emphasise the need to recognise patients at risk for cardiac arrest and their timely management before a cardiac arrest occurs. The basic components of CPR include chest compressions for blood circulation; airway maintenance to ensure airway patency; lung ventilation to enable oxygenation and defibrillation to convert a pathologic ‘shockable’ cardiac rhythm to one capable to maintaining effective blood circulation. CCLS emphasises incorporation of airway management, drugs, and identification of the cause of arrest and its correction, while chest compression and ventilation are ongoing. It also emphasises the value of organised team approach and optimal post-resuscitation care. PMID:29217853

Efficacy and safety of a single 2 mg dose or 4 mg double dose of alteplase for 50 occluded chest ports using a unique instillation technique.

PubMed

Sharma, Rajinder P; Ree, Chung Ja; Ree, Alexander

2008-01-01

To evaluate the effectiveness and safety of a single 2 mg dose or a 4 mg double dose of alteplase for restoring function in occluded chest ports. A prospective, open-label, nonblinded study was performed on 40 enrolled patients with a total of 50 chest ports at the Henry Ford Hospital Interventional Radiology Department (Detroid, Michigan, USA). Alteplase (Cathflo Activase; Genentech, USA), a recombinant tissue plasminogen activator produced by recombinant DNA technology, was used to restore the function of 50 occluded chest ports. Occlusion was defined as the inability to withdraw blood freely from the port, or the inability to flush the port easily. A 2 mg (2 mL) dose of alteplase was injected into the port through a Huber needle, using a gentle push and pull technique, and was left to dwell for 30 min. If the port remained occluded after the initial 2 mg alteplase treatment, an additional 2 mg alteplase treatment was administered with the same dwell time of 30 min. If a port had remained occluded despite the above regimen, this outcome would have been considered a failure and the chest port would have required surgical intervention. However, all ports were successfully treated, and no surgical intervention was required. The safety end points included minor or major hemorrhages, such as intracranial hemorrhages, or sepsis. Safety end points were determined by a 24 h follow-up telephone call. Of the 50 chest ports (30 single ports and 10 double ports) treated with alteplase, 36 required 2 mg (72%) and 14 required 4 mg (28%). The efficacy end point was 100% for all chest ports treated, without any adverse events. High efficacy and safety rates of restoring function in occluded chest ports were obtained with 2 mg or 4 mg doses of alteplase. Part of this high efficacy rate may be due to the gentle push and pull technique used in the present study.

[Imaging of pleural diseases: evaluation of imaging methods based on chest radiography].

PubMed

Poyraz, Necdet; Kalkan, Havva; Ödev, Kemal; Ceran, Sami

2017-03-01

The most commonly employed radiologic method in diagnosis of pleural diseases is conventional chest radiograph. The commonest chest- X-Ray findings are the presence of pleural effusion and thickening. Small pleural effusions are not readily identified on posteroanterior chest radiograph. However, lateral decubitus chest radiograph and chest ultrasonography may show small pleural effusions. These are more efficient methods than posteroanterior chest radiograph in the erect position for demonstrating small amounts of free pleural effusions. Chest ultrasonograph may be able to help in distinguishing the pleural pathologies from parenchymal lesions. On chest radiograph pleural effusions or pleural thickening may obscure the visibility of the underlying disease or parenchymal abnormality. Thus, computed tomography (CT) may provide additional information of determining the extent and severity of pleural disease and may help to differentiate malign pleural lesions from the benign ones. Moreover, CT may provide the differentiation of parenchmal abnormalities from pleural pathologies. CT (coronal and sagittal reformatted images) that also show invasion of chest wall, mediastinum and diaphragm, as well as enlarged hilar or mediastinal lymph nodes. Standart non-invasive imaging techniques may be supplemented with magnetic resonans imaging (MRI).

Angular relational signature-based chest radiograph image view classification.

PubMed

Santosh, K C; Wendling, Laurent

2018-01-22

In a computer-aided diagnosis (CAD) system, especially for chest radiograph or chest X-ray (CXR) screening, CXR image view information is required. Automatically separating CXR image view, frontal and lateral can ease subsequent CXR screening process, since the techniques may not equally work for both views. We present a novel technique to classify frontal and lateral CXR images, where we introduce angular relational signature through force histogram to extract features and apply three different state-of-the-art classifiers: multi-layer perceptron, random forest, and support vector machine to make a decision. We validated our fully automatic technique on a set of 8100 images hosted by the U.S. National Library of Medicine (NLM), National Institutes of Health (NIH), and achieved an accuracy close to 100%. Our method outperforms the state-of-the-art methods in terms of processing time (less than or close to 2 s for the whole test data) while the accuracies can be compared, and therefore, it justifies its practicality. Graphical Abstract Interpreting chest X-ray (CXR) through the angular relational signature.

[Detection of lung nodules. New opportunities in chest radiography].

PubMed

Pötter-Lang, S; Schalekamp, S; Schaefer-Prokop, C; Uffmann, M

2014-05-01

Chest radiography still represents the most commonly performed X-ray examination because it is readily available, requires low radiation doses and is relatively inexpensive. However, as previously published, many initially undetected lung nodules are retrospectively visible in chest radiographs. The great improvements in detector technology with the increasing dose efficiency and improved contrast resolution provide a better image quality and reduced dose needs. The dual energy acquisition technique and advanced image processing methods (e.g. digital bone subtraction and temporal subtraction) reduce the anatomical background noise by reduction of overlapping structures in chest radiography. Computer-aided detection (CAD) schemes increase the awareness of radiologists for suspicious areas. The advanced image processing methods show clear improvements for the detection of pulmonary lung nodules in chest radiography and strengthen the role of this method in comparison to 3D acquisition techniques, such as computed tomography (CT). Many of these methods will probably be integrated into standard clinical treatment in the near future. Digital software solutions offer advantages as they can be easily incorporated into radiology departments and are often more affordable as compared to hardware solutions.

Anesthesia for minimally invasive chest wall reconstructive surgeries: Our experience and review of literature

PubMed Central

Shah, Shagun Bhatia; Hariharan, Uma; Bhargava, Ajay Kumar; Darlong, Laleng M.

2017-01-01

Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum) and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function indices, namely, forced expiratory volume over 1 s, forced vital capacity, vital capacity, and total lung capacity are markedly compromised in pectus excavatum. Earlier, open surgical correction in the form of the Ravitch procedure was followed. Currently, in the era of minimally invasive surgery, Nuss technique (pectus bar procedure) is a promising step in chest wall reconstructive surgery for pectus excavatum. Reverse Nuss is a corrective, minimally invasive surgery for pectus carinatum chest deformity. A tailor-made anesthetic technique for this new procedure has been described here based on the authors’ personal experience and thorough review of literature based on Medline, Embase, and Scopus databases search. PMID:28757834

Cosmological Particle Data Compression in Practice

NASA Astrophysics Data System (ADS)

Zeyen, M.; Ahrens, J.; Hagen, H.; Heitmann, K.; Habib, S.

2017-12-01

In cosmological simulations trillions of particles are handled and several terabytes of unstructured particle data are generated in each time step. Transferring this data directly from memory to disk in an uncompressed way results in a massive load on I/O and storage systems. Hence, one goal of domain scientists is to compress the data before storing it to disk while minimizing the loss of information. To prevent reading back uncompressed data from disk, this can be done in an in-situ process. Since the simulation continuously generates data, the available time for the compression of one time step is limited. Therefore, the evaluation of compression techniques has shifted from only focusing on compression rates to include run-times and scalability.In recent years several compression techniques for cosmological data have become available. These techniques can be either lossy or lossless, depending on the technique. For both cases, this study aims to evaluate and compare the state of the art compression techniques for unstructured particle data. This study focuses on the techniques available in the Blosc framework with its multi-threading support, the XZ Utils toolkit with the LZMA algorithm that achieves high compression rates, and the widespread FPZIP and ZFP methods for lossy compressions.For the investigated compression techniques, quantitative performance indicators such as compression rates, run-time/throughput, and reconstruction errors are measured. Based on these factors, this study offers a comprehensive analysis of the individual techniques and discusses their applicability for in-situ compression. In addition, domain specific measures are evaluated on the reconstructed data sets, and the relative error rates and statistical properties are analyzed and compared. Based on this study future challenges and directions in the compression of unstructured cosmological particle data were identified.

Cardiopulmonary resuscitation duty cycle in out-of-hospital cardiac arrest.

PubMed

Johnson, Bryce V; Johnson, Bryce; Coult, Jason; Fahrenbruch, Carol; Blackwood, Jennifer; Sherman, Larry; Kudenchuk, Peter; Sayre, Michael; Rea, Thomas

2015-02-01

Duty cycle is the portion of time spent in compression relative to total time of the compression-decompression cycle. Guidelines recommend a 50% duty cycle based largely on animal investigation. We undertook a descriptive evaluation of duty cycle in human resuscitation, and whether duty cycle correlates with other CPR measures. We calculated the duty cycle, compression depth, and compression rate during EMS resuscitation of 164 patients with out-of-hospital ventricular fibrillation cardiac arrest. We captured force recordings from a chest accelerometer to measure ten-second CPR epochs that preceded rhythm analysis. Duty cycle was calculated using two methods. Effective compression time (ECT) is the time from beginning to end of compression divided by total period for that compression-decompression cycle. Area duty cycle (ADC) is the ratio of area under the force curve divided by total area of one compression-decompression cycle. We evaluated the compression depth and compression rate according to duty cycle quartiles. There were 369 ten-second epochs among 164 patients. The median duty cycle was 38.8% (SD=5.5%) using ECT and 32.2% (SD=4.3%) using ADC. A relatively shorter compression phase (lower duty cycle) was associated with greater compression depth (test for trend <0.05 for ECT and ADC) and slower compression rate (test for trend <0.05 for ADC). Sixty-one of 164 patients (37%) survived to hospital discharge. Duty cycle was below the 50% recommended guideline, and was associated with compression depth and rate. These findings provider rationale to incorporate duty cycle into research aimed at understanding optimal CPR metrics. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Quantitative kinetic analysis of lung nodules by temporal subtraction technique in dynamic chest radiography with a flat panel detector

NASA Astrophysics Data System (ADS)

Tsuchiya, Yuichiro; Kodera, Yoshie; Tanaka, Rie; Sanada, Shigeru

2007-03-01

Early detection and treatment of lung cancer is one of the most effective means to reduce cancer mortality; chest X-ray radiography has been widely used as a screening examination or health checkup. The new examination method and the development of computer analysis system allow obtaining respiratory kinetics by the use of flat panel detector (FPD), which is the expanded method of chest X-ray radiography. Through such changes functional evaluation of respiratory kinetics in chest has become available. Its introduction into clinical practice is expected in the future. In this study, we developed the computer analysis algorithm for the purpose of detecting lung nodules and evaluating quantitative kinetics. Breathing chest radiograph obtained by modified FPD was converted into 4 static images drawing the feature, by sequential temporal subtraction processing, morphologic enhancement processing, kinetic visualization processing, and lung region detection processing, after the breath synchronization process utilizing the diaphragmatic analysis of the vector movement. The artificial neural network used to analyze the density patterns detected the true nodules by analyzing these static images, and drew their kinetic tracks. For the algorithm performance and the evaluation of clinical effectiveness with 7 normal patients and simulated nodules, both showed sufficient detecting capability and kinetic imaging function without statistically significant difference. Our technique can quantitatively evaluate the kinetic range of nodules, and is effective in detecting a nodule on a breathing chest radiograph. Moreover, the application of this technique is expected to extend computer-aided diagnosis systems and facilitate the development of an automatic planning system for radiation therapy.

Low-Complexity Lossless and Near-Lossless Data Compression Technique for Multispectral Imagery

NASA Technical Reports Server (NTRS)

Xie, Hua; Klimesh, Matthew A.

2009-01-01

This work extends the lossless data compression technique described in Fast Lossless Compression of Multispectral- Image Data, (NPO-42517) NASA Tech Briefs, Vol. 30, No. 8 (August 2006), page 26. The original technique was extended to include a near-lossless compression option, allowing substantially smaller compressed file sizes when a small amount of distortion can be tolerated. Near-lossless compression is obtained by including a quantization step prior to encoding of prediction residuals. The original technique uses lossless predictive compression and is designed for use on multispectral imagery. A lossless predictive data compression algorithm compresses a digitized signal one sample at a time as follows: First, a sample value is predicted from previously encoded samples. The difference between the actual sample value and the prediction is called the prediction residual. The prediction residual is encoded into the compressed file. The decompressor can form the same predicted sample and can decode the prediction residual from the compressed file, and so can reconstruct the original sample. A lossless predictive compression algorithm can generally be converted to a near-lossless compression algorithm by quantizing the prediction residuals prior to encoding them. In this case, since the reconstructed sample values will not be identical to the original sample values, the encoder must determine the values that will be reconstructed and use these values for predicting later sample values. The technique described here uses this method, starting with the original technique, to allow near-lossless compression. The extension to allow near-lossless compression adds the ability to achieve much more compression when small amounts of distortion are tolerable, while retaining the low complexity and good overall compression effectiveness of the original algorithm.

Improving Hybrid III injury assessment in steering wheel rim to chest impacts using responses from finite element Hybrid III and human body model.

PubMed

Holmqvist, Kristian; Davidsson, Johan; Mendoza-Vazquez, Manuel; Rundberget, Peter; Svensson, Mats Y; Thorn, Stefan; Törnvall, Fredrik

2014-01-01

The main aim of this study was to improve the quality of injury risk assessments in steering wheel rim to chest impacts when using the Hybrid III crash test dummy in frontal heavy goods vehicle (HGV) collision tests. Correction factors for chest injury criteria were calculated as the model chest injury parameter ratios between finite element (FE) Hybrid III, evaluated in relevant load cases, and the Total Human Model for Safety (THUMS). This is proposed to be used to compensate Hybrid III measurements in crash tests where steering wheel rim to chest impacts occur. The study was conducted in an FE environment using an FE-Hybrid III model and the THUMS. Two impactor shapes were used, a circular hub and a long, thin horizontal bar. Chest impacts at velocities ranging from 3.0 to 6.0 m/s were simulated at 3 impact height levels. A ratio between FE-Hybrid III and THUMS chest injury parameters, maximum chest compression C max, and maximum viscous criterion VC max, were calculated for the different chest impact conditions to form a set of correction factors. The definition of the correction factor is based on the assumption that the response from a circular hub impact to the middle of the chest is well characterized and that injury risk measures are independent of impact height. The current limits for these chest injury criteria were used as a basis to develop correction factors that compensate for the limitations in biofidelity of the Hybrid III in steering wheel rim to chest impacts. The hub and bar impactors produced considerably higher C max and VC max responses in the THUMS compared to the FE-Hybrid III. The correction factor for the responses of the FE-Hybrid III showed that the criteria responses for the bar impactor were consistently overestimated. Ratios based on Hybrid III and THUMS responses provided correction factors for the Hybrid III responses ranging from 0.84 to 0.93. These factors can be used to estimate C max and VC max values when the Hybrid III is used in crash tests for which steering wheel rim to chest interaction occurs. For the FE-Hybrid III, bar impacts caused higher chest deflection compared to hub impacts, although the contrary results were obtained with the more humanlike THUMS. Correction factors were developed that can be used to correct the Hybrid III chest responses. Higher injury criteria capping limits for steering wheel impacts are acceptable. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

The sandwich technique for repair of pectus carinatum and excavatum/carinatum complex.

PubMed

Park, Hyung Joo; Kim, Kyung Soo

2016-09-01

Simple external compression of pectus carinatum seems to have its limitations, particularly the repair of asymmetric pectus carinatum or excavatum/carinatum complex. We devised the sandwich technique (press-molding) to remodel the entire chest wall. The purpose of this study is to introduce the sandwich technique and appraise the early results. Between January 2007 and January 2016, 523 consecutive patients with pectus carinatum and its variants were analyzed retrospectively. No patients were excluded during the study period. The sandwich 1 and 2 techniques using the internal and external pectus bars were for pectus carinatum repair. Modified techniques using the external string and the internal bar were to treat the lower costal flare (the flare-buster) and focal protuberances (the magic string) in pectus excavatum repair. Statistical analyses were carried out using paired and unpaired t -test or Wilcoxon signed rank tests. The sandwich repair with the external and internal bars was applied to 58 pectus carinatum patients: seven symmetric (12.1%), 14 asymmetric (24.1%), and 37 carinatum-excavatum complex (63.8%). After pectus excavatum repair, 426 patients had the flare-buster and 39 patients received the magic string. The sandwich 1 technique achieved near-complete resolution of carinatum in 52 patients (86.2%). The sandwich 2 technique accomplished almost symmetric configuration with no residual carinatum in all six cases. The sandwich technique using the external and internal bars seems to be effective in treating asymmetric pectus carinatum and complex excavatum/carinatum deformities. The flare-buster and the magic string effectively relieve the costal flare and focal protuberances in pectus excavatum repair.

Altered Standards of Care: An Analysis of Existing Federal, State, and Local Guidelines

DTIC Science & Technology

2011-12-01

Approved for public release; distribution is unlimited 12b. DISTRIBUTION CODE A 13. ABSTRACT (maximum 200 words ) A...data systems for communications and the transference of data. Losing data systems during disasters cuts off access to electronic medical records...emergency procedures as mouth - to- mouth resuscitation, external chest compression, electric shock, insertion of a tube to open the patient’s airway

Atypical autoerotic deaths

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gowitt, G.T.; Hanzlick, R.L.

1992-06-01

So-called typical' autoerotic fatalities are the result of asphyxia due to mechanical compression of the neck, chest, or abdomen, whereas atypical' autoeroticism involves sexual self-stimulation by other means. The authors present five atypical autoerotic fatalities that involved the use of dichlorodifluoromethane, nitrous oxide, isobutyl nitrite, cocaine, or compounds containing 1-1-1-trichloroethane. Mechanisms of death are discussed in each case and the pertinent literature is reviewed.

Quality of basic life support when using different commercially available public access defibrillators.

PubMed

Müller, Michael P; Poenicke, Cynthia; Kurth, Maxi; Richter, Torsten; Koch, Thea; Eisold, Carolin; Pfältzer, Adrian; Heller, Axel R

2015-06-21

Basic life support (BLS) guidelines focus on chest compressions with a minimal no-flow fraction (NFF), early defibrillation, and a short perishock pause. By using an automated external defibrillator (AED) lay persons are guided through the process of attaching electrodes and initiating defibrillation. It is unclear, however, to what extent the voice instructions given by the AED might influence the quality of initial resuscitation. Using a patient simulator, 8 different commercially available AEDs were evaluated within two different BLS scenarios (ventricular fibrillation vs. asystole). A BLS certified instructor acted according to the current European Resuscitation Council 2010 Guidelines and followed all of the AED voice prompts. In a second set of scenarios, the rescuer anticipated the appropriate actions and started already before the AED stopped speaking. A BLS scenario without AED served as the control. All scenarios were run three times. The time until the first chest compression was 25 ± 2 seconds without the AED and ranged from 50 ± 3 to 148 ± 13 seconds with the AED depending on the model used. The NFF was .26 ± .01 without the AED and between .37 ± .01 and .72 ± .01 when an AED was used. The perishock pause ranged from 12 ± 0 to 46 ± 0 seconds. The optimized sequence of actions reduced the NFF, which ranged now from .32 ± .01 to .41 ± .01, and the perishock pause ranging from 1 ± 1 to 19 ± 1 seconds. Voice prompts given by commercially available AED merely meet the requirements of current evidence in basic life support. Furthermore, there is a significant difference between devices with regard to time until the first chest compression, perishock pause, no-flow fraction and other objective measures of the quality of BLS. However, the BLS quality may be improved with optimized handling of the AED. Thus, rescuers should be trained on the respective AED devices, and manufacturers should expend more effort in improving user guidance to shorten the NFF and perishock pause.

Standardized model of porcine resuscitation using a custom-made resuscitation board results in optimal hemodynamic management.

PubMed

Wollborn, Jakob; Ruetten, Eva; Schlueter, Bjoern; Haberstroh, Joerg; Goebel, Ulrich; Schick, Martin A

2018-01-22

Standardized modeling of cardiac arrest and cardiopulmonary resuscitation (CPR) is crucial to evaluate new treatment options. Experimental porcine models are ideal, closely mimicking human-like physiology. However, anteroposterior chest diameter differs significantly, being larger in pigs and thus poses a challenge to achieve adequate perfusion pressures and consequently hemodynamics during CPR, which are commonly achieved during human resuscitation. The aim was to prove that standardized resuscitation is feasible and renders adequate hemodynamics and perfusion in pigs, using a specifically designed resuscitation board for a pneumatic chest compression device. A "porcine-fit" resuscitation board was designed for our experiments to optimally use a pneumatic compression device (LUCAS® II, Physio-Control Inc.), which is widely employed in emergency medicine and ideal in an experimental setting due to its high standardization. Asphyxial cardiac arrest was induced in 10 German hybrid landrace pigs and cardiopulmonary resuscitation was performed according to ERC/AHA 2015 guidelines with mechanical chest compressions. Hemodynamics were measured in the carotid and pulmonary artery. Furthermore, arterial blood gas was drawn to assess oxygenation and tissue perfusion. The custom-designed resuscitation board in combination with the LUCAS® device demonstrated highly sufficient performance regarding hemodynamics during CPR (mean arterial blood pressure, MAP 46 ± 1 mmHg and mean pulmonary artery pressure, mPAP of 36 ± 1 mmHg over the course of CPR). MAP returned to baseline values at 2 h after ROSC (80 ± 4 mmHg), requiring moderate doses of vasopressors. Furthermore, stroke volume and contractility were analyzed using pulse contour analysis (106 ± 3 ml and 1097 ± 22 mmHg/s during CPR). Blood gas analysis revealed CPR-typical changes, normalizing in the due course. Thermodilution parameters did not show persistent intravascular volume shift. Standardized cardiopulmonary resuscitation is feasible in a porcine model, achieving adequate hemodynamics and consecutive tissue perfusion of consistent quality. Copyright © 2018 Elsevier Inc. All rights reserved.

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

PubMed Central

Liparulo, Valeria; Pica, Alessandra; Guarro, Giuseppe; Alfano, Carmine; Puma, Francesco

2017-01-01

Background Chest wall resection and reconstruction (CWRR) is quite challenging in surgery, due to evolution in techniques. Neoplasms of the chest wall, primary or secondary, have been considered inoperable for a long time. Thanks to evolving surgical techniques, reconstruction after extensive chest wall resection is possible with good functional and aesthetic results. Methods In our single-center experience, seven cases of extensive CWRR for tumors were performed with a multidisciplinary approach by both thoracic and plastic surgeons. Patients have been retrospective analyzed. Results Acceptable clinical and aesthetical results have been recorded, with a smooth post-operative course and a low rate of post-surgical complications. Two early complications and one late complication (asymptomatic bone allograft fracture on the site of the bar implant) were recorded. Neither postoperative deaths nor local recurrences were registered after a median follow-up period of 13 months. Conclusions Surgical planning is most effective when it is tailored to the patient. Specifically, in the treatment of selected chest wall tumors, the multidisciplinary approach is considered mandatory when an extensive demolition is required. Indeed, here, the radical wide en-bloc resection can lead to good results provided that the extent of resection is not influenced by any anticipated problem in reconstruction. PMID:29312715

Lung ultrasound compared with chest X-ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study.

PubMed

Touw, H R; Parlevliet, K L; Beerepoot, M; Schober, P; Vonk, A; Twisk, J W; Elbers, P W; Boer, C; Tuinman, P R

2018-03-12

Postoperative pulmonary complications are common after cardiothoracic surgery and are associated with adverse outcomes. The ability to detect postoperative pulmonary complications using chest X-rays is limited, and this technique requires radiation exposure. Little is known about the diagnostic accuracy of lung ultrasound for the detection of postoperative pulmonary complications after cardiothoracic surgery, and we therefore aimed to compare lung ultrasound with chest X-ray to detect postoperative pulmonary complications in this group of patients. We performed this prospective, observational, single-centre study in a tertiary intensive care unit treating adult patients who had undergone cardiothoracic surgery. We recorded chest X-ray findings upon admission and on postoperative days 2 and 3, as well as rates of postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications that required therapy according to the treating physician as part of their standard clinical practice. Lung ultrasound was performed by an independent researcher at the time of chest X-ray. We compared lung ultrasound with chest X-ray for the detection of postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications. We also assessed inter-observer agreement for lung ultrasound, and the time to perform both imaging techniques. Subgroup analyses were performed to compare the time to detection of clinically-relevant postoperative pulmonary complications by both modalities. We recruited a total of 177 patients in whom both lung ultrasound and chest X-ray imaging were performed. Lung ultrasound identified 159 (90%) postoperative pulmonary complications on the day of admission compared with 107 (61%) identified with chest X-ray (p < 0.001). Lung ultrasound identified 11 out of 17 patients (65%) and chest X-ray 7 out of 17 patients (41%) with clinically-relevant postoperative pulmonary complications (p < 0.001). The clinically-relevant postoperative pulmonary complications were detected earlier using lung ultrasound compared with chest X-ray (p = 0.024). Overall inter-observer agreement for lung ultrasound was excellent (κ = 0.907, p < 0.001). Following cardiothoracic surgery, lung ultrasound detected more postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications than chest X-ray, and at an earlier time-point. Our results suggest lung ultrasound may be used as the primary imaging technique to search for postoperative pulmonary complications after cardiothoracic surgery, and will enhance bedside decision making. © 2018 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

Extreme compression for extreme conditions: pilot study to identify optimal compression of CT images using MPEG-4 video compression.

PubMed

Peterson, P Gabriel; Pak, Sung K; Nguyen, Binh; Jacobs, Genevieve; Folio, Les

2012-12-01

This study aims to evaluate the utility of compressed computed tomography (CT) studies (to expedite transmission) using Motion Pictures Experts Group, Layer 4 (MPEG-4) movie formatting in combat hospitals when guiding major treatment regimens. This retrospective analysis was approved by Walter Reed Army Medical Center institutional review board with a waiver for the informed consent requirement. Twenty-five CT chest, abdomen, and pelvis exams were converted from Digital Imaging and Communications in Medicine to MPEG-4 movie format at various compression ratios. Three board-certified radiologists reviewed various levels of compression on emergent CT findings on 25 combat casualties and compared with the interpretation of the original series. A Universal Trauma Window was selected at -200 HU level and 1,500 HU width, then compressed at three lossy levels. Sensitivities and specificities for each reviewer were calculated along with 95 % confidence intervals using the method of general estimating equations. The compression ratios compared were 171:1, 86:1, and 41:1 with combined sensitivities of 90 % (95 % confidence interval, 79-95), 94 % (87-97), and 100 % (93-100), respectively. Combined specificities were 100 % (85-100), 100 % (85-100), and 96 % (78-99), respectively. The introduction of CT in combat hospitals with increasing detectors and image data in recent military operations has increased the need for effective teleradiology; mandating compression technology. Image compression is currently used to transmit images from combat hospital to tertiary care centers with subspecialists and our study demonstrates MPEG-4 technology as a reasonable means of achieving such compression.

Videographic assessment of cardiopulmonary resuscitation quality in the pediatric emergency department.

PubMed

Donoghue, Aaron; Hsieh, Ting-Chang; Myers, Sage; Mak, Allison; Sutton, Robert; Nadkarni, Vinay

2015-06-01

To describe the adherence to guidelines for CPR in a tertiary pediatric emergency department (ED) where resuscitations are reviewed by videorecording. Resuscitations in a tertiary pediatric ED are videorecorded as part of a quality improvement project. Patients receiving CPR under videorecorded conditions were eligible for inclusion. CPR parameters were quantified by retrospective review. Data were described by 30-s epoch (compression rate, ventilation rate, compression:ventilation ratio), by segment (duration of single providers' compressions) and by overall event (compression fraction). Duration of interruptions in compressions was measured; tasks completed during pauses were tabulated. 33 children received CPR under videorecorded conditions. A total of 650 min of CPR were analyzed. Chest compressions were performed at <100/min in 90/714 (13%) of epochs; 100-120/min in 309/714 (43%); >120/min in 315/714 (44%). Ventilations were 6-12 breaths/min in 201/708 (23%) of epochs and >12/min in 489/708 (70%). During CPR without an artificial airway, compression:ventilation coordination (15:2) was done in 93/234 (40%) of epochs. 178 pauses in CPR occurred; 120 (67%) were <10s in duration. Of 370 segments of compressions by individual providers, 282/370 (76%) were <2 min in duration. Median compression fraction was 91% (range 88-100%). CPR in a tertiary pediatric ED frequently met recommended parameters for compression rate, pause duration, and compression fraction. Hyperventilation and failure of C:V coordination were very common. Future studies should focus on the impact of training methods on CPR performance as documented by videorecording. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Acute spinal cord compression: a rare complication of dual antiplatelet therapy

PubMed Central

Iskandar, Muhammad Zaid; Chong, Victor; Hutcheon, Stuart

2015-01-01

A 73-year-old woman presented with acute shortness of breath and exacerbation of chronic back pain. She was diagnosed with pulmonary oedema and a non-ST-elevation myocardial infarction following chest X-ray, ECG and high sensitivity troponin levels. She subsequently underwent coronary angioplasty with deployment of drug-eluting stents to her circumflex and left anterior descending arteries and was started on aspirin and clopidogrel for her dual antiplatelet therapy. Unfortunately, following the procedure, she gradually lost power and sensation in both lower limbs. MRI of her spine confirmed an extradural haematoma causing thoracic cord compression. She was managed conservatively following discussions with neurosurgeons and developed further complications secondary to her immobility. PMID:26202314

[Features of cranio-cerebral trauma in victims of road accidents].

PubMed

Ogleznev, K Ia; Stankevich, P V

2001-01-01

The paper deals with the specific features of brain injury (BI) in victims of road traffic accidents (RTA). RTA victims are most commonly pedestrians (62.6%) and less commonly drivers (17.5%). In over half the cases (62.6%), BI due to RTA is associated with extracranial lesions, leading to diagnostic problems. The pattern and site of lesions are related to the type of a transport vehicle and to the role of a victim as a traffic participant. Multiple extracranial lesions are mostly frequently encountered in victim pedestrians (30.3%), BI concurrent with chest damage is common in drivers (12.8%), BI concurrent with "whip" injury of the cervical spine is found in drivers and passengers though such combinations may also seen in pedestrians (1.5%--5 cases). The most severe form of brain compression is multifactorial compression (27.6%) and its most common form is compression with subdural hematoma (35.3%).

Comparison of the quality of basic life support provided by rescuers trained using the 2005 or 2010 ERC guidelines.

PubMed

Jones, Christopher M; Owen, Andrew; Thorne, Christopher J; Hulme, Jonathan

2012-08-09

Effective delivery of cardiopulmonary resuscitation (CPR) and prompt defibrillation following sudden cardiac arrest (SCA) is vital. Updated guidelines for adult basic life support (BLS) were published in 2010 by the European Resuscitation Council (ERC) in an effort to improve survival following SCA. There has been little assessment of the ability of rescuers to meet the standards outlined within these new guidelines. We conducted a retrospective analysis of the performance of first year healthcare students trained and assessed using either the new 2010 ERC guidelines or their 2005 predecessor, within the University of Birmingham, United Kingdom. All students were trained as lay rescuers during a standardised eight hour ERC-accredited adult BLS course. We analysed the examination records of 1091 students. Of these, 561 were trained and assessed using the old 2005 ERC guidelines and 530 using the new 2010 guidelines. A significantly greater proportion of candidates failed in the new guideline group (16.04% vs. 11.05%; p < 0.05), reflecting a significantly greater proportion of lay-rescuers performing chest compressions at too fast a rate when trained and assessed with the 2010 rather than 2005 guidelines (6.04% vs. 2.67%; p < 0.05). Error rates for other skills did not differ between guideline groups. The new ERC guidelines lead to a greater proportion of lay rescuers performing chest compressions at an erroneously fast rate and may therefore worsen BLS efficacy. Additional study is required in order to define the clinical impact of compressions performed to a greater depth and at too fast a rate.

Management of Chest Drains After Thoracic Resections.

PubMed

Filosso, Pier Luigi; Sandri, Alberto; Guerrera, Francesco; Roffinella, Matteo; Bora, Giulia; Solidoro, Paolo

2017-02-01

Immediately after lung resection, air tends to collect in the retrosternal part of the chest wall (in supine position), and fluids in its lower part (costodiaphragmatic sinus). Several general thoracic surgery textbooks currently recommend the placement of 2 chest tubes after major pulmonary resections, one anteriorly, to remove air, and another into the posterior and basilar region, to drain fluids. Recently, several authors advocated the placement of a single chest tube. In terms of air and fluid drainage, this technique demonstrated to be as effective as the conventional one after wedge resection or uncomplicated lobectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

Measurement of lung volumes from supine portable chest radiographs.

PubMed

Ries, A L; Clausen, J L; Friedman, P J

1979-12-01

Lung volumes in supine nonambulatory patients are physiological parameters often difficult to measure with current techniques (plethysmograph, gas dilution). Existing radiographic methods for measuring lung volumes require standard upright chest radiographs. Accordingly, in 31 normal supine adults, we determined helium-dilution functional residual and total lung capacities and measured planimetric lung field areas (LFA) from corresponding portable anteroposterior and lateral radiographs. Low radiation dose methods, which delivered less than 10% of that from standard portable X-ray technique, were utilized. Correlation between lung volume and radiographic LFA was highly significant (r = 0.96, SEE = 10.6%). Multiple-step regressions using height and chest diameter correction factors reduced variance, but weight and radiographic magnification factors did not. In 17 additional subjects studied for validation, the regression equations accurately predicted radiographic lung volume. Thus, this technique can provide accurate and rapid measurement of lung volume in studies involving supine patients.

Asymptomatic Presentation of Large Cardiac Hydatid.

PubMed

Beedkar, Amey; Parikh, Rohan; Deshmukh, Pradeep

2017-02-01

Hydatid cyst is a tissue parasitic infection caused by tapeworm Echinococcus granulosus. Common location for hydatid cysts are the liver (65%) and the lungs (25%). Cardiac hydatid cyst is seen rarely, occurring in about 0.5-2% of all cases of hydatid disease. We present this case of 45 years female who presented with short duration of dry cough and atypical chest pain. Chest X ray showed cardiomegaly with round bulge at the right heart border and curvilinear calcification in left upper abdomen in the region of spleen. Transthoracic echocardiography (TTE) depicted cystic lesion in Right Ventricle free wall causing compression of right atrial and ventricular cavity. Cardiac CT confirmed this cyst as hydatid cyst. Patient underwent successful excision of right ventricular hydatid cyst. © Journal of the Association of Physicians of India 2011.

Nineth Rib Syndrome after 10(th) Rib Resection.

PubMed

Yu, Hyun Jeong; Jeong, Yu Sub; Lee, Dong Hoon; Yim, Kyoung Hoon

2016-07-01

The 12(th) rib syndrome is a disease that causes pain between the upper abdomen and the lower chest. It is assumed that the impinging on the nerves between the ribs causes pain in the lower chest, upper abdomen, and flank. A 74-year-old female patient visited a pain clinic complaining of pain in her back, and left chest wall at a 7 on the 0-10 Numeric Rating scale (NRS). She had a lateral fixation at T12-L2, 6 years earlier. After the operation, she had multiple osteoporotic compression fractures. When the spine was bent, the patient complained about a sharp pain in the left mid-axillary line and radiating pain toward the abdomen. On physical examination, the 10(th) rib was not felt, and an image of the rib-cage confirmed that the left 10(th) rib was severed. When applying pressure from the legs to the 9(th) rib of the patient, pain was reproduced. Therefore, the patient was diagnosed with 9(th) rib syndrome, and ultrasound-guided 9(th) and 10(th) intercostal nerve blocks were performed around the tips of the severed 10(th) rib. In addition, local anesthetics with triamcinolone were administered into the muscles beneath the 9(th) rib at the point of the greatest tenderness. The patient's pain was reduced to NRS 2 point. In this case, it is suspected that the patient had a partial resection of the left 10(th) rib in the past, and subsequent compression fractures at T8 and T9 led to the deformation of the rib cage, causing the tip of the remaining 10(th) rib to impinge on the 9(th) intercostal nerves, causing pain.

Radiological Findings in a case of Advance staged Mesothelioma

PubMed Central

Aziz, Fahad

2009-01-01

Chest X Ray is the initial screening test for the mesothelioma like all other the chest diseases. But computed tomography (CT) is the imaging technique of choice for charactering pleural masses. CT also gives important information regarding invasion of the chest wall and surrounding structures. Certain CT features help differentiate benign from malignant processes. This short article highlights the salient CT appearance of mesothelioma; the most common pleural tumor. PMID:22263002

Loss of Consciousness During Single Sling Helicopter Hoist Rescue Resulting in a Fatal Fall.

PubMed

Biles, Jessie; Garner, Alan A

2016-09-01

Although harness suspension trauma has been documented since the 1960s, especially in the mountaineering setting, there is little robust medical research into the area. Helicopter hoist rescue shares similar risks and is reserved for those cases that cannot be accessed safely by other routes, where extrication may be hazardous or will take an unreasonable amount of time. The single sling or chest harness used for hoist rescue is a single harness around the upper torso and is easier and quicker to apply than a stretcher. However, the risks of a chest harness need to be balanced against the patient's condition, the environment, aircraft performance, and the urgency of the rescue. We report an adult male falling 80 ft to his death while being hoisted into a rescue helicopter for a likely fractured ankle. A single rescue sling harness technique was used, but the patient became unconscious, slipped out of the harness, and fell. He had significant comorbidities, including cardiomyopathy, obstructive sleep apnea, morbid obesity, and diabetes. A decrease in cardiac output secondary to thoracic compression was the presumed cause for his loss of consciousness and the potential physiological mechanisms and modifying factors are discussed. Further research into harness suspension trauma is required. Stretcher, double point harnesses, or rescue baskets are likely safer methods of hoisting, especially in a medically compromised patient. Biles J, Garner AA. Loss of consciousness during single sling helicopter hoist rescue resulting in a fatal fall. Aerosp Med Hum Perform. 2016; 87(9):821-824.

Application of off-line image processing for optimization in chest computed radiography using a low cost system.

PubMed

Muhogora, Wilbroad E; Msaki, Peter; Padovani, Renato

2015-03-08

 The objective of this study was to improve the visibility of anatomical details by applying off-line postimage processing in chest computed radiography (CR). Four spatial domain-based external image processing techniques were developed by using MATLAB software version 7.0.0.19920 (R14) and image processing tools. The developed techniques were implemented to sample images and their visual appearances confirmed by two consultant radiologists to be clinically adequate. The techniques were then applied to 200 chest clinical images and randomized with other 100 images previously processed online. These 300 images were presented to three experienced radiologists for image quality assessment using standard quality criteria. The mean and ranges of the average scores for three radiologists were characterized for each of the developed technique and imaging system. The Mann-Whitney U-test was used to test the difference of details visibility between the images processed using each of the developed techniques and the corresponding images processed using default algorithms. The results show that the visibility of anatomical features improved significantly (0.005 ≤ p ≤ 0.02) with combinations of intensity values adjustment and/or spatial linear filtering techniques for images acquired using 60 ≤ kVp ≤ 70. However, there was no improvement for images acquired using 102 ≤ kVp ≤ 107 (0.127 ≤ p ≤ 0.48). In conclusion, the use of external image processing for optimization can be effective in chest CR, but should be implemented in consultations with the radiologists.

Application of off‐line image processing for optimization in chest computed radiography using a low cost system

PubMed Central

Msaki, Peter; Padovani, Renato

2015-01-01

The objective of this study was to improve the visibility of anatomical details by applying off‐line postimage processing in chest computed radiography (CR). Four spatial domain‐based external image processing techniques were developed by using MATLAB software version 7.0.0.19920 (R14) and image processing tools. The developed techniques were implemented to sample images and their visual appearances confirmed by two consultant radiologists to be clinically adequate. The techniques were then applied to 200 chest clinical images and randomized with other 100 images previously processed online. These 300 images were presented to three experienced radiologists for image quality assessment using standard quality criteria. The mean and ranges of the average scores for three radiologists were characterized for each of the developed technique and imaging system. The Mann‐Whitney U‐test was used to test the difference of details visibility between the images processed using each of the developed techniques and the corresponding images processed using default algorithms. The results show that the visibility of anatomical features improved significantly (0.005≤p≤0.02) with combinations of intensity values adjustment and/or spatial linear filtering techniques for images acquired using 60≤kVp≤70. However, there was no improvement for images acquired using 102≤kVp≤107 (0.127≤p≤0.48). In conclusion, the use of external image processing for optimization can be effective in chest CR, but should be implemented in consultations with the radiologists. PACS number: 87.59.−e, 87.59.−B, 87.59.−bd PMID:26103165

Efficacy and safety of a single 2 mg dose or 4 mg double dose of alteplase for 50 occluded chest ports using a unique instillation technique

PubMed Central

Sharma, Rajinder P; Ree, Chung Ja; Ree, Alexander

2008-01-01

PURPOSE: To evaluate the effectiveness and safety of a single 2 mg dose or a 4 mg double dose of alteplase for restoring function in occluded chest ports. METHODS: A prospective, open-label, nonblinded study was performed on 40 enrolled patients with a total of 50 chest ports at the Henry Ford Hospital Interventional Radiology Department (Detroid, Michigan, USA). Alteplase (Cathflo Activase; Genentech, USA), a recombinant tissue plasminogen activator produced by recombinant DNA technology, was used to restore the function of 50 occluded chest ports. Occlusion was defined as the inability to withdraw blood freely from the port, or the inability to flush the port easily. A 2 mg (2 mL) dose of alteplase was injected into the port through a Huber needle, using a gentle push and pull technique, and was left to dwell for 30 min. If the port remained occluded after the initial 2 mg alteplase treatment, an additional 2 mg alteplase treatment was administered with the same dwell time of 30 min. If a port had remained occluded despite the above regimen, this outcome would have been considered a failure and the chest port would have required surgical intervention. However, all ports were successfully treated, and no surgical intervention was required. The safety end points included minor or major hemorrhages, such as intracranial hemorrhages, or sepsis. Safety end points were determined by a 24 h follow-up telephone call. RESULTS: Of the 50 chest ports (30 single ports and 10 double ports) treated with alteplase, 36 required 2 mg (72%) and 14 required 4 mg (28%). The efficacy end point was 100% for all chest ports treated, without any adverse events. CONCLUSION: High efficacy and safety rates of restoring function in occluded chest ports were obtained with 2 mg or 4 mg doses of alteplase. Part of this high efficacy rate may be due to the gentle push and pull technique used in the present study. PMID:22477414

Correlation of contrast-detail analysis and clinical image quality assessment in chest radiography with a human cadaver study.

PubMed

De Crop, An; Bacher, Klaus; Van Hoof, Tom; Smeets, Peter V; Smet, Barbara S; Vergauwen, Merel; Kiendys, Urszula; Duyck, Philippe; Verstraete, Koenraad; D'Herde, Katharina; Thierens, Hubert

2012-01-01

To determine the correlation between the clinical and physical image quality of chest images by using cadavers embalmed with the Thiel technique and a contrast-detail phantom. The use of human cadavers fulfilled the requirements of the institutional ethics committee. Clinical image quality was assessed by using three human cadavers embalmed with the Thiel technique, which results in excellent preservation of the flexibility and plasticity of organs and tissues. As a result, lungs can be inflated during image acquisition to simulate the pulmonary anatomy seen on a chest radiograph. Both contrast-detail phantom images and chest images of the Thiel-embalmed bodies were acquired with an amorphous silicon flat-panel detector. Tube voltage (70, 81, 90, 100, 113, 125 kVp), copper filtration (0.1, 0.2, 0.3 mm Cu), and exposure settings (200, 280, 400, 560, 800 speed class) were altered to simulate different quality levels. Four experienced radiologists assessed the image quality by using a visual grading analysis (VGA) technique based on European Quality Criteria for Chest Radiology. The phantom images were scored manually and automatically with use of dedicated software, both resulting in an inverse image quality figure (IQF). Spearman rank correlations between inverse IQFs and VGA scores were calculated. A statistically significant correlation (r = 0.80, P < .01) was observed between the VGA scores and the manually obtained inverse IQFs. Comparison of the VGA scores and the automated evaluated phantom images showed an even better correlation (r = 0.92, P < .001). The results support the value of contrast-detail phantom analysis for evaluating clinical image quality in chest radiography. © RSNA, 2011.

[Spontaneous hematoma of the atrial wall].

PubMed

Iglesias López, A; Rodríguez Pan, A; Pazos Silva, V

2014-01-01

The clinical signs of heart masses tend to be nonspecific, generally depending more on their repercussions on heart function caused by their location rather than on their type. Imaging techniques make it possible to limit the differential diagnosis of heart masses based on their location, morphology, and characteristics of echogenicity, density, or intensity, depending on the technique used to study them. We present the case of a woman with squeezing mid chest pain irradiating to her shoulder and positive cardiac markers in whom a left atrial mass was identified at echocardiography. This finding was confirmed at chest CT. The signs at chest CT were compatible with a mural hematoma and this diagnosis was confirmed after intraoperative biopsy. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

Masculine Chest-Wall Contouring in FtM Transgender: a Personal Approach.

PubMed

Lo Russo, Giulia; Tanini, Sara; Innocenti, Marco

2017-04-01

Chest-wall contouring surgery is one of the first steps in sexual reassignment in female-to-male (FtM) transsexuals that contributes to strengthening of the self-image and facilitates living in the new gender role. The main goal is to masculinize the chest by removing the female contour. Chest contour, scar placement, scar shape, scar length, nipple-areola position, nipple size and the areola size are the key points. Between July 2013 and June 2016, 25 FtM transgender patients underwent surgical procedures to create a masculine chest-wall contour. In our study, we just considered 16 patients who have undergone chest surgery with the double incision method. The patients' survey revealed a high satisfaction rate with the aesthetic result. In our group, no complications occurred, and two patients have undergone supplementary surgery for axillary dog-ear revision and nipple reconstruction. The authors propose a new technical approach and indications for FtM transgender patients' surgery. A longer scar that emphasizes the pectoralis muscle, a smaller nipple and a resized and refaced areola are the key points of our technique to give a masculine appearance to the chest. The scars are permanent, but most of them will fade and the patients are enthusiastic with their new "male" chest appearance. The high level of satisfaction, the great aesthetic result and the low rate of complications suggest to us the use of this technique in medium- and large-size breasts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Improvement of the clinical use of computed radiography for mobile chest imaging: Image quality and patient dose

NASA Astrophysics Data System (ADS)

Rill, Lynn Neitzey

Chest radiography is technically difficult because of the wide variation of tissue attenuations in the chest and limitations of screen-film systems. Mobile chest radiography, performed bedside on hospital inpatients, presents additional difficulties due to geometrical and equipment limitations inherent to mobile x-ray procedures and the severity of illness in patients. Computed radiography (CR) offers a new approach for mobile chest radiography by utilizing a photostimulable phosphor. Photostimulable phosphors are more efficient in absorbing lower-energy x-rays than standard intensifying screens and overcome some image quality limitations of mobile chest imaging, particularly because of the inherent latitude. This study evaluated changes in imaging parameters for CR to take advantage of differences between CR and screen-film radiography. Two chest phantoms, made of acrylic and aluminum, simulated x-ray attenuation for average-sized and large- sized adult chests. The phantoms contained regions representing the lungs, heart and subdiaphragm. Acrylic and aluminum disks (1.9 cm diameter) were positioned in the chest regions to make signal-to-noise ratio (SNR) measurements for different combinations of imaging parameters. Disk thicknesses (contrast) were determined from disk visibility. Effective dose to the phantom was also measured for technique combinations. The results indicated that using an anti-scatter grid and lowering x- ray tube potential improved the SNR significantly; however, the dose to the phantom also increased. An evaluation was performed to examine the clinical applicability of the observed improvements in SNR. Parameter adjustments that improved phantom SNRs by more than 50% resulted in perceived image quality improvements in the lung region of clinical mobile chest radiographs. Parameters that produced smaller improvements in SNR had no apparent effect on clinical image quality. Based on this study, it is recommended that a 3:1 grid be used for mobile chest radiography with CR in order to improve image quality. Using a higher kVp (+15 kVp) did not have a detrimental effect on image quality and offered a patient dose savings, including effective dose and breast dose. Higher kVp techniques should be considered when using a grid is not possible.

Impact of an open-chest extracorporeal membrane oxygenation model for in situ simulated team training: a pilot study.

PubMed

Atamanyuk, Iryna; Ghez, Olivier; Saeed, Imran; Lane, Mary; Hall, Judith; Jackson, Tim; Desai, Ajay; Burmester, Margarita

2014-01-01

To develop an affordable realistic open-chest extracorporeal membrane oxygenation (ECMO) model for embedded in situ interprofessional crisis resource management training in emergency management of a post-cardiac surgery child. An innovative attachment to a high-fidelity mannequin (Laerdal Simbaby) was used to enable a cardiac tamponade/ECMO standstill scenario. Two saline bags with blood dye were placed over the mannequin's chest. A 'heart' bag with venous and arterial outlets was connected to the corresponding tubes of the ECMO circuit. The bag was divided into arterial and venous parts by loosely wrapping silicon tubing around its centre. A 'pericardial' bag was placed above it. Both were then covered by a chest skin that had a sutured silicone membrane window. False blood injected into the 'pericardial' bag caused expansion leading to (i) bulging of silastic membrane, simulating tamponade, and (ii) compression of tubing around the 'heart' bag, creating negative venous pressures and cessation of ECMO flow. In situ Simulation Paediatric Resuscitation Team Training (SPRinT) was performed on paediatric intensive care unit; the course included a formal team training/scenario of an open-chest ECMO child with acute cardiac tamponade due to blocked chest drains/debriefing by trained facilitators. Cardiac tamponade was reproducible, and ECMO flow/circuit pressure changes were effective and appropriate. There were eight participants: one cardiac surgeon, two intensivists, one cardiologist, one perfusionist and three nurses. Five of the eight reported the realism of the model and 6/8 the realism of the clinical scenario as highly effective. Eight of eight reported a highly effective impact on (i) their practice and (ii) teamwork. Six of eight reported a highly effective impact on communication skills and increased confidence in attending future real events. Innovative adaptation of a high-fidelity mannequin for open-chest ECMO simulation can achieve a realistic and reproducible training model. The impact on interprofessional team training is promising but needs to be validated further.

Clinical experience with orthotic repair of pectus carinatum.

PubMed

Al-Githmi, Iskander S

2016-01-01

Pectus carinatum is a congenital chest wall deformity characterized by protrusion of the sternum and adjacent costal cartilages. Multiple treatment options are available for correction of pectus carinatum. We report our initial experience with first-line treatment using a custom fitted dynamic compression orthosis. Prospective evaluation of all patients seen between November 2013 and December 2014. University hospital. The treatment protocol for patients who had pressure for initial correction.

A Posteriori Restoration of Block Transform-Compressed Data

NASA Technical Reports Server (NTRS)

Brown, R.; Boden, A. F.

1995-01-01

The Galileo spacecraft will use lossy data compression for the transmission of its science imagery over the low-bandwidth communication system. The technique chosen for image compression is a block transform technique based on the Integer Cosine Transform, a derivative of the JPEG image compression standard. Considered here are two known a posteriori enhancement techniques, which are adapted.

A new method to detect cerebral blood flow waveform in synchrony with chest compression by near-infrared spectroscopy during CPR.

PubMed

Koyama, Yasuaki; Wada, Takafumi; Lohman, Brandon D; Takamatsu, Yuka; Matsumoto, Junichi; Fujitani, Shigeki; Taira, Yasuhiko

2013-10-01

The objective of the study is to demonstrate the utility of near-infrared spectroscopy (NIRS) in evaluating chest compression (CC) quality in cardiac arrest (CA) patients as well as determine its prognosis predictive value. We present a nonconsecutive case series of adult patients with CA whose cardiopulmonary resuscitation (CPR) was monitored with NIRS and collected the total hemoglobin concentration change (ΔcHb), the tissue oxygen index (TOI), and the ΔTOI to assess CC quality in a noninvasive fashion. During CPR, ΔcHb displayed waveforms monitor, which we regarded as a surrogate for CC quality. Total hemoglobin concentration change waveforms responded accurately to variations or cessations of CCs. In addition, a TOI greater than 40% measured upon admission appears to be significant in predicting patient's outcome. Of 15 patients, 6 had a TOI greater than 40% measured upon admission, and 67% of the latter were in return of spontaneous circulation after CPR and were found to be significantly different between return of spontaneous circulation and death (P = .047; P < .05). Near-infrared spectroscopy reliably assesses the quality of CCs in patients with CA demonstrated by synchronous waveforms during CPR and possible prognostic predictive value, although further investigation is warranted. © 2013 Elsevier Inc. All rights reserved.

[Effectiveness of resuscitation delivered by Polish paramedics].

PubMed

Guła, Przemysław; Koszowska, Małgorzata; Larysz, Dawid; Koszowski, Marcin; Nabzdyk, Andrzej; Maślanka, Marek

2008-01-01

The aim of the study was to evaluate the effectiveness and skills in BLS and use of automatic external defibrillators (AED) by paramedics from units of the National Fire and Rescue System. One hundred and fifty-eight rescuers participated in the study. They included both volunteers and professionals, and were recruited from 40 different rescue organizations. The results were evaluated by experienced physicians, nurses and paramedics, all holders of ALS and BLS-AED instructor diplomas. The following skills were evaluated: initial assessment, ventilation, chest compression, and use of the AED. The quality of the BLS-AED was rated against the professional experience of the rescuers, and the frequency of repetition training. Although theoretical background was rated good, 45% of participants omitted assessment of consciousness. Airway patency and respiration were properly assessed by 82.5% and 72.5% of paramedics respectively, but only 20% could provide adequate rescue breaths to the phantom victims. Circulation was correctly assessed by 65% of participants, but once again, only 34.4% of paramedics could provide adequate chest compression. The results correlated positively with professional experience, based on the number of rescue missions (0-250, mean 4.3, median 1). The results proved that despite adequate theoretical knowledge, practical skills of paramedics were poor, due to the inadequate time devoted to practical training and the lack of certificate courses.

[Current international recommendations for pediatric cardiopulmonary resuscitation: the European guidelines].

PubMed

López-Herce, Jesús; Rodríguez Núñez, Antonio; Maconochie, Ian; Van de Voorde, Patric; Biarent, Dominique; Eich, Christof; Bingham, Robert; Rajka, Thomas; Zideman, David; Carrillo, Ángel; de Lucas, Nieves; Calvo, Custodio; Manrique, Ignacio

2017-07-01

This summary of the European guidelines for pediatric cardiopulmonary resuscitation (CPR) emphasizes the main changes and encourages health care professionals to keep their pediatric CPR knowledge and skills up to date. Basic and advanced pediatric CPR follow the same algorithm in the 2015 guidelines. The main changes affect the prevention of cardiac arrest and the use of fluids. Fluid expansion should not be used routinely in children with fever in the abuse of signs of shock because too high a volume can worsen prognosis. Rescue breaths should last around 1 second in basic CPR, making pediatric recommendations consistent with those for adults. Chest compressions should be at least as deep as one-third the anteroposterior diameter of the thorax. Most children in cardiac arrest lack a shockable rhythm, and in such cases a coordinated sequence of breaths, chest compressions, and administration of adrenalin is essential. An intraosseous canula may be the first choice for introducing fluids and medications, especially in young infants. In treating supraventricular tachycardia with cardioversion, an initial dose of 1 J/kg is currently recommended (vs the dose of 0.5 J/kg previously recommended). After spontaneous circulation is recovered, measures to control fever should be taken. The goal is to reach a normal temperature even before arrival to the hospital.

The Effect of the Duration of Basic Life Support Training on the Learners' Cardiopulmonary and Automated External Defibrillator Skills

PubMed Central

Kang, Ku Hyun; Song, Keun Jeong; Lee, Chang Hee

2016-01-01

Background. Basic life support (BLS) training with hands-on practice can improve performance during simulated cardiac arrest, although the optimal duration for BLS training is unknown. This study aimed to assess the effectiveness of various BLS training durations for acquiring cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills. Methods. We randomised 485 South Korean nonmedical college students into four levels of BLS training: level 1 (40 min), level 2 (80 min), level 3 (120 min), and level 4 (180 min). Before and after each level, the participants completed questionnaires regarding their willingness to perform CPR and use AEDs, and their psychomotor skills for CPR and AED use were assessed using a manikin with Skill-Reporter™ software. Results. There were no significant differences between levels 1 and 2, although levels 3 and 4 exhibited significant differences in the proportion of overall adequate chest compressions (p < 0.001) and average chest compression depth (p = 0.003). All levels exhibited a greater posttest willingness to perform CPR and use AEDs (all, p < 0.001). Conclusions. Brief BLS training provided a moderate level of skill for performing CPR and using AEDs. However, high-quality skills for CPR required longer and hands-on training, particularly hands-on training with AEDs. PMID:27529066

Tension pneumothorax secondary to automatic mechanical compression decompression device.

PubMed

Hutchings, A C; Darcy, K J; Cumberbatch, G L A

2009-02-01

The details are presented of the first published case of a tension pneumothorax induced by an automatic compression-decompression (ACD) device during cardiac arrest. An elderly patient collapsed with back pain and, on arrival of the crew, was in pulseless electrical activity (PEA) arrest. He was promptly intubated and correct placement of the endotracheal tube was confirmed by noting equal air entry bilaterally and the ACD device applied. On the way to the hospital he was noted to have absent breath sounds on the left without any change in the position of the endotracheal tube. Needle decompression of the left chest caused a hiss of air but the patient remained in PEA. Intercostal drain insertion in the emergency department released a large quantity of air from his left chest but without any change in his condition. Post-mortem examination revealed a ruptured abdominal aortic aneurysm as the cause of death. Multiple left rib fractures and a left lung laceration secondary to the use of the ACD device were also noted, although the pathologist felt that the tension pneumothorax had not contributed to the patient's death. It is recommended that a simple or tension pneumothorax should be considered when there is unilateral absence of breath sounds in addition to endobronchial intubation if an ACD device is being used.

Comparisons of the Pentax-AWS, Glidescope, and Macintosh Laryngoscopes for Intubation Performance during Mechanical Chest Compressions in Left Lateral Tilt: A Randomized Simulation Study of Maternal Cardiopulmonary Resuscitation

PubMed Central

Lee, Sanghyun; Kim, Wonhee; Kang, Hyunggoo; Oh, Jaehoon; Lim, Tae Ho; Lee, Yoonjae; Kim, Changsun; Cho, Jun Hwi

2015-01-01

Purpose. Rapid advanced airway management is important in maternal cardiopulmonary resuscitation (CPR). This study aimed to compare intubation performances among Pentax-AWS (AWS), Glidescope (GVL), and Macintosh laryngoscope (MCL) during mechanical chest compression in 15° and 30° left lateral tilt. Methods. In 19 emergency physicians, a prospective randomized crossover study was conducted to examine the three laryngoscopes. Primary outcomes were the intubation time and the success rate for intubation. Results. The median intubation time using AWS was shorter than that of GVL and MCL in both tilt degrees. The time to visualize the glottic view in GVL and AWS was significantly lower than that of MCL (all P < 0.05), whereas there was no significant difference between the two video laryngoscopes (in 15° tilt, P = 1; in 30° tilt, P = 0.71). The progression of tracheal tube using AWS was faster than that of MCL and GVL in both degrees (all P < 0.001). Intubations using AWS and GVL showed higher success rate than that of Macintosh laryngoscopes. Conclusions. The AWS could be an appropriate laryngoscope for airway management of pregnant women in tilt CPR considering intubation time and success rate. PMID:26161426

Multi-scale Morphological Image Enhancement of Chest Radiographs by a Hybrid Scheme.

PubMed

Alavijeh, Fatemeh Shahsavari; Mahdavi-Nasab, Homayoun

2015-01-01

Chest radiography is a common diagnostic imaging test, which contains an enormous amount of information about a patient. However, its interpretation is highly challenging. The accuracy of the diagnostic process is greatly influenced by image processing algorithms; hence enhancement of the images is indispensable in order to improve visibility of the details. This paper aims at improving radiograph parameters such as contrast, sharpness, noise level, and brightness to enhance chest radiographs, making use of a triangulation method. Here, contrast limited adaptive histogram equalization technique and noise suppression are simultaneously performed in wavelet domain in a new scheme, followed by morphological top-hat and bottom-hat filtering. A unique implementation of morphological filters allows for adjustment of the image brightness and significant enhancement of the contrast. The proposed method is tested on chest radiographs from Japanese Society of Radiological Technology database. The results are compared with conventional enhancement techniques such as histogram equalization, contrast limited adaptive histogram equalization, Retinex, and some recently proposed methods to show its strengths. The experimental results reveal that the proposed method can remarkably improve the image contrast while keeping the sensitive chest tissue information so that radiologists might have a more precise interpretation.

Multi-scale Morphological Image Enhancement of Chest Radiographs by a Hybrid Scheme

PubMed Central

Alavijeh, Fatemeh Shahsavari; Mahdavi-Nasab, Homayoun

2015-01-01

Chest radiography is a common diagnostic imaging test, which contains an enormous amount of information about a patient. However, its interpretation is highly challenging. The accuracy of the diagnostic process is greatly influenced by image processing algorithms; hence enhancement of the images is indispensable in order to improve visibility of the details. This paper aims at improving radiograph parameters such as contrast, sharpness, noise level, and brightness to enhance chest radiographs, making use of a triangulation method. Here, contrast limited adaptive histogram equalization technique and noise suppression are simultaneously performed in wavelet domain in a new scheme, followed by morphological top-hat and bottom-hat filtering. A unique implementation of morphological filters allows for adjustment of the image brightness and significant enhancement of the contrast. The proposed method is tested on chest radiographs from Japanese Society of Radiological Technology database. The results are compared with conventional enhancement techniques such as histogram equalization, contrast limited adaptive histogram equalization, Retinex, and some recently proposed methods to show its strengths. The experimental results reveal that the proposed method can remarkably improve the image contrast while keeping the sensitive chest tissue information so that radiologists might have a more precise interpretation. PMID:25709942

TU-CD-BRA-11: Application of Bone Suppression Technique to Inspiratory/expiratory Chest Radiography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tanaka, R; Sanada, S; Sakuta, K

Purpose: The bone suppression technique based on advanced image processing can suppress the conspicuity of bones on chest radiographs, creating soft tissue images normally obtained by the dual-energy subtraction technique. This study was performed to investigate the usefulness of bone suppression technique in quantitative analysis of pulmonary function in inspiratory/expiratory chest radiography. Methods: Commercial bone suppression image processing software (ClearRead; Riverain Technologies) was applied to paired inspiratory/expiratory chest radiographs of 107 patients (normal, 33; abnormal, 74) to create corresponding bone suppression images. The abnormal subjects had been diagnosed with pulmonary diseases, such as pneumothorax, pneumonia, emphysema, asthma, and lung cancer.more » After recognition of the lung area, the vectors of respiratory displacement were measured in all local lung areas using a cross-correlation technique. The measured displacement in each area was visualized as displacement color maps. The distribution pattern of respiratory displacement was assessed by comparison with the findings of lung scintigraphy. Results: Respiratory displacement of pulmonary markings (soft tissues) was able to be quantified separately from the rib movements on bone suppression images. The resulting displacement map showed a left-right symmetric distribution increasing from the lung apex to the bottom region of the lung in many cases. However, patients with ventilatory impairments showed a nonuniform distribution caused by decreased displacement of pulmonary markings, which were confirmed to correspond to area with ventilatory impairments found on the lung scintigrams. Conclusion: The bone suppression technique was useful for quantitative analysis of respiratory displacement of pulmonary markings without any interruption of the rib shadows. Abnormal areas could be detected as decreased displacement of pulmonary markings. Inspiratory/expiratory chest radiography combined with the bone suppression technique has potential for predicting local lung function on the basis of dynamic analysis of pulmonary markings. This work was partially supported by Nakatani Foundation, Grant-in-aid for Scientific Research (C) of Ministry of Education, Culture, Sports, Science and Technology, JAPAN (Grant number : 24601007), and Nakatani Foundation, Mitsubishi Foundation, and the he Mitani Foundation for Research and Development. Yasushi Kishitani is a staff of TOYO corporation.« less

Techniques for information extraction from compressed GPS traces : final report.

DOT National Transportation Integrated Search

2015-12-31

Developing techniques for extracting information requires a good understanding of methods used to compress the traces. Many techniques for compressing trace data : consisting of position (i.e., latitude/longitude) and time values have been developed....

Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection

PubMed Central

Turna, Akif; Kavakli, Kuthan; Sapmaz, Ersin; Arslan, Hakan; Caylak, Hasan; Gokce, Hasan Suat; Demirkaya, Ahmet

2014-01-01

The reconstruction of full-thickness chest wall defects is a challenging problem for thoracic surgeons, particularly after a wide resection of the chest wall that includes the sternum. The location and the size of the defect play a major role when selecting the method of reconstruction, while acceptable cosmetic and functional results remain the primary goal. Improvements in preoperative imaging techniques and reconstruction materials have an important role when planning and performing a wide chest wall resection with a low morbidity rate. In this report, we describe the reconstruction of a wide anterior chest wall defect with a patient-specific custom-made titanium implant. An infected mammary tumour recurrence in a 62-year old female, located at the anterior chest wall including the sternum, was resected, followed by a large custom-made titanium implant. Latissimus dorsi flap and split-thickness graft were also used for covering the implant successfully. A titanium custom-made chest wall implant could be a viable alternative for patients who had large chest wall tumours. PMID:24227881

Routine Chest X-ray: Still Valuable for the Assessment of Left Ventricular Size and Function in the Era of Super Machines?

PubMed Central

Morales, Maria-Aurora; Prediletto, Renato; Rossi, Giuseppe; Catapano, Giosuè; Lombardi, Massimo; Rovai, Daniele

2012-01-01

Objectives: The development of technologically advanced, expensive techniques has progressively reduced the value of chest X-ray in clinical practice for the assessment of left ventricular (LV) dilatation and dysfunction. Although controversial data are reported on the role of this widely available technique in cardiac assessment, it is known that the cardio-thoracic ratio is predictive of risk of progression in the NYHA Class, hospitalization, and outcome in patients with LV dysfunction. This study aimed to evaluate the reliability of the transverse diameter of heart shadow [TDH] by chest X-ray for detecting LV dilatation and dysfunction as compared to Magnetic Resonance Imaging (MRI) performed for different clinical reasons. Materials and Methods: In 101 patients, TDH was measured in digital chest X-ray and LV volumes and ejection fraction (EF) by MRI, both exams performed within 2 days. Results: A direct correlation between TDH and end-diastolic volumes (r = .75, P<0.0001) was reported. TDH cut-off values of 14.5 mm in females identified LV end-diastolic volumes >150 mL (sensitivity: 82%, specificity: 69%); in males a cut-off value of 15.5 mm identified LV end-diastolic volumes >210 mL (sensitivity: 84%; specificity: 72%). A negative relation was found between TDH and LVEF (r = -.54, P<0.0001). The above cut-off values of TDH discriminated patients with LV systolic dysfunction – LVEF <35% (sensitivity and specificity: 67% and 57% in females; 76% and 59% in males, respectively). Conclusions: Chest X-ray may still be considered a reliable technique in predicting LV dilatation by the accurate measurement of TDH as compared to cardiac MRI. Technologically advanced, expensive, and less available imaging techniques should be performed on the basis of sound clinical requests. PMID:22754739

Routine Chest X-ray: Still Valuable for the Assessment of Left Ventricular Size and Function in the Era of Super Machines?

PubMed

Morales, Maria-Aurora; Prediletto, Renato; Rossi, Giuseppe; Catapano, Giosuè; Lombardi, Massimo; Rovai, Daniele

2012-01-01

The development of technologically advanced, expensive techniques has progressively reduced the value of chest X-ray in clinical practice for the assessment of left ventricular (LV) dilatation and dysfunction. Although controversial data are reported on the role of this widely available technique in cardiac assessment, it is known that the cardio-thoracic ratio is predictive of risk of progression in the NYHA Class, hospitalization, and outcome in patients with LV dysfunction. This study aimed to evaluate the reliability of the transverse diameter of heart shadow [TDH] by chest X-ray for detecting LV dilatation and dysfunction as compared to Magnetic Resonance Imaging (MRI) performed for different clinical reasons. In 101 patients, TDH was measured in digital chest X-ray and LV volumes and ejection fraction (EF) by MRI, both exams performed within 2 days. A direct correlation between TDH and end-diastolic volumes (r = .75, P<0.0001) was reported. TDH cut-off values of 14.5 mm in females identified LV end-diastolic volumes >150 mL (sensitivity: 82%, specificity: 69%); in males a cut-off value of 15.5 mm identified LV end-diastolic volumes >210 mL (sensitivity: 84%; specificity: 72%). A negative relation was found between TDH and LVEF (r = -.54, P<0.0001). The above cut-off values of TDH discriminated patients with LV systolic dysfunction - LVEF <35% (sensitivity and specificity: 67% and 57% in females; 76% and 59% in males, respectively). Chest X-ray may still be considered a reliable technique in predicting LV dilatation by the accurate measurement of TDH as compared to cardiac MRI. Technologically advanced, expensive, and less available imaging techniques should be performed on the basis of sound clinical requests.

Potential clinical impact of advanced imaging and computer-aided diagnosis in chest radiology: importance of radiologist's role and successful observer study.

PubMed

Li, Feng

2015-07-01

This review paper is based on our research experience in the past 30 years. The importance of radiologists' role is discussed in the development or evaluation of new medical images and of computer-aided detection (CAD) schemes in chest radiology. The four main topics include (1) introducing what diseases can be included in a research database for different imaging techniques or CAD systems and what imaging database can be built by radiologists, (2) understanding how radiologists' subjective judgment can be combined with technical objective features to improve CAD performance, (3) sharing our experience in the design of successful observer performance studies, and (4) finally, discussing whether the new images and CAD systems can improve radiologists' diagnostic ability in chest radiology. In conclusion, advanced imaging techniques and detection/classification of CAD systems have a potential clinical impact on improvement of radiologists' diagnostic ability, for both the detection and the differential diagnosis of various lung diseases, in chest radiology.

[Laennec and the creation of auscultation signs].

PubMed

Merino, José G

2003-01-01

Toward the end of the 18th century, clinical diagnosis in medicine shifted its focus from reliance on symptoms, which translates to subjective experience of illness, to signs, objective manifestations of pathologic changes. Several techniques were developed to elicit signs in clinical practice, and Laennec used them routinely. He palpated and prodded his patients to get an idea of changes in internal organs. He also applied his ear directly to his patient's chest to hear their heartbeat. On one occassion, he was unable to use these techniques and had the happy occurrence of rolling up a notebook to hear his patient's chest. This led him to hear a great number of new sounds. Through detailed observations, he was able to describe, classify, and correlate these sounds with autopsy findings, thus creating a new semiology of chest diseases. In this essay explore how in which Laennec created his instrument and system of signs of chest diseases, and how he was able to transmit his inventions to his colleagues.

[Laser-assisted lipolysis for gynecomastia: safe and effective skin retraction].

PubMed

Trelles, Mario; Bonanad, Enrique; Moreno-Moraga, Javier; Alcolea, Justo; Mordon, Serge; Leclère, Franck Marie

2013-01-01

To evaluate efficacy of laser lipolysis in the treatment of gynecomastia to correct breast volume, flaccidity and excess skin without its excision. Prospectively, 32 patients with gynecomastia under tumescent anaesthesia and sedation underwent laser lipolysis with 980 nm diode laser, 15W continuous emission and 8 to 12 kJ energy per breast. Externally cold air was used to protect the skin. No drainages were used but a compressive bandage. Patients evaluated results on a VAS scale. Two doctors evaluated results comparing before and 6 month after photographs and also measured the areola and chest diameter. Twenty three patients considered results as Very Good, 7 Good and 2 Fair Cutaneous retraction of the areola was noticeable one month after the surgery and was maximum 6 months after. Evaluation by doctors was 26 Very Good, 5 Good and 1 Fair. There were no burns, ischemia or lesions in areolas or nipples. Laser assisted liposuction is a simple and efficacious technique, barely traumatic and permits a rapid reincorporation to normal activities.

Management of chest drainage tubes after lung surgery.

PubMed

Satoh, Yukitoshi

2016-06-01

Since chest tubes have been routinely used to drain the pleural space, particularly after lung surgery, the management of chest tubes is considered to be essential for the thoracic surgeon. The pleural drainage system requires effective drainage, suction, and water-sealing. Another key point of chest tube management is that a water seal is considered to be superior to suction for most air leaks. Nowadays, the most common pleural drainage device attached to the chest tube is the three-bottle system. An electronic chest drainage system has been developed that is effective in standardizing the postoperative management of chest tubes. More liberal use of digital drainage devices in the postoperative management of the pleural space is warranted. The removal of chest tubes is a common procedure occurring almost daily in hospitals throughout the world. Extraction of the tube is usually done at the end of full inspiration or at the end of full expiration. The tube removal technique is not as important as how it is done and the preparation for the procedure. The management of chest tubes must be based on careful observation, the patient's characteristics, and the operative procedures that had been performed.

Is it adequate to carry out a chest-CT in patients with mild-moderate chest trauma?

PubMed

García de Pereda de Blas, V; Carreras Aja, M; Carbajo Azabal, S; Arana-Arri, E

2017-10-12

Mild-moderate blunt chest trauma is defined as a blunt chest trauma that is not caused by a high-energy mechanism, causing thoracic tenderness with or without rib fractures and that has no immediate life-threatening consequences for the patient. It is a frequent clinical situation in the emergency department. The most common radiological techniques that are used in this context are chest X-ray and thoracic computed tomography (CT). The CT scan is set as the gold standard. However, there are no current clinical-radiological guidelines that establish the adequacy of the requests of the CT scan. Therefore, we decided to search for evidence-based recommendations to improve the adequacy of the chest X-ray and CT scan in our daily practice in order to reduce the costs and avoid unnecessary radiation exposure. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Digital compression algorithms for HDTV transmission

NASA Technical Reports Server (NTRS)

Adkins, Kenneth C.; Shalkhauser, Mary JO; Bibyk, Steven B.

1990-01-01

Digital compression of video images is a possible avenue for high definition television (HDTV) transmission. Compression needs to be optimized while picture quality remains high. Two techniques for compression the digital images are explained and comparisons are drawn between the human vision system and artificial compression techniques. Suggestions for improving compression algorithms through the use of neural and analog circuitry are given.

Development of a chest digital tomosynthesis R/F system and implementation of low-dose GPU-accelerated compressed sensing (CS) image reconstruction.

PubMed

Choi, Sunghoon; Lee, Haenghwa; Lee, Donghoon; Choi, Seungyeon; Lee, Chang-Lae; Kwon, Woocheol; Shin, Jungwook; Seo, Chang-Woo; Kim, Hee-Joung

2018-05-01

This work describes the hardware and software developments of a prototype chest digital tomosynthesis (CDT) R/F system. The purpose of this study was to validate the developed system for its possible clinical application on low-dose chest tomosynthesis imaging. The prototype CDT R/F system was operated by carefully controlling the electromechanical subsystems through a synchronized interface. Once a command signal was delivered by the user, a tomosynthesis sweep started to acquire 81 projection views (PVs) in a limited angular range of ±20°. Among the full projection dataset of 81 images, several sets of 21 (quarter view) and 41 (half view) images with equally spaced angle steps were selected to represent a sparse view condition. GPU-accelerated and total-variation (TV) regularization strategy-based compressed sensing (CS) image reconstruction was implemented. The imaged objects were a flat-field using a copper filter to measure the noise power spectrum (NPS), a Catphan ® CTP682 quality assurance (QA) phantom to measure a task-based modulation transfer function (MTF T ask ) of three different cylinders' edge, and an anthropomorphic chest phantom with inserted lung nodules. The authors also verified the accelerated computing power over CPU programming by checking the elapsed time required for the CS method. The resultant absorbed and effective doses that were delivered to the chest phantom from two-view digital radiographic projections, helical computed tomography (CT), and the prototype CDT system were compared. The prototype CDT system was successfully operated, showing little geometric error with fast rise and fall times of R/F x-ray pulse less than 2 and 10 ms, respectively. The in-plane NPS presented essential symmetric patterns as predicted by the central slice theorem. The NPS images from 21 PVs were provided quite different pattern against 41 and 81 PVs due to aliased noise. The voxel variance values which summed all NPS intensities were inversely proportional to the number of PVs, and the CS method gave much lower voxel variance by the factors of 3.97-6.43 and 2.28-3.36 compared to filtered backprojection (FBP) and 20 iterations of simultaneous algebraic reconstruction technique (SART). The spatial frequencies of the f 50 at which the MTF T ask reduced to 50% were 1.50, 1.55, and 1.67 cycles/mm for FBP, SART, and CS methods, respectively, in the case of Bone 20% cylinder using 41 views. A variety of ranges of TV reconstruction parameters were implemented during the CS method and we could observe that the NPS and MTF T ask preserved best when the regularization and TV smoothing parameters α and τ were in a range of 0.001-0.1. For the chest phantom data, the signal difference to noise ratios (SDNRs) were higher in the proposed CS scheme images than in the FBP and SART, showing the enhanced rate of 1.05-1.43 for half view imaging. The total averaged reconstruction time during 20 iterations of the CS scheme was 124.68 s, which could match-up a clinically feasible time (<3 min). This computing time represented an enhanced speed 386 times greater than CPU programming. The total amounts of estimated effective doses were 0.12, 0.53 (half view), and 2.56 mSv for two-view radiographs, the prototype CDT system, and helical CT, respectively, showing 4.49 times higher than conventional radiography and 4.83 times lower than a CT exam, respectively. The current work describes the development and performance assessment of both hardware and software for tomosynthesis applications. The authors observed reasonable outcomes by showing a potential for low-dose application in CDT imaging using GPU acceleration. © 2018 American Association of Physicists in Medicine.

A comparison of spectral decorrelation techniques and performance evaluation metrics for a wavelet-based, multispectral data compression algorithm

NASA Technical Reports Server (NTRS)

Matic, Roy M.; Mosley, Judith I.

1994-01-01

Future space-based, remote sensing systems will have data transmission requirements that exceed available downlinks necessitating the use of lossy compression techniques for multispectral data. In this paper, we describe several algorithms for lossy compression of multispectral data which combine spectral decorrelation techniques with an adaptive, wavelet-based, image compression algorithm to exploit both spectral and spatial correlation. We compare the performance of several different spectral decorrelation techniques including wavelet transformation in the spectral dimension. The performance of each technique is evaluated at compression ratios ranging from 4:1 to 16:1. Performance measures used are visual examination, conventional distortion measures, and multispectral classification results. We also introduce a family of distortion metrics that are designed to quantify and predict the effect of compression artifacts on multi spectral classification of the reconstructed data.

Segmentation of lung fields using Chan-Vese active contour model in chest radiographs

NASA Astrophysics Data System (ADS)

Sohn, Kiwon

2011-03-01

A CAD tool for chest radiographs consists of several procedures and the very first step is segmentation of lung fields. We develop a novel methodology for segmentation of lung fields in chest radiographs that can satisfy the following two requirements. First, we aim to develop a segmentation method that does not need a training stage with manual estimation of anatomical features in a large training dataset of images. Secondly, for the ease of implementation, it is desirable to apply a well established model that is widely used for various image-partitioning practices. The Chan-Vese active contour model, which is based on Mumford-Shah functional in the level set framework, is applied for segmentation of lung fields. With the use of this model, segmentation of lung fields can be carried out without detailed prior knowledge on the radiographic anatomy of the chest, yet in some chest radiographs, the trachea regions are unfavorably segmented out in addition to the lung field contours. To eliminate artifacts from the trachea, we locate the upper end of the trachea, find a vertical center line of the trachea and delineate it, and then brighten the trachea region to make it less distinctive. The segmentation process is finalized by subsequent morphological operations. We randomly select 30 images from the Japanese Society of Radiological Technology image database to test the proposed methodology and the results are shown. We hope our segmentation technique can help to promote of CAD tools, especially for emerging chest radiographic imaging techniques such as dual energy radiography and chest tomosynthesis.

Effects of depth and chest volume on cardiac function during breath-hold diving.

PubMed

Marabotti, Claudio; Scalzini, Alessandro; Cialoni, Danilo; Passera, Mirko; Ripoli, Andrea; L'Abbate, Antonio; Bedini, Remo

2009-07-01

Cardiac response to breath-hold diving in human beings is primarily characterized by the reduction of both heart rate and stroke volume. By underwater Doppler-echocardiography we observed a "restrictive/constrictive" left ventricular filling pattern compatible with the idea of chest squeeze and heart compression during diving. We hypothesized that underwater re-expansion of the chest would release heart constriction and normalize cardiac function. To this aim, 10 healthy male subjects (age 34.2 +/- 10.4) were evaluated by Doppler-echocardiography during breath-hold immersion at a depth of 10 m, before and after a single maximal inspiration from a SCUBA device. During the same session, all subjects were also studied at surface (full-body immersion) and at 5-m depth in order to better characterize the relationship of echo-Doppler pattern with depth. In comparison to surface immersion, 5-m deep diving was sufficient to reduce cardiac output (P = 0.042) and increase transmitral E-peak velocity (P < 0.001). These changes remained unaltered at a 10-m depth. Chest expansion at 10 m decreased left ventricular end-systolic volume (P = 0.024) and increased left ventricular stroke volume (P = 0.024). In addition, it decreased transmitral E-peak velocity (P = 0.012) and increased deceleration time of E-peak (P = 0.021). In conclusion the diving response, already evident during shallow diving (5 m) did not progress during deeper dives (10 m). The rapid improvement in systolic and diastolic function observed after lung volume expansion is congruous with the idea of a constrictive effect on the heart exerted by chest squeeze.

Acute spinal cord compression: a rare complication of dual antiplatelet therapy.

PubMed

Iskandar, Muhammad Zaid; Chong, Victor; Hutcheon, Stuart

2015-07-22

A 73-year-old woman presented with acute shortness of breath and exacerbation of chronic back pain. She was diagnosed with pulmonary oedema and a non-ST-elevation myocardial infarction following chest X-ray, ECG and high sensitivity troponin levels. She subsequently underwent coronary angioplasty with deployment of drug-eluting stents to her circumflex and left anterior descending arteries and was started on aspirin and clopidogrel for her dual antiplatelet therapy. Unfortunately, following the procedure, she gradually lost power and sensation in both lower limbs. MRI of her spine confirmed an extradural haematoma causing thoracic cord compression. She was managed conservatively following discussions with neurosurgeons and developed further complications secondary to her immobility. 2015 BMJ Publishing Group Ltd.

Radiological Image Compression

NASA Astrophysics Data System (ADS)

Lo, Shih-Chung Benedict

The movement toward digital images in radiology presents the problem of how to conveniently and economically store, retrieve, and transmit the volume of digital images. Basic research into image data compression is necessary in order to move from a film-based department to an efficient digital -based department. Digital data compression technology consists of two types of compression technique: error-free and irreversible. Error -free image compression is desired; however, present techniques can only achieve compression ratio of from 1.5:1 to 3:1, depending upon the image characteristics. Irreversible image compression can achieve a much higher compression ratio; however, the image reconstructed from the compressed data shows some difference from the original image. This dissertation studies both error-free and irreversible image compression techniques. In particular, some modified error-free techniques have been tested and the recommended strategies for various radiological images are discussed. A full-frame bit-allocation irreversible compression technique has been derived. A total of 76 images which include CT head and body, and radiographs digitized to 2048 x 2048, 1024 x 1024, and 512 x 512 have been used to test this algorithm. The normalized mean -square-error (NMSE) on the difference image, defined as the difference between the original and the reconstructed image from a given compression ratio, is used as a global measurement on the quality of the reconstructed image. The NMSE's of total of 380 reconstructed and 380 difference images are measured and the results tabulated. Three complex compression methods are also suggested to compress images with special characteristics. Finally, various parameters which would effect the quality of the reconstructed images are discussed. A proposed hardware compression module is given in the last chapter.

An image compression survey and algorithm switching based on scene activity

NASA Technical Reports Server (NTRS)

Hart, M. M.

1985-01-01

Data compression techniques are presented. A description of these techniques is provided along with a performance evaluation. The complexity of the hardware resulting from their implementation is also addressed. The compression effect on channel distortion and the applicability of these algorithms to real-time processing are presented. Also included is a proposed new direction for an adaptive compression technique for real-time processing.

The sandwich technique for repair of pectus carinatum and excavatum/carinatum complex

PubMed Central

Kim, Kyung Soo

2016-01-01

Background Simple external compression of pectus carinatum seems to have its limitations, particularly the repair of asymmetric pectus carinatum or excavatum/carinatum complex. We devised the sandwich technique (press-molding) to remodel the entire chest wall. The purpose of this study is to introduce the sandwich technique and appraise the early results. Methods Between January 2007 and January 2016, 523 consecutive patients with pectus carinatum and its variants were analyzed retrospectively. No patients were excluded during the study period. The sandwich 1 and 2 techniques using the internal and external pectus bars were for pectus carinatum repair. Modified techniques using the external string and the internal bar were to treat the lower costal flare (the flare-buster) and focal protuberances (the magic string) in pectus excavatum repair. Statistical analyses were carried out using paired and unpaired t-test or Wilcoxon signed rank tests. Results The sandwich repair with the external and internal bars was applied to 58 pectus carinatum patients: seven symmetric (12.1%), 14 asymmetric (24.1%), and 37 carinatum-excavatum complex (63.8%). After pectus excavatum repair, 426 patients had the flare-buster and 39 patients received the magic string. The sandwich 1 technique achieved near-complete resolution of carinatum in 52 patients (86.2%). The sandwich 2 technique accomplished almost symmetric configuration with no residual carinatum in all six cases. Conclusions The sandwich technique using the external and internal bars seems to be effective in treating asymmetric pectus carinatum and complex excavatum/carinatum deformities. The flare-buster and the magic string effectively relieve the costal flare and focal protuberances in pectus excavatum repair. PMID:27747176

Hydroxocobalamin and Epinephrine Both Improve Survival in a Swine Model of Cyanide-Induced Cardiac Arrest

DTIC Science & Technology

2012-10-01

Neurologic effects were not measured in this preliminary study. Oxygen therapy has been used as a sole treatment for cyanide toxicity; however, both groups...standardized mechanical chest compressions and were randomly assigned to receive one of 3 intravenous bolus therapies : hydroxocobalamin, epinephrine, or...arterial pressure and pH, decreased blood lactate and cyanide levels, and decreased the use of rescue epinephrine therapy compared with that in the

Problems and solutions: accounts by parents and children of adhering to chest physiotherapy for cystic fibrosis.

PubMed

Williams, Brian; Mukhopadhyay, Somnath; Dowell, Jon; Coyle, Joanne

2007-07-30

Although chest physiotherapy is central to the management of cystic fibrosis (CF), adherence among children is problematic. This study explores accounts by parents and children of the difficulties of adhering to chest physiotherapy for cystic fibrosis, and identifies strategies used by families to overcome these. A qualitative study based on in-depth interviews with 32 children with a diagnosis of cystic fibrosis aged 7 - 17 years, and with 31 parents. Physiotherapy was frequently described as restrictive, threatening to identity and boring, giving rise to feelings of unfairness, inequality, 'difference', and social stigma. Motivation to adhere was influenced by perceptions of effectiveness that depended on external signs evident during or after the physiotherapy. Motivation was enhanced where parents and children visualized the accumulation of mucus. Some parents had developed distraction techniques that improved the experience of chest physiotherapy but had few opportunities to share these with other parents. The experience of physiotherapy is problematic to some parents and children. Furthermore, motivation to overcome these problems may be undermined by perceptions of ineffectiveness. Distraction techniques that change the value that the child places on the time spent doing physiotherapy and that reduces their perception of its duration may improve experience and adherence. The potential of visualization techniques to promote adherence should be investigated further.

Compression of Probabilistic XML Documents

NASA Astrophysics Data System (ADS)

Veldman, Irma; de Keijzer, Ander; van Keulen, Maurice

Database techniques to store, query and manipulate data that contains uncertainty receives increasing research interest. Such UDBMSs can be classified according to their underlying data model: relational, XML, or RDF. We focus on uncertain XML DBMS with as representative example the Probabilistic XML model (PXML) of [10,9]. The size of a PXML document is obviously a factor in performance. There are PXML-specific techniques to reduce the size, such as a push down mechanism, that produces equivalent but more compact PXML documents. It can only be applied, however, where possibilities are dependent. For normal XML documents there also exist several techniques for compressing a document. Since Probabilistic XML is (a special form of) normal XML, it might benefit from these methods even more. In this paper, we show that existing compression mechanisms can be combined with PXML-specific compression techniques. We also show that best compression rates are obtained with a combination of PXML-specific technique with a rather simple generic DAG-compression technique.

Virtual arterial blood pressure feedback improves chest compression quality during simulated resuscitation.

PubMed

Rieke, Horst; Rieke, Martin; Gado, Samkon K; Nietert, Paul J; Field, Larry C; Clark, Carlee A; Furse, Cory M; McEvoy, Matthew D

2013-11-01

Quality chest compressions (CC) are the most important factor in successful cardiopulmonary resuscitation. Adjustment of CC based upon an invasive arterial blood pressure (ABP) display would be theoretically beneficial. Additionally, having one compressor present for longer than a 2-min cycle with an ABP display may allow for a learning process to further maximize CC. Accordingly, we tested the hypothesis that CC can be improved with a real-time display of invasively measured blood pressure and with an unchanged, physically fit compressor. A manikin was attached to an ABP display derived from a hemodynamic model responding to parameters of CC rate, depth, and compression-decompression ratio. The area under the blood pressure curve over time (AUC) was used for data analysis. Each participant (N=20) performed 4 CPR sessions: (1) No ABP display, exchange of compressor every 2 min; (2) ABP display, exchange of compressor every 2 min; (3) no ABP display, no exchange of the compressor; (4) ABP display, no exchange of the compressor. Data were analyzed by ANOVA. Significance was set at a p-value<0.05. The average AUC for cycles without ABP display was 5201 mm Hgs (95% confidence interval (CI) of 4804-5597 mm Hgs), and for cycles with ABP display 6110 mm Hgs (95% CI of 5715-6507 mm Hgs) (p<0.0001). The average AUC increase with ABP display for each participant was 20.2±17.4% 95 CI (p<0.0001). Our study confirms the hypothesis that a real-time display of simulated ABP during CPR that responds to participant performance improves achieved and sustained ABP. However, without any real-time visual feedback, even fit compressors demonstrated degradation of CC quality. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Compression-only CPR training in elementary schools and student attitude toward CPR.

PubMed

Kitamura, Tetsuhisa; Nishiyama, Chika; Murakami, Yukiko; Yonezawa, Takahiro; Nakai, Shohei; Hamanishi, Masayoshi; Marukawa, Seishiro; Sakamoto, Tetsuya; Iwami, Taku

2016-08-01

Little is known about the effectiveness of systematic cardiopulmonary resuscitation (CPR) training for elementary school children. We introduced systematic training of chest compression-only CPR and automated external defibrillator (AED) use to elementary school students aged 10-12 years at 17 schools. The questionnaire compared student attitudes towards CPR and their knowledge about it before and after CPR training. We also evaluated parent and teacher views about CPR training in school education. The primary outcome was positive attitude, defined as "yes" and "maybe yes" on a 5 point Likert-type scale of student attitudes towards CPR.1 RESULTS: A total of 2047 elementary school students received CPR training. Of them, 1899 (92.8%) responded to the questionnaire regarding their attitude towards CPR before and after the training. Before training, 50.2% answered "yes" and 30.3% answered "maybe yes", to the question: "If someone suddenly collapses in front of you, can you do something such as check response or call emergency?" After training, their answers changed to 75.6% and 18.3% for "yes" and "maybe yes", respectively. Many of the students (72.3%, 271/370) who did not have a positive attitude before CPR training had a positive attitude after the training (P < 0.001). Most students understood how to perform CPR (97.7%) and use an AED (98.5%). Parents (96.2%, 1173/1220) and teachers (98.3%, 56/57) answered that it was "good" and "maybe good" for children to receive the training at elementary schools. Systematic chest compression-only CPR training helped elementary school students to improve their attitude towards CPR. © 2015 Japan Pediatric Society.

Compression for radiological images

NASA Astrophysics Data System (ADS)

Wilson, Dennis L.

1992-07-01

The viewing of radiological images has peculiarities that must be taken into account in the design of a compression technique. The images may be manipulated on a workstation to change the contrast, to change the center of the brightness levels that are viewed, and even to invert the images. Because of the possible consequences of losing information in a medical application, bit preserving compression is used for the images used for diagnosis. However, for archiving the images may be compressed to 10 of their original size. A compression technique based on the Discrete Cosine Transform (DCT) takes the viewing factors into account by compressing the changes in the local brightness levels. The compression technique is a variation of the CCITT JPEG compression that suppresses the blocking of the DCT except in areas of very high contrast.

Real-Time Mobile Device-Assisted Chest Compression During Cardiopulmonary Resuscitation.

PubMed

Sarma, Satyam; Bucuti, Hakiza; Chitnis, Anurag; Klacman, Alex; Dantu, Ram

2017-07-15

Prompt administration of high-quality cardiopulmonary resuscitation (CPR) is a key determinant of survival from cardiac arrest. Strategies to improve CPR quality at point of care could improve resuscitation outcomes. We tested whether a low cost and scalable mobile phone- or smart watch-based solution could provide accurate measures of compression depth and rate during simulated CPR. Fifty health care providers (58% intensive care unit nurses) performed simulated CPR on a calibrated training manikin (Resusci Anne, Laerdal) while wearing both devices. Subjects received real-time audiovisual feedback from each device sequentially. Primary outcome was accuracy of compression depth and rate compared with the calibrated training manikin. Secondary outcome was improvement in CPR quality as defined by meeting both guideline-recommend compression depth (5 to 6 cm) and rate (100 to 120/minute). Compared with the training manikin, typical error for compression depth was <5 mm (smart phone 4.6 mm; 95% CI 4.1 to 5.3 mm; smart watch 4.3 mm; 95% CI 3.8 to 5.0 mm). Compression rates were similarly accurate (smart phone Pearson's R = 0.93; smart watch R = 0.97). There was no difference in improved CPR quality defined as the number of sessions meeting both guideline-recommended compression depth (50 to 60 mm) and rate (100 to 120 compressions/minute) with mobile device feedback (60% vs 50%; p = 0.3). Sessions that did not meet guideline recommendations failed primarily because of inadequate compression depth (46 ± 2 mm). In conclusion, a mobile device application-guided CPR can accurately track compression depth and rate during simulation in a practice environment in accordance with resuscitation guidelines. Copyright © 2017 Elsevier Inc. All rights reserved.

Lossless Astronomical Image Compression and the Effects of Random Noise

NASA Technical Reports Server (NTRS)

Pence, William

2009-01-01

In this paper we compare a variety of modern image compression methods on a large sample of astronomical images. We begin by demonstrating from first principles how the amount of noise in the image pixel values sets a theoretical upper limit on the lossless compression ratio of the image. We derive simple procedures for measuring the amount of noise in an image and for quantitatively predicting how much compression will be possible. We then compare the traditional technique of using the GZIP utility to externally compress the image, with a newer technique of dividing the image into tiles, and then compressing and storing each tile in a FITS binary table structure. This tiled-image compression technique offers a choice of other compression algorithms besides GZIP, some of which are much better suited to compressing astronomical images. Our tests on a large sample of images show that the Rice algorithm provides the best combination of speed and compression efficiency. In particular, Rice typically produces 1.5 times greater compression and provides much faster compression speed than GZIP. Floating point images generally contain too much noise to be effectively compressed with any lossless algorithm. We have developed a compression technique which discards some of the useless noise bits by quantizing the pixel values as scaled integers. The integer images can then be compressed by a factor of 4 or more. Our image compression and uncompression utilities (called fpack and funpack) that were used in this study are publicly available from the HEASARC web site.Users may run these stand-alone programs to compress and uncompress their own images.

Optimisation of radiation dose and image quality in mobile neonatal chest radiography.

PubMed

Hinojos-Armendáriz, V I; Mejía-Rosales, S J; Franco-Cabrera, M C

2018-05-01

To optimise the radiation dose and image quality for chest radiography in the neonatal intensive care unit (NICU) by increasing the mean beam energy. Two techniques for the acquisition of NICU AP chest X-ray images were compared for image quality and radiation dose. 73 images were acquired using a standard technique (56 kV, 3.2 mAs and no additional filtration) and 90 images with a new technique (62 kV, 2 mAs and 2 mm Al filtration). The entrance surface air kerma (ESAK) was measured using a phantom and compared between the techniques and against established diagnostic reference levels (DRL). Images were evaluated using seven image quality criteria independently by three radiologists. Images quality and radiation dose were compared statistically between the standard and new techniques. The maximum ESAK for the new technique was 40.20 μGy, 43.7% of the ESAK of the standard technique. Statistical evaluation demonstrated no significant differences in image quality between the two acquisition techniques. Based on the techniques and acquisition factors investigated within this study, it is possible to lower the radiation dose without any significant effects on image quality by adding filtration (2 mm Al) and increasing the tube potential. Such steps are relatively simple to undertake and as such, other departments should consider testing and implementing this dose reduction strategy within clinical practice where appropriate. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Failure rate of prehospital chest decompression after severe thoracic trauma.

PubMed

Kaserer, Alexander; Stein, Philipp; Simmen, Hans-Peter; Spahn, Donat R; Neuhaus, Valentin

2017-03-01

Chest decompression can be performed by different techniques, like needle thoracocentesis (NT), lateral thoracostomy (LT), or tube thoracostomy (TT). The aim of this study was to report the incidence of prehospital chest decompression and to analyse the effectiveness of these techniques. In this retrospective case series study, all medical records of adult trauma patients undergoing prehospital chest decompression and admitted to the resuscitation area of a level-1 trauma center between 2009 and 2015 were reviewed and analysed. Only descriptive statistics were applied. In a 6-year period 24 of 2261 (1.1%) trauma patients had prehospital chest decompression. Seventeen patients had NT, six patients TT, one patient NT as well as TT, and no patients had LT. Prehospital successful release of a tension pneumothorax was reported by the paramedics in 83% (5/6) with TT, whereas NT was effective in 18% only (3/17). In five CT scans all thoracocentesis needles were either removed or extrapleural, one patient had a tension pneumothorax, and two patients had no pneumothorax. No NT or TT related complications were reported during hospitalization. Prehospital NT or TT is infrequently attempted in trauma patients. Especially NT is associated with a high failure rate of more than 80%, potentially due to an inadequate ratio between chest wall thickness and catheter length as previously published as well as a possible different pathophysiological cause of respiratory distress. Therefore, TT may be considered already in the prehospital setting to retain sufficient pleural decompression upon admission. Copyright © 2016. Published by Elsevier Inc.

Radiation dose and image quality in pediatric chest CT: effects of iterative reconstruction in normal weight and overweight children.

PubMed

Yoon, Haesung; Kim, Myung-Joon; Yoon, Choon-Sik; Choi, Jiin; Shin, Hyun Joo; Kim, Hyun Gi; Lee, Mi-Jung

2015-03-01

New CT reconstruction techniques may help reduce the burden of ionizing radiation. To quantify radiation dose reduction when performing pediatric chest CT using a low-dose protocol and 50% adaptive statistical iterative reconstruction (ASIR) compared with age/gender-matched chest CT using a conventional dose protocol and reconstructed with filtered back projection (control group) and to determine its effect on image quality in normal weight and overweight children. We retrospectively reviewed 40 pediatric chest CT (M:F = 21:19; range: 0.1-17 years) in both groups. Radiation dose was compared between the two groups using paired Student's t-test. Image quality including noise, sharpness, artifacts and diagnostic acceptability was subjectively assessed by three pediatric radiologists using a four-point scale (superior, average, suboptimal, unacceptable). Eight children in the ASIR group and seven in the control group were overweight. All radiation dose parameters were significantly lower in the ASIR group (P < 0.01) with a greater than 57% dose reduction in overweight children. Image noise was higher in the ASIR group in both normal weight and overweight children. Only one scan in the ASIR group (1/40, 2.5%) was rated as diagnostically suboptimal and there was no unacceptable study. In both normal weight and overweight children, the ASIR technique is associated with a greater than 57% mean dose reduction, without significantly impacting diagnostic image quality in pediatric chest CT examinations. However, CT scans in overweight children may have a greater noise level, even when using the ASIR technique.

Viscoelastic behavior of lung and chest wall in dogs determined by flow interruption.

PubMed

Similowski, T; Levy, P; Corbeil, C; Albala, M; Pariente, R; Derenne, J P; Bates, J H; Jonson, B; Milic-Emili, J

1989-12-01

Pulmonary and chest wall mechanics were studied in six anesthetized paralyzed dogs, by use of the technique of rapid airway occlusion during constant flow inflation. Analysis of the pressure changes after flow interruption allowed us to partition the overall resistance of the lung (Rl) and chest wall (Rw) and total respiratory system (Rrs) into two components, one (Rinit) reflecting in the lung airway resistance (Raw), the other (delta R) reflecting primarily the viscoelastic properties of the pulmonary and chest wall tissues. The effects of varying inspiratory flow and inflation volume were interpreted in terms of frequency dependence of resistance, by using a spring-and-dashpot model previously proposed and substantiated by Bates et al. (Proc. 9th Annu. Conf. IEEE Med. Biol. Soc., 1987, vol. 3, p. 1802-1803). We observed that 1) Raw and Rw,init were nearly equal and small relative to Rl and Rw (both were unaffected by flow); 2) Rrs,init decreased slightly with increasing volume; 3) both delta Rl and delta Rw decreased with increasing flow and increased with increasing lung volume. These changes were manifestations of frequency dependence of delta R, as it is predicted by the model; 4) Rrs, Rl, and Rw followed the same trends as delta R. These results corroborate data previously reported in the literature with the use of different techniques to measure airways and pulmonary tissue resistances and confirm that the use of Rl to assess bronchial reactivity is problematic. The interrupter techniques provides a convenient way to obtain Raw values, as well as analogs of lung and chest wall tissue resistances in intact dogs.

Treatment of Morbidity with Atypical Chest Pain

PubMed Central

Cott, Arthur

1987-01-01

The appropriate management of atypical chest pain requires an integration of medical and behavioural treatments. Unnecessary medicalization can increase morbidity. A sensitivity to the behavioural factors contributing to symptoms and disability may reduce both. The purpose of this paper is to provide physicians with a cognitive-behavioural perspective of the nature of morbidity and disability associated with chronic chest discomfort; some strategies for detecting heretofore unsuspected disability associated with chronic chest pain and related discomfort in patients with organic findings (both cardiac and non-cardiac), as well those with no identifiable disease process or organic cause; and some simple behavioural and cognitive-behavioural therapeutic techniques for treating and preventing such problems. PMID:21263912

Osteoradionecrosis of the chest wall. Management of postresection defects using Marlex mesh and a rotated latissimus dorsi myocutaneous flap

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hines, G.L.; Lee, G.

1983-11-01

Full thickness chest wall resection and single stage reconstruction for osteoradionecrosis of the chest wall was performed on five patients. All patients had undergone radical mastectomy and radiation therapy from 5 to 18 years prior to chest wall resection. Defects varied from 12 X 5 cm to 15 X 15 cm, and included from two to four ribs. Reconstruction was performed using Marlex mesh to reconstruct the bony thorax and a rotated latissimus dorsi myocutaneous flap. Coverage was successfully performed in all cases, and no patient experienced postoperative pulmonary dysfunction. There were no complications related to either the bony thoraxmore » reconstruction or the latissimus flap. The use of this technique has provided a safe, convenient, and reliable method of chest wall reconstruction.« less

Dispatcher-assisted compression-only cardiopulmonary resuscitation provides best quality cardiopulmonary resuscitation by laypersons: A randomised controlled single-blinded manikin trial.

PubMed

Spelten, Oliver; Warnecke, Tobias; Wetsch, Wolfgang A; Schier, Robert; Böttiger, Bernd W; Hinkelbein, Jochen

2016-08-01

High-quality cardiopulmonary resuscitation (CPR) by laypersons is a key determinant of both outcome and survival for out-of-hospital cardiac arrest. Dispatcher-assisted CPR (telephone-CPR, T-CPR) increases the frequency and correctness of bystander-CPR but results in prolonged time to first chest compressions. However, it remains unclear whether instructions for rescue ventilation and/or chest compressions should be recommended for dispatcher-assisted CPR. The aim of this study was to evaluate both principles of T-CPR with respect to CPR quality. Randomised controlled single-blinded manikin trial. University Hospital of Cologne, Germany, 1 July 2012 to 30 September 2012. Sixty laypersons between 18 and 65 years. Medically educated individuals, medical professionals and pregnant women were excluded. Participants were asked to resuscitate a manikin and were randomised into three groups: not dispatcher-assisted (uninstructed) CPR (group 1; U-CPR; n = 20), dispatcher-assisted compression-only CPR (group 2; DACO-CPR; n = 19) and full dispatcher-assisted CPR with rescue ventilation (group 3; DAF-CPR; n = 19). Specific parameters of CPR quality [i.e. no-flow-time (NFT) as well as compression and ventilation parameters] were analysed. To compare different groups we used Student's t test and P less than 0.05 was considered significant. Initial NFT was lowest in the DACO-CPR group (mean 21.3 ± 14.4%), followed by dispatcher-assisted full CPR (mean 49.1 ± 8.5%) and by unassisted CPR (mean 55.0 ± 12.9%). Initial NFT covering the time of instruction was lower in DACO-CPR (12.1 ± 5.4%) as compared to dispatcher-assisted full CPR (20.7 ± 8.1%). Compression depth was similar in all three groups: 40.6 ± 13.0 mm (unassisted CPR), 41.0 ± 12.2 mm (DACO-CPR) and 38.8 ± 15.8 mm (dispatcher-assisted full CPR). Average compression frequency was highest in the DACO-CPR group (65.2 ± 22.4 min) compared with the unassisted CPR group (35.6 ± 24.2 min) and the dispatcher-assisted full CPR group (44.5 ± 10.8 min). Correct rescue ventilation was given in 3.1 ± 11.1% (unassisted CPR) and 1.6 ± 16.1% (dispatcher-assisted full CPR) of all ventilation attempts. Best quality of CPR was achieved by DACO-CPR because of superior compression frequencies and reduced NFT. In contrast, the full dispatcher-assisted CPR with a longer initial instructing phase (initial NFT) did not result in enhanced CPR quality or an optimised compression depth.

Comparison of lossless compression techniques for prepress color images

NASA Astrophysics Data System (ADS)

Van Assche, Steven; Denecker, Koen N.; Philips, Wilfried R.; Lemahieu, Ignace L.

1998-12-01

In the pre-press industry color images have both a high spatial and a high color resolution. Such images require a considerable amount of storage space and impose long transmission times. Data compression is desired to reduce these storage and transmission problems. Because of the high quality requirements in the pre-press industry only lossless compression is acceptable. Most existing lossless compression schemes operate on gray-scale images. In this case the color components of color images must be compressed independently. However, higher compression ratios can be achieved by exploiting inter-color redundancies. In this paper we present a comparison of three state-of-the-art lossless compression techniques which exploit such color redundancies: IEP (Inter- color Error Prediction) and a KLT-based technique, which are both linear color decorrelation techniques, and Interframe CALIC, which uses a non-linear approach to color decorrelation. It is shown that these techniques are able to exploit color redundancies and that color decorrelation can be done effectively and efficiently. The linear color decorrelators provide a considerable coding gain (about 2 bpp) on some typical prepress images. The non-linear interframe CALIC predictor does not yield better results, but the full interframe CALIC technique does.

Estimating the concrete compressive strength using hard clustering and fuzzy clustering based regression techniques.

PubMed

Nagwani, Naresh Kumar; Deo, Shirish V

2014-01-01

Understanding of the compressive strength of concrete is important for activities like construction arrangement, prestressing operations, and proportioning new mixtures and for the quality assurance. Regression techniques are most widely used for prediction tasks where relationship between the independent variables and dependent (prediction) variable is identified. The accuracy of the regression techniques for prediction can be improved if clustering can be used along with regression. Clustering along with regression will ensure the more accurate curve fitting between the dependent and independent variables. In this work cluster regression technique is applied for estimating the compressive strength of the concrete and a novel state of the art is proposed for predicting the concrete compressive strength. The objective of this work is to demonstrate that clustering along with regression ensures less prediction errors for estimating the concrete compressive strength. The proposed technique consists of two major stages: in the first stage, clustering is used to group the similar characteristics concrete data and then in the second stage regression techniques are applied over these clusters (groups) to predict the compressive strength from individual clusters. It is found from experiments that clustering along with regression techniques gives minimum errors for predicting compressive strength of concrete; also fuzzy clustering algorithm C-means performs better than K-means algorithm.

Estimating the Concrete Compressive Strength Using Hard Clustering and Fuzzy Clustering Based Regression Techniques

PubMed Central

Nagwani, Naresh Kumar; Deo, Shirish V.

2014-01-01

Understanding of the compressive strength of concrete is important for activities like construction arrangement, prestressing operations, and proportioning new mixtures and for the quality assurance. Regression techniques are most widely used for prediction tasks where relationship between the independent variables and dependent (prediction) variable is identified. The accuracy of the regression techniques for prediction can be improved if clustering can be used along with regression. Clustering along with regression will ensure the more accurate curve fitting between the dependent and independent variables. In this work cluster regression technique is applied for estimating the compressive strength of the concrete and a novel state of the art is proposed for predicting the concrete compressive strength. The objective of this work is to demonstrate that clustering along with regression ensures less prediction errors for estimating the concrete compressive strength. The proposed technique consists of two major stages: in the first stage, clustering is used to group the similar characteristics concrete data and then in the second stage regression techniques are applied over these clusters (groups) to predict the compressive strength from individual clusters. It is found from experiments that clustering along with regression techniques gives minimum errors for predicting compressive strength of concrete; also fuzzy clustering algorithm C-means performs better than K-means algorithm. PMID:25374939

Brace compression for treatment of pectus carinatum.

PubMed

Jung, Joonho; Chung, Sang Ho; Cho, Jin Kyoung; Park, Soo-Jin; Choi, Ho; Lee, Sungsoo

2012-12-01

Surgery has been the classical treatment of pectus carinatum (PC), though compressive orthotic braces have shown successful results in recent years. We propose a non-operative approach using a lightweight, patient-controlled dynamic chest-bracing device. Eighteen patients with PC were treated between July 2008 and June 2009. The treatment involved fitting of the brace, which was worn for at least 20 hours per day for 6 months. Their degree of satisfaction (1, no correction; 4, remarkable correction) was measured at 12 months after the initiation of the treatment. Thirteen (72.2%) patients completed the treatment (mean time, 4.9±1.4 months). In patients who completed the treatment, the mean overall satisfaction score was 3.73±0.39. The mean satisfaction score was 4, and there was no recurrence of pectus carinatum in patients who underwent the treatment for at least 6 months. Minimal recurrence of pectus carinatum after removal of the compressive brace occurred in 5 (38.5%) patients who stopped wearing the compressive brace at 4 months. Compressive bracing results in a significant improvement in PC appearance in patients with an immature skeleton. However, patient compliance and diligent follow-up appear to be paramount for the success of this method of treatment. We currently offer this approach as a first-line treatment for PC.

[Development of image quality assurance support system using image recognition technology in radiography in lacked images of chest and abdomen].

PubMed

Shibuya, Toru; Kato, Kyouichi; Eshima, Hidekazu; Sumi, Shinichirou; Kubo, Tadashi; Ishida, Hideki; Nakazawa, Yasuo

2012-01-01

In order to provide a precise radiography for diagnosis, it is required that we avoid radiography with defects by having enough evaluation. Conventionally, evaluation was performed only by observation of a radiological technologist (RT). The evaluation support system was developed for providing a high quality assurance without depending on RT observation only. The evaluation support system, called as the Image Quality Assurance Support System (IQASS), is characterized in that "image recognition technology" for the purpose of diagnostic radiography of chest and abdomen areas. The technique of the system used in this study. Of the 259 samples of posterior-anterior (AP) chest, lateral chest, and upright abdominal x-rays, the sensitivity and specificity was 93.1% and 91.8% in the chest AP, 93.3% and 93.6% in the chest lateral, and 95.0% and 93.8% in the upright abdominal x-rays. In the light of these results, it is suggested that AIQAS could be applied to practical usage for the RT.

Imaging of congenital chest wall deformities

PubMed Central

Bhaludin, Basrull N; Naaseri, Sahar; Di Chiara, Francesco; Jordan, Simon; Padley, Simon

2016-01-01

To identify the anatomy and pathology of chest wall malformations presenting for consideration for corrective surgery or as a possible chest wall “mass”, and to review the common corrective surgical procedures. Congenital chest wall deformities are caused by anomalies of chest wall growth, leading to sternal depression or protrusion, or are related to failure of normal spine or rib development. Cross-sectional imaging allows appreciation not only of the involved structures but also assessment of the degree of displacement or deformity of adjacent but otherwise normal structures and differentiation between anatomical deformity and neoplasia. In some cases, CT is also useful for surgical planning. The use of three-dimensional reconstructions, utilizing a low-dose technique, provides important information for the surgeon to discuss the nature of anatomical abnormalities and planned corrections with the patient and often with their parents. In this pictorial essay, we discuss the radiological features of the commonest congenital chest wall deformities and illustrate pre- and post-surgical appearances for those undergoing surgical correction. PMID:26916279

Minimal invasive treatment of life-threatening bleeding caused by cardiopulmonary resuscitation-associated liver injury: a case report.

PubMed

Næss, Pål Aksel; Engeseth, Kristian; Grøtta, Ole; Andersen, Geir Øystein; Gaarder, Christine

2016-05-29

Life-threatening bleeding caused by liver injury due to chest compressions is a rare complication in otherwise successful cardiopulmonary resuscitation. Surgical intervention has been suggested to achieve bleeding control; however, reported mortality is high. In this report, we present a brief literature review and a case report in which use of a less invasive strategy was followed by an uneventful recovery. A 37-year-old white woman was admitted after out-of-hospital cardiac arrest. Bystander cardiopulmonary resuscitation was immediately performed, followed by advanced cardiopulmonary resuscitation that included tracheal intubation, mechanical chest compressions, and external defibrillation with return of spontaneous circulation. Upon hospital admission, the patient's blood pressure was 94/45 mmHg and her heart rate was 110 beats per minute. Her electrocardiogram showed no signs of ST-segment elevations or Q-wave development. Coronary angiography revealed a proximal thrombotic occlusion of the left anterior descending coronary artery. Successful recanalization, after thrombus aspiration and balloon dilation followed by stent implant, was verified with normalized anterograde flow. Immediately after the patient's arrival in the intensive cardiac care unit, a drop in her blood pressure to 60/30 mmHg and a hemoglobin concentration of 4.5 g/dl were noticed. Transfusion was started, and bedside abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography of the abdomen revealed liver injury with active extravasation from the cranial surface of the right lobe and a massive hemoperitoneum. The patient was coagulopathic and acidotic with a body temperature of 33.5 °C. A minimally invasive treatment strategy, including angiography and selective trans-catheter arterial embolization, were performed in combination with percutaneous evacuation of 4.5 L of intraperitoneal blood. After completion of these procedures, the patient was hemodynamically stable. She was weaned off mechanical ventilation 2 days later and made an uneventful recovery. She was discharged to a local hospital on day 13 without neurological disability. Although rare, bleeding caused by liver injury due to chest compressions can be life-threatening after successful cardiopulmonary resuscitation. Reported mortality is high after surgical intervention, and patients may benefit from less invasive treatment strategies such as those presented in this case report.

Operative Fixation of Rib Fractures Indications, Techniques, and Outcomes.

PubMed

Galos, David; Taylor, Benjamin; McLaurin, Toni

2017-01-01

Rib fractures are extremely common injuries and vary in there severity from single nondisplaced fractures to multiple segmental fractures resulting in flail chest and respiratory compromise. Historically, rib fractures have been treated conservatively with pain control and respiratory therapy. However this method may not be the best treatment modality in all situations. Operative fixation of select rib fractures has been increasing in popularity especially in patients with flail chest and respiratory compromise. Newer techniques use muscle sparing approaches and precontoured locking plate technology to obtain stable fixation and allow improved respiration. Current reports shows that rib fracture fixation offers the benefits of improved respiratory mechanics and improved pain control in the severe chest wall injury with resultant improvement in patient outcomes by decreasing time on the ventilator, time in the intensive care unit, and overall hospital length of stay.

An adaptive technique to maximize lossless image data compression of satellite images

NASA Technical Reports Server (NTRS)

Stewart, Robert J.; Lure, Y. M. Fleming; Liou, C. S. Joe

1994-01-01

Data compression will pay an increasingly important role in the storage and transmission of image data within NASA science programs as the Earth Observing System comes into operation. It is important that the science data be preserved at the fidelity the instrument and the satellite communication systems were designed to produce. Lossless compression must therefore be applied, at least, to archive the processed instrument data. In this paper, we present an analysis of the performance of lossless compression techniques and develop an adaptive approach which applied image remapping, feature-based image segmentation to determine regions of similar entropy and high-order arithmetic coding to obtain significant improvements over the use of conventional compression techniques alone. Image remapping is used to transform the original image into a lower entropy state. Several techniques were tested on satellite images including differential pulse code modulation, bi-linear interpolation, and block-based linear predictive coding. The results of these experiments are discussed and trade-offs between computation requirements and entropy reductions are used to identify the optimum approach for a variety of satellite images. Further entropy reduction can be achieved by segmenting the image based on local entropy properties then applying a coding technique which maximizes compression for the region. Experimental results are presented showing the effect of different coding techniques for regions of different entropy. A rule-base is developed through which the technique giving the best compression is selected. The paper concludes that maximum compression can be achieved cost effectively and at acceptable performance rates with a combination of techniques which are selected based on image contextual information.

Radiation exposure from Chest CT: Issues and Strategies

PubMed Central

Maher, Michael M.; Rizzo, Stefania; Kanarek, David; Shephard, Jo-Anne O.

2004-01-01

Concerns have been raised over alleged overuse of CT scanning and inappropriate selection of scanning methods, all of which expose patients to unnecessary radiation. Thus, it is important to identify clinical situations in which techniques with lower radiation dose such as plain radiography or no radiation such as MRI and occasionally ultrasonography can be chosen over CT scanning. This article proposes the arguments for radiation dose reduction in CT scanning of the chest and discusses recommended practices and studies that address means of reducing radiation exposure associated with CT scanning of the chest. PMID:15082885

Breath-Hold Diving.

PubMed

Fitz-Clarke, John R

2018-03-25

Breath-hold diving is practiced by recreational divers, seafood divers, military divers, and competitive athletes. It involves highly integrated physiology and extreme responses. This article reviews human breath-hold diving physiology beginning with an historical overview followed by a summary of foundational research and a survey of some contemporary issues. Immersion and cardiovascular adjustments promote a blood shift into the heart and chest vasculature. Autonomic responses include diving bradycardia, peripheral vasoconstriction, and splenic contraction, which help conserve oxygen. Competitive divers use a technique of lung hyperinflation that raises initial volume and airway pressure to facilitate longer apnea times and greater depths. Gas compression at depth leads to sequential alveolar collapse. Airway pressure decreases with depth and becomes negative relative to ambient due to limited chest compliance at low lung volumes, raising the risk of pulmonary injury called "squeeze," characterized by postdive coughing, wheezing, and hemoptysis. Hypoxia and hypercapnia influence the terminal breakpoint beyond which voluntary apnea cannot be sustained. Ascent blackout due to hypoxia is a danger during long breath-holds, and has become common amongst high-level competitors who can suppress their urge to breathe. Decompression sickness due to nitrogen accumulation causing bubble formation can occur after multiple repetitive dives, or after single deep dives during depth record attempts. Humans experience responses similar to those seen in diving mammals, but to a lesser degree. The deepest sled-assisted breath-hold dive was to 214 m. Factors that might determine ultimate human depth capabilities are discussed. © 2018 American Physiological Society. Compr Physiol 8:585-630, 2018. Copyright © 2018 American Physiological Society. All rights reserved.

Measurement of Full Field Strains in Filament Wound Composite Tubes Under Axial Compressive Loading by the Digital Image Correlation (DIC) Technique

DTIC Science & Technology

2013-05-01

Measurement of Full Field Strains in Filament Wound Composite Tubes Under Axial Compressive Loading by the Digital Image Correlation (DIC...of Full Field Strains in Filament Wound Composite Tubes Under Axial Compressive Loading by the Digital Image Correlation (DIC) Technique Todd C...Wound Composite Tubes Under Axial Compressive Loading by the Digital Image Correlation (DIC) Technique 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c

Cardiopulmonary resuscitation quality and beyond: the need to improve real-time feedback and physiologic monitoring.

PubMed

Lin, Steve; Scales, Damon C

2016-06-28

High-quality cardiopulmonary resuscitation (CPR) has been shown to improve survival outcomes after cardiac arrest. The current standard in studies evaluating CPR quality is to measure CPR process measures-for example, chest compression rate, depth, and fraction. Published studies evaluating CPR feedback devices have yielded mixed results. Newer approaches that seek to optimize CPR by measuring physiological endpoints during the resuscitation may lead to individualized patient care and improved patient outcomes.

Spool-like stent for the open sternum after cardiac operations.

PubMed

Satoh, H; Sakai, K; Koyama, M; Matsuda, H

1997-02-01

Severe edematous heart after a cardiac operation is impossible to treat if there is compression of the heart due to the sternum. In these patients delayed sternal closure may be a useful procedure until the heart decreases in size. We devised a spool-like stent for the open sternum to maintain the optimal cardiac space for the severely edematous heart and to fix the chest wall to allow for management while the sternum is open.

Pre-recorded instructional audio vs. dispatchers' conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study.

PubMed

Birkun, Alexei; Glotov, Maksim; Ndjamen, Herman Franklin; Alaiye, Esther; Adeleke, Temidara; Samarin, Sergey

2018-01-01

To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation (CPR) guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation. It was a prospective, blind, randomised controlled study involving 109 medical students without previous CPR training. In a standardized mannequin scenario, after the step of dispatcher-assisted cardiac arrest recognition, the participants performed compression-only resuscitation guided over the telephone by either: (1) the pre-recorded instructional audio ( n =57); or (2) verbal dispatcher assistance ( n =52). The simulation video records were reviewed to assess the CPR performance using a 13-item checklist. The interval from call reception to the first compression, total number and rate of compressions, total number and duration of pauses after the first compression were also recorded. There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score (5.6±2.2 vs. 5.1±1.9, P >0.05) or individual criteria of the CPR performance checklist. The recording-assisted group demonstrated significantly shorter time interval from call receipt to the first compression (86.0±14.3 vs. 91.2±14.2 s, P <0.05), higher compression rate (94.9±26.4 vs. 89.1±32.8 min -1 ) and number of compressions provided (170.2±48.0 vs. 156.2±60.7). When provided by untrained persons in the simulated settings, the compression-only resuscitation guided by the pre-recorded instructional audio is no less efficient than dispatcher-assisted CPR. Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.

Observer detection of image degradation caused by irreversible data compression processes

NASA Astrophysics Data System (ADS)

Chen, Ji; Flynn, Michael J.; Gross, Barry; Spizarny, David

1991-05-01

Irreversible data compression methods have been proposed to reduce the data storage and communication requirements of digital imaging systems. In general, the error produced by compression increases as an algorithm''s compression ratio is increased. We have studied the relationship between compression ratios and the detection of induced error using radiologic observers. The nature of the errors was characterized by calculating the power spectrum of the difference image. In contrast with studies designed to test whether detected errors alter diagnostic decisions, this study was designed to test whether observers could detect the induced error. A paired-film observer study was designed to test whether induced errors were detected. The study was conducted with chest radiographs selected and ranked for subtle evidence of interstitial disease, pulmonary nodules, or pneumothoraces. Images were digitized at 86 microns (4K X 5K) and 2K X 2K regions were extracted. A full-frame discrete cosine transform method was used to compress images at ratios varying between 6:1 and 60:1. The decompressed images were reprinted next to the original images in a randomized order with a laser film printer. The use of a film digitizer and a film printer which can reproduce all of the contrast and detail in the original radiograph makes the results of this study insensitive to instrument performance and primarily dependent on radiographic image quality. The results of this study define conditions for which errors associated with irreversible compression cannot be detected by radiologic observers. The results indicate that an observer can detect the errors introduced by this compression algorithm for compression ratios of 10:1 (1.2 bits/pixel) or higher.

Pre-recorded instructional audio vs. dispatchers’ conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study

PubMed Central

Birkun, Alexei; Glotov, Maksim; Ndjamen, Herman Franklin; Alaiye, Esther; Adeleke, Temidara; Samarin, Sergey

2018-01-01

BACKGROUND: To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation (CPR) guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation. METHODS: It was a prospective, blind, randomised controlled study involving 109 medical students without previous CPR training. In a standardized mannequin scenario, after the step of dispatcher-assisted cardiac arrest recognition, the participants performed compression-only resuscitation guided over the telephone by either: (1) the pre-recorded instructional audio (n=57); or (2) verbal dispatcher assistance (n=52). The simulation video records were reviewed to assess the CPR performance using a 13-item checklist. The interval from call reception to the first compression, total number and rate of compressions, total number and duration of pauses after the first compression were also recorded. RESULTS: There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score (5.6±2.2 vs. 5.1±1.9, P>0.05) or individual criteria of the CPR performance checklist. The recording-assisted group demonstrated significantly shorter time interval from call receipt to the first compression (86.0±14.3 vs. 91.2±14.2 s, P<0.05), higher compression rate (94.9±26.4 vs. 89.1±32.8 min-1) and number of compressions provided (170.2±48.0 vs. 156.2±60.7). CONCLUSION: When provided by untrained persons in the simulated settings, the compression-only resuscitation guided by the pre-recorded instructional audio is no less efficient than dispatcher-assisted CPR. Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.

Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality training: a randomised crossover mannequin pilot study.

PubMed

Semeraro, Federico; Frisoli, Antonio; Loconsole, Claudio; Bannò, Filippo; Tammaro, Gaetano; Imbriaco, Guglielmo; Marchetti, Luca; Cerchiari, Erga L

2013-04-01

Outcome after cardiac arrest is dependent on the quality of chest compressions (CC). A great number of devices have been developed to provide guidance during CPR. The present study evaluates a new CPR feedback system (Mini-VREM: Mini-Virtual Reality Enhanced Mannequin) designed to improve CC during training. Mini-VREM system consists of a Kinect(®) (Microsoft, Redmond, WA, USA) motion sensing device and specifically developed software to provide audio-visual feedback. Mini-VREM was connected to a commercially available mannequin (Laerdal Medical, Stavanger, Norway). Eighty trainees (healthcare professionals and lay people) volunteered in this randomised crossover pilot study. All subjects performed a 2 min CC trial, 1h pause and a second 2 min CC trial. The first group (FB/NFB, n=40) performed CC with Mini-VREM feedback (FB) followed by CC without feedback (NFB). The second group (NFB/FB, n=40) performed vice versa. Primary endpoints: adequate compression (compression rate between 100 and 120 min(-1) and compression depth between 50 and 60mm); compressions rate within 100-120 min(-1); compressions depth within 50-60mm. When compared to the performance without feedback, with Mini-VREM feedback compressions were more adequate (FB 35.78% vs. NFB 7.27%, p<0.001) and more compressions achieved target rate (FB 72.04% vs. 31.42%, p<0.001) and target depth (FB 47.34% vs. 24.87%, p=0.002). The participants perceived the system to be easy to use with effective feedback. The Mini-VREM system was able to improve significantly the CC performance by healthcare professionals and by lay people in a simulated CA scenario, in terms of compression rate and depth. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Comparison of a flexible versus a rigid breast compression paddle: pain experience, projected breast area, radiation dose and technical image quality.

PubMed

Broeders, Mireille J M; Ten Voorde, Marloes; Veldkamp, Wouter J H; van Engen, Ruben E; van Landsveld-Verhoeven, Cary; 't Jong-Gunneman, Machteld N L; de Win, Jos; Greve, Kitty Droogh-de; Paap, Ellen; den Heeten, Gerard J

2015-03-01

To compare pain, projected breast area, radiation dose and image quality between flexible (FP) and rigid (RP) breast compression paddles. The study was conducted in a Dutch mammographic screening unit (288 women). To compare both paddles one additional image with RP was made, consisting of either a mediolateral-oblique (MLO) or craniocaudal-view (CC). Pain experience was scored using the Numeric Rating Scale (NRS). Projected breast area was estimated using computer software. Radiation dose was estimated using the model by Dance. Image quality was reviewed by three radiologists and three radiographers. There was no difference in pain experience between both paddles (mean difference NRS: 0.08 ± 0.08, p = 0.32). Mean radiation dose was 4.5 % lower with FP (0.09 ± 0.01 p = 0.00). On MLO-images, the projected breast area was 0.79 % larger with FP. Paired evaluation of image quality indicated that FP removed fibroglandular tissue from the image area and reduced contrast in the clinically relevant retroglandular area at chest wall side. Although FP performed slightly better in the projected breast area, it moved breast tissue from the image area at chest wall side. RP showed better contrast, especially in the retroglandular area. We therefore recommend the use of RP for standard MLO and CC views.

The effect of differing support surfaces on the efficacy of chest compressions using a resuscitation manikin model.

PubMed

Tweed, M; Tweed, C; Perkins, G D

2001-11-01

External chest compression (ECC) efficacy is influenced by factors including the surface supporting the patient. Air-filled support surfaces are deflated for cardiopulmonary resuscitation, with little evidence to substantiate this. We investigated the effect that differing support surfaces had on ECC efficacy using a CPR manikin model. Four participants carried out four cycles of ECC with an assistant ventilating. The subjects were blinded to the seven support surfaces and the order was randomised. For each participant/surface combination, ECC variables and the participants' perceptions were measured. Participants produced effective ECC with the manikin on the floor (mean proportion correct, 94.5%; mean depth, 42.5 mm). Compared with the floor: the proportion of correct ECC was less for the overlay inflated (P<0.05); the depth of ECC was less effective (30-37 mm) for the overlay inflated/deflated and low-air-loss inflated and foam mattresses (P<0.05). The foam mattress, overlay inflated/deflated, and low-air-loss inflated were perceived as being less stable and as having reduced ECC efficacy compared with the floor. There was no difference or agreement, regarding subjects' perceptions or ECC variables, between the support surfaces or between inflated/deflated air-filled support surfaces. The efficacy of ECC is affected by the support surfaces. There seems little evidence to substantiate deflating all air-filled support surfaces for CPR.

Usefulness of emergency ultrasound in nontraumatic cardiac arrest.

PubMed

Volpicelli, Giovanni

2011-02-01

Treatment of nontraumatic cardiac arrest in the hospital setting depends on the recognition of heart rhythm and differential diagnosis of the underlying condition while maintaining a constant oxygenated blood flow by ventilation and chest compression. Diagnostic process relies only on patient's history, physical findings, and active electrocardiography. Ultrasound is not currently scheduled in the resuscitation guidelines. Nevertheless, the use of real-time ultrasonography during resuscitation has the potential to improve diagnostic accuracy and allows the physician a greater confidence in deciding aggressive life-saving therapeutic procedures. This article reviews the current opinions and literature about the use of emergency ultrasound during resuscitation of nontraumatic cardiac arrest. Cardiac and lung ultrasound have a great potential in identifying the reversible mechanical causes of pulseless electrical activity or asystole. Brief examination of the heart can even detect a real cardiac standstill regardless of electrical activity displayed on the monitor, which is a crucial prognostic indicator. Moreover, ultrasound can be useful to verify and monitor the tracheal tube placement. Limitation to the use of ultrasound is the need to minimize the no-flow intervals during mechanical cardiopulmonary resuscitation. However, real-time ultrasound can be successfully applied during brief pausing of chest compression and first pulse-check. Finally, lung sonographic examination targeted to the detection of signs of pulmonary congestion has the potential to allow hemodynamic noninvasive monitoring before and after mechanical cardiopulmonary maneuvers. Copyright © 2011 Elsevier Inc. All rights reserved.

The Stop-Only-While-Shocking algorithm reduces hands-off time by 17% during cardiopulmonary resuscitation - a simulation study.

PubMed

Koch Hansen, Lars; Mohammed, Anna; Pedersen, Magnus; Folkestad, Lars; Brodersen, Jacob; Hey, Thomas; Lyhne Christensen, Nicolaj; Carter-Storch, Rasmus; Bendix, Kristoffer; Hansen, Morten R; Brabrand, Mikkel

2016-12-01

Reducing hands-off time during cardiopulmonary resuscitation (CPR) is believed to increase survival after cardiac arrests because of the sustaining of organ perfusion. The aim of our study was to investigate whether charging the defibrillator before rhythm analyses and shock delivery significantly reduced hands-off time compared with the European Resuscitation Council (ERC) 2010 CPR guideline algorithm in full-scale cardiac arrest scenarios. The study was designed as a full-scale cardiac arrest simulation study including administration of drugs. Participants were randomized into using the Stop-Only-While-Shocking (SOWS) algorithm or the ERC2010 algorithm. In SOWS, chest compressions were only interrupted for a post-charging rhythm analysis and immediate shock delivery. A Resusci Anne HLR-D manikin and a LIFEPACK 20 defibrillator were used. The manikin recorded time and chest compressions. Sample size was calculated with an α of 0.05 and 80% power showed that we should test four scenarios with each algorithm. Twenty-nine physicians participated in 11 scenarios. Hands-off time was significantly reduced 17% using the SOWS algorithm compared with ERC2010 [22.1% (SD 2.3) hands-off time vs. 26.6% (SD 4.8); P<0.05]. In full-scale cardiac arrest simulations, a minor change consisting of charging the defibrillator before rhythm check reduces hands-off time by 17% compared with ERC2010 guidelines.

A Comparison of Compressed Sensing and Sparse Recovery Algorithms Applied to Simulation Data

DOE PAGES

Fan, Ya Ju; Kamath, Chandrika

2016-09-01

The move toward exascale computing for scientific simulations is placing new demands on compression techniques. It is expected that the I/O system will not be able to support the volume of data that is expected to be written out. To enable quantitative analysis and scientific discovery, we are interested in techniques that compress high-dimensional simulation data and can provide perfect or near-perfect reconstruction. In this paper, we explore the use of compressed sensing (CS) techniques to reduce the size of the data before they are written out. Using large-scale simulation data, we investigate how the sufficient sparsity condition and themore » contrast in the data affect the quality of reconstruction and the degree of compression. Also, we provide suggestions for the practical implementation of CS techniques and compare them with other sparse recovery methods. Finally, our results show that despite longer times for reconstruction, compressed sensing techniques can provide near perfect reconstruction over a range of data with varying sparsity.« less

A Comparison of Compressed Sensing and Sparse Recovery Algorithms Applied to Simulation Data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fan, Ya Ju; Kamath, Chandrika

The move toward exascale computing for scientific simulations is placing new demands on compression techniques. It is expected that the I/O system will not be able to support the volume of data that is expected to be written out. To enable quantitative analysis and scientific discovery, we are interested in techniques that compress high-dimensional simulation data and can provide perfect or near-perfect reconstruction. In this paper, we explore the use of compressed sensing (CS) techniques to reduce the size of the data before they are written out. Using large-scale simulation data, we investigate how the sufficient sparsity condition and themore » contrast in the data affect the quality of reconstruction and the degree of compression. Also, we provide suggestions for the practical implementation of CS techniques and compare them with other sparse recovery methods. Finally, our results show that despite longer times for reconstruction, compressed sensing techniques can provide near perfect reconstruction over a range of data with varying sparsity.« less

Improved compression technique for multipass color printers

NASA Astrophysics Data System (ADS)

Honsinger, Chris

1998-01-01

A multipass color printer prints a color image by printing one color place at a time in a prescribed order, e.g., in a four-color systems, the cyan plane may be printed first, the magenta next, and so on. It is desirable to discard the data related to each color plane once it has been printed, so that data from the next print may be downloaded. In this paper, we present a compression scheme that allows the release of a color plane memory, but still takes advantage of the correlation between the color planes. The compression scheme is based on a block adaptive technique for decorrelating the color planes followed by a spatial lossy compression of the decorrelated data. A preferred method of lossy compression is the DCT-based JPEG compression standard, as it is shown that the block adaptive decorrelation operations can be efficiently performed in the DCT domain. The result of the compression technique are compared to that of using JPEG on RGB data without any decorrelating transform. In general, the technique is shown to improve the compression performance over a practical range of compression ratios by at least 30 percent in all images, and up to 45 percent in some images.

Design of a digital compression technique for shuttle television

NASA Technical Reports Server (NTRS)

Habibi, A.; Fultz, G.

1976-01-01

The determination of the performance and hardware complexity of data compression algorithms applicable to color television signals, were studied to assess the feasibility of digital compression techniques for shuttle communications applications. For return link communications, it is shown that a nonadaptive two dimensional DPCM technique compresses the bandwidth of field-sequential color TV to about 13 MBPS and requires less than 60 watts of secondary power. For forward link communications, a facsimile coding technique is recommended which provides high resolution slow scan television on a 144 KBPS channel. The onboard decoder requires about 19 watts of secondary power.

Automated method and system for the alignment and correlation of images from two different modalities

DOEpatents

Giger, Maryellen L.; Chen, Chin-Tu; Armato, Samuel; Doi, Kunio

1999-10-26

A method and system for the computerized registration of radionuclide images with radiographic images, including generating image data from radiographic and radionuclide images of the thorax. Techniques include contouring the lung regions in each type of chest image, scaling and registration of the contours based on location of lung apices, and superimposition after appropriate shifting of the images. Specific applications are given for the automated registration of radionuclide lungs scans with chest radiographs. The method in the example given yields a system that spatially registers and correlates digitized chest radiographs with V/Q scans in order to correlate V/Q functional information with the greater structural detail of chest radiographs. Final output could be the computer-determined contours from each type of image superimposed on any of the original images, or superimposition of the radionuclide image data, which contains high activity, onto the radiographic chest image.

The Role of Echocardiography in Coronary Artery Disease and Acute Myocardial Infarction

PubMed Central

Esmaeilzadeh, Maryam; Parsaee, Mozhgan; Maleki, Majid

2013-01-01

Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardial effusion. Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea. This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction. PMID:23646042

SU-E-T-18: A Comparison of Planning Techniques for Bilateral Reconstructed Chest Wall Patients Undergoing Whole Breast Irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Volpe, T; Margiasso, R; Saleh, Z

2015-06-15

Purpose: As we continuously see more bilateral reconstructed chest wall cases, new challenges are being presented to deliver left-sided breast irradiation. We herein compare three Deep Inspiration Breath Hold (DIBH) planning techniques (tangents, VMAT, and IMRT) and two free breathing techniques (VMAT and IMRT). Methods: Three left-sided chest wall patients with bilateral implants were studied. Tangents, VMAT, and IMRT plans were created for DIBH scans. VMAT and IMRT plans were created for free breathing scans. All plans were normalized so that 95% of the prescription dose was delivered to 95% of the planning target volume (PTV). The maximum point dosemore » was constrained to less than 120% of the prescription dose. Since the success of DIBH delivery largely depends on patient’s ability to perform consistent breath hold during beam on time, smaller number of Monitor Units (MU) is in general desired. For each patient, the following information was collected to compare the planning techniques: heart mean dose, left and right lung V20 Gy, contra-lateral (right) breast mean dose, cord max dose, and MU. Results: The average heart mean dose over all patients are 1561, 692, 985, 1245, and 1121 cGy, for DIBH tangents, VMAT, IMRT, free breathing VMAT and IMRT, respectively. For left lung V20 are 60%, 28%, 26%, 30%, and 29%. For contra-lateral breast mean dose are 244, 687, 616, 783, 438 cGy. MU are 253, 853, 2048, 1035, and 1874 MUs. Conclusion: In the setting of bilateral chest wall reconstruction, opposed tangent beams cannot consistently achieve desired heart and left lung sparing. DIBH consistently achieves better healthy tissue sparing. VMAT appears to be preferential to IMRT for planning and delivering radiation to patients with bilaterally reconstructed chest walls being treated with DIBH.« less

Practical use of bone scan in patients with an osteoporotic vertebral compression fracture.

PubMed

Jun, Deuk Soo; An, Byoung Keun; Yu, Chang Hun; Hwang, Kyung Hoon; Paik, Je Won

2015-02-01

Rib fractures are one of main causes of chest or flank pain when related to an osteoporotic vertebral compression fracture (OVCF). The authors investigated the incidence and risk factors of rib fracture in 284 patients with OVCF using bone scans and evaluated the feasibility as to whether bone scans could be utilized as a useful screening tool. Hot uptake lesions on ribs were found in 122 cases (43.0%). The factors analyzed were age, sex, number and locations of fractured vertebrae, BMD, and compression rates as determined using initial radiography. However, no statistical significances were found. In 16 cases (5.6%), there were concurrent multiple fractures of both the thoracic and lumbar spines not detected by single site MRI. Sixty cases (21.1%) of OVCF with the a compression rate of less than 15% could not be identified definitely by initial plain radiography, but were confirmed by bone scans. It is concluded that a bone scan has outstanding ability for the screening of rib fractures associated with OVCF. Non-adjacent multiple fractures in both thoracic and lumbar spines and fractures not identified definitely by plain radiography were detected on bone scans, which provided a means for determining management strategies and predicting prognosis.

Compressed NMR: Combining compressive sampling and pure shift NMR techniques.

PubMed

Aguilar, Juan A; Kenwright, Alan M

2017-12-26

Historically, the resolution of multidimensional nuclear magnetic resonance (NMR) has been orders of magnitude lower than the intrinsic resolution that NMR spectrometers are capable of producing. The slowness of Nyquist sampling as well as the existence of signals as multiplets instead of singlets have been two of the main reasons for this underperformance. Fortunately, two compressive techniques have appeared that can overcome these limitations. Compressive sensing, also known as compressed sampling (CS), avoids the first limitation by exploiting the compressibility of typical NMR spectra, thus allowing sampling at sub-Nyquist rates, and pure shift techniques eliminate the second issue "compressing" multiplets into singlets. This paper explores the possibilities and challenges presented by this combination (compressed NMR). First, a description of the CS framework is given, followed by a description of the importance of combining it with the right pure shift experiment. Second, examples of compressed NMR spectra and how they can be combined with covariance methods will be shown. Copyright © 2017 John Wiley & Sons, Ltd.

Using "Rebar" to Stabilize Rigid Chest Wall Reconstruction.

PubMed

Robinson, Lary A; Grubbs, Deanna M

2016-04-01

After major chest wall resection, reconstruction of the bony defect with a rigid prosthesis is mandatory to protect the underlying thoracic organs, and to prevent flail chest physiology. Although many methods have been described for chest wall reconstruction, a commonly used technique employs a composite Marlex (polypropylene) mesh with methyl-methacrylate cement sandwiched between two layers of mesh (MMS), which is tailored to the defect size and shape. In building construction, steel "rebar" is used to strengthen and reinforce masonry structures. To avoid the initial residual motion of the rigid prosthesis used to reconstruct very large defects, particularly the sternum, we devised a simple technique of adding one or more Steinmann steel pins as "rebar" to strengthen and immediately stabilize the prosthesis to the surrounding ribs and sternum. For the very large defects, particularly over the heart and great vessels, titanium mesh may also be readily added into the sandwich construction for increased strength and to prevent late prosthetic fractures. Short- and long-term results of this inexpensive modification of the MMS reconstruction technique are excellent. This modified MMS tailor-made prosthesis is only one-third the cost of the recently popular prosthetic titanium systems, takes much less operative time to create and implant, and avoids the well-described complications of late titanium bar fracture and erosion/infection as well as loosening of screws and/or titanium bars. Georg Thieme Verlag KG Stuttgart · New York.

Low dose scatter correction for digital chest tomosynthesis

NASA Astrophysics Data System (ADS)

Inscoe, Christina R.; Wu, Gongting; Shan, Jing; Lee, Yueh Z.; Zhou, Otto; Lu, Jianping

2015-03-01

Digital chest tomosynthesis (DCT) provides superior image quality and depth information for thoracic imaging at relatively low dose, though the presence of strong photon scatter degrades the image quality. In most chest radiography, anti-scatter grids are used. However, the grid also blocks a large fraction of the primary beam photons requiring a significantly higher imaging dose for patients. Previously, we have proposed an efficient low dose scatter correction technique using a primary beam sampling apparatus. We implemented the technique in stationary digital breast tomosynthesis, and found the method to be efficient in correcting patient-specific scatter with only 3% increase in dose. In this paper we reported the feasibility study of applying the same technique to chest tomosynthesis. This investigation was performed utilizing phantom and cadaver subjects. The method involves an initial tomosynthesis scan of the object. A lead plate with an array of holes, or primary sampling apparatus (PSA), was placed above the object. A second tomosynthesis scan was performed to measure the primary (scatter-free) transmission. This PSA data was used with the full-field projections to compute the scatter, which was then interpolated to full-field scatter maps unique to each projection angle. Full-field projection images were scatter corrected prior to reconstruction. Projections and reconstruction slices were evaluated and the correction method was found to be effective at improving image quality and practical for clinical implementation.

Single-stage multi-level construct design incorporating ribs and chest wall reconstruction after en bloc resection of spinal tumour.

PubMed

Xiao, Jianru; He, Shaohui; Jiao, Jian; Wan, Wei; Xu, Wei; Zhang, Dan; Liu, Weibo; Zhong, Nanzhe; Liu, Tielong; Wei, Haifeng; Yang, Xinghai

2018-03-01

Multi-level reconstruction incorporating the chest wall and ribs is technically demanding after multi-segmental total en bloc spondylectomy (TES) of thoracic spinal tumours. Few surgical techniques are reported for effective reconstruction. A novel and straightforward technical reconstruction through posterior-lateral approach was presented to solve the extensive chest wall defect and prevent occurrences of severe respiratory dysfunctions after performing TES. The preliminary outcomes of surgery were reviewed. Multi-level TES was performed for five patients with primary or recurrent thoracic spinal malignancies through posterior-lateral approach. The involved ribs and chest wall were removed to achieve tumour-free margin. Then titanium mesh with allograft bone and pedicle screw-rod system were adopted for the circumferential spinal reconstruction routinely. Titanium rods were modified accordingly to attach to the screw-rod system proximally, and the distal end of rods was dynamically inserted into the ribs. The mean surgery time was 6.7 hours (range 5-8), with the average blood loss of 3260 ml (range 2300-4500). No severe neurological complications were reported while three patients had complaints of slight numbness of chest skin (no. 1, 3, and 5). No severe respiratory complications occurred during peri-operative period. No implant failure and no local recurrence or distant metastases were observed with an average follow-up of 12.5 months. The single-stage reconstructions incorporating spine and chest wall are straightforward and easy to perform. The preliminary outcomes of co-reconstructions are promising and favourable. More studies and longer follow-up are required to validate this technique.

Reducing the impact of intensive care unit mattress compressibility during CPR: a simulation-based study.

PubMed

Lin, Yiqun; Wan, Brandi; Belanger, Claudia; Hecker, Kent; Gilfoyle, Elaine; Davidson, Jennifer; Cheng, Adam

2017-01-01

The depth of chest compression (CC) during cardiac arrest is associated with patient survival and good neurological outcomes. Previous studies showed that mattress compression can alter the amount of CCs given with adequate depth. We aim to quantify the amount of mattress compressibility on two types of ICU mattresses and explore the effect of memory foam mattress use and a backboard on mattress compression depth and effect of feedback source on effective compression depth. The study utilizes a cross-sectional self-control study design. Participants working in the pediatric intensive care unit (PICU) performed 1 min of CC on a manikin in each of the following four conditions: (i) typical ICU mattress; (ii) typical ICU mattress with a CPR backboard; (iii) memory foam ICU mattress; and (iv) memory foam ICU mattress with a CPR backboard, using two different sources of real-time feedback: (a) external accelerometer sensor device measuring total compression depth and (b) internal light sensor measuring effective compression depth only. CPR quality was concurrently measured by these two devices. The differences of the two measures (mattress compression depth) were summarized and compared using multilevel linear regression models. Effective compression depths with different sources of feedback were compared with a multilevel linear regression model. The mean mattress compression depth varied from 24.6 to 47.7 mm, with percentage of depletion from 31.2 to 47.5%. Both use of memory foam mattress (mean difference, MD 11.7 mm, 95%CI 4.8-18.5 mm) and use of backboard (MD 11.6 mm, 95% CI 9.0-14.3 mm) significantly minimized the mattress compressibility. Use of internal light sensor as source of feedback improved effective CC depth by 7-14 mm, compared with external accelerometer sensor. Use of a memory foam mattress and CPR backboard minimizes mattress compressibility, but depletion of compression depth is still substantial. A feedback device measuring sternum-to-spine displacement can significantly improve effective compression depth on a mattress. Not applicable. This is a mannequin-based simulation research.

A new physiological model for studying the effect of chest compression and ventilation during cardiopulmonary resuscitation: The Thiel cadaver.

PubMed

Charbonney, Emmanuel; Delisle, Stéphane; Savary, Dominique; Bronchti, Gilles; Rigollot, Marceau; Drouet, Adrien; Badat, Bilal; Ouellet, Paul; Gosselin, Patrice; Mercat, Alain; Brochard, Laurent; Richard, Jean-Christophe M

2018-04-01

Studying ventilation and intrathoracic pressure (ITP) induced by chest compressions (CC) during Cardio Pulmonary Resuscitation is challenging and important aspects such as airway closure have been mostly ignored. We hypothesized that Thiel Embalmed Cadavers could constitute an appropriate model. We assessed respiratory mechanics and ITP during CC in 11 cadavers, and we compared it to measurements obtained in 9 out-of-hospital cardiac arrest patients and to predicted values from a bench model. An oesophageal catheter was inserted to assess chest wall compliance, and ITP variation (ΔITP). Airway pressure variation (ΔPaw) at airway opening and ΔITP generated by CC were measured at decremental positive end expiratory pressure (PEEP) to test its impact on flow and ΔPaw. The patient's data were derived from flow and airway pressure captured via the ventilator during resuscitation. Resistance and Compliance of the respiratory system were comparable to those of the out-of-hospital cardiac arrest patients (C RS TEC 42 ± 12 vs C RS PAT 37.3 ± 10.9 mL/cmH 2 O and Res TEC 17.5 ± 7.5 vs Res PAT 20.2 ± 5.3 cmH 2 O/L/sec), and remained stable over time. During CC, ΔITP varied from 32 ± 12 cmH 2 O to 69 ± 14 cmH 2 O with manual and automatic CC respectively. Transmission of ΔITP at the airway opening was significantly affected by PEEP, suggesting dynamic small airway closure at low lung volumes. This phenomenon was similarly observed in patients. Respiratory mechanics and dynamic pressures during CC of cadavers behave as predicted by a theoretical model and similarly to patients. The Thiel model is a suitable to assess ITP variations induced by ventilation during CC. Copyright © 2018 Elsevier B.V. All rights reserved.

Matching Electron Beams Without Secondary Collimation for Treatment of Extensive Recurrent Chest-Wall Carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feygelman, Vladimir; Department of Physics, University of Manitoba, Winnipeg, MB; Mandelzweig, Yuri

2015-01-15

Matching electron beams without secondary collimators (applicators) were used for treatment of extensive, recurrent chest-wall carcinoma. Due to the wide penumbra of such beams, the homogeneity of the dose distribution at and around the junction point is clinically acceptable and relatively insensitive to positional errors. Specifically, dose around the junction point is homogeneous to within ±4% as calculated from beam profiles, while the positional error of 1 cm leaves this number essentially unchanged. The experimental isodose distribution in an anthropomorphic phantom supports this conclusion. Two electron beams with wide penumbra were used to cover the desired treatment area with satisfactorymore » dose homogeneity. The technique is relatively simple yet clinically useful and can be considered a viable alternative for treatment of extensive chest-wall disease. The steps are suggested to make this technique more universal.« less

4800 B/S speech compression techniques for mobile satellite systems

NASA Technical Reports Server (NTRS)

Townes, S. A.; Barnwell, T. P., III; Rose, R. C.; Gersho, A.; Davidson, G.

1986-01-01

This paper will discuss three 4800 bps digital speech compression techniques currently being investigated for application in the mobile satellite service. These three techniques, vector adaptive predictive coding, vector excitation coding, and the self excited vocoder, are the most promising among a number of techniques being developed to possibly provide near-toll-quality speech compression while still keeping the bit-rate low enough for a power and bandwidth limited satellite service.

Monitoring of cerebral oxygen saturation during resuscitation in out-of-hospital cardiac arrest: a feasibility study in a physician staffed emergency medical system.

PubMed

Schewe, Jens-Christian; Thudium, Marcus O; Kappler, Jochen; Steinhagen, Folkert; Eichhorn, Lars; Erdfelder, Felix; Heister, Ulrich; Ellerkmann, Richard

2014-10-05

Despite recent advances in resuscitation algorithms, neurological injury after cardiac arrest due to cerebral ischemia and reperfusion is one of the reasons for poor neurological outcome. There is currently no adequate means of measuring cerebral perfusion during cardiac arrest. It was the aim of this study to investigate the feasibility of measuring near infrared spectroscopy (NIRS) as a potential surrogate parameter for cerebral perfusion in patients with out-of-hospital resuscitations in a physician-staffed emergency medical service. An emergency physician responding to out-of-hospital emergencies was equipped with a NONIN cerebral oximetry device. Cerebral oximetry values (rSO2) were continuously recorded during resuscitation and transport. Feasibility was defined as >80% of total achieved recording time in relation to intended recording time. 10 patients were prospectively enrolled. In 89.8% of total recording time, rSO2 values could be recorded (213 minutes and 20 seconds), thus meeting feasibility criteria. 3 patients experienced return of spontaneous circulation (ROSC). rSO2 during manual cardiopulmonary resuscitation (CPR) was lower in patients who did not experience ROSC compared to the 3 patients with ROSC (31.6%, ± 7.4 versus 37.2% ± 17.0). ROSC was associated with an increase in rSO2. Decrease of rSO2 indicated occurrence of re-arrest in 2 patients. In 2 patients a mechanical chest compression device was used. rSO2 values during mechanical compression were increased by 12.7% and 19.1% compared to manual compression. NIRS monitoring is feasible during resuscitation of patients with out-of-hospital cardiac arrest and can be a useful tool during resuscitation, leading to an earlier detection of ROSC and re-arrest. Higher initial rSO2 values during CPR seem to be associated with the occurrence of ROSC. The use of mechanical chest compression devices might result in higher rSO2. These findings need to be confirmed by larger studies.

Effects of flashlight guidance on chest compression performance in cardiopulmonary resuscitation in a noisy environment.

PubMed

You, Je Sung; Chung, Sung Phil; Chang, Chul Ho; Park, Incheol; Lee, Hye Sun; Kim, SeungHo; Lee, Hahn Shick

2013-08-01

In real cardiopulmonary resuscitation (CPR), noise can arise from instructional voices and environmental sounds in places such as a battlefield and industrial and high-traffic areas. A feedback device using a flashing light was designed to overcome noise-induced stimulus saturation during CPR. This study was conducted to determine whether 'flashlight' guidance influences CPR performance in a simulated noisy setting. We recruited 30 senior medical students with no previous experience of using flashlight-guided CPR to participate in this prospective, simulation-based, crossover study. The experiment was conducted in a simulated noisy situation using a cardiac arrest model without ventilation. Noise such as patrol car and fire engine sirens was artificially generated. The flashlight guidance device emitted light pulses at the rate of 100 flashes/min. Participants also received instructions to achieve the desired rate of 100 compressions/min. CPR performances were recorded with a Resusci Anne mannequin with a computer skill-reporting system. There were significant differences between the control and flashlight groups in mean compression rate (MCR), MCR/min and visual analogue scale. However, there were no significant differences in correct compression depth, mean compression depth, correct hand position, and correctly released compression. The flashlight group constantly maintained the pace at the desired 100 compressions/min. Furthermore, the flashlight group had a tendency to keep the MCR constant, whereas the control group had a tendency to decrease it after 60 s. Flashlight-guided CPR is particularly advantageous for maintaining a desired MCR during hands-only CPR in noisy environments, where metronome pacing might not be clearly heard.

Pulsed Dose Delivery of Oxygen in Mechanically Ventilated Pigs with Acute Lung Injury

DTIC Science & Technology

2013-03-01

collapse or arrhythmia were encountered after administration of oleic acid, chest compressions, electrical defibrillation , and epinephrine (0.1-1 mg/kg...endotracheal tube to continuously measure the oxygen content of the gas in the circuit. We designed the study as a crossover trial, so each animal served as... designed to prove that a pulsed dose delivery system would be a better method of oxygen delivery, it is interesting to note that pulsed dose delivery did

Assessment of the Accuracy of Certain Reduced Order Models used in the Prediction of Occupant Injury during Under-Body Blast Events

DTIC Science & Technology

2014-04-15

the floor on which the platform is dropped upon. Alternatively, a base excitation can be provided to the sliding platform in the upward vertical...7ms clips of chest resultant acceleration, (7) 7ms clip of pelvic vertical acceleration, (8,9) Peak and 30ms clips of lumbar spine compression, and...10) Pelvic vertical Dynamic Response Index (DRI)[12]. The sample size for each of the three seating variants consisted of 230 MADYMO

Congenital Symmastia: A 3-Step Approach

PubMed Central

Allam, Atef A.

2016-01-01

Summary: Congenital symmastia is a medial confluence of the breasts. It is a rare anomaly with few reports in the literature and no standard treatment. In this article, we present a case of congenital symmastia treated by 3 steps: liposuction, fixation of the skin to the chest wall in the area of the intermammary sulcus, and postoperative intermammary compression. A successful result was achieved with normal cleavage between the breasts. So, this is considered the ideal treatment for this condition. PMID:28293510

Comparative data compression techniques and multi-compression results

NASA Astrophysics Data System (ADS)

Hasan, M. R.; Ibrahimy, M. I.; Motakabber, S. M. A.; Ferdaus, M. M.; Khan, M. N. H.

2013-12-01

Data compression is very necessary in business data processing, because of the cost savings that it offers and the large volume of data manipulated in many business applications. It is a method or system for transmitting a digital image (i.e., an array of pixels) from a digital data source to a digital data receiver. More the size of the data be smaller, it provides better transmission speed and saves time. In this communication, we always want to transmit data efficiently and noise freely. This paper will provide some compression techniques for lossless text type data compression and comparative result of multiple and single compression, that will help to find out better compression output and to develop compression algorithms.

Single-incision video-assisted thoracoscopic evaluation and emergent surgery for severe lung and chest wall injury after thoracic trauma in a water park.

PubMed

Sesma, Julio; Alvarez, Melodie; Lirio, Francisco; Galvez, Carlos; Galiana, Maria; Baschwitz, Benno; Fornes, Francisca; Bolufer, Sergio

2017-08-01

Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear. After checking bronchial and vascular viability of LLL we suggested a lung parenchyma preserving technique with PTFE protected pulmonary primary suture in order to avoid a lobectomy. Chest tubes were removed on 3 rd postoperative day and patient was discharged on 14 th postoperative day. He has already recovered his normal activity 6 months after surgery.

Single-incision video-assisted thoracoscopic evaluation and emergent surgery for severe lung and chest wall injury after thoracic trauma in a water park

PubMed Central

Alvarez, Melodie; Lirio, Francisco; Galvez, Carlos; Galiana, Maria; Baschwitz, Benno; Fornes, Francisca; Bolufer, Sergio

2017-01-01

Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear. After checking bronchial and vascular viability of LLL we suggested a lung parenchyma preserving technique with PTFE protected pulmonary primary suture in order to avoid a lobectomy. Chest tubes were removed on 3rd postoperative day and patient was discharged on 14th postoperative day. He has already recovered his normal activity 6 months after surgery. PMID:28861425

Chest Ultrasonography in Modern Day Extreme Settings: From Military Setting and Natural Disasters to Space Flights and Extreme Sports

PubMed Central

Mucci, Viviana

2018-01-01

Chest ultrasonography (CU) is a noninvasive imaging technique able to provide an immediate diagnosis of the underlying aetiology of acute respiratory failure and traumatic chest injuries. Given the great technologies, it is now possible to perform accurate CU in remote and adverse environments including the combat field, extreme sport settings, and environmental disasters, as well as during space missions. Today, the usage of CU in the extreme emergency setting is more likely to occur, as this technique proved to be a fast diagnostic tool to assist resuscitation manoeuvres and interventional procedures in many cases. A scientific literature review is presented here. This was based on a systematic search of published literature, on the following online databases: PubMed and Scopus. The following words were used: “chest sonography,” “ thoracic ultrasound,” and “lung sonography,” in different combinations with “extreme sport,” “extreme environment,” “wilderness,” “catastrophe,” and “extreme conditions.” This manuscript reports the most relevant usages of CU in the extreme setting as well as technological improvements and current limitations. CU application in the extreme setting is further encouraged here. PMID:29736195

Omitting chest tube drainage after thoracoscopic major lung resection.

PubMed

Ueda, Kazuhiro; Hayashi, Masataro; Tanaka, Toshiki; Hamano, Kimikazu

2013-08-01

Absorbable mesh and fibrin glue applied to prevent alveolar air leakage contribute to reducing the length of chest tube drainage, length of hospitalization and the rate of pulmonary complications. This study investigated the feasibility of omitting chest tube drainage in selected patients undergoing thoracoscopic major lung resection. Intraoperative air leakages were sealed with fibrin glue and absorbable mesh in patients undergoing thoracoscopic major lung resection. The chest tube was removed just after tracheal extubation if no air leakages were detected in a suction-induced air leakage test, which is an original technique to confirm pneumostasis. Patients with bleeding tendency or extensive thoracic adhesions were excluded. Chest tube drainage was omitted in 29 (58%) of 50 eligible patients and was used in 21 (42%) on the basis of suction-induced air leakage test results. Male gender and compromised pulmonary function were significantly associated with the failure to omit chest tube drainage (both, P < 0.05). Regardless of omitting the chest tube drainage, there were no adverse events during hospitalization, such as subcutaneous emphysema, pneumothorax, pleural effusion or haemothorax, requiring subsequent drainage. Furthermore, there was no prolonged air leakage in any patients: The mean length of chest tube drainage was only 0.9 days. Omitting the chest tube drainage was associated with reduced pain on the day of the operation (P = 0.046). The refined strategy for pneumostasis allowed the omission of chest tube drainage in the majority of patients undergoing thoracoscopic major lung resection without increasing the risk of adverse events, which may contribute to a fast-track surgery.

[Flexible endoscope in thoracic surgery: CITES or cVATS?].

PubMed

Assouad, J; Fénane, H; Masmoudi, H; Giol, M; Karsenti, A; Gounant, V; Grunenwald, D

2013-10-01

Early pain and persistent parietal disorders remains a major unresolved problem in thoracic surgery. Thoracotomy and the use of multiple ports in most Video Assisted Thoracic Surgery (VATS) procedures are the major cause of this persistent pain. For the last decade, a few publications describing the use of either single incision VATS and cervical thoracic approaches have been reported without significant results in comparison with current used techniques. Intercostals compression during surgery and early after by intercostals chest tube placement, are probably the major cause of postoperative pain. Flexible endoscope is currently used in several surgeries and will take more and more importance in our daily use in thoracic surgery. Instrument flexibility allows its use through minimally invasive approaches and offers a very interesting intra-thoracic navigation. We describe here the first use in France of a flexible endoscope in thoracic surgery through a single cervical incision to perform simultaneous exploration and biopsies of the mediastinum and right pleura using the original approach of Cervical Incision Thoracic Endoscopic Surgery (CITES). Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Improving throughput and user experience for information intensive websites by applying HTTP compression technique.

PubMed

Malla, Ratnakar

2008-11-06

HTTP compression is a technique specified as part of the W3C HTTP 1.0 standard. It allows HTTP servers to take advantage of GZIP compression technology that is built into latest browsers. A brief survey of medical informatics websites show that compression is not enabled. With compression enabled, downloaded files sizes are reduced by more than 50% and typical transaction time is also reduced from 20 to 8 minutes, thus providing a better user experience.

Comparison of Small Bore Catheter Aspiration and Chest Tube Drainage in the Management of Spontaneous Pneumothorax.

PubMed

Korczyński, P; Górska, K; Nasiłowski, J; Chazan, R; Krenke, R

2015-01-01

Beside standard chest tube drainage other less invasive techniques have been used in the management of patients with an acute episode of spontaneous pneumothorax. The aim of the study was to evaluate the short term effect of spontaneous pneumothorax treatment with small-bore pleural catheter and manual aspiration as compared to large-bore chest tube drainage. Patients with an episode of pneumothorax who required pleural intervention were enrolled in the study and randomly assigned to one of the treatment arms: (1) small-bore pleural catheter (8 Fr) with manual aspiration; (2) standard chest tube drainage (20-24 Fr). Success rate of the first line treatment, duration of catheter or chest tube drainage, and the need for surgical intervention were the outcome measures. The study group included 49 patients (mean age 46.9±21.3 years); with 22 and 27 allocated to small bore manual aspiration and chest tube drainage groups, respectively. There were no significant differences in the baseline characteristics of patients in both therapeutic arms. First line treatment success rates were 64% and 82% in the manual aspiration and chest tube drainage groups, respectively; the difference was insignificant. Median time of treatment with small bore catheter was significantly shorter than conventional chest tube drainage (2.0 vs. 6.0 days; p<0.05). Our results show that treatment of spontaneous pneumothorax with small-bore pleural catheter and manual aspiration might be similarly effective as is chest tube drainage in terms of immediate lung re-expansion.

Brace Compression for Treatment of Pectus Carinatum

PubMed Central

Jung, Joonho; Chung, Sang Ho; Cho, Jin Kyoung; Park, Soo-Jin; Choi, Ho

2012-01-01

Background Surgery has been the classical treatment of pectus carinatum (PC), though compressive orthotic braces have shown successful results in recent years. We propose a non-operative approach using a lightweight, patient-controlled dynamic chest-bracing device. Materials and Methods Eighteen patients with PC were treated between July 2008 and June 2009. The treatment involved fitting of the brace, which was worn for at least 20 hours per day for 6 months. Their degree of satisfaction (1, no correction; 4, remarkable correction) was measured at 12 months after the initiation of the treatment. Results Thirteen (72.2%) patients completed the treatment (mean time, 4.9±1.4 months). In patients who completed the treatment, the mean overall satisfaction score was 3.73±0.39. The mean satisfaction score was 4, and there was no recurrence of pectus carinatum in patients who underwent the treatment for at least 6 months. Minimal recurrence of pectus carinatum after removal of the compressive brace occurred in 5 (38.5%) patients who stopped wearing the compressive brace at 4 months. Conclusion Compressive bracing results in a significant improvement in PC appearance in patients with an immature skeleton. However, patient compliance and diligent follow-up appear to be paramount for the success of this method of treatment. We currently offer this approach as a first-line treatment for PC. PMID:23275922

SU-F-T-85: Energy Modulated Electron Postmastectomy Unreconstructed (PU) Chest Wall (CW) Irradiation Technique to Achieve Heart Sparing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hong, L; Ballangrud, A; Mechalakos, J

Purpose: For left-sided PU patients requiring CW and nodal irradiation, sometimes partial wide tangents (PWT) are not feasible due to abnormal chest wall contour or heart position close to the anterior chest wall or unusual wide excision scar. We developed an energy modulated electron chest wall irradiation technique that will achieve heart sparing. Methods: Ten left-sided PU patients were selected for this dosimetry study. If PWT were used, the amount of the ipsilateral lung would be ranged 3.4 to 4.4 cm, and the amount of heart would be ranged 1.3 to 3.8 cm. We used electron paired fields that matchedmore » on the skin to achieve dose conformity to the chest wall. The enface electron fields were designed at extended SSD from a single isocenter and gantry angle with different energy beams using different cutout. Lower energy was used in the central chest wall part and higher energy was used in the periphery of the chest wall. Bolus was used for the electron fields to ensure adequate skin dose coverage. The electron fields were matched to the photon supra-clavicle field in the superior region. Daily field junctions were used to feather the match lines between all the fields. Target volumes and normal tissues were drawn according to institutional protocols. Prescription dose was 2Gy per fraction for a total 50Gy. Dose calculations were done with Eclipse EMC-11031 for Electron and AAA-11031 for photons. Results: Six patients were planned using 6/9MeV, three using 9/12MeV and one 6/12MeV. Target volumes achieved adequate coverage. For heart, V30Gy, V20Gy and Mean Dose were 0.6%±0.6%, 2.7%±1.7%, and 3.0Gy±0.8Gy respectively. For ipsilateral lung, V50Gy, V20Gy, V10Gy and V5Gy were 0.9%±1.1%, 34.3%±5.1%, 51.6%±6.3% and 64.1%±7.5% respectively. Conclusion: For left-sided PU patients with unusual anatomy, energy modulated electron CW irradiation technique can achieve heart sparing with acceptable lung dose.« less

Survey of Header Compression Techniques

NASA Technical Reports Server (NTRS)

Ishac, Joseph

2001-01-01

This report provides a summary of several different header compression techniques. The different techniques included are: (1) Van Jacobson's header compression (RFC 1144); (2) SCPS (Space Communications Protocol Standards) header compression (SCPS-TP, SCPS-NP); (3) Robust header compression (ROHC); and (4) The header compression techniques in RFC2507 and RFC2508. The methodology for compression and error correction for these schemes are described in the remainder of this document. All of the header compression schemes support compression over simplex links, provided that the end receiver has some means of sending data back to the sender. However, if that return path does not exist, then neither Van Jacobson's nor SCPS can be used, since both rely on TCP (Transmission Control Protocol). In addition, under link conditions of low delay and low error, all of the schemes perform as expected. However, based on the methodology of the schemes, each scheme is likely to behave differently as conditions degrade. Van Jacobson's header compression relies heavily on the TCP retransmission timer and would suffer an increase in loss propagation should the link possess a high delay and/or bit error rate (BER). The SCPS header compression scheme protects against high delay environments by avoiding delta encoding between packets. Thus, loss propagation is avoided. However, SCPS is still affected by an increased BER (bit-error-rate) since the lack of delta encoding results in larger header sizes. Next, the schemes found in RFC2507 and RFC2508 perform well for non-TCP connections in poor conditions. RFC2507 performance with TCP connections is improved by various techniques over Van Jacobson's, but still suffers a performance hit with poor link properties. Also, RFC2507 offers the ability to send TCP data without delta encoding, similar to what SCPS offers. ROHC is similar to the previous two schemes, but adds additional CRCs (cyclic redundancy check) into headers and improves compression schemes which provide better tolerances in conditions with a high BER.

Application of content-based image compression to telepathology

NASA Astrophysics Data System (ADS)

Varga, Margaret J.; Ducksbury, Paul G.; Callagy, Grace

2002-05-01

Telepathology is a means of practicing pathology at a distance, viewing images on a computer display rather than directly through a microscope. Without compression, images take too long to transmit to a remote location and are very expensive to store for future examination. However, to date the use of compressed images in pathology remains controversial. This is because commercial image compression algorithms such as JPEG achieve data compression without knowledge of the diagnostic content. Often images are lossily compressed at the expense of corrupting informative content. None of the currently available lossy compression techniques are concerned with what information has been preserved and what data has been discarded. Their sole objective is to compress and transmit the images as fast as possible. By contrast, this paper presents a novel image compression technique, which exploits knowledge of the slide diagnostic content. This 'content based' approach combines visually lossless and lossy compression techniques, judiciously applying each in the appropriate context across an image so as to maintain 'diagnostic' information while still maximising the possible compression. Standard compression algorithms, e.g. wavelets, can still be used, but their use in a context sensitive manner can offer high compression ratios and preservation of diagnostically important information. When compared with lossless compression the novel content-based approach can potentially provide the same degree of information with a smaller amount of data. When compared with lossy compression it can provide more information for a given amount of compression. The precise gain in the compression performance depends on the application (e.g. database archive or second opinion consultation) and the diagnostic content of the images.

Lossless compression techniques for maskless lithography data

NASA Astrophysics Data System (ADS)

Dai, Vito; Zakhor, Avideh

2002-07-01

Future lithography systems must produce more dense chips with smaller feature sizes, while maintaining the throughput of one wafer per sixty seconds per layer achieved by today's optical lithography systems. To achieve this throughput with a direct-write maskless lithography system, using 25 nm pixels for 50 nm feature sizes, requires data rates of about 10 Tb/s. In a previous paper, we presented an architecture which achieves this data rate contingent on consistent 25 to 1 compression of lithography data, and on implementation of a decoder-writer chip with a real-time decompressor fabricated on the same chip as the massively parallel array of lithography writers. In this paper, we examine the compression efficiency of a spectrum of techniques suitable for lithography data, including two industry standards JBIG and JPEG-LS, a wavelet based technique SPIHT, general file compression techniques ZIP and BZIP2, our own 2D-LZ technique, and a simple list-of-rectangles representation RECT. Layouts rasterized both to black-and-white pixels, and to 32 level gray pixels are considered. Based on compression efficiency, JBIG, ZIP, 2D-LZ, and BZIP2 are found to be strong candidates for application to maskless lithography data, in many cases far exceeding the required compression ratio of 25. To demonstrate the feasibility of implementing the decoder-writer chip, we consider the design of a hardware decoder based on ZIP, the simplest of the four candidate techniques. The basic algorithm behind ZIP compression is Lempel-Ziv 1977 (LZ77), and the design parameters of LZ77 decompression are optimized to minimize circuit usage while maintaining compression efficiency.

Wavelet-based audio embedding and audio/video compression

NASA Astrophysics Data System (ADS)

Mendenhall, Michael J.; Claypoole, Roger L., Jr.

2001-12-01

Watermarking, traditionally used for copyright protection, is used in a new and exciting way. An efficient wavelet-based watermarking technique embeds audio information into a video signal. Several effective compression techniques are applied to compress the resulting audio/video signal in an embedded fashion. This wavelet-based compression algorithm incorporates bit-plane coding, index coding, and Huffman coding. To demonstrate the potential of this audio embedding and audio/video compression algorithm, we embed an audio signal into a video signal and then compress. Results show that overall compression rates of 15:1 can be achieved. The video signal is reconstructed with a median PSNR of nearly 33 dB. Finally, the audio signal is extracted from the compressed audio/video signal without error.

Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists.

PubMed

Porcel, José M

2018-04-01

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity ("water seal") drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established. Copyright©2018. The Korean Academy of Tuberculosis and Respiratory Diseases.

Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter

PubMed Central

Yi, Jian-hua; Liu, Hua-bo; Zhang, Mao; Wu, Jun-song; Yang, Jian-xin; Chen, Jin-ming; Xu, Shan-xiang; Wang, Jian-an

2012-01-01

Objective: To evaluate the efficacy and safety of the treatment of traumatic hemothorax by closed pleural drainage using a central venous catheter (CVC), compared with using a conventional chest tube. Methods: A prospective controlled study with the Ethics Committee approval was undertaken. A total of 407 patients with traumatic hemothorax were involved and they were randomly assigned to undergo closed pleural drainage with CVCs (n=214) or conventional chest tubes (n=193). The Seldinger technique was used for drainage by CVC, and the conventional technique for drainage by chest tube. If the residual volume of the hemothorax was less than 200 ml after the daily volume of drainage decreased to below 100 ml for two consecutive days, the treatment was considered successful. The correlative data of efficacy and safety between the two groups were analyzed using t or chi-squared tests with SPSS 13.0. A P value of less than 0.05 was taken as indicating statistical significance. Results: Compared with the chest tube group, the operation time, fraction of analgesic treatment, time of surgical wound healing, and infection rate of surgical wounds were significantly decreased (P<0.05) in the CVC group. There were no significant differences between the two groups in the success rate of treatment and the incidence of serious complications (P>0.05), or in the mean catheter/tube indwelling time and mean medical costs of patients treated successfully (P>0.05). Conclusions: Management of medium or large traumatic hemothoraxes by closed thoracic drainage using CVC is minimally invasive and as effective as using a conventional large-bore chest tube. Its complications can be prevented and it has the potential to replace the large-bore chest tube. PMID:22205619

Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists

PubMed Central

2018-01-01

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity (“water seal”) drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established. PMID:29372629

CT-angiography protocol with low dose radiation and low volume contrast medium for non-cardiac chest pain

PubMed Central

Ozkurt, Huseyin; Tokgoz, Safiye; Karabay, Esra; Ucan, Berna; Akdogan, Melek Pala; Basak, Muzaffer

2014-01-01

Aim To evaluate the diagnostic quality of a new multiple detector-row computed tomography angiography (MDCT-A) protocol using low dose radiation and low volume contrast medium techniques for evaluation of non-cardiac chest pain. Methods Forty-five consecutive patients with clinically suspected noncardiac chest pain and requiring contrast-enhanced chest computed tomography (CT) were examined. The patients were assigned to the protocol, with 80 kilovolt (peak) (kV[p]) and 150 effective milliampere-second (eff mA-s). In our study group, 40 mL of low osmolar contrast material was administered at 3.0 mL/s. Results In the study group, four patients with pulmonary embolism, four with pleural effusion, two with ascending aortic aneurysm and eight patients with pneumonic consolidation were detected. The mean attenuation of the pulmonary truncus and ascendant aortic locations was considered 264±44 and 249±51 HU, respectively. The mean effective radiation dose was 0.83 mSv for MDCT-A. Conclusions Pulmonary artery and the aorta scanning simultaneously was significantly reduced radiation exposure with the mentioned dose saving technique. Additionally, injection of low volume (40 cc) contrast material may reduce the risk of contrast induced nephropathy, therefore, facilitate the diagnostic approach. This technique can be applied to all cases and particularly patients at high risk of contrast induced nephropathy due to its similar diagnostic quality with a low dose and high levels of arteriovenous enhancement simultaneously. PMID:25392818

Validation of an image-based technique to assess the perceptual quality of clinical chest radiographs with an observer study

NASA Astrophysics Data System (ADS)

Lin, Yuan; Choudhury, Kingshuk R.; McAdams, H. Page; Foos, David H.; Samei, Ehsan

2014-03-01

We previously proposed a novel image-based quality assessment technique1 to assess the perceptual quality of clinical chest radiographs. In this paper, an observer study was designed and conducted to systematically validate this technique. Ten metrics were involved in the observer study, i.e., lung grey level, lung detail, lung noise, riblung contrast, rib sharpness, mediastinum detail, mediastinum noise, mediastinum alignment, subdiaphragm-lung contrast, and subdiaphragm area. For each metric, three tasks were successively presented to the observers. In each task, six ROI images were randomly presented in a row and observers were asked to rank the images only based on a designated quality and disregard the other qualities. A range slider on the top of the images was used for observers to indicate the acceptable range based on the corresponding perceptual attribute. Five boardcertificated radiologists from Duke participated in this observer study on a DICOM calibrated diagnostic display workstation and under low ambient lighting conditions. The observer data were analyzed in terms of the correlations between the observer ranking orders and the algorithmic ranking orders. Based on the collected acceptable ranges, quality consistency ranges were statistically derived. The observer study showed that, for each metric, the averaged ranking orders of the participated observers were strongly correlated with the algorithmic orders. For the lung grey level, the observer ranking orders completely accorded with the algorithmic ranking orders. The quality consistency ranges derived from this observer study were close to these derived from our previous study. The observer study indicates that the proposed image-based quality assessment technique provides a robust reflection of the perceptual image quality of the clinical chest radiographs. The derived quality consistency ranges can be used to automatically predict the acceptability of a clinical chest radiograph.

Quantitative analysis of rib movement based on dynamic chest bone images: preliminary results

NASA Astrophysics Data System (ADS)

Tanaka, R.; Sanada, S.; Oda, M.; Mitsutaka, M.; Suzuki, K.; Sakuta, K.; Kawashima, H.

2014-03-01

Rib movement during respiration is one of the diagnostic criteria in pulmonary impairments. In general, the rib movement is assessed in fluoroscopy. However, the shadows of lung vessels and bronchi overlapping ribs prevent accurate quantitative analysis of rib movement. Recently, an image-processing technique for separating bones from soft tissue in static chest radiographs, called "bone suppression technique", has been developed. Our purpose in this study was to evaluate the usefulness of dynamic bone images created by the bone suppression technique in quantitative analysis of rib movement. Dynamic chest radiographs of 10 patients were obtained using a dynamic flat-panel detector (FPD). Bone suppression technique based on a massive-training artificial neural network (MTANN) was applied to the dynamic chest images to create bone images. Velocity vectors were measured in local areas on the dynamic bone images, which formed a map. The velocity maps obtained with bone and original images for scoliosis and normal cases were compared to assess the advantages of bone images. With dynamic bone images, we were able to quantify and distinguish movements of ribs from those of other lung structures accurately. Limited rib movements of scoliosis patients appeared as reduced rib velocity vectors. Vector maps in all normal cases exhibited left-right symmetric distributions, whereas those in abnormal cases showed nonuniform distributions. In conclusion, dynamic bone images were useful for accurate quantitative analysis of rib movements: Limited rib movements were indicated as a reduction of rib movement and left-right asymmetric distribution on vector maps. Thus, dynamic bone images can be a new diagnostic tool for quantitative analysis of rib movements without additional radiation dose.

Management of chest deformity caused by microtia reconstruction: Comparison of autogenous diced cartilage versus cadaver cartilage graft partial filling techniques.

PubMed

Go, Ju Young; Kang, Bo Young; Hwang, Jin Hee; Oh, Kap Sung

2017-01-01

Efforts to prevent chest wall deformity after costal cartilage graft are ongoing. In this study, we introduce a new method to prevent donor site deformation using irradiated cadaver cartilage (ICC) and compare this method to the autogenous diced cartilage (ADC) technique. Forty-two pediatric patients comprised the ADC group (n = 24) and the ICC group (n = 18). After harvesting costal cartilage, the empty perichondrial space was filled with autologous diced cartilage in the ADC group and cadaver cartilage in the ICC group. Digital photographs and rib cartilage three-dimensional computed tomography (CT) data were analyzed to compare the preventive effect of donor site deformity. We compared the pre- and postoperative costal cartilage volumes using 3D-CT and graded the volumes (grade I: 0%-25%, grade II: 25%-50%, grade III: 50%-75%, and grade IV: 75%-100%). The average follow-up period was 20 and 24 months in the ADC and ICC groups, respectively. Grade IV maintenance of previous costal cartilage volume was evident postoperatively in 22% of patients in the ADC group and 82% of patients in the ICC group. Intercostal space narrowing and chest wall depression were less in the ICC group. There were no complications or severe resorption of cadaver cartilage. ICC support transected costal ring and prevented stability loss by acting as a spacer. The ICC technique is more effective in preventing intercostal space narrowing and chest wall depression than the ADC technique. Samsung Medical Center Institution Review Board, Unique protocol ID: 2009-10-006-008. This study is also registered on PRS (ClinicalTrials.gov Record 2009-10-006). Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Oblique Chest X-Ray: An Alternative Way to Detect Pneumothorax.

PubMed

Tulay, Cumhur Murat; Yaldız, Sadık; Bilge, Adnan

2018-03-16

To identify occult pneumothorax with oblique chest X-ray (OCXR) in clinically suspected patients. In this retrospective study, we examined 1082 adult multitrauma patients who were admitted to our emergency service between January 2016 and January 2017. Clinical findings that suggest occult pneumothorax were rib fracture, flail chest, chest pain, subcutaneous emphysema, abrasion or ecchymosis and moderate to severe hypoxia in clinical parameters. All of these patients underwent anteroposterior chest X-ray (APCXR), but no pneumothorax could be detected. Upon this, OCXR was performed using mobile X-ray equipment. Traumatic pneumothorax was observed in 421 (38.9%) of 1082 patients. We applied OCXR to 26 multitrauma patients. Occult pneumothorax was evaluated at 22 patients (2.03%) in 1082 multitrauma patients. The 22 patients who had multitrauma occult pneumothorax on OCXR were internated at intensive care unit (ICU) and follow-up was done using OCXR and APCXR. OCXR can be an alternative imaging technique to identify occult pneumothorax in some trauma patients at emergency room and also follow period at ICU.

Effect of shape and size of lung and chest wall on stresses in the lung

NASA Technical Reports Server (NTRS)

Vawter, D. L.; Matthews, F. L.; West, J. B.

1975-01-01

To understand better the effect of shape and size of lung and chest wall on the distribution of stresses, strains, and surface pressures, we analyzed a theoretical model using the technique of finite elements. First we investigated the effects of changing the chest wall shape during expansion, and second we studied lungs of a variety of inherent shapes and sizes. We found that, in general, the distributions of alveolar size, mechanical stresses, and surface pressures in the lungs were dominated by the weight of the lung and that changing the shape of the lung or chest wall had relatively little effect. Only at high states of expansion where the lung was very stiff did changing the shape of the chest wall cause substantial changes. Altering the inherent shape of the lung generally had little effect but the topographical differences in stresses and surface pressures were approximately proportional to lung height. The results are generally consistent with those found in the dog by Hoppin et al (1969).

Functions of standard CPR training on performance qualities of medical volunteers for Mt. Taishan International Mounting Festival.

PubMed

Fanshan, Meng; Lin, Zhao; Wenqing, Liu; Chunlei, Lu; Yongqiang, Liu; Naiyi, Li

2013-01-01

Cardiopulmonary resuscitation (CPR) is a sudden emergency procedure that requires a rapid and efficient response, and personnel training in lifesaving procedures. Regular practice and training are necessary to improve resuscitation skills and reduce anxiety among the staff. As one of the most important skills mastered by medical volunteers serving for Mt. Taishan International Mounting Festival, we randomly selected some of them to evaluate the quality of CPR operation and compared the result with that of the untrained doctors and nurses. In order to evaluate the functions of repeating standard CPR training on performance qualities of medical volunteers for Mt. Taishan International Mounting Festival, their performance qualities of CPR were compared with those of the untrained medical workers working in emergency departments of hospitals in Taian. The CPR performance qualities of 52 medical volunteers (Standard Training Group), who had continually taken part in standard CPR technical training for six months, were tested at random and were compared with those of 68 medical workers (Compared Group) working in emergency departments of hospitals in Taian who hadn't attended CPR training within a year. The QCPR 3535 monitor (provided by Philips Company) was used to measure the standard degree of single simulated CPR performance, including the chest compression depth, frequency, released pressure between compressions and performance time of compression and ventilation, the results of which were recorded in the table and the number of practical compression per minute was calculated. The data were analyzed by x2 Test and t Test. The factors which would influence CPR performance, including gender, age, placement, hand skill, posture of compression and frequency of training, were classified and given parameters, and were put to Logistic repression analysis. The CPR performance qualities of volunteers were much higher than those of the compared group. The overall pass rates were respectively 86.4% and 31.9%; the pass rates of medical volunteers in terms of the chest compression depth, frequency, released pressure between compressions were higher than those of the compared group, which were 89.6%, 94.2%, 95.8% vs 50.3%, 53.0%, 83.1%, P<0.01; there were few differences in overall performance time, which were (118.4 ± 13.5s) vs (116.0 ± 10.4s), P>0.05; the duration time of ventilation in each performance section was much shorter than that in the compared group, which were (6.38 ± 1.2) vs (7.47 ± 1.7), P<0.01; there were few differences in the number of practical compression per minute, which were (78.2 ± 3.5) vs (78.8 ± 12.2), P>0.05); the time proportion of compression and ventilation was 2.6:1 vs 2.1:1. The Logistic repression analysis showed that CPR performance qualities were clearly related to hand skill, posture of compression and repeating standard training, which were respectively OR 13.12 and 95%CI (2.35~73.2); OR 30.89, 95%CI (3.62~263.5); OR 4.07,95%CI (1.16~14.2). The CPR performance qualities of volunteers who had had repeating standard training were much higher than those of untrained medical workers, which proved that standard training helped improve CPR performance qualities.

Classification Techniques for Digital Map Compression

DTIC Science & Technology

1989-03-01

classification improved the performance of the K-means classification algorithm resulting in a compression of 8.06:1 with Lempel - Ziv coding. Run-length coding... compression performance are run-length coding [2], [8] and Lempel - Ziv coding 110], [11]. These techniques are chosen because they are most efficient when...investigated. After the classification, some standard file compression methods, such as Lempel - Ziv and run-length encoding were applied to the

DEVELOPMENT AND EVALUATION OF A NOVEL TAEKWONDO CHEST PROTECTOR TO IMPROVE MOBILITY WHEN PERFORMING AXE KICKS

PubMed Central

Woo, J.H.; Ko, J.Y.; Choi, E.Y.; O'Sullivan, D.M.

2013-01-01

The axe kick, in Olympic style taekwondo, has been identified as the most popular scoring technique aimed to the head during full contact competition. The first purpose of this study was to identify and investigate design issues with the current World Taekwondo Federation approved chest protector. A secondary purpose was to develop a novel chest protector addressing the identified design issues and to conduct a biomechanical analysis. Fifteen male elite Taekwondo players were selected to perform three different styles of the axe kick, i.e., front, in-out, and out-in axe kick five times each for a total of 45 kicks. Two-way repeated measures ANOVA showed significant differences between the novel and existing chest protector conditions for vertical height of the toe, downward kicking foot speed, hip flexion angle and ipsilateral shoulder flexion extension range of motion (ROM) (p < 0.05). There were no significant differences between the control condition (no chest protector) and the novel chest protector condition for these variables (p > 0.05). These results indicate that the novel chest protector interferes less with both the lower and upper limbs during the performance of the axe kick and provides a more natural, free-moving alternative to the current equipment used. PMID:24744466

Injury Patterns After the Landslide Disaster in Oshima, Tokyo, Japan on October 16, 2013.

PubMed

Homma, Yasuhiro; Watari, Taiji; Baba, Tomonori; Suzuki, Misako; Shimizu, Tadanori; Fujii, Yuji; Takazawa, Yuji; Maruyama, Yuichiro; Kaneko, Kazuo

2016-04-01

Landslides represent a frequent and threatening natural disaster. The aim of this study was to investigate the injury patterns observed after a landslide and to discuss how to minimize the damage caused by a landslide disaster. A landslide occurred on Oshima Island, Japan, on October 16, 2013. A total of 49 victims with landslide-related injuries were identified and analyzed. The patients ranged in age from 5 to 89 years with an average age of 61.0±19.3 years. Of all patients, 69.4% were triaged as black. Of 15 patients who were treated in the nearest hospital (the only hospital on the island), 8 were triaged as red and yellow with severe chest or pelvic injury and a high Injury Severity Score (average score, 25.6; range, 4-45). Of these, 75% had chest injury and 75% had pelvic injury. The percentage of chest and/or pelvic injury was 100% in patients triaged as red or yellow. Traumatic asphyxia was diagnosed in 62.5% of these patients. Compression of the trunk was the main injury in patients triaged as red or yellow after this landslide disaster. Evacuation in advance, the rapid launch of emergency medical support, and knowledge of this specific injury pattern are essential to minimize the potential damage resulting from landslide disasters.

A model of acoustic transmission in the respiratory system.

PubMed

Wodicka, G R; Stevens, K N; Golub, H L; Cravalho, E G; Shannon, D C

1989-09-01

A theoretical model of sound transmission from within the respiratory tract to the chest wall due to the motion of the walls of the large airways was developed. The vocal tract, trachea, and the first five bronchial generations are represented over the frequency range from 100 to 600 Hz by an equivalent acoustic circuit. This circuit allows the estimation of the magnitude of airway wall motion in response to an acoustic perturbation at the mouth. The radiation of sound through the surrounding lung parenchyma is represented as a cylindrical wave in a homogeneous mixture of air bubbles in water. The effect of thermal losses associated with the polytropic compressions and expansions of these bubbles by the acoustic wave is included and the chest wall is represented as a massive boundary to the wave propagation. The model estimates the magnitude of acceleration over the extrathoracic trachea and at three locations on the posterior chest wall in the same vertical plane. The predicted spectral characteristics of transmission are consistent with previous experimental observations. This theoretical approach suggests that the locations of the spectral peaks are a strong function of the geometry and the wall properties of the airways, while the attenuation at higher frequencies is primarily associated with the absorption of sound in the parenchyma.

The National Lung Screening Trial (NLST) | Division of Cancer Prevention

Cancer.gov

The National Lung Screening Trial (NLST) compared two ways of detecting lung cancer: low-dose helical computed tomography (CT) and standard chest X-ray. Both chest X-rays and low-dose helical CT scans have been used to find lung cancer early, but the effects of these screening techniques on lung cancer mortality rates had not been determined. NLST enrolled 53,454 current or

Development and characterization of a dual-energy subtraction imaging system for chest radiography based on CsI:Tl amorphous silicon flat-panel technology

NASA Astrophysics Data System (ADS)

Sabol, John M.; Avinash, Gopal B.; Nicolas, Francois; Claus, Bernhard E. H.; Zhao, Jianguo; Dobbins, James T., III

2001-06-01

Dual-energy subtraction imaging increases the sensitivity and specificity of pulmonary nodule detection in chest radiography by reducing the contrast of overlying bone structures. Recent development of a fast, high-efficiency detector enables dual-energy imaging to be integrated into the traditional workflow. We have modified a GE RevolutionTM XQ/i chest imaging system to construct a dual-energy imaging prototype system. Here we describe the operating characteristics of this prototype and evaluate image quality. Empirical results show that the dual-energy CNR is maximized if the dose is approximately equal for both high and low energy exposures. Given the high detector DQE, and allocation of dose between the two views, we can acquire dual-energy PA and conventional lateral images with total dose equivalent to a conventional two-view film chest exam. Calculations have shown that the dual-exposure technique has superior CNR and tissue cancellation than single-exposure CR systems. Clinical images obtained on a prototype dual-energy imaging system show excellent tissue contrast cancellation, low noise, and modest motion artefacts. In summary, a prototype dual-energy system has been constructed which enables rapid, dual-exposure imaging of the chest using a commercially available high-efficiency, flat-panel x-ray detector. The quality of the clinical images generated with this prototype exceeds that of CR techniques and demonstrates the potential for improved detection and characterization of lung disease through dual-energy imaging.

Stabilization of flail chest injuries: minimized approach techniques to treat the core of instability.

PubMed

Schulz-Drost, S; Grupp, S; Pachowsky, M; Oppel, P; Krinner, S; Mauerer, A; Hennig, F F; Langenbach, A

2017-04-01

Stabilizing techniques of flail chest injuries usually need wide approaches to the chest wall. Three main regions need to be considered when stabilizing the rib cage: median-anterior with dissection of pectoral muscle; lateral-axillary with dissection of musculi (mm) serratus, externus abdominis; posterior inter spinoscapular with division of mm rhomboidei, trapezius and latissimus dorsi. Severe morbidity due to these invasive approaches needs to be considered. This study discusses possibilities for minimized approaches to the shown regions. Fifteen patients were stabilized by locked plate osteosynthesis (MatrixRib ® ) between May 2012 and April 2014 and prospectively followed up. Flail chest injuries were managed through limited incisions to the anterior, the lateral, and the posterior parts of the chest wall or their combinations. Each approach was 4-10 cm using Alexis ® retractor. One minimized approach offered sufficient access at least to four ribs posterior and laterally, four pairs of ribs anterior in all cases. There was no need to divide latissimus dorsi muscle. Trapezius und rhomboid muscles were only limited divided, whereas a subcutaneous dissection of serratus and abdominis muscles was necessary. A follow-up showed sufficient consolidation. pneumothorax (2) and seroma (2). Minimized approaches allow sufficient stabilization of severe dislocated rib fractures without extensive dissection or division of the important muscles. Keeping the arm and, thus, the scapula mobile is very important for providing the largest reachable surface of the rib cage through each approach.

Return of spontaneous Circulation Is Not Affected by Different Chest Compression Rates Superimposed with Sustained Inflations during Cardiopulmonary Resuscitation in Newborn Piglets

PubMed Central

Li, Elliott S.; Cheung, Po-Yin; Lee, Tze-Fun; Lu, Min; O'Reilly, Megan

2016-01-01

Objective Recently, sustained inflations (SI) during chest compression (CC) have been suggested as an alternative to the current approach during neonatal resuscitation. However, the optimal rate of CC during SI has not yet been established. Our aim was to determine whether different CC rates during SI reduce time to return of spontaneous circulation (ROSC) and improve hemodynamic recovery in newborn piglets with asphyxia-induced bradycardia. Intervention and measurements Term newborn piglets were anesthetized, intubated, instrumented and exposed to 45-min normocapnic hypoxia followed by asphyxia. Resuscitation was initiated when heart rate decreased to 25% of baseline. Piglets were randomized into three groups: CC superimposed by SI at a rate of 90 CC per minute (SI+CC 90, n = 8), CC superimposed by SI at a rate of 120 CC per minute (SI+CC 120, n = 8), or a sham group (n = 6). Cardiac function, carotid blood flow, cerebral oxygenation and respiratory parameters were continuously recorded throughout the experiment. Main results Both treatment groups had similar time of ROSC, survival rates, hemodynamic and respiratory parameters during cardiopulmonary resuscitation. The hemodynamic recovery in the subsequent 4h was similar in both groups and was only slightly lower than sham-operated piglets at the end of experiment. Conclusion Newborn piglets resuscitated by SI+CC 120 did not show a significant advantage in ROSC, survival, and hemodynamic recovery as compared to those piglets resuscitated by SI+CC 90. PMID:27304210

Dynamic Compression System: An Effective Nonoperative Treatment for Pectus Carinatum: A Single Center Experience in Basel, Switzerland.

PubMed

Sesia, Sergio B; Holland-Cunz, Stefan; Häcker, Frank-Martin

2016-12-01

Background  Several nonoperative treatments are currently available for the correction of pectus carinatum (PC). Objective  The objective of this study is to report our single center experience with the dynamic compression system (DCS). Materials and Methods  The DCS is a rigid aluminum brace. PC is reshaped into a normal appearance through anterior-posterior pressure and lateral expansion of the chest. Patients with chondrogladiolar PC were considered suitable for the nonoperative treatment with DCS. Results  In this study, 53 of 68 children (78%) with chondrogladiolar PC were assessed retrospectively: 2 children were corrected by surgery, 12/53 (23%) treated by a conventional orthesis, 11/53 (21%) remained without therapy because of minor PC, and 36/53 (68%) were treated using the DCS. Of these 36 patients, 17 (47%) are already cured with a good (7/17) to excellent (10/17) cosmetic result after a median treatment period of 9 months (range, 2.5-16 months). The mean daily time of wearing of the device for those 17 patients was 9 hours (range, 5-18). None abandoned the treatment and there were almost no complications. Conclusions  Lateral expansion of the chest and the possibility to measure the applied pressure seemed to be the key to DCSs success. We propose the DCS as first choice in the treatment of chondrogladiolar PC in children. Georg Thieme Verlag KG Stuttgart · New York.

Ultrasound assisted evaluation of chest pain in the emergency department.

PubMed

Colony, M Deborah; Edwards, Frank; Kellogg, Dylan

2018-04-01

Chest pain is a commonly encountered emergency department complaint, with a broad differential including several life-threatening possible conditions. Ultrasound-assisted evaluation can potentially be used to rapidly and accurately arrive at the correct diagnosis. We propose an organized, ultrasound assisted evaluation of the patient with chest pain using a combination of ultrasound, echocardiography and clinical parameters. Basic echo techniques which can be mastered by residents in a short time are used plus standardized clinical questions and examination. Information is kept on a checklist. We hypothesize that this will result in a quicker, more accurate evaluation of chest pain in the ED leading to timely treatment and disposition of the patient, less provider anxiety, a reduction in the number of diagnostic errors, and the removal of false assumptions from the diagnostic process. Copyright © 2017 Elsevier Inc. All rights reserved.

Radiometric resolution enhancement by lossy compression as compared to truncation followed by lossless compression

NASA Technical Reports Server (NTRS)

Tilton, James C.; Manohar, Mareboyana

1994-01-01

Recent advances in imaging technology make it possible to obtain imagery data of the Earth at high spatial, spectral and radiometric resolutions from Earth orbiting satellites. The rate at which the data is collected from these satellites can far exceed the channel capacity of the data downlink. Reducing the data rate to within the channel capacity can often require painful trade-offs in which certain scientific returns are sacrificed for the sake of others. In this paper we model the radiometric version of this form of lossy compression by dropping a specified number of least significant bits from each data pixel and compressing the remaining bits using an appropriate lossless compression technique. We call this approach 'truncation followed by lossless compression' or TLLC. We compare the TLLC approach with applying a lossy compression technique to the data for reducing the data rate to the channel capacity, and demonstrate that each of three different lossy compression techniques (JPEG/DCT, VQ and Model-Based VQ) give a better effective radiometric resolution than TLLC for a given channel rate.

Adherence evaluation of vented chest seals in a swine skin model.

PubMed

Arnaud, Françoise; Maudlin-Jeronimo, Eric; Higgins, Adam; Kheirabadi, Bijan; McCarron, Richard; Kennedy, Daniel; Housler, Greggory

2016-10-01

Perforation of the chest (open pneumothorax) with and without lung injury can cause air accumulation in the chest, positive intrapleural pressure and lead to tension pneumothorax if untreated. The performance of chest seals to prevent tension physiology depends partially on their ability to adhere to the skin and seal the chest wound. Novel non-occlusive vented chest seals were assessed for their adhesiveness on skin of live swine under normal and extreme environmental conditions to simulate austere battlefield conditions. Chest seals were applied on the back of the swine on skin that was soiled by various environmental contaminants to represent battlefield situations. A peeling (horizontal rim peeling) and detachment and breaching (vertical pulling) techniques were used to quantify the adhesive performance of vented chest seals. Among eight initially selected vented seals, five (Bolin, Russell, Fast breathe, Hyfin and SAM) were further down-selected based on their superior adherence scores at ambient temperatures. The adherence of these seals was then assessed after approximately 17h storage at extreme cold (-19.5°C) and hot (71.5°C) temperatures. Adherence scores for peeling (above 90%) and detachment scores (less than 25%) were comparable for four vented chest seals when tested at ambient temperature, except for the Bolin seal which had higher breaching. Under extreme storage temperatures, adherence peeling scores were comparable to those at ambient temperatures for four chest seals. Scores were significantly lower for the Bolin seal at extreme temperatures. This seal also had the highest detachment and breaching scores. In contrast, the Russell, Fast breathe, Hyfin and SAM seals showed similar ability to stay air tight without breaching after hot storage. No significant difference was found in skin adherence of the five vented chest seals at ambient temperature and the four seals (Russell, Fast breathe, Hyfin and SAM) maintained superior adherence even after exposure to extreme temperatures compared to the Bolin. To select the most effective product from the 5 selected vented chest seals, further functional evaluation of the valve of these chest seals on a chest wound with the potential for tension in the pneumothorax or hemopneumothorax is warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.

Extranodal Marginal Zone Lymphoma: No Longer Just a Sidekick.

PubMed

Kamdar, Manali K; Smith, Sonali M

2017-06-10

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 51-year-old healthy female with good performance status presented for gynecologic surgery for a benign condition. A preprocedure chest x-ray showed a right lower lobe infiltrate. A subsequent computed tomography (CT) scan of the chest with contrast revealed a large consolidative right lower lobe mass with surrounding inflammation ( Fig 1A ). Bronchoscopy with biopsy revealed a low-grade lymphoma with the following immunophenotype: CD45 + , CD20 + , BCL2 + , CD10 negative, CD5 negative, cyclin D1 negative, and Ki-67 index of less than 5%. Morphology and immunohistochemistry were most consistent with pulmonary extranodal marginal zone lymphoma (ENMZL; Fig 2 ). The patient was asymptomatic and denied fevers, sweats, weight loss, shortness of breath or dyspnea on exertion, or cough. Her history was notable for exposure to parrots over several months before presentation. Complete staging with a CT of the chest, abdomen, and pelvis with contrast redemonstrated disease that was localized to the chest with mild compression of the pulmonary vasculature but no other evidence of lymphoma. She was referred to discuss management of stage I AE pulmonary ENMZL lymphoma.

Composeable Chat over Low-Bandwidth Intermittent Communication Links

DTIC Science & Technology

2007-04-01

Compression (STC), introduced in this report, is a data compression algorithm intended to compress alphanumeric... Ziv - Lempel coding, the grandfather of most modern general-purpose file compression programs, watches for input symbol sequences that have previously... data . This section applies these techniques to create a new compression algorithm called Small Text Compression . Various sequence compression

Image compression/decompression based on mathematical transform, reduction/expansion, and image sharpening

DOEpatents

Fu, Chi-Yung; Petrich, Loren I.

1997-01-01

An image represented in a first image array of pixels is first decimated in two dimensions before being compressed by a predefined compression algorithm such as JPEG. Another possible predefined compression algorithm can involve a wavelet technique. The compressed, reduced image is then transmitted over the limited bandwidth transmission medium, and the transmitted image is decompressed using an algorithm which is an inverse of the predefined compression algorithm (such as reverse JPEG). The decompressed, reduced image is then interpolated back to its original array size. Edges (contours) in the image are then sharpened to enhance the perceptual quality of the reconstructed image. Specific sharpening techniques are described.

Shock temperature measurement of transparent materials under shock compression

NASA Astrophysics Data System (ADS)

Hu, Jinbiao

1999-06-01

Under shock compression, some materials have very small absorptance. So it's emissivity is very small too. For this kinds of materials, although they stand in high temperature state under shock compression, the temperature can not be detected easily by using optical radiation technique because of the low emissivity. In this paper, an optical radiation temperature measurement technique of measuring temperature of very low emissive material under shock compression was proposed. For making sure this technique, temperature of crystal NaCl at shock pressure 41 GPa was measured. The result agrees with the results of Kormer et al and Ahrens et al very well. This shows that this technique is reliable and can be used to measuring low emissive shock temperature.

Electron arc therapy for bilateral chest wall irradiation: treatment planning and dosimetric study.

PubMed

Sharma, P K; Jamema, S V; Kaushik, K; Budrukkar, A; Jalali, R; Deshpande, D D; Tambe, C M; Sarin, R; Munshi, A

2011-04-01

The treatment of patients with synchronous bilateral breast cancer is a challenge. We present a report of dosimetric data of patients with bilateral chest walls as the target treated with electron arc therapy. Ten consecutive patients who had undergone electron arc therapy to the bilateral chest wall for breast cancer were analysed. After positioning and immobilisation, patients underwent computed tomography scans from the neck to the upper abdomen. Electron arc plans were generated using the PLATO RTS (V1.8.2 Nucletron) treatment planning system. Electron energy was chosen depending upon the depth and thickness of the planning target volume (PTV). For all patients, the arc angle ranged between 80 and 280° (start angle 80°, stop angle 280°). The homogeneity index, coverage index and doses to organs at risk were evaluated. The patient-specific output factor and thermoluminescence dosimetry (TLD) measurements were carried out for all patients. The total planned dose to the PTV was 50Gy/25 fractions/5 weeks. The mean PTV (± standard deviation) was 568.9 (±116)cm(3). The mean PTV coverage was 89 (±5.8)% of the prescribed dose. For the right lung, the mean values of D(1) and D(10) were 46 (±7.6) and 30 (±9)Gy, respectively. For the left lung, the mean values of D(1) and D(10) were 45 (±7) and 27 (±8)Gy, respectively. For the heart, the mean values of D(1), D(5) and D(10) were 21 (±15), 13.5 (±12) and 9 (±9)Gy, respectively. The mean values of TLD at various pre-specified locations on the chest wall surface were 1.84, 1.82, 1.82, 1.89 and 1.78Gy, respectively The electron arc technique for treating the bilateral chest wall is a feasible and pragmatic technique. This technique has the twin advantages of adequate coverage of the target volume and sparing of adjacent normal structures. However, compared with other techniques, it needs a firm quality assurance protocol for dosimetry and treatment delivery. Copyright © 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Design of a receiver operating characteristic (ROC) study of 10:1 lossy image compression

NASA Astrophysics Data System (ADS)

Collins, Cary A.; Lane, David; Frank, Mark S.; Hardy, Michael E.; Haynor, David R.; Smith, Donald V.; Parker, James E.; Bender, Gregory N.; Kim, Yongmin

1994-04-01

The digital archiving system at Madigan Army Medical Center (MAMC) uses a 10:1 lossy data compression algorithm for most forms of computed radiography. A systematic study on the potential effect of lossy image compression on patient care has been initiated with a series of studies focused on specific diagnostic tasks. The studies are based upon the receiver operating characteristic (ROC) method of analysis for diagnostic systems. The null hypothesis is that observer performance with approximately 10:1 compressed and decompressed images is not different from using original, uncompressed images for detecting subtle pathologic findings seen on computed radiographs of bone, chest, or abdomen, when viewed on a high-resolution monitor. Our design involves collecting cases from eight pathologic categories. Truth is determined by committee using confirmatory studies performed during routine clinical practice whenever possible. Software has been developed to aid in case collection and to allow reading of the cases for the study using stand-alone Siemens Litebox workstations. Data analysis uses two methods, ROC analysis and free-response ROC (FROC) methods. This study will be one of the largest ROC/FROC studies of its kind and could benefit clinical radiology practice using PACS technology. The study design and results from a pilot FROC study are presented.

Compressive orthotic bracing in the treatment of pectus carinatum: the use of radiographic markers to predict success.

PubMed

Stephenson, Jacob T; Du Bois, Jeffrey

2008-10-01

The treatment of pectus carinatum (PC) has classically been operative, though compressive orthotic braces have been used with good success in recent years. The purpose of this article is to evaluate the use of radiologic measurements in a successful bracing protocol. Sixty-three patients with PC have been evaluated for an 8-year span. The average age is 13.3 +/- 2.5. Follow-up is from 4 to 60 months, with a median of 24 months. Seventeen patients with mild defects elected observation alone. The remaining 46 patients began the bracing protocol. Baseline chest computed tomography (CT) was obtained, and custom-fitted orthotic braces were constructed for each patient. Radiographic markers were evaluated to include the Haller index, angle of sternal rotation, and asymmetry index. Patient surveys and chart review were used to identify compliance and success rates. Pretreatment CTs were retrospectively reviewed by bracing outcomes and radiographic measurements were compared. Ten patients received posttreatment CTs after successful bracing. Of 63 patients with PC, 17 patients (27%) with mild defects elected observation alone. The remaining 46 patients began the bracing protocol as described above. Of these, 10 are excluded from analysis, with 6 patients currently in the early treatment phase and 4 who have been lost to follow-up. Of the remaining 36 patients, 8 failed bracing because of noncompliance. Of the 28, 24 patients who completed treatment report either good or excellent results after bracing. Eight patients have required surgical intervention, 4 as a result of noncompliance and 4 who were compliant but failed bracing. In patients who were compliant, significant differences were seen on initial CT between those with successful outcomes and those who required surgical repair. Haller index (2.85 vs 2.05; P < .05), angle of sternal rotation (27.3 vs 14.8; P < .05), and asymmetry index (1.23 vs 1.06; P < .01) were all higher in the group who failed bracing. In those who successfully completed treatment, there was no significant difference in the Haller or asymmetry indices, but the average improvement in sternal rotation was 53.8%. Compressive orthotic bracing is a successful method of treatment of pectus carinatum. The associated sternal rotation can be significantly improved with appropriate bracing that results in a subjective improvement in the deformity. Asymmetry of chest diameter related to concomitant excavatum-type deformity is less likely to respond to bracing attempts. In this way, initial chest CT can be of value in treatment planning.

A hemodynamic-directed approach to pediatric cardiopulmonary resuscitation (HD-CPR) improves survival.

PubMed

Morgan, Ryan W; Kilbaugh, Todd J; Shoap, Wesley; Bratinov, George; Lin, Yuxi; Hsieh, Ting-Chang; Nadkarni, Vinay M; Berg, Robert A; Sutton, Robert M

2017-02-01

Most pediatric in-hospital cardiac arrests (IHCAs) occur in ICUs where invasive hemodynamic monitoring is frequently available. Titrating cardiopulmonary resuscitation (CPR) to the hemodynamic response of the individual improves survival in preclinical models of adult cardiac arrest. The objective of this study was to determine if titrating CPR to systolic blood pressure (SBP) and coronary perfusion pressure (CoPP) in a pediatric porcine model of asphyxia-associated ventricular fibrillation (VF) IHCA would improve survival as compared to traditional CPR. After 7min of asphyxia followed by VF, 4-week-old piglets received either hemodynamic-directed CPR (HD-CPR; compression depth titrated to SBP of 90mmHg and vasopressor administration to maintain CoPP ≥20mmHg); or Standard Care (compression depth 1/3 of the anterior-posterior chest diameter and epinephrine every 4min). All animals received CPR for 10min prior to the first defibrillation attempt. CPR was continued for a maximum of 20min. Protocolized intensive care was provided to all surviving animals for 4h. The primary outcome was 4-h survival. Survival rate was greater with HD-CPR (12/12) than Standard Care (6/10; p=0.03). CoPP during HD-CPR was higher compared to Standard Care (point estimate +8.1mmHg, CI 95 : 0.5-15.8mmHg; p=0.04). Chest compression depth was lower with HD-CPR than Standard Care (point estimate -14.0mm, CI95: -9.6 to -18.4mm; p<0.01). Prior to the first defibrillation attempt, more vasopressor doses were administered with HD-CPR vs. Standard Care (median 5 vs. 2; p<0.01). Hemodynamic-directed CPR improves short-term survival compared to standard depth-targeted CPR in a porcine model of pediatric asphyxia-associated VF IHCA. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.