Evaluation of manual chest compressions according to the updated cardiopulmonary resuscitation guidelines and the impact of feedback devices in an educational resuscitation course.

BACKGROUND: The cardiopulmonary resuscitation guidelines revised in 2015 recommend target chest compression rate (CCR) and chest compression depth (CCD) of 100-120 compressions per minute (cpm) and 5-6 cm, respectively. We hypothesized that the new guidelines are harder to comply with, even with proper feedback. METHODS: This prospective observational study using data collected from the participants of an Immediate Cardiac Life Support course included the evaluation of chest compressions using performance data from a feedback device after the completion of the course. Participants completed chest compressions for 1 min and were provided with feedback, after which they performed another cycle of CC. Primary outcome measures were CCR and CCD as well as the correct CCR percentage and CCD percentage for pre and post feedback. RESULTS: The study included a total of 88 participants. The median pre-CCR was 112.5 cpm (interquartile range [IQR] 108-116 cpm), and the median correct pre-CCR percentage was 96% (IQR 82.5-99.5%). After the feedback, there was a slight increase in the correct CCR percentage (99% [IQR 92.5-100%]). Conversely, the median pre-CCD was 5.4 cm (IQR 4.9-5.8 cm), and the median pre-correct CCD percentage was 66% (IQR 18.5-90%). The increase in the median post-correct CCD percentage to 72% (IQR 27-94%) observed after the feedback was not statistically significant (P = 0.361). CONCLUSIONS: Compliance with the new guidelines for chest compressions, especially those regarding the CCD, might be difficult. However, whether the changes in guidelines affect outcomes in actual clinical settings is uncertain and requires further investigation.

Resuscitative endovascular balloon occlusion of the aorta might be dangerous in patients with severe torso trauma: A propensity score analysis.

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a key procedure in early trauma care that provides hemorrhage control in hemodynamically unstable torso trauma patients. However, the clinical efficacy of REBOA remains uncertain. The objective of this study was to estimate the efficacy of REBOA in surgically treated severe torso trauma patients. METHODS: We obtained data from the nationwide trauma registry in Japan (the Japan Trauma Data Bank) for trauma subjects who had undergone emergency surgery or transcatheter embolization against torso trauma. A logistic regression analysis estimated a propensity score to predict REBOA use from available predictors of in-hospital mortality. We then used a propensity score matching analysis to compare in-hospital mortality and door-to-primary surgery time in subjects who underwent REBOA and those who did not. In addition, we used an instrumental variable method to adjust for unmeasured confounding variables as a sensitivity analysis. RESULTS: Overall, 12,053 of the 183,457 trauma patients registered in the Japan Trauma Data Bank were eligible based on selection criteria. Propensity score matching selected 625 patients each for the with-REBOA and without-REBOA groups. The in-hospital mortality was significantly higher in subjects who underwent REBOA (61.8% vs. 45.3%; absolute difference, +16.5%; 95% confident interval, +10.9% to +22.0%). Door-to-primary surgery time was shorter in subjects who underwent REBOA than in those who did not (97 minutes vs. 110 minutes; absolute difference, -14 minutes; 95% confidence interval, -25 minutes to -3 minutes). The sensitivity analysis with the instrumental variable method did not alter the results and estimated nonsignificantly higher in-hospital mortality in REBOA subjects (+16.4%; 95% confidence interval, -0.6% to 33.3%). CONCLUSION: This study showed an association between the use of REBOA and excess mortality in patients with hemodynamically unstable torso trauma that had a median door-to-primary surgery time of 97 minutes. Further observational studies with detailed REBOA data are necessary to assess whether selected trauma subgroups could benefit from REBOA. LEVEL OF EVIDENCE: Therapeutic study, level III.