Video-recording and time-motion analyses of manual versus mechanical cardiopulmonary resuscitation during ambulance transport.
BACKGROUND
The quality of cardiopulmonary resuscitation (CPR) plays a crucial role in saving lives from out-of-hospital cardiac arrest (OHCA). Previous studies have identified sub-optimal CPR quality in the prehospital settings, but the causes leading to such deficiencies were not fully elucidated.


OBJECTIVE
This prospective study was conducted to identify operator- and ambulance-related factors affecting CPR quality during ambulance transport; and to assess the effectiveness of mechanical CPR device in such environment.


METHODS
A digital video-recording system was set up in two ambulances in Taipei City to study CPR practice for adult, non-traumatic OHCAs from January 2005 to March 2006. Enrolled patients received either manual CPR or CPR by a mechanical device (Thumper). Quality of CPR in terms of (1) adequacy of chest compressions, (2) instantaneous compression rates, and (3) unnecessary no-chest compression interval, was assessed by time-motion analysis of the videos.


RESULTS
A total of 20 ambulance resuscitations were included. Compared to the manual group (n=12), the Thumper group (n=8) had similar no-chest compression interval (33.40% versus 31.63%, P=0.16); significantly lower average chest compression rate (113.3+/-47.1 min(-1) versus 52.3+/-14.2 min(-1), P<0.05), average chest compression rate excluding no-chest compression interval (164.2+/-43.3 min(-1) versus 77.2+/-6.9 min(-1), P<0.05), average ventilation rate (16.1+/-4.9 min(-1) versus 11.7+/-3.5 min(-1), P<0.05); and longer no-chest compression interval before getting off the ambulance (5.7+/-9.9s versus 18.7+/-9.1s, P<0.05). The majority of the no-chest compression interval was considered operator-related; only 15.3% was caused by ambulance related factors.


CONCLUSIONS
Many unnecessary no-chest compression intervals were identified during ambulance CPR, and most of this was operator, rather than ambulance related. Though a mechanical device could minimise the no-chest compression intervals after activation, it took considerable time to deploy in a system with short transport time. Human factors remained the most important cause of poor CPR quality. Ways to improve the CPR quality in the ambulance warrant further study.
Wang
Hui-Chih
HC
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chiang
Wen-Chu
WC
Chen
Shey-Ying
SY
Ke
Yi-Ling
YL
Chi
Chun-Lin
CL
Yang
Chih-Wei
CW
Lin
Pei-Ching
PC
Ko
Patrick Chow-In
PC
Wang
Yao-Cheng
YC
Tsai
Tsung-Che
TC
Huang
Chien-Hwa
CH
Hsiung
Kuan-Hwa
KH
Ma
Matthew Huei-Ming
MH
Chen
Shyr-Chyr
SC
Chen
Wen-Jone
WJ
Lin
Fang-Yue
FY
D000368:Aged; D000552:Ambulances; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D014187:Transportation of Patients; D014741:Video Recording / Q000379:methods*