title: Comparative quality analysis of hands-off time in simulated basic and advanced life support following European Resuscitation Council 2000 and 2005 guidelines.
abstract: OBJECTIVE
  To compare hands-off time (HOT) in simulated advanced life support (ALS) following European Resuscitation Council (ERC) 2005 guidelines and ERC 2000 and to provide quantitative data on workflow.
  
  
  METHODS
  Observations with 18 professional paramedics, performing 39 megacodes (mega-code training; MCT) were videotaped during ALS re-certification. Teams were randomly assigned to train according to ERC 2000 or ERC 2005. HOT, hands-off intervals (HOI) and other variables describing interventions and workflow were analysed.
  
  
  RESULTS
  In group ERC 2000 17±3 HOI appeared with a mean duration of 17.5±10.8 s (mean±SD). Overall HOT was 382±47 s, equivalent to a mean hands-off fraction (HOF) of 0.45±0.05. 15±5 ventilation-free intervals (VFI) were observed, with a mean duration of 21±10 s. In contrast after ERC 2005 variables resulted in 18±3 HOI with a mean duration of 10.0±4.0 s (p<0.001 vs ERC 2000), overall HOT 196±33 s (HOF 0.23±0.04; p<0.001), 24±12 VFI with a duration of 24±7 s (p<0.05). The first HOI lasted for 60.4±33.1 s in ERC 2000 and 17.6±4.3 s in ERC 2005 (p<0.001). In ERC 2000 6.1±2.6 interruptions for two bag/mask ventilations (BMV) lasted for 5.4±0.8 s, whereas in ERC 2005 9.6±3.1 interruptions for two BMV took 6.5±2.2 s (p<0.001). In both groups HOI were used thoroughly for basic life support/ALS-based interventions.
  
  
  CONCLUSIONS
  The application of ERC guidelines of 2005 markedly reduced the first HOI and mean duration of HOI at the cost of delayed secure airway management and ECG analysis in this MCT model.
authors.affiliation: Clinic of Anaesthesiology, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Ilper
authors.forename: Tina
authors.initials: T
authors.lastname: Kunz
authors.forename: Holger
authors.initials: H
authors.lastname: Pfleger
authors.forename: Richard
authors.initials: R
authors.lastname: Schalk
authors.forename: Christian
authors.initials: C
authors.lastname: Byhahn
authors.forename: Hanns
authors.initials: H
authors.lastname: Ackermann
authors.forename: Raoul
authors.initials: R
authors.lastname: Breitkreutz
mesh_terms: D022561:Advanced Cardiac Life Support / Q000379:methods; D000465:Algorithms; D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000379:methods / Q000592:standards*; D004634:Emergency Medical Technicians / Q000193:education; D006801:Humans; D016544:Patient Simulation; D017410:Practice Guidelines as Topic; D013997:Time Factors