title: Obstacles delaying the prompt deployment of piston-type mechanical cardiopulmonary resuscitation devices during emergency department resuscitation: a video-recording and time-motion study.
abstract: BACKGROUND
  The quality of cardiopulmonary resuscitation (CPR) is important to survival after cardiac arrest. Mechanical devices (MD) provide constant CPR, but their effectiveness may be affected by deployment timeliness.
  
  
  OBJECTIVE
  To identify the timeliness of the overall and of each essential step in the deployment of a piston-type MD during emergency department (ED) resuscitation, and to identify factors associated with delayed MD deployment by video recordings.
  
  
  METHODS
  Between December 2005 and December 2008, video clips from resuscitations with CPR sessions using a MD in the ED were reviewed using time-motion analyses. The overall deployment timeliness and the time spent on each essential step of deployment were measured.
  
  
  RESULTS
  There were 37 CPR recordings that used a MD. Deployment of MD took an average 122.6 ± 57.8s. The 3 most time-consuming steps were: (1) setting the device (57.8 ± 38.3s), (2) positioning the patient (33.4 ± 38.0 s), and (3) positioning the device (14.7 ± 9.5s). Total no flow time was 89.1 ± 41.2s (72.7% of total time) and associated with the 3 most time-consuming steps. There was no difference in the total timeliness, no-flow time, and no-flow ratio between different rescuer numbers, time of day of the resuscitation, or body size of patients.
  
  
  CONCLUSIONS
  Rescuers spent a significant amount of time on MD deployment, leading to long no-flow times. Lack of familiarity with the device and positioning strategy were associated with poor performance. Additional training in device deployment strategies are required to improve the benefits of mechanical CPR.
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Edward Pei-Chuan
authors.initials: EP
authors.lastname: Huang
authors.forename: Hui-Chih
authors.initials: HC
authors.lastname: Wang
authors.forename: Patrick Chow-In
authors.initials: PC
authors.lastname: Ko
authors.forename: Anna Marie
authors.initials: AM
authors.lastname: Chang
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Fu
authors.forename: Jiun-Wei
authors.initials: JW
authors.lastname: Chen
authors.forename: Yen-Chen
authors.initials: YC
authors.lastname: Liao
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Liu
authors.forename: Yao-De
authors.initials: YD
authors.lastname: Fang
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.forename: Wen-Chu
authors.initials: WC
authors.lastname: Chiang
authors.forename: Matthew Huei-Ming
authors.initials: MH
authors.lastname: Ma
authors.forename: Shyr-Chyr
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D047548:Defibrillators; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods; D004636:Emergency Service, Hospital; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013624:Taiwan; D013996:Time and Motion Studies; D016896:Treatment Outcome; D014741:Video Recording
keywords: Cardiopulmonary resuscitation (CPR); Mechanical devices; No-flow time; Quality; Time-motion analysis; Video-recording