title: Providers with Limited Experience Perform Better in Advanced Life Support with Assistance Using an Interactive Device with an Automated External Defibrillator Linked to a Ventilator.
abstract: BACKGROUND
  Medical teams with limited experience in performing advanced life support (ALS) or with a low frequency of cardiopulmonary resuscitation (CPR) while on duty, often have difficulty complying with CPR guidelines.
  
  
  OBJECTIVE
  This study evaluated whether the quality of CPR of trained medical students, who served as an example of teams with limited experience in ALS, could be improved with device assistance. The primary outcome was the hands-off time (i.e., the percentage of the entire CPR time without chest compressions). The secondary outcome was seven time intervals, which should be as short as possible, and the quality of ventilations and chest compressions on the mannequin.
  
  
  METHODS
  We compared standard CPR equipment to an interactive device with visual and acoustic instructions for ALS workflow measures to guide briefly trained medical students through the ALS algorithm in a full-scale mannequin simulation study with a randomized crossover study design. The study equipment consisted of an automatic external defibrillator and ventilator that were electronically linked and communicating as a single system. Included were regular medical students in the third to sixth years of medical school of one class who provided written informed consent for voluntary participation and for the analysis of their CPR performance data. No exclusion criteria were applied. For statistical measures of evaluation we used an analysis of variance for crossover trials accounting for treatment effect, sequence effect, and carry-over effect, with adjustment for prior practical experience of the participants.
  
  
  RESULTS
  Forty-two medical students participated in 21 CPR sessions, each using the standard and study equipment. Regarding the primary end point, the study equipment reduced the hands-off time from 40.1% (95% confidence interval [CI] 36.9-43.4%) to 35.6% (95% CI 32.4-38.9%, p = 0.031) compared with the standard equipment. Within the prespecified secondary end points, study equipment reduced the time interval until the first rescuer changeover from 273 s (95% CI 244-302 s) to 223 s (95% CI 194-253 s, p = 0.001) and increased the percentage of ventilations with a correct tidal volume of 400-600 mL from 34.3% (95% CI 19.0-49.6%) to 60.9% (95% CI 45.6-76.2%, p = 0.018).
  
  
  CONCLUSIONS
  The assist device increased the rescuers' CPR quality. CPR providers with limited experience or a limited frequency of CPR performance (i.e., rural Emergency Medical Services crew) may potentially benefit from this assist device.
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christian Werner
authors.initials: CW
authors.lastname: Busch
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Qalanawi
authors.affiliation: Department of Medical Biometry and Epidemiology of the University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jan Felix
authors.initials: JF
authors.lastname: Kersten
authors.affiliation: WEINMANN Emergency Medical Technology, Hamburg, Germany.
authors.forename: Tobias Johannes
authors.initials: TJ
authors.lastname: Kalwa
authors.affiliation: WEINMANN Emergency Medical Technology, Hamburg, Germany.
authors.forename: Norman Alexander
authors.initials: NA
authors.lastname: Scotti
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Wikhart
authors.initials: W
authors.lastname: Reip
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Doehn
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Maisch
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Nitzschke
mesh_terms: D000328:Adult; D022561:Advanced Cardiac Life Support / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D000704:Analysis of Variance; D018592:Cross-Over Studies; D047548:Defibrillators; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008348:Manikins; D012123:Pulmonary Ventilation; D011787:Quality of Health Care / Q000592:standards*; D013997:Time Factors
keywords: advanced cardiac life support; cardiopulmonary resuscitation; equipment and supplies; heart arrest