title: Effect of an interactive cardiopulmonary resuscitation assist device with an automated external defibrillator synchronised with a ventilator on the CPR performance of emergency medical service staff: a randomised simulation study.
abstract: BACKGROUND
  The present study evaluates whether the quality of advanced cardiac life support (ALS) is improved with an interactive prototype assist device. This device consists of an automated external defibrillator linked to a ventilator and provides synchronised visual and acoustic instructions for guidance through the ALS algorithm and assistance for face-mask ventilations.
  
  
  METHODS
  We compared the cardiopulmonary resuscitation (CPR) quality of emergency medical system (EMS) staff members using the study device or standard equipment in a mannequin simulation study with a prospective, controlled, randomised cross-over study design. Main outcome was the effect of the study device compared to the standard equipment and the effect of the number of prior ALS trainings of the EMS staff on the CPR quality. Data were analysed using analyses of covariance (ANCOVA) and binary logistic regression, accounting for the study design.
  
  
  RESULTS
  In 106 simulations of 56 two-person rescuer teams, the mean hands-off time was 24.5% with study equipment and 23.5% with standard equipment (Difference 1.0% (95% CI: -0.4 to 2.5%); p = 0.156). With both types of equipment, the hands-off time decreased with an increasing cumulative number of previous CPR trainings (p = 0.042). The study equipment reduced the mean time until administration of adrenaline (epinephrine) by 23 s (p = 0.003) and that of amiodarone by 17 s (p = 0.016). It also increased the mean number of changes in the person doing chest compressions (0.6 per simulation; p < 0.001) and decreased the mean number of chest compressions (2.8 per minute; p = 0.022) and the mean number of ventilations (1.8 per minute; p < 0.001). The chance of administering amiodarone at the appropriate time was higher, with an odds ratio of 4.15, with the use of the study equipment CPR.com compared to the standard equipment (p = 0.004). With an increasing number of prior CPR trainings, the time intervals in the ALS algorithm until the defibrillations decreased with standard equipment but increased with the study device.
  
  
  CONCLUSIONS
  EMS staff with limited training in CPR profit from guidance through the ALS algorithm by the study device. However, the study device somehow reduced the ALS quality of well-trained rescuers and thus can only be recommended for ALS provider with limited experience.
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. r.nitzschke@uke.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Nitzschke
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Doehn
authors.affiliation: Department of Medical Biometry and Epidemiology of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jan F
authors.initials: JF
authors.lastname: Kersten
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Blanz
authors.affiliation: WEINMANN Emergency Medical Technology, Hamburg, Germany.
authors.forename: Tobias J
authors.initials: TJ
authors.lastname: Kalwa
authors.affiliation: WEINMANN Emergency Medical Technology, Hamburg, Germany.
authors.forename: Norman A
authors.initials: NA
authors.lastname: Scotti
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Jens C
authors.initials: JC
authors.lastname: Kubitz
mesh_terms: D000328:Adult; D000465:Algorithms; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000592:standards*; D018592:Cross-Over Studies; D047548:Defibrillators; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D008397:Masks; D011446:Prospective Studies; D000066908:Simulation Training / Q000592:standards*; D012122:Ventilators, Mechanical; D055815:Young Adult
keywords: Advanced life support; CPR assist devices; Cardiopulmonary resuscitation; Education and simulation; Emergency medical service