As a consequence, ERC guidelines 2015 recommend the use of CPR feedback devices as part of a broader system of care that should include comprehensive CPR quality improvement initiatives, rather than as an isolated intervention. The clinical studies conducted to date had an insufficient power to demonstrate improved survival with the use of feedback devices. Metronomes generate regular audible beats that help rescuers to follow the rhythm, while feedback devices are more sophisticated they measure CPR performance in real time and provide audiovisual messages to guide the rescuer toward target depth and rate. In an effort to alleviate this problem, since 2010, resuscitation guidelines recommend monitoring CPR quality and using metronomes and real-time feedback systems to guide rescuers during resuscitation attempts. However, several studies have shown that both professionals and laypeople often apply CPR at improper rates and depths. Current resuscitation guidelines emphasize the importance of providing chest compressions with an adequate depth (between 5 and 6 cm) and rate (between 100 and 120 compressions per minute ), completely releasing the chest between compressions and minimizing interruptions. There is a strong evidence that the quality of chest compressions is related to the chance of successful defibrillation.
In out-of-hospital settings, early defibrillation is normally procured using an automated external defibrillator (AED). CPR consists of cycles of chest compressions and ventilations delivered to the patient to artificially maintain a minimal flow of oxygenated blood to the vital organs, whereas defibrillation consists in the passage of electrical current through the myocardium (cardiac muscle) to terminate certain lethal arrhythmias. The four links of the chain of survival are important, but early CPR and early defibrillation are pivotal for a successful outcome of the patient.
The sequence of actions linking a victim of out-of-hospital cardiac arrest with survival is described by the chain of survival, which consists of four independent links: early activation of the emergency medical services, early cardiopulmonary resuscitation (CPR), early defibrillation, and early advanced care. Development of simpler methods to provide feedback on CPR quality could contribute to the widespread of these devices. However, compression rate could be accurately estimated. When a wide variety of patients and rescuers were included, TI could not be used to reliably estimate the compression depth. For that purpose, we retrospectively analyzed three databases of out-of-hospital cardiac arrest episodes. Then, we assessed the feasibility of using the transthoracic impedance (TI) signal acquired through defibrillation pads to provide feedback on chest compression depth and rate. One of the methods, based on the spectral analysis of the acceleration, was particularly accurate in a wide range of conditions. To evaluate the accuracy of the methods, we used episodes of simulated cardiac arrest acquired in a manikin model. First, we describe and evaluate three methods to compute chest compression depth and rate using exclusively the chest acceleration. This chapter explores new alternatives to provide feedback on the quality of chest compressions during CPR. The use of real-time feedback devices increases adherence to CPR quality guidelines. During cardiopulmonary resuscitation (CPR), chest compression quality is the key for patient survival.
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