Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-28T11:39:53.975Z Has data issue: false hasContentIssue false
  • English
  • Français

Can a Software-Based Metronome Tool Enhance Compression Rate in a Realistic 911 Call Scenario Without Adversely Impacting Compression Depth for Dispatcher-Assisted CPR?

Published online by Cambridge University Press:  23 July 2018

Greg Scott ,
Tracey Barron ,
Isabel Gardett ,
Meghan Broadbent ,
Holly Downs ,
Leslie Devey ,
EJ Hinterman ,
Jeff Clawson  and
Christopher Olola
Greg Scott
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
Tracey Barron
Affiliation:
International Academies of Emergency Dispatch, Bristol, United Kingdom
Isabel Gardett
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
Meghan Broadbent
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
Holly Downs
Affiliation:
Salt Lake Valley Emergency Communications Center, West Valley, UtahUSA
Leslie Devey
Affiliation:
Salt Lake Valley Emergency Communications Center, West Valley, UtahUSA
EJ Hinterman
Affiliation:
United Fire Authority, Salt Lake City, UtahUSA
Jeff Clawson*
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
Christopher Olola
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
*
Correspondence: Isabel Gardett, PhD International Academies of Emergency Dispatch 110 Regent Street Salt Lake City, Utah 84111 USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Implementation of high-quality, dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is critical to improving survival from out-of-hospital cardiac arrest (OHCA). However, despite some studies demonstrating the use of a metronome in a stand-alone setting, no research has yet demonstrated the effectiveness of a metronome tool in improving DA-CPR in the context of a realistic 911 call or using instructions that have been tested in real-world emergency calls.

Hypothesis

Use of the metronome tool will increase the proportion of callers able to perform CPR within the target rate without affecting depth.

Methods

The prospective, randomized, controlled study involved simulated 911 cardiac arrest calls made by layperson-callers and handled by certified emergency medical dispatchers (EMDs) at four locations in Salt Lake City, Utah USA. Participants were randomized into two groups. In the experimental group, layperson-callers received CPR pre-arrival instructions with metronome assistance. In the control group, layperson-callers received only pre-arrival instructions. The primary outcome measures were correct compression rate (counts per minute [cpm]) and depth (mm).

Results

A total of 148 layperson-callers (57.4% assigned to experimental group) participated in the study. There was a statistically significant association between the number of participants who achieved the target compression rate and experimental study group (P=.003), and the experimental group had a significantly higher median compression rate than the control group (100 cpm and 89 cpm, respectively; P=.013). Overall, there was no significant correlation between compression rate and depth.

Conclusion:

An automated software metronome tool is effective in getting layperson-callers to achieve the target compression rate and compression depth in a realistic DA-CPR scenario.

Scott G, Barron T, Gardett I, Broadbent M, Downs H, Devey L, Hinterman EJ, Clawson J, Olola C. Can a software-based metronome tool enhance compression rate in a realistic 911 call scenario without adversely impacting compression depth for dispatcher-assisted CPR? Prehosp Disaster Med. 2018;33(4):399–405

Keywords

automated metronomedispatcher-assisted CPRemergency dispatch protocolsemergency medical dispatchMedical Priority Dispatch Systempre-arrival instructions
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 4 , August 2018 , pp. 399 - 405
Copyright
© World Association for Disaster and Emergency Medicine 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: Dr. Clawson is the original creator of the MPDS protocol system studied. All other authors have no conflicts of interest to declare.

References

1. Institute of Medicine. Strategies to improve cardiac arrest survival: a time to act. http://www.nationalacademies.org/hmd/Reports/2015/Strategies-to-improve-cardiac-arrest-survival.aspx. Published June 30, 2015. Accessed May 30, 2017.Google Scholar
2. Neumar, RW, Shuster, M, Callaway, CW, et al. 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18): suppl 2.Google Scholar
3. Bobrow, BJ, Eisenberg, MS, Panczyk, M. The Institute of Medicine says it’s time to improve cardiac arrest survival: here’s how. Ann Emerg Med. 2016;67(4):492-495.Google Scholar
4. Hopkins, CL, Burk, C, Moser, S, Meersman, J, Baldwin, C, Youngquist, S. Implementation of pit crew approach and cardiopulmonary resuscitation metrics for out-of-hospital cardiac arrest improves patient survival and neurological outcome. J Am Heart Assoc. 2016;5(1):e002892.Google Scholar
5. Levy, M, Yost, D, Walker, RG, Scheunemann, E, Mendive, SR. A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation. Resuscitation. 2015;92:32-37.Google Scholar
6. Hansen, CM, Kragholm, K, Pearson, DA, et al. Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010-2013. JAMA. 2015;314(3):255-264.Google Scholar
7. Persse, DE, Key, CB, Bradley, RN, Miller, CC, Dhingra, A. Cardiac arrest survival as a function of ambulance deployment strategy in a large urban emergency medical services system. Resuscitation. 2003;59(1):97-104.Google Scholar
8. Eckstein, M, Stratton, SJ, Chan, LS. Cardiac arrest evaluation in Los Angeles: CARE-LA. Ann Emerg Med. 2005;45(5):504-509.Google Scholar
9. Jimenez, CJ, Padro, PP, Garcia, AS, et al. Analysis of the response time to a cardiac arrest in an emergency medical system. Resuscitation. 2012;83(s1):e6.Google Scholar
10. Conway, AB, McDavid, A, Emert, JM, Kudenchuk, PJ, Stubbs, BA, Rea, TD. Impact of building height and volume on cardiac arrest response time. Prehosp Emerg Care. 2016;20(2):212-219.Google Scholar
11. Sladjana, A, Gordana, P, Ana, S. Emergency response time after out-of-hospital cardiac arrest. Eur J Int Med. 2011;22(4):386-393.Google Scholar
12. Larsen, MP, Eisenberg, MS, Cummins, RO, Hallstrom, AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med. 1993;22(11):1652-1658.Google Scholar
13. Gold, LS, Fahrenbruch, CE, Rea, TD, Eisenberg, MS. The relationship between time to arrival of Emergency Medical Services and survival from out-of-hospital ventricular fibrillation cardiac arrest. Resuscitation. 2010;81(5):622-625.Google Scholar
14. Song, KJ, Shin, SD, Park, CB, et al. Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: a before – after population-based study. Resuscitation. 2014;85:34-41.Google Scholar
15. Rea, TD, Eisenberg, MS, Culley, LL, Becker, L. Dispatcher-assisted cardiopulmonary resuscitation and survival in cardiac arrest. Circulation. 2001;104(21):2513-2516.Google Scholar
16. Lewis, M, Stubbs, BA, Eisenberg, MS. Dispatcher-assisted cardiopulmonary resuscitation: time to identify cardiac arrest and deliver chest compression instructions. Circulation. 2013;128(14):1522-1530.Google Scholar
17. Rasmussen, ES, Nebsbjerg, MA, Krogh, LQ, et al. A novel protocol for dispatcher assisted CPR improves CPR quality and motivation among rescuers—a randomized controlled simulation study. Resuscitation. 2017;110:74-80.Google Scholar
18. Park, SO, Hong, CK, Shin, DH, Lee, JH, Hwang, SY. Efficacy of metronome sound guidance via a phone speaker during dispatcher-assisted compression-only cardiopulmonary resuscitation by an untrained layperson: a randomized controlled simulation study using a mannikin. Emerg Med J. 2013;30(8):657-661.Google Scholar
19. Kim, SE, Lee, SJ, Lee, DH, Lim, JH, Kim, CW. Effects on the quality of compression-only, cardiopulmonary resuscitation performance according to the methods of telephone-assisted instructions of dispatcher by untrained laypersons. Resuscitation. 2013;84(6):e67-e68.Google Scholar
20. Kern, KB, Stickney, RE, Gallison, L, et al. Metronome improves compression and ventilation rates during CPR on a manikin in a randomized trial. Resuscitation. 2010;81(2):206-210.Google Scholar
21. Oh, JH, Lee, SJ, Kim, SE, et al. Effects of audio tone guidance on performance of CPR in simulated cardiac arrest with an advanced airway. Resuscitation. 2008;79(2):273-277.Google Scholar
22. Jantti, H, Silfvast, T, Turpeinen, A, et al. Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins. Resuscitation. 2009;80(4):453-457.Google Scholar
23. Park, SO, Hong, CK, Shin, DH, et al. Efficacy of metronome sound guidance via phone speaker during dispatcher-assisted compression-only cardiopulmonary resuscitation by an untrained layperson: a randomized controlled simulation study using a manikin. Emerg Med. 2013;30(8):657-661.Google Scholar
24. R Core Team 2017. R: A language and environment for statistical computing. R Foundation for Statistical Computing; Vienna, Austria. https://www.R-project.org/. Accessed September 26, 2017.Google Scholar
25. Kim, SC, Hwang, SO, Cha, KC, et al. A simple audio-visual prompt device can improve CPR performance. J Emerg Med. 2013;44(1):128-134.Google Scholar
26. Chung, TN, Kim, SW, You, JS, et al. The specific effect of metronome guidance on the quality of one-person cardiopulmonary resuscitation and rescuer fatigue. J Emerg Med. 2012;43(6):1049-1054.Google Scholar
27. Hafner, JW, Jou, AC, Wang, H, Bleess, BB, Tham, SK. Death before disco: the effectiveness of a musical metronome in layperson cardiopulmonary resuscitation training. J Emerg Med. 2015;48(1):43-52.Google Scholar
28. Monsieurs, G, DeMelissa, R, Vansteelandt, K, et al. Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest. Resuscitation. 2012;83(11):1319.Google Scholar
29. Bae, J, Chung, TN, Je, SM. Effect of the rate off chest compression familiarized in previous training on the depth of chest compression during metronome-guided cardiopulmonary resuscitation: a randomized crossover trial. BMJ Open. 2016;6:e010873.Google Scholar
30. Stiell, IG, Brown, PB, Nichol, G, et al. What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients? Circulation. 2014;130(22):1962-1970.Google Scholar