Immediate Feedback = CPR Success

Ambu Smartman CPR

When we’re trying to learn a new skill, whether it’s learning to play the guitar, writing an essay, or performing CPR, the immediacy of the feedback we receive is a critical factor affecting how quickly we improve our skills.

If, over time, we continually perform an action incorrectly, it becomes more entrenched in our memory – and more difficult to correct at a later time.  Imagine a golfer with a swing that consistently produces a hook.  If after several years she attempts fix her swing, it will be an uphill battle in comparison to addressing the problem the moment the hook first emerged.

The same logic applies to CPR training.

As a leader in the development of medical education workshops, Iridia Medical understands the importance of immediate feedback when learning CPR.  That’s why, earlier this year, we introduced a cutting-edge, new manikin called the Ambu SmartMan in our educational workshops.

The Ambu SmartMan is an award-winning, innovative training tool that helps healthcare providers improve their CPR and Bag-Mask Ventilation skills.  It connects via USB to a computer and provides real-time visual feedback results while students are performing CPR.

The feedback provided assesses performance quality according to:

  • Compression depth and ration
  • Chest recoil during compressions
  • Frequency of ventilations
  • Volume of air and ration of air delivery during compressions

Ambu Smartman CPR Demo

Colour-coded bars depict the quality of each compression and ventilation that is being performed on the manikin.  For example, red bars indicate that chest compressions are not deep enough; upon seeing this information in real-time, the student can quickly adjust her method to achieve the desired green colour.

Ambu SmartMan also allows for two students to practice a coordinated response to a Sudden Cardiac Arrest.  If students are too slow to initiate CPR, or perform out of sync, the manikin will slowly show vital signs deteriorating. 

Recently, in controlled tests, EMS magazine reported that with only one minute of the Ambu SmartMan feedback training, CPR providers were able to improve their CPR performance from a score of 20% to 80%.

When it comes to CPR, performing the steps quickly, calmly, and at a high level of competency can mean the difference between life and death.  Ambu SmartMan offers an objective means to measure our CPR skills and competency and facilitates continual improvement of CPR skills.

Ambu Smartman CPR Demo

As always, Iridia Medical is dedicated to providing the best equipment, instructors, content, and learning environment to its students. 

We invite you to stop by the office and get your hands on the chest of the AmbuSmartman to see how it can improve your CPR skills! 

For more information on the Ambu SmartMan or any of our upcoming education workshops, please contact us at 604-685-4747.

 

Make Way, Here’s the Future of CPR

Cardiopulmonary Resuscitation (CPR) has always demanded the utmost skill and accuracy from first responders. Unfortunately, without intensive training and re-certification, CPR skills can deteriorate over time – even in as little as six months (learn more about CPR Retention).

For this reason, Iridia Medical has partnered with Physio-Control to help distribute their innovative TrueCPR coaching device to Canadian first responders.

truecpr

TrueCPR

In simple terms, TrueCPR is a portable device that measures CPR quality on the fly. TrueCPR is able to take the guesswork out of CPR by providing real-time feedback to healthcare professionals – leading to better outcomes.  

From Physio-Control:

“The best outcomes demand the best CPR. Simple enough to say, but in the heat of a cardiac resuscitation, accurately assessing CPR performance—even knowing your true chest compression depth, rate and recoil—can be anything but easy. And in your world, the constant drive for performance improvement makes the challenge of measuring CPR quality more critical than ever.”

TrueCPR differs from other devices in two important areas: TrueCPR works in conjunction with any brand defibrillator and it measures sternal-spinal displacement using three-dimensional magnetic fields.

During an Event

Once the device has been placed on the chest, it immediately begins to analyze, measure and benchmark the quality of CPR delivered – establishing a feedback loop for response teams.

TrueCPR

During chest compressions TrueCPR shows you exactly what you are doing right and where you need improvement. Compression depth, rate and recoil are displayed in real time on a highly visible dial on the patient’s chest. In addition, a CPR metronome and ventilation prompts guide responders to provide CPR per recommended rates.

After an Event

After CPR has been performed, statistics such as average rate, percentage of compressions at the correct depth and recoil, hands-on time and total event time are displayed and provide a snapshot of event performance.

TrueCPR

Up to 180 minutes of CPR information can be assessed, which will allow reviewers to evaluate overall performance and establish feedback loop for continuous CPR improvement.

Iridia believes TrueCPR will give healthcare professionals the tool they need to deliver the best possible CPR and the continued feedback necessary to retain their CPR skills.

We are very interested in TrueCPR feedback from healthcare professionals such as fire rescue personnel, physicians, paramedics, nurses, life-guards and other first responders. If you would like to test this device out for yourself, we invite you to stop by our office in Vancouver. For more information, please contact us.

TrueCPR

Iridia Founder Dr. Allan Holmes giving TrueCPR a test drive.

Learn more about TrueCPR

 

Resuscitation and ETCO2: So what’s the use?

Resuscitation and ETCO2

Remember back in 2005 when it became ACLS Guideline directed practice to resume CPR immediately after defibrillation. Did that freak you out? Do you still pause after defibrillation, and try to sneak a quick peak at the monitor to check for a life sustaining rhythm?  Do you delay chest compressions to quickly feel for a pulse? If you answered, “yes” to either or both of these questions, perhaps you are doing so propelled by a combination of hope and or fear. Hope that your efforts at defibrillation were successful, and fear that your ongoing resuscitation efforts will cause harm. Indeed after defibrillation, the curious practitioner is left to wonder “what if our shock was successful and we obtained return of spontaneous circulation [ROSC], could we cause harm with chest compressions or by pushing IV epinephrine?”  At first glance delaying a rhythm and pulse check can feel like a great leap of faith, and for some members of the resuscitation community this leap represents a significant clinical hurdle to overcome. The 2010 ACLS Guidelines have given us a way to jump over that hurdle and keep on running safely through our resuscitations. In this latest iteration, emphasis has been placed on continuous waveform or capnometric ETCO2 monitoring. Achieved in cardiac arrest by inserting a line onto an advanced airway to a receiving monitor, this metric is used not only for ongoing confirmation of advanced airways, but also provides real time breath-by-breath physiological evaluation of patients. The study of capnography is multi-faceted and as a simplified statement normal values are 35-45 mm/Hg. The waveform below shows a patient with an ETCO2 of 34 mm/Hg: ETCO2 Naturally a pulseless patient, who has no pulmonary circulation, will in turn have no ETCO2. However when high quality CPR is performed, the exhaled ETCO2 jumps from 0 mm/Hg to greater than 10mm/Hg.  If during compressions, the ETCO2 lowers; code team members should turn their attention to the quality of the CPR being given. Rescuer fatigue for instance can dramatically decrease chest compression efficiency. The waveform below shows a patient receiving CPR with an ETCO2 rising from around 10 to 16 mm/Hg: ETCO2 If during high quality CPR there is a return of spontaneous circulation then the ETCO2 will display “an abrupt sustained increase” and as shown below will jump into the 35-45 mm/Hg range. ETCO2 This is how employing the use of continuous ETCO2 monitoring during CPR, that resuscitators are provided with insight into the outcome of their defibrillation attempts and with a window to ROSC. Indeed it is this information that allows clinicians to jump over the hurdle described above, and to gain an increased sense of comfort with the decision to resume chest compressions immediately after defibrillation. CPR

    Darin Abbey RN Clinical Nurse Educator Emergency Department Nanaimo Regional General Hospital

Medical Director Update – BC Ambulance AEDs reconfiguration

BC Ambulance AEDs

A recent memo was circulated by the Director of First Responder Services Randy Shaw regarding the reconfiguration of the BC Ambulance AEDs. In part this memo outlines the following. The BCAS AEDs are being reset to eliminate the “charge‐up whine” when a shockable rhythm is detected and instead prompt the responders to resume CPR – See appendix 1 for the complete memo.

This AED reconfiguration is being done to encourage crews to continue chest compressions during the charge‐up phase of the AED and is one more step in maximizing time on the chest.

Although I am in agreement in principle with this initiative, it has come to my attention that there may be a considerable cost for some Fire Service AEDs to be reconfigured. This cost depends on the software version installed in the AED. In discussions with BCAS and the Emergency Health Services Commission, the following is recommended based on the model of AED and the software version:

lp500/1000

1. LP 1000s with software version 2.42
Recommend – reconfigure as these units contain the same software as BCAS AEDS (no costs incurred)

2. LP 1000’s with software versions older than version 2.42
Recommend – reconfigure not required ‐ The cost to upgrade ($700.00 per unit) does not justify the benefit

3. LP 500
Recommend – reconfigure not required ‐ The cost to upgrade ($300.00 per unit)does not justify the benefit

For those units where there is a recommendation not to reconfigure, the same benefit (chest compressions during charge‐up) can be obtained by reminding crews that chest compressions should continue throughout the “charge‐up whine”.

Best regards,
Allan Holmes
Medical Director, Iridia Medical

Appendix 1

TO ALL FIRST RESPONDER AGENCIES, SENT ON BEHALF OF RANDY SHAW, DIRECTOR, FIRST RESPONDER SERVICES

This note is to advise you that effective this week BC Ambulance Service (BCAS) AEDs will begin to undergo a minor reconfiguration. The AEDs are being reset to eliminate the “charge‐up whine” when a shockable rhythm is detected and instead prompt the responders to resume CPR.

If a shockable rhythm was detected on analysis, the AED will begin to charge and a 15 second timer will show in the display window. At 12 seconds, the AED will warn the responders that a shock is advised and at 15 seconds, prompt the responders to stand clear and to push the shock button.

There is no change in the procedures for CPR.

As you know, we teach that chest compressions are to resume during the charge‐up phase. This change in AED configuration is purely intended to support the re‐establishment of chest compressions during that phase. Please notify your first responder agencies accordingly both so that they are aware of the BCAS AED change and so that first responder agency medical oversight may consider the change with their own AEDs if similarly configurable.

Bystander CPR – Moral Obligation?

Bystander CPR

Nearly 20,000 people go into cardiac arrest outside of hospital every single year in Canada. Unfortunately, less than 10 percent of those individuals survive.

One of the leading causes is that 75 percent of those people do not receive bystander CPR.

In many of these cases the cardiac arrest is witnessed, but the bystanders do not have any training in CPR. Bystanders in this situation often fail to offer assistance because of the belief they do not have the necessary skills to act, and potentially they may cause more harm than good.

Recently, the Canadian Association of Emergency Physicians (CAEP) has spoken out to say “every Canadian should be willing to offer CPR when they witness someone in cardiac arrest — even if they’ve never been trained in it.”

bystander cpr

 

It is clear that any sort of assistance provided can increase the chances of survival for those who experience out-of-hospital cardiac arrest.

The CAEP clearly wants to push the expectations of CPR further. “It must become a moral obligation and a social expectation that bystanders will perform CPR when they witness a cardiac arrest.

Many more lives can be saved, but we need stronger inducements and a systematic approach to ensure more people in the community are prepared and ready to perform CPR,” says the group.

The CAEP is looking for the next step to be mandatory CPR training in all Canadian high schools. They even go as far to say that it should be a requirement of graduation.

Although CPR is not a guarantee for survival, it is believed that up to 2000 people a year could be saved if all Canadians were taught how to properly give CPR.

For those who haven’t had formal training, the Heart and Stroke Foundation of Canada has updated its guidelines in 2010 to simplify CPR training in the hopes that more bystanders will be willing to give CPR.

It is now recommended that untrained bystanders who don’t want to give mouth-tomouth resuscitation can simply offer chest compressions to adults in cardiac arrest.

If you are interested in learning CPR or would like to update your certification, contact us.

See our 2014 course offerings.