Feedback Devices for CPR

[Aprz]

Have any of you guys ever used feedback devices for CPR like the Philip's MRx QCPR where it tells you if you need to compress deeper, faster, or allow recoil?

During our off time, my crew and I were going over how to use it, what to expect, etc. Talking about how we can improve our CPR.

Only thing I disliked about it when I was doing chest compressions on a pillow was that it told me to slow down (was doing compressions rate around 120-130). New AHA standards are > 100. I am guessing it goes by the old standard of 100. Meh. Overall, I likes that it shows the person doing chest compressions how well they are doing and has audio (muted by default I assume?), and the person on the monitor can see how well they are doing too (other than looking for pseudo complexes on the monitor, not sure if any real difference between what the QCPR shows and the monitor).

Couldn't figure out the lung symbol on there if it detects rise and fall of the chest as you ventilate or something? Couldn't mimic anything on a pillow.

 

[emt11]

Have any of you guys ever used feedback devices for CPR like the Philip's MRx QCPR where it tells you if you need to compress deeper, faster, or allow recoil?

During our off time, my crew and I were going over how to use it, what to expect, etc. Talking about how we can improve our CPR.

Only thing I disliked about it when I was doing chest compressions on a pillow was that it told me to slow down (was doing compressions rate around 120-130). New AHA standards are > 100. I am guessing it goes by the old standard of 100. Meh. Overall, I likes that it shows the person doing chest compressions how well they are doing and has audio (muted by default I assume?), and the person on the monitor can see how well they are doing too (other than looking for pseudo complexes on the monitor, not sure if any real difference between what the QCPR shows and the monitor).

Couldn't figure out the lung symbol on there if it detects rise and fall of the chest as you ventilate or something? Couldn't mimic anything on a pillow.

We have the Lucas device, obviously just does auto CPR. If/when the battery dies(which it can be plugged in while in operation) we just do manual CPR but we don't have anything to measure depth etc at that point.

 

[mycrofft]

The device presupposes you are locating it in the proper anatomy, then it measures force and alignment.

Your brain makes sure the anatomic location remains proper, and can do realtime monitoring of depth and "verticality" of compressions.

As long as it gets food and rest, the brain works no matter how big or small the pt, how dark or light it is, how noisy or rough the ride is, the batteries don't wear out, and you can't leave it behind at the scene.

Just learn it and learn to be mindful, not automatic.

Training simulators… I don't like them. They screw up the role of the instructor, they cow or falsely encourage students, and can malfunction. They don't do anything to make it more educational except sometimes coincidentally rewarding correct work when everything falls onto place…but in real world, pts always vary.

 

[Aprz]

Nah, this is an actual feedback device for real patients, not a simulator. It detects how fast you are giving compressions, tell you to speed up or slow down (due to old AHA standards), tells you to compress deeper or allow recoil. You can visually see it on the monitor or on the thing you are compressing on (called the CPR meter I think).

 

[mycrofft]

I do not see how a device can gauge depth of compression when pt chests vary so much.

And I assume it works all the time and truer are plenty to go around.
Naw, I still don't like them.

 

[DesertMedic66]

I've used it once in the ER on a patient we brought in (ER was staffed short so we helped out). I didn't find it useful. The one the hospital had used a cushion that was 1-2 inches thick. Only thing it did was make your hands hurt from the extra pressure on a small pad.

 

[Handsome Robb]

We are required to use the qCPR puck on all cardiac arrests. Except pedis or if they arrest during transport because it's not reliable when you're moving. The new pucks have a screen on them so the compressor can just look down at the chest and focus on what they're doing rather than having to look up at the monitor. I always mute the sound because I need to communicate and the constant verbal coaching can bother families sometimes. If you can't keep good CPR going though I turn it back on and it does help.

I honestly don't know what the lungs are for, I think they're supposed to be timed for ventilations but don't quote me on that, I never really paid any attention to them.

 

[VFlutter]

Arterial lines FTW h34r:

 

[Handsome Robb]

That would be cool for sure. Add a balloon pump on a art pressure trigger and it's a real party.

I wonder what clinical would say about that...

 

[Christopher]

Have any of you guys ever used feedback devices for CPR like the Philip's MRx QCPR where it tells you if you need to compress deeper, faster, or allow recoil?

We use the Zoll X-Series in the field, with real-time feedback enabled, and post event QA/QI of the compression fraction, depth, rate, tempo, and the peri-shock pause.

During our off time, my crew and I were going over how to use it, what to expect, etc. Talking about how we can improve our CPR.

If you don't measure it, you can't improve it as much as you'd think. Bobrow's work in AZ has proven this.

Only thing I disliked about it when I was doing chest compressions on a pillow was that it told me to slow down (was doing compressions rate around 120-130). New AHA standards are > 100. I am guessing it goes by the old standard of 100. Meh. Overall, I likes that it shows the person doing chest compressions how well they are doing and has audio (muted by default I assume?), and the person on the monitor can see how well they are doing too (other than looking for pseudo complexes on the monitor, not sure if any real difference between what the QCPR shows and the monitor).

>120 is most likely not good. I believe 110-120 is the sweet spot, but that is based on retrospective data.

Q-CPR uses accelerometer data while pseudo-complexes simply looks at how the change in chest wall impedance affects the ECG recording. Impedance measurement can ONLY be used for rate. Accelerometer data is Ok for depth and recoil, but not great.

I'd really like to get Physio-Control's TrueCPR in the field to measure our crews. We've been on the X-Series for almost a year and we've maximized any gains we'll see in adherence to standards. You'd think I had shot a puppy if I suggested a crew did less than 90% compression fraction, and they will stop whatever they're doing to ask me to prove it to them if I say it was <95%.

Couldn't figure out the lung symbol on there if it detects rise and fall of the chest as you ventilate or something? Couldn't mimic anything on a pillow.

Detects changes in chest wall movement I believe, although it may interface with the cardiac monitor to detect the changes in impedance thru limb leads due to air volume in the thorax.

 

[Christopher]

I've used it once in the ER on a patient we brought in (ER was staffed short so we helped out). I didn't find it useful. The one the hospital had used a cushion that was 1-2 inches thick. Only thing it did was make your hands hurt from the extra pressure on a small pad.

Bobrow et al found that you can improve your CPR through dedicated training, and then that will improve survival to discharge. They also found that if you throw in real time feedback, you'll realize even larger gains.

I don't care which device you use, but if you're serious about CPR you'll measure it in real time.

If you can't prove your agency's competence at CPR, it is hard to know if you need to improve it. CPR is the #1 modifiable factor in survival to discharge (peri-shock pause is probably #2).