Optimising basic skills in adult cardiopulmonary resuscitation

102 Pages·2012·1.31 MB·English

Optimising
basic skills in adult
cardiopulmonary resuscitation
Thesis for the degree PhD
cand.med. Conrad Arnfinn Bjørshol
Department of Anaesthesiology and Intensive Care
Stavanger University Hospital
Faculty of Medicine
University of Oslo
2012
© Conrad Arnfinn Bjørshol, 2012

Series of dissertations submitted to the
Faculty of Medicine, University of Oslo
No. 1372

ISBN 978-82-8264-463-1

All rights reserved. No part of this publication may be
reproduced or transmitted, in any form or by any means, without permission.

Cover: Inger Sandved Anfinsen.
Printed in Norway: AIT Oslo AS.

Produced in co-operation with Unipub.
The thesis is produced by Unipub merely in connection with the
thesis defence. Kindly direct all inquiries regarding the thesis to the copyright
holder or the unit which grants the doctorate.
This thesis is dedicated
to the memory of my father
Kolbjørn Bjørshol
(1928-2009)
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Optimising basic skills in adult cardiopulmonary resuscitation
Table of contents
1.(cid:2) ACKNOWLEDGEMENTS ........................................................................................................................ 7(cid:2)
2.(cid:2) ABBREVIATIONS ...................................................................................................................................... 8(cid:2)
3.(cid:2) LIST OF PAPERS ....................................................................................................................................... 9(cid:2)
4.(cid:2) INTRODUCTION ..................................................................................................................................... 11(cid:2)
4.1.(cid:2) HISTORY OF CPR ................................................................................................................................ 12(cid:2)
4.2.(cid:2) INTERNATIONAL CPR GUIDELINES ..................................................................................................... 14(cid:2)
4.3.(cid:2) CURRENT CPR GUIDELINES ................................................................................................................ 16(cid:2)
4.4.(cid:2) CPR TRAINING .................................................................................................................................... 20(cid:2)
4.5.(cid:2) THE CHAIN OF SURVIVAL ................................................................................................................... 23(cid:2)
5.(cid:2) AIMS OF THE THESIS ........................................................................................................................... 25(cid:2)
5.1.(cid:2) PAPER I ............................................................................................................................................... 25(cid:2)
5.2.(cid:2) PAPER II .............................................................................................................................................. 25(cid:2)
5.3.(cid:2) PAPER III ............................................................................................................................................ 25(cid:2)
5.4.(cid:2) PAPER IV ............................................................................................................................................ 25(cid:2)
6.(cid:2) MATERIALS AND METHODS .............................................................................................................. 27(cid:2)
6.1.(cid:2) PAPER I ............................................................................................................................................... 27(cid:2)
6.2.(cid:2) PAPER II .............................................................................................................................................. 29(cid:2)
6.3.(cid:2) PAPER III AND IV ................................................................................................................................ 29(cid:2)
6.4.(cid:2) STATISTICAL ANALYSES ..................................................................................................................... 33(cid:2)
7.(cid:2) MAIN RESULTS ....................................................................................................................................... 35(cid:2)
7.1.(cid:2) PAPER I ............................................................................................................................................... 35(cid:2)
7.2.(cid:2) PAPER II .............................................................................................................................................. 35(cid:2)
7.3.(cid:2) PAPER III ............................................................................................................................................ 35(cid:2)
7.4.(cid:2) PAPER IV ............................................................................................................................................ 36(cid:2)
8.(cid:2) DISCUSSION ............................................................................................................................................. 37(cid:2)
8.1.(cid:2) PAPER I ............................................................................................................................................... 37(cid:2)
8.2.(cid:2) PAPER II-IV ........................................................................................................................................ 39(cid:2)
9.(cid:2) CONCLUSION .......................................................................................................................................... 46(cid:2)
9.1.(cid:2) PAPER I ............................................................................................................................................... 46(cid:2)
9.2.(cid:2) PAPER II .............................................................................................................................................. 46(cid:2)
9.3.(cid:2) PAPER III ............................................................................................................................................ 46(cid:2)
9.4.(cid:2) PAPER IV ............................................................................................................................................ 46(cid:2)
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Conrad Arnfinn Bjørshol
10.(cid:2) ERRATA .................................................................................................................................................... 47(cid:2)
10.1.(cid:2) PAPER III ............................................................................................................................................ 47(cid:2)
11.(cid:2) REFERENCES .......................................................................................................................................... 48(cid:2)
12.(cid:2) APPENDICES ........................................................................................................................................... 69(cid:2)
12.1.(cid:2) APPENDIX 1 ........................................................................................................................................ 69(cid:2)
12.2.(cid:2) APPENDIX 2 ........................................................................................................................................ 72(cid:2)
12.3.(cid:2) APPENDIX 3 ........................................................................................................................................ 75(cid:2)
12.4.(cid:2) APPENDIX 4 ........................................................................................................................................ 78(cid:2)
13.(cid:2) REPRINTS OF PAPER I-IV .................................................................................................................... 85(cid:2)
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Optimising basic skills in adult cardiopulmonary resuscitation
1. Acknowledgements
I wish to thank my supervisors Kjetil Sunde and Eldar Søreide for your endless support and
patience. Without your contributions this thesis would not have been possible. I also thank my
co-supervisor Petter Andreas Steen for valuable feedback. I am also grateful for the
contributions from my co-authors.
I wish to thank Siri Tau Ursin and the Department for Anaesthesiology and Intensive Care
at Stavanger University Hospital (SUH) for giving me opportunities to conduct these research
projects, and the Research Department at SUH for offering research facilities.
I also wish to thank the paramedics and the hospital employees at SUH who participated
in our studies, the Ambulance Department and the Emergency Medical dispatch centre at
SUH for cooperation in the conduct of my studies.
I also wish to thank the library at SUH for always being helpful in obtaining journal
articles in a very short time, Helge Myklebust who was always optimistic when we were
facing problems, Margot Viste who repeatedly saved me from failing software applications,
Joar Eilevstjønn who provided invaluable technical support and June Glomsaker for
organising lists of hospital employees.
Thanks to my office mates Thomas Lindner and Wenche Mathiesen for continuous
scientific discussions and company.
I am grateful to Stavanger Acute Medicine Foundation for Education and Research
(SAFER) for giving me splendid simulation facilities. Further,
I wish to thank the Laerdal Foundation for Acute Medicine for granting me a Bjørn Lind
PhD scholarship, and to the Regional Centre for Emergency Medical Research and
Development (RAKOS) for financial support.
I am especially grateful to the Academy of St Martin in the Fields and its founder and
lifetime president Sir Neville Marriner. Your crisp rhythms, brisk tempi and arresting silence
have changed the way music is performed, and has been an enormous inspiration for me in
the continuous struggle for optimising basic skills in cardiopulmonary resuscitation.
Most of all I am grateful to Linda, your patience and support has been invaluable.
Stavanger, 3 February 2012
Conrad Arnfinn Bjørshol
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Conrad Arnfinn Bjørshol
2. Abbreviations
AED automated external defibrillator
AHA American Heart Association
ALS advanced life support
BC before Christ
BLS basic life support
CCC continuous chest compressions
CPR cardiopulmonary resuscitation
CRM crisis resource management
C:V ratio compression:ventilation ratio
EMS emergency medical services
ERC European Resuscitation Council
ICD implantable cardioverter defibrillator
ICU intensive care unit
IHCA in-hospital cardiac arrest
ILCOR the International Liaison Committee on Resuscitation
IV intravenous
MTM mouth-to-mouth
NASA TLX the National Aeronautics and Space Administration Task Load Index
NFR no-flow ratio
NRC Norwegian Resuscitation Council
OHCA out-of-hospital cardiac arrest
PEA pulseless electrical activity
ROC Resuscitation Outcome Consortium
ROSC return of spontaneous circulation
SAFER Stavanger Acute Medicine Foundation for Education and Research
SUH Stavanger University Hospital
VAS visual analogue scale
VF ventricular fibrillation
VT ventricular tachycardia
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Optimising basic skills in adult cardiopulmonary resuscitation
3. List of papers
This thesis is based on the following papers.
Paper I
Bjørshol CA, Lindner TW, Søreide E, Moen L, Sunde K. Hospital employees improve basic
life support skills and confidence with a personal resuscitation manikin and a 24-min video
instruction. Resuscitation 2009;80:898-902.
Paper II
Bjørshol CA, Søreide E, Torsteinbø TH, Lexow K, Nilsen OB, Sunde K. Quality of chest
compressions during 10 min of single-rescuer basic life support with different compression:
ventilation ratios in a manikin model. Resuscitation 2008;77:95-100.
Paper III
Bjørshol CA, Myklebust H, Nilsen KL, Hoff T, Bjørkli C, Illguth E, Søreide E, Sunde K.
Effect of socioemotional stress on the quality of cardiopulmonary resuscitation during
advanced life support in a randomized manikin study. Crit Care Med 2011;39:300-4.
Paper IV
Bjørshol CA, Sunde K, Myklebust H, Assmus J, Søreide E. Decay in chest compression
quality due to fatigue is rare during prolonged advanced life support in a manikin model.
Scand J Trauma Resusc Emerg Med 2011;19:46.
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Conrad Arnfinn Bjørshol
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