Advertisement

Medical students do not adversely affect the quality of cardiopulmonary resuscitation for ED patients

Published:December 12, 2013DOI:https://doi.org/10.1016/j.ajem.2013.12.007

      Abstract

      Objectives

      To investigate the effect of medical student involvement on the quality of actual cardiopulmonary resuscitation (CPR).

      Methods

      A digital video-recording system was used to record and analyze CPR procedures for adult patients from March 2011 to September 2012.

      Results

      Twenty-six student-involved and 40 non–student-involved cases were studied. The chest compression rate in the student-involved group was significantly higher than that in the non–student-involved group (P < .001). The proportion of compressions at “above 110 cpm” was higher in the student-involved group (P = .021), whereas the proportion at “90-110 cpm” was lower in the student-involved group (P = .015). The ratio of hands-off time to total manual compression time was significantly lower in the student-involved group than in the non–student-involved group (P = .04). In contrast, the student-involved group delivered a higher ventilation rate compared with the non–student-involved group (P = .02). The observed time delay to first compression and first ventilation were very similar between the groups. There were no significant differences between the groups in either return of spontaneous circulation or time from survival to discharge.

      Conclusion

      Student-involved resuscitation teams were able to perform good CPR, with higher compression rates and fewer interruptions. However, the supervision from medical staff is still needed to ensure appropriate chest compression and ventilation rate in student-involved actual CPR in the emergency department.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fincher R.M.
        • Lewis L.A.
        Learning, experience, and self-assessment of competence of third-year medical students in performing bedside procedures.
        Acad Med. 1994; 69: 291-295
        • Taylor D.M.
        Undergraduate procedural skills training in Victoria: is it adequate?.
        Med J Aust. 1997; 166: 251-254
        • Graber M.A.
        • Wyatt C.
        • Kasparek L.
        • et al.
        Does simulator training for medical students change patient opinions and attitudes toward medical student procedures in the emergency department?.
        Acad Emerg Med. 2005; 12: 635-639
        • Graber M.A.
        • Pierre J.
        • Charlton M.
        Patient opinions and attitudes toward medical student procedures in the emergency department.
        Acad Emerg Med. 2003; 10: 1329-1333
        • Jiang C.
        • Zhao Y.
        • Chen Z.
        • et al.
        Improving cardiopulmonary resuscitation in the emergency department by real-time video recording and regular feedback learning.
        Resuscitation. 2010; 81: 1664-1669
        • Wik L.
        • Steen P.A.
        • Bircher N.G.
        Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest.
        Resuscitation. 1994; 28: 195-203
        • Berg R.A.
        • Hilwig R.W.
        • Kern K.B.
        • et al.
        “Bystander” chest compressions and assisted ventilation independently improve outcome from piglet asphyxial pulseless “cardiac arrest”.
        Circulation. 2000; 101: 1743-1748
        • Ko P.C.
        • Chen W.J.
        • Lin C.H.
        • et al.
        Evaluating the quality of prehospital cardiopulmonary resuscitation by reviewing automated external defibrillator records and survival for out-of-hospital witnessed arrests.
        Resuscitation. 2005; 64: 163-169
        • Edelson D.P.
        • Litzinger B.
        • Arora V.
        • et al.
        Improving in-hospital cardiac arrest process and outcomes with performance debriefing.
        Arch Intern Med. 2008; 168: 1063-1069
        • Berg R.A.
        • Hemphill R.
        • Abella B.S.
        • et al.
        Part 5: adult basic life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2010; 122: S685-S705
        • Olasveengen T.M.
        • Sunde K.
        • Brunborg C.
        • et al.
        Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial.
        JAMA. 2009; 302: 2222-2229
        • van Walraven C.
        • Stiell I.G.
        • Wells G.A.
        • et al.
        Do advanced cardiac life support drugs increase resuscitation rates from in-hospital cardiac arrest? The OTAC Study Group.
        Ann Emerg Med. 1998; 32: 544-553
        • Sutton R.M.
        • Nadkarni V.
        • Abella B.S.
        “Putting it all together” to improve resuscitation quality.
        Emerg Med Clin North Am. 2012; 30: 105-122
        • Abella B.S.
        • Alvarado J.P.
        • Myklebust H.
        • et al.
        Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest.
        JAMA. 2005; 293: 305-310
        • Wik L.
        • Kramer-Johansen J.
        • Myklebust H.
        • et al.
        Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest.
        JAMA. 2005; 293: 299-304
        • Committee E.C.C.
        Subcommittees and task forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Circulation. 2005; 112: IV1-IV203
        • Abella B.S.
        • Sandbo N.
        • Vassilatos P.
        • et al.
        Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest.
        Circulation. 2005; 111: 428-434
        • Edelson D.P.
        • Abella B.S.
        • Kramer-Johansen J.
        • et al.
        Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest.
        Resuscitation. 2006; 71: 137-145
        • Yu T.
        • Weil M.H.
        • Tang W.
        • et al.
        Adverse outcomes of interrupted precordial compression during automated defibrillation.
        Circulation. 2002; 106: 368-372
        • Berg R.A.
        • Sanders A.B.
        • Kern K.B.
        • et al.
        Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest.
        Circulation. 2001; 104: 2465-2470
        • Valenzuela T.D.
        • Kern K.B.
        • Clark L.L.
        • et al.
        Interruptions of chest compressions during emergency medical systems resuscitation.
        Circulation. 2005; 112: 1259-1265
        • Stiell I.G.
        • Brown S.P.
        • Christenson J.
        • et al.
        What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation?.
        Crit Care Med. 2012; 40: 1192-1198
        • Field R.A.
        • Soar J.
        • Davies R.P.
        • et al.
        The impact of chest compression rates on quality of chest compressions—a manikin study.
        Resuscitation. 2012; 83: 360-364
        • O'Neill J.F.
        • Deakin C.D.
        Do we hyperventilate cardiac arrest patients?.
        Resuscitation. 2007; 73: 82-85
        • Aufderheide T.P.
        • Sigurdsson G.
        • Pirrallo R.G.
        • et al.
        Hyperventilation-induced hypotension during cardiopulmonary resuscitation.
        Circulation. 2004; 109: 1960-1965
        • Yannopoulos D.
        • Tang W.
        • Roussos C.
        • et al.
        Reducing ventilation frequency during cardiopulmonary resuscitation in a porcine model of cardiac arrest.
        Respir Care. 2005; 50: 628-635
        • Yannopoulos D.
        • McKnite S.
        • Aufderheide T.P.
        • et al.
        Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest.
        Resuscitation. 2005; 64: 363-372