Quality of BLS decreases with increasing resuscitation complexity

• Published in: Resuscitation Vol. 68; no. 3; pp. 365 - 369
• Main Authors: Rittenberger, Jon C., Guimond, Guy, Platt, Thomas E., Hostler, David
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-03-2006; Elsevier
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Basic life support (BLS); Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Cardiopulmonary resuscitation (CPR); Cardiopulmonary Resuscitation - education; Cardiopulmonary Resuscitation - standards; Defibrillators; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Humans; Intensive care medicine; Male; Manikins; Medical sciences; Out-of-hospital CPR; Pennsylvania; Prospective Studies; Quality of Health Care; Resuscitation; Students, Health Occupations; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Pennsylvania; Out-of-hospital CPR; Cardiopulmonary resuscitation (CPR); Resuscitation; Basic life support (BLS); Intensive cardiocirculatory care; Intensive care; Out of hospital
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2005.07.019

Multiple procedures performed in parallel may cause each procedure to be performed less effectively than if performed in isolation. BLS performed by prehospital providers potentially includes artificial ventilations, chest compressions, and application of an automated external defibrillator (AED). This study examines the effectiveness of artificial ventilation and chest compressions both with and without an AED.
Thirty-six prehospital providers participated in a prospective observational study. Tested in pairs (
n
=
18), subjects randomly completed three, 6-min scenarios [apneic patient with a pulse (VENT), a pulseless patient (CPR), and a pulseless patient with an AED available (CPR
+
AED)]. A full-torso manikin capable of generating a carotid pulse was connected to a computer to record number of ventilations, tidal volume, flow rate, number of compressions, and compression depth. Data were analyzed by
t-test, ANOVA, and Mann–Whitney
U-test.
Artificial ventilation performed in isolation provided more correct ventilations than during CPR or CPR
+
AED (25.7%, 14.2%, 13.7%,
p
=
0.02). Fewer ventilations were delivered during CPR and CPR
+
AED (
p
=
0.03). More compressions were delivered with CPR alone vs. CPR
+
AED (51.9, 35.7
min
−1,
p
=
0.00). More correct compressions were delivered during CPR alone vs. CPR
+
AED (
p
=
0.05).
Both the quality and quantity of BLS decreases as the number of procedures performed simultaneously increases. Further decrements might occur when ALS skills enter into resuscitation. These results suggest a need to automate and/or prompt the performance of BLS to optimize resuscitation.