The Benefits of Hands-On CPR Procedure

‘Hands-only’ Cardiopulmonary Resuscitation (HO-CPR) is the use of both hands to give chest compressions (CCs). There are many forms of CPR, but HO-CPR is a more simplified and effective technique to deliver chest compressions. HO-CPR is a procedure that is linked to eliminating the stigma ’of the breath’ in which mouth to mouth CPR is now discouraged. Many people are reluctant to give mouth to mouth through fear of contracting diseases from a person’s saliva. The use of HO-CPR will lead to increased bystanders who ought to intervene immediately in a real life sudden cardiac arrest (Trowbridge et al., 2009). It is important to educate and bring awareness to this topic as it will lead to increased bystander participation and significantly reduce the increasing statistics of out of hospital cardiac arrests. This essay evaluates the findings from two peer-reviewed journal articles focusing on three areas: quality of HO-CPR compared to standard chest compressions 30:2(ST-CPR) and the use of a prompt device feedback on chest compressions. There will also be a critique of these sources looking at the strengths and weaknesses of the research methods used and if they had an influence on the findings.

The findings by Shin et al. (2014) and Yuanshan et al. (2018) examined the effects of chest compression between HO-CPR and ST-CPR in a manikin model. In the Shin et al. (2014) study it showed that participants were first year Emergency medical technicians (EMT) university students recruited via a class presentation. Whereas, in Yuanshan et al. (2018) study individuals were selected based on lack of experience in basic life support and real CPR, participants were blinded from the study where they did not the goal of the study. The sample populations and design varied however, where in the Shin et al. (2014) study there were 36 volunteers separated based on gender. Eighteen men and women were randomized into CPR or HO-CPR groups respectively. Participants of group 1 and 2 were further divided into classes according to gender. This research was conducted by performing each form of CPR for 8 minutes with a three- hour rest interval in which participants were able to stop for as long as they required. The data was measured using the ‘Skill Reporter manikin’. The study by Yuanshan et al. (2018) used a total of 140 laypersons whom were assigned randomly into three groups to perform 2 min of hands-only CPR on manikins: the 2010 group and 2015 group perform CPR without the assistance of a prompt device and the 2015F group whom were required to perform CPR with a prompt device. The participants in the 2010 and 2015 groups did not receive assistance from the feedback/prompt device whereas participants in 2015F group were notified and alerted when they missed their targets given by the prompt device. The prompt device that was used is the ‘Link CPR’ which accurately measured the CC depth and rate on its own algorithm. To measure adequate chest compressions both studies were required to deliver a chest compression depth from at least 50-60mm and a compression rate from at least 100- 120/min.

The research by Shin et al. (2014) showed that the number of adequate chest compressions was lower with CO-CPR than with ST-CPR during the 8 minutes of CPR. Particularly, it was indicated in the first 2 minutes HO:CPR shown elevated results compared to ST-CPR during the beginning where the median was at 25mm and reduced to 18mm at the end of 8 minutes. It was higher with ST-CPR than with HO-CPR after 3 minutes. This is obvious where the median starts at 41mm and reduced to 38mm at the end of 8 minutes. In the Yuanshan et al. (2018) study there was a striking similarity in which HO-CPR and the use of a prompt device at the beginning of 1-minute start at 49mm and 56mm respectively and reduced to 44 mm and 52mm at the end of 2 minutes respectively. In both studies, the maintenance of adequate CCs using HO-CPR is difficult to deliver throughout the duration of the study. More so, HO-CPR is seen to gradually decline in the first two minutes of the trial towards the end of study. Furthermore, the study group of Shin et al. was uniquely diverse as there was a clear statistical difference in the performance of CCs between male and female participants in which male participants showcased a change in both forms of CPR but did not apply to female participants. In this study male participants performed exceedingly well whereas females did not show a change. In addition, Shin et al. (2014) study participants were enabled to stop anytime during the duration of the study if they were experiencing any cases of fatigue however such a thing did not occur. In Yuanshan et al. study, 10 participants were excluded from the study due to failing the examination and another 6 left on their own accord because of personal reasons however in Shin et al.(2014) study not one participant was excluded from the time of the main study and the examination.

There are strengths and weaknesses of these studies that may have influenced its research findings. The strengths and weaknesses in using a case study is it is good for deep exploration in which researchers in this case investigate the effects of HO:CPR with the use of a prompt device and the comparison to ST-CPR. It also relates to giving a more human feel where research is not merely abstract data. The disadvantage of a case study is it is very difficult to generalise and there may be research bias in which researchers influence the research findings, which becomes very subjective. In Yuanshan et al. (2018) study uses a larger sample size in which provide more data and thus information that is representative of a larger portion of the population. The use of a larger sample can be a disadvantage because the process of collecting data is time consuming and the incurred expenses compared to a smaller sample group. Shin et al. (2018) research uses a relatively small sample size that acts as a disadvantage in which it is difficult to generalize the results because it does not provide a wider coverage of a population outside this group and taking into account that participants were not blinded from the experiment because they were aware of the form of CPR they were performing. This also means if a larger sample was collected based on the small number of participants in this study, findings may differ. A small sample size may also be a strength in this study as more in-depth information can be collected. Within, both articles authors primary aim was to measure the effect of CC’s based on the level of fatigue and the use of a prompt device to assist with CPR. In Yuanshan et al. (2018) study, methods were conducted using SPSS to analyse data and to measure compression rate and depth whereas in Shin et al study methods measured not only rate and depth but also blood lactate levels and muscular fatigue. This strengthens the research findings and clearly makes a significant difference by providing a far more qualitative analysis of fatigue.

In conclusion, this essay has examined in depth the benefits of HO-CPR by comparing CPR between HO-CPR and with the use of a feedback/prompt devices. It is evident HO-CPR is strenuous in maintaining adequate CCs for a longer period. It is vital to educate the general public in bystander CPR because it will increase bystander intervention thus leading to improved CPR outcome as well as the survival rates of hospital cardiac- arrest. In addition, the use of a prompt device may also contribute to CPR outcome and is significantly needed to be studied and assessed further. CPR rescuers should consider taking turns performing CPR and switch roles every two minutes to ensure the quality of adequate CCs are maintained.