Validation of a Monitoring System for CPR Quality in a Manikin Model

PURPOSE: The 2005 resuscitation guidelines stipulate the need for monitoring CPR (cardiopulmonary resuscitation) quality. Recently, several clinical investigations have shown that a real time monitoring and feedback system is effective for improving the quality of chest compressions during resuscitation. However little data exists regarding the accuracy of the monitoring system using an accelerometer sensor and a pressure sensor for the measuring of compression rate and depth. Our goal for this study was to investigate how well chest compression rate and depth can be estimated using the monitoring system. METHODS: Thirty seconds of continuous chest compressions were delivered on a standard skillmeter manikin lying on the floor with the monitoring system. The chest compressions were delivered with variations in compression rate (67~142 /min) and with variations in compression depth (22~61 mm). A total of 120 sets of compressions were delivered for validation of rate and depth. RESULTS: The correlation coefficient for compression rate between the monitoring system and the standard method was 0.999 (p<0.001), and Bland-Altman analysis showed a mean bias of -0.10+/-0.77/min, with limits of agreement ranging from -1.60 to 1.40 /min. The correlation coefficient for compression depth between two methods was 0.983 (p<0.001), and Bland-Altman analysis showed a mean bias of 4.2+/-2.0 mm, with limits of agreement ranging from 0.24 to 8.10 mm. CONCLUSION: Compared with a skillmeter manikin, a monitoring system for the quality of CPR estimates chest compression rate precisely, but overestimates chest compression depth by an average of 10.3%.

The Study of an Automated External Defibrillator (AED) Use by 119 Rescuers in Gyeonggi-do

PURPOSE: The purpose of this study was to investigate the use of an AED by 119 rescuers in prehospital cardiac arrest. METHODS: 132 patients who experienced prehospital cardiac arrest and was defibrillated by 119 rescuers using AED from January 2003 to December 2004 were included in this study. They were reviewed retrospectively based on 119 rescue service records and ECG. We analyzed patients' general characteristics, types of ECG rhythm, time intervals from EMS activation to arrival and from EMS activation to the first defibrillation, numbers of defibrillation, and return of spontaneous circulation (ROSC). RESULTS: The mean age was 57.33+/-17.84 years with 92 males and 40 females. 68 patients showed shockable rhythms (coarse ventricular fibrillation 41, fine ventricular fibrillation 24, pulseless ventricular tachycardia 3) and 39 patients showed unshockable rhythms (pulseless electrical activity 19 , asystole 18, normal sinus rhythm 2) as an initial rhythm at EMS arrival. Unshockable rhythms were changed to shockable rhythms after cardiopulmonary resuscitation. 25 patients had no ECG rhythms on 119 rescue service records. In the patients with shockable rhythms initially (68 patients), 18 patients experienced ROSC, whereas only 1 patients experienced ROSC in the patients with unshockable rhythms initially (39 patients). The patients with shockable rhythms initially had higher ROSC rates than the patients with unshockable rhythms initially (26.1% vs 2.6%, p=0.001) and received less defibrillation than the patients with unshockable rhythms initially (1.37+/-0.60 vs 2.49+/-1.87, p=0.016). There were no significant differences in the time intervals from EMS activation to arrival (5.74+/-2.13 minutes vs 7.12+/-4.33 minutes, p=0.529) and from EMS activation to the first defibrillation (14.20+/-7.97 minutes vs 13.75+/-7.30 minutes, p=0.542) between ROSC group & non-ROSC group. There was no significant difference in ROSC between male and female (13% vs 17.5%, p=0.164). CONCLUSION: The patients with shockable rhythms initially had higher ROSC rates than the patients with unshockable rhythms initially (26.1% vs 2.6%, p=0.001) and received less defibrillation than the patients with unshockable rhythms initially (1.37+/-0.60 vs 2.49+/-1.87, p=0.016).

Effect of the New Emergency Fee Schedule on the Pattern of Emergency Patients

PURPOSE: This study was conducted to solve the problems due to overcrowding of emergency medical centers (EMC) and to help EMCs to improve their financial status. Korean government has implemented a new emergency fee schedule into National Health Insurance (NHI). This policy is aimed at reducing non-emergent visits to EMCs. METHOD: This study was conducted to analyze the impact of the new policy by using a before-after comparison of the patterns of patients' visit to an EMC, Asan Medical Center (AMC). Data electronically recorded at the EMC of AMC were reviewed retrospectively. RESULT: The new emergency fee schedule reduced the rate of increase of non-emergent visit to EMC. CONCLUSION: However, this policy could not succeed in limiting total number of EMC visits. It means that this pricing policy made a partial success in solving the problem of overcrowding of EMCs.