Yeung, Joyce (2011) Strategies to improve quality of cardiopulmonary resuscitation. PhD thesis, University of Warwick.

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Abstract

Despite advances in resuscitation science, survival rates from cardiac arrests remains low. High quality cardiopulmonary resuscitation (CPR) is paramount to patient survival, but observational studies have revealed that quality of clinical CPR is poor. This thesis explores different strategies that can improve the quality of CPR.
Correct hand position is essential to effective chest compressions. Two landmark techniques, centre of the chest (CoC) and midpoint of inter-nipple line (INL), were compared. Both methods locate the lower third of the sternum but ventricles are more likely to be compressed using INL. The physiological implications remain unclear.
Three types of real time feedback and prompt devices and their impact on quality of chest compressions were compared in a randomised controlled trial. Whilst some devices lead to improvement in quality of chest compressions, feedback based on accelerometer technology can lead to worse performance in compression depth.
The cardiac arrest team leader is responsible for ensuring quality of CPR and team performance. There is an association between leadership behaviours and overall quality of CPR in simulated cardiac arrests. Developing leadership behaviours should be considered an integral part of resuscitation training.
With the changing workforce in healthcare, allied health professionals (AHP) are now taking on some responsibilities of clinicians. The thesis demonstrates equivalence in quality of CPR performance of clinicians and ACPs as cardiac arrest team leaders. Future studies should evaluate characteristics of a good team leader and its interaction with team dynamics.
Advanced airway devices have been evaluated for their ease of insertion but their impact on the quality of CPR has not been studied. This thesis demonstrates that insertion of airway devices improve the quality of CPR. There is no significant difference between quality of CPR with endotracheal tube (ETT) or laryngeal mask airway (LMA). LMA was quicker to insert. This supports the use of LMA in cardiac arrests.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RC Internal medicine
Library of Congress Subject Headings (LCSH):	CPR (First aid), Cardiac arrest -- Treatment
Official Date:	August 2011
Dates:	Date Event August 2011 Submitted
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Perkins, Gavin D. ; Smith, F. Gao (Fang Gao)
Sponsors:	Resuscitation Council (UK)
Extent:	xxi, 350 leaves : ill.
Language:	eng

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