Scientific Letter
Assessment of the reliability of the accelerometers feedback devices depending on the surface on which cardiopulmonary resuscitation is performed
Evaluación de la fiabilidad de los dispositivos acelerómetros de retroalimentación inmediata en función de la superficie en la que se realice la reanimación cardiopulmonar
M. Freire Telladoa, R. Navarro Patónb,
, M.P. Pavón Prietoa, J.D. Vázquez Lópezc, J. Mateos Lorenzod, M.A. Neira Pájaroe
Corresponding author
a Médico del Servicio de Emergencias Médicas de la Fundación Pública Urgencias Sanitarias 061, Base 061 Lugo, Centro de Salud de Fingoy, Lugo, Spain
b Docente de la Facultad de Formación de Profesorado, Universidad de Santiago de Compostela, Lugo, Spain
c Enfermero del Servicio de Emergencias Médicas de la Fundación Pública Urgencias Sanitarias 061, Base 061 Foz, Lugo, Spain
d Técnico del Servicio de Emergencias Médicas de la Fundación Pública Urgencias Sanitarias 061, Base 061 Lugo, Centro de Salud de Fingoy, Lugo, Spain
e Técnico del Servicio de Emergencias Médicas de la Fundación Pública Urgencias Sanitarias 061, Base 061 Foz, Lugo, Spain
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Freire Tellado, R. Navarro Patón, M.P. Pavón Prieto, J.D. Vázquez López, J. Mateos Lorenzo, M.A. Neira Pájaro" "autores" => array:6 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Freire Tellado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "R." "apellidos" => "Navarro Patón" "email" => array:1 [ 0 => "ruben.navarro.paton@usc.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "M.P." "apellidos" => "Pavón Prieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.D." 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"apellidos" => "Mateos Lorenzo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "M.A." "apellidos" => "Neira Pájaro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Médico del Servicio de Emergencias Médicas de la Fundación Pública Urgencias Sanitarias 061, Base 061 Lugo, Centro de Salud de Fingoy, Lugo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Docente de la Facultad de Formación de Profesorado, Universidad de Santiago de Compostela, Lugo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Enfermero del Servicio de Emergencias Médicas de la Fundación Pública Urgencias Sanitarias 061, Base 061 Foz, Lugo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Técnico del Servicio de Emergencias Médicas de la Fundación Pública Urgencias Sanitarias 061, Base 061 Lugo, Centro de Salud de Fingoy, Lugo, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Técnico del Servicio de Emergencias Médicas de la Fundación Pública Urgencias Sanitarias 061, Base 061 Foz, Lugo, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la fiabilidad de los dispositivos acelerómetros de retroalimentación inmediata en función de la superficie en la que se realice la reanimación cardiopulmonar" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The current guides of the European Resuscitation Council 2015<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> recommend that whenever possible, cardiopulmonary resuscitation (CPR) should be performed on a hard surface. If this is not possible, a hard spinal board is considered to be acceptable,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> taking care to minimize CPR interruption and the inadvertent removal of the intravenous accesses and advanced airway management devices.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In relation to CPR feedback devices, the current guides<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> consider that their use should only be contemplated as part of a broader patient care system. Despite the lack of evidence of any significant improvement in patient survival at hospital discharge, the studies in this field have reported significant improvement in percentage recovery of spontaneous circulation in the context of in-hospital CPR when the use of such devices is combined with an improvement system based on training and debriefing sessions.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although several studies on elastic surfaces and their influence upon compression depth<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a> alert to the negative impact of accelerometer feedback devices when used on elastic surfaces commonly found in hospitals, the utilization of such systems has become widespread among out-hospital emergency care teams, and such devices presently contribute to data recording in both in- and out-hospital CPR studies,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> which have generated new information on the relationship between compression depth and patient survival in CPR.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In order to investigate whether the CPR guiding distortion effect of hospital bed elastic surfaces also occurs with ambulance stretchers, a study was carried out with the specific aim of determining the reliability of the Philips accelerometer feedback device HeartStart Mrx Q-CPR™ (Q-CPR) when used as CPR guiding element on a mannequin by the staff of an emergency care team on three different surfaces: floor, bed and ambulance stretcher.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Sixteen volunteers (11 men [68.75%] and 5 women [31.25%]) comprising physicians, nurses and emergency care technicians of the SEM FPUS 061 (Lugo, Spain), participated in the study. The Skill Reporter mannequin (Leardal) was used for the simulations, with a gyroscopic control device following feedback from the Q-CPR during two continuous chest compressions on a standard hospital bed with mattress (190<span class="elsevierStyleHsp" style=""></span>cm in length, 90<span class="elsevierStyleHsp" style=""></span>cm in width and 19<span class="elsevierStyleHsp" style=""></span>cm in thickness); a Promeba 6107 ambulance transfer stretcher raised to a height of 57<span class="elsevierStyleHsp" style=""></span>cm, with mattress (190<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>48<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>cm); and on a non-elastic surface (floor). The primary outcome variable was the difference in compression depth (difference between the parameters recorded by the Q-CPR and the Skill Reporter mannequin accelerometer) on each of the three surfaces.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The statistical analyses were performed using the SPSS version 20 statistical package for MS Windows. The Kolmogorov–Smirnov test was used to assess normal distribution of the data. The differences in means among the different surfaces were explored by single-factor analysis of variance (ANOVA), with Bonferroni post hoc testing.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The mean compression depth recorded with the Q-CPR accelerometer versus the gyroscopic recording was 51.68<span class="elsevierStyleHsp" style=""></span>mm (standard deviation [SD] 6.11) (range 43–62<span class="elsevierStyleHsp" style=""></span>mm) vs 56.06<span class="elsevierStyleHsp" style=""></span>mm (SD 5.05) (range 46–63<span class="elsevierStyleHsp" style=""></span>mm) on the floor; 54.93<span class="elsevierStyleHsp" style=""></span>mm (SD 7.88) (range 43–69<span class="elsevierStyleHsp" style=""></span>mm) vs 45.12<span class="elsevierStyleHsp" style=""></span>mm (SD 4.88) (range 35–54<span class="elsevierStyleHsp" style=""></span>mm) on the ambulance stretcher; and 57.18<span class="elsevierStyleHsp" style=""></span>mm (SD 10.79) (range 40–78<span class="elsevierStyleHsp" style=""></span>mm) vs 31.12<span class="elsevierStyleHsp" style=""></span>mm (SD 4.16) (range 24–42<span class="elsevierStyleHsp" style=""></span>mm) on the hospital bed. The differences in mean depth (in mm) between the two recording methods on the three surfaces were: <span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">Floor</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−4.41 (SD 7.34); <span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">Stretcher</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9.81 (SD 5.92) <span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">Bed</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>26.06 (SD 9.39). These differences were considered to be statistically significant on all three surfaces (<span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">(2.45)</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>62.38 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), Eta<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.7349).</p><p id="par0040" class="elsevierStylePara elsevierViewall">The participants repeatedly failed to follow the indications of the device. These were health professionals used to performing cardiac compression on real-life victims: the subjective impression of performing compressions of little depth caused them to stop monitoring the device, and this tendency was seen to increase with the thickness of the elastic surface on which compression was performed.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The accelerometer proved adequate as a compression quality guide when used on a hard surface (floor), but not so on the elastic surfaces, since the device suggested that cardiac compression depth was correct, when in fact the depth fell short of the limit recommended by the CPR guides.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> This effect was attributable to the inertia of the low resistance of the elastic surface, and was related to the thickness of the latter–depth error increasing with the thickness of the elastic surface.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Despite the small sample size, which precludes generalization of the findings, this study obtained results similar to those of previous publications involving accelerometers on elastic surfaces commonly used in hospital. The findings are consistent with those of other authors<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and are less concordant with those of studies involving prior calibration.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Recent studies offer encouraging data on new feedback devices not affected by elastic resistance, such as gyroscopic systems<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and flexible pressure sensors (Shinnosekuken),<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> and on the potential advantages of using mechanical cardiac compression devices<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> versus the human operator, especially on elastic surfaces. However, for the time being, it is probably advisable to strengthen the recommendation of the European Resuscitation Council<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> to perform chest compression on a hard surface whenever possible, and to develop specific protocols for the use of these new and promising devices in the case of those Departments which because of their special characteristics are unable to maintain high quality compression<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>–such practice in all cases forming part of an integral patient management system.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In sum, the Q-CPR accelerometer offered reliable guidance feedback when used on hard surfaces, though not so on surfaces with a degree of elasticity, such as hospital beds or ambulance stretchers, where the use of such devices should be avoided.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authorship/collaborators</span><p id="par0065" class="elsevierStylePara elsevierViewall">All the authors have participated in this study and in preparation of the article (study conception and design, data acquisition, analysis and interpretation of the data, drafting of the manuscript, critical review of the intellectual content, and definitive approval of the paper).</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authorship/collaborators" ] 1 => array:2 [ "identificador" => "xack319701" "titulo" => "Acknowledgements" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Freire Tellado M, Navarro Patón R, Pavón Prieto MP, Vázquez López JD, Mateos Lorenzo J, Neira Pájaro MA. Evaluación de la fiabilidad de los dispositivos acelerómetros de retroalimentación inmediata en función de la superficie en la que se realice la reanimación cardiopulmonar. Med Intensiva. 2017;41:569–570.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Resuscitation Council Summary of the main changes in the Resuscitation Guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Bossaert" 1 => "R. Greif" 2 => "I. Maconochie" 3 => "K.G. Monsieurs" 4 => "N. Nikolaou" 5 => "J.P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 5 | 6 |
| 2024 October | 41 | 45 | 86 |
| 2024 September | 45 | 36 | 81 |
| 2024 August | 55 | 41 | 96 |
| 2024 July | 32 | 27 | 59 |
| 2024 June | 66 | 52 | 118 |
| 2024 May | 31 | 31 | 62 |
| 2024 April | 56 | 40 | 96 |
| 2024 March | 39 | 31 | 70 |
| 2024 February | 38 | 37 | 75 |
| 2024 January | 34 | 35 | 69 |
| 2023 December | 26 | 33 | 59 |
| 2023 November | 40 | 32 | 72 |
| 2023 October | 27 | 34 | 61 |
| 2023 September | 33 | 38 | 71 |
| 2023 August | 27 | 17 | 44 |
| 2023 July | 35 | 27 | 62 |
| 2023 June | 28 | 19 | 47 |
| 2023 May | 59 | 31 | 90 |
| 2023 April | 34 | 17 | 51 |
| 2023 March | 76 | 45 | 121 |
| 2023 February | 50 | 41 | 91 |
| 2023 January | 17 | 25 | 42 |
| 2022 December | 63 | 37 | 100 |
| 2022 November | 78 | 38 | 116 |
| 2022 October | 58 | 52 | 110 |
| 2022 September | 40 | 39 | 79 |
| 2022 August | 34 | 59 | 93 |
| 2022 July | 30 | 41 | 71 |
| 2022 June | 35 | 30 | 65 |
| 2022 May | 29 | 33 | 62 |
| 2022 April | 31 | 49 | 80 |
| 2022 March | 43 | 55 | 98 |
| 2022 February | 31 | 35 | 66 |
| 2022 January | 22 | 41 | 63 |
| 2021 December | 34 | 46 | 80 |
| 2021 November | 37 | 36 | 73 |
| 2021 October | 79 | 68 | 147 |
| 2021 September | 50 | 40 | 90 |
| 2021 August | 32 | 42 | 74 |
| 2021 July | 27 | 30 | 57 |
| 2021 June | 32 | 32 | 64 |
| 2021 May | 37 | 43 | 80 |
| 2021 April | 103 | 84 | 187 |
| 2021 March | 67 | 45 | 112 |
| 2021 February | 58 | 33 | 91 |
| 2021 January | 44 | 30 | 74 |
| 2020 December | 38 | 16 | 54 |
| 2020 November | 27 | 16 | 43 |
| 2020 October | 35 | 25 | 60 |
| 2020 September | 30 | 22 | 52 |
| 2020 August | 18 | 19 | 37 |
| 2020 July | 22 | 24 | 46 |
| 2020 June | 21 | 21 | 42 |
| 2020 May | 23 | 22 | 45 |
| 2020 April | 30 | 31 | 61 |
| 2020 March | 25 | 19 | 44 |
| 2020 February | 47 | 22 | 69 |
| 2020 January | 36 | 39 | 75 |
| 2019 December | 25 | 28 | 53 |
| 2019 November | 25 | 29 | 54 |
| 2019 October | 28 | 22 | 50 |
| 2019 September | 24 | 21 | 45 |
| 2019 August | 44 | 23 | 67 |
| 2019 July | 34 | 23 | 57 |
| 2019 June | 23 | 17 | 40 |
| 2019 May | 48 | 28 | 76 |
| 2019 April | 23 | 20 | 43 |
| 2019 March | 35 | 33 | 68 |
| 2019 February | 29 | 31 | 60 |
| 2019 January | 39 | 20 | 59 |
| 2018 December | 30 | 38 | 68 |
| 2018 November | 43 | 28 | 71 |
| 2018 October | 43 | 24 | 67 |
| 2018 September | 29 | 14 | 43 |
| 2018 August | 32 | 12 | 44 |
| 2018 July | 31 | 17 | 48 |
| 2018 June | 46 | 17 | 63 |
| 2018 May | 16 | 10 | 26 |
| 2018 April | 32 | 11 | 43 |
| 2018 March | 3 | 0 | 3 |
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