Book ChapterDOI

# CPR Module with Variable Chest Stiffness in High Fidelity Mannequins

01 Jan 2013-pp 159-167

TL;DR: This work proposes a CPR mannequin which exhibits a chest with increasing stiffness as the depth of compression is increased, which should improve CPR training efficacy and compares the measured values against acceptance criteria that can be tuned to different standards.
Abstract: Cardio Pulmonary Resuscitation (CPR), especially chest compression, should be performed promptly on victims of cardiac arrest for improved morbidity. CPR is performed in 2 steps, chest compression and chest ventilation. But, commercially available CPR mannequins do not accurately mimic the viscoelastic properties of the human chest, resulting in poor CPR performance. We propose a CPR mannequin which exhibits a chest with increasing stiffness as the depth of compression is increased; the increased bio-fidelity of this mannequin should improve CPR training efficacy. This mannequin also measures depth and rate of compression, the air volume during chest ventilation, and compares the measured values against acceptance criteria that can be tuned to different standards.
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Proceedings ArticleDOI
S I Varun Durai1, Raj Arjunan1, M. Manivannan1Institutions (1)
01 Oct 2017-
TL;DR: An immersive Virtual Reality based CPR simulator in which force feedback is provided using a dummy chest with a linear spring mounted on a force plate demonstrates that visual feedback could influence haptics perception of chest compliance and the VR-CPR system could simulate various linear and non-linear chest compliance controlling visual feedback alone.
Abstract: Haptic skills are essential for effective Cardiopulmonary Resuscitation (CPR). Existing CPR training simulators provide unrealistic chest conditions. It is assumed that the CPR performance on a real human chest is the same even when the trainees have learnt on unrealistic dummy chests. To test this assumption we have developed an immersive Virtual Reality based CPR simulator in which force feedback is provided using a dummy chest with a linear spring mounted on a force plate. The user applied force is mapped to visual chest compressions modeling various springs, either linear or non-linear. Two groups of subjects were trained either with linear or non-linear chests. Both the groups were tested for their CPR performance on an unknown non-linear chest and their performance score was compared. The % of mean and standard deviation of the score (p value: 0.001) for the group with the non-linear chest is 91.66% and 1.70% and that with linear chest is 86.39% and 3.44% respectively. This suggests that the group that were trained on non-linear chest performed better. The experiments clearly demonstrates that visual feedback could influence haptics perception of chest compliance and the VR-CPR system could simulate various linear and non-linear chest compliance controlling visual feedback alone.

4 citations

### Cites background from "CPR Module with Variable Chest Stif..."

• ...The trainees learn CPR skills mostly with linear chests available in the currently existing mannequins, however, they are expected to perform on a real casualty with non-linear human chest [4]....

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Proceedings ArticleDOI
Durai S I Varun1, Raj Arjunan1, M. Manivannan1Institutions (1)
23 Mar 2019-
TL;DR: The results show that the group who trained with the three sensory modalities have better performance than that of the other two groups, and rescue breathing is incorporated in the CPR training simulator for better skill training.
Abstract: The hypothesis of this study is to verify the sensory dominance with the combinations of three sensory modalities (Audio-Haptics (AH), Visual-Haptics (VH), Audio-Visual-Haptics (AVH)) using Virtual Reality (VR) based Cardiopulmonary Resuscitation (CPR) simulator. To test this hypothesis three experiments with three different groups of participants were conducted with the above three modes of combinations. Finally, three groups were tested for their CPR performance on an unknown linear chest stiffness of mannequin-based CPR simulator and their performance score was compared. The % mean and standard deviation of the performance score (p-value: 0.00006) in the testing phase for group A-AH, B-VH, and C-AVH is $77.95\%\pm 8.27\%, 89.47\%\pm 6.19\%, \ \text{and} \ 91.73\%\pm 3.14\%$ respectively. The results show that the group who trained with the three sensory modalities have better performance than that of the other two groups. Our future work is to incorporate rescue breathing in the CPR training simulator for better skill training.

2 citations

### Cites methods from "CPR Module with Variable Chest Stif..."

• ...Participants were trained for three days in the VR-based simulation with six different linear chest compliance and then tested for their CPR performance on an unknown linear chest stiffness of a mannequin based CPR simulator [5] as shown in Fig....

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##### References
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Journal ArticleDOI
01 Sep 1999-JAMA
TL;DR: Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures.
Abstract: Changes in medical practice that limit instruction time and patient availability, the expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technology in medical education. Four areas of high-technology simulations currently being used are laparoscopic techniques, which provide surgeons with an opportunity to enhance their motor skills without risk to patients; a cardiovascular disease simulator, which can be used to simulate cardiac conditions; multimedia computer systems, which includes patient-centered, casebased programs that constitute a generalist curriculum in cardiology; and anesthesia simulators, which have controlled responses that vary according to numerous possible scenarios. Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures. These systems help to address the problem of poor skills training and proficiency and may provide a method for physicians to become self-directed lifelong learners.

847 citations

Journal ArticleDOI
TL;DR: The development of mannequin simulators used for education, training, and research is reviewed, tracing the motivations, evolution to commercial availability, and efforts toward assessment of efficacy of those for teaching cardiopulmonary resuscitation, cardiology skills, anaesthesia clinical skills, and crisis management.
Abstract: Simulation for medical and healthcare applications, although still in a relatively nascent stage of development, already has a history that can inform the process of further research and dissemination. The development of mannequin simulators used for education, training, and research is reviewed, tracing the motivations, evolution to commercial availability, and efforts toward assessment of efficacy of those for teaching cardiopulmonary resuscitation, cardiology skills, anaesthesia clinical skills, and crisis management. A brief overview of procedural simulators and part-task trainers is also presented, contrasting the two domains and suggesting that a thorough history of the 20+ types of simulator technologies would provide a useful overview and perspective. There has been relatively little cross fertilisation of ideas and methods between the two simulator domains. Enhanced interaction between investigators and integration of simulation technologies would be beneficial for the dissemination of the concepts and their applications.

502 citations

Journal Article

158 citations

Journal ArticleDOI
TL;DR: A viscoelastic model was developed to describe the dynamic response of the human chest to cyclic loading during manual cardiopulmonary resuscitation (CPR) and consists of the parallel combination of a spring and dashpot.
Abstract: A viscoelastic model is presented to describe the dynamic response of the human chest to cyclic loading during manual cardiopulmonary resuscitation (CPR) Sternal force and displacement were measured during 16 clinical resuscitation attempts and during compressions on five CPR training manikins The model was developed to describe the clinical data and consists of the parallel combination of a spring and dashpot The human chests' elastic and damping properties were both augmented with increasing displacement The manikins' elastic properties were stiffer and both elastic and damping properties were less dependent on displacement than the humans'

63 citations

Journal ArticleDOI
01 Jul 2007-Resuscitation
TL;DR: Ambulance personnel were physically capable of consistently compressing to the Guidelines depth even on the stiffest chest, which strongly indicate that the inadequate chest compressions found in the clinical study were not due to lack of physical capability.
Abstract: Summary Introduction Quality of cardiopulmonary resuscitation (CPR) performed by professionals is reported to be substandard even with automated corrective feedback. We hypothesised that lack of quality is not due to physical capabilities. Materials and methods Eighty ambulance personnel from the same services where the quality of clinical CPR was investigated, performed two-rescuer CPR with similar corrective feedback for 5min on each of four manikins with different chest stiffness. The personnel also scored their agreement with statements on clinical CPR performance. Results All study subjects performed CPR well within Guidelines recommendations on all four manikins with mean compression depth 44±3mm, compression rate 101±3min −1 , and 7±2 ventilations per minute. Three quarters stated that during CPR on patients their personal sense of correct depth and force determined their performance. Fifty-five percent believed that too deep chest compressions could cause serious injury to the patient, and 39% that compressing to Guidelines recommended depth may often result in severe patient injury. A quarter felt that the potential benefits of compressing to the Guidelines depth could not justify the injuries it would cause. Breaking ribs made 54% feel very uncomfortable. Conclusions Ambulance personnel were physically capable of consistently compressing to the Guidelines depth even on the stiffest chest. These laboratory results cannot be directly compared to the clinical out-of-hospital ALS situation, but strongly indicate that the inadequate chest compressions found in our clinical study were not due to lack of physical capability. We speculate that this may at least partly be explained by their fear of causing patient injury and trust in their own opinion of what is the correct compression depth and force in preference to the feedback.

57 citations

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