OBJECTIVE: Shallow chest compressions and incomplete recoil are common during cardiopulmonary resuscitation (CPR) and negatively affect outcomes. A step stool has the potential to alter these parameters when performing CPR in a bed but the impact has not been quantified. METHODS: We conducted a cross-over design, simulated study of in-hospital cardiac arrest. Rescuers performed a total of four 2-min segments of uninterrupted chest compressions, half of which were on a step stool. Compression characteristics were measured using a CPR-sensing defibrillator and subjective impressions were obtained from rescuer surveys. Paired analyses were performed to measure the impact of the step stool, taking into account rescuer characteristics, including height. RESULTS:Fifty subjects, of whom 36% were men, with a median height of 169.8 cm (range 148.6-190.5) volunteered to participate. Use of a step stool resulted in an average increase in compression depth of 4 mm (p<0.001) and 18% increase in incomplete recoil (p<0.001). However, unlike with incomplete recoil, the effect was more pronounced in rescuers in the lowest height tertile (9±9 mm vs 2±6 mm for those rescuers taller than 167 cm, p=0.006). CONCLUSIONS: Using a step stool when performing CPR in a bed results in a trade-off between increased compression depth and increased incomplete recoil. Given the nonlinear relationship between the increase in compression depth and rescuer height, the benefit of a step stool may outweigh the risks of incomplete release for rescuers ≤167 cm in height. The benefit is less clear in taller rescuers.
RCT Entities:
OBJECTIVE: Shallow chest compressions and incomplete recoil are common during cardiopulmonary resuscitation (CPR) and negatively affect outcomes. A step stool has the potential to alter these parameters when performing CPR in a bed but the impact has not been quantified. METHODS: We conducted a cross-over design, simulated study of in-hospital cardiac arrest. Rescuers performed a total of four 2-min segments of uninterrupted chest compressions, half of which were on a step stool. Compression characteristics were measured using a CPR-sensing defibrillator and subjective impressions were obtained from rescuer surveys. Paired analyses were performed to measure the impact of the step stool, taking into account rescuer characteristics, including height. RESULTS: Fifty subjects, of whom 36% were men, with a median height of 169.8 cm (range 148.6-190.5) volunteered to participate. Use of a step stool resulted in an average increase in compression depth of 4 mm (p<0.001) and 18% increase in incomplete recoil (p<0.001). However, unlike with incomplete recoil, the effect was more pronounced in rescuers in the lowest height tertile (9±9 mm vs 2±6 mm for those rescuers taller than 167 cm, p=0.006). CONCLUSIONS: Using a step stool when performing CPR in a bed results in a trade-off between increased compression depth and increased incomplete recoil. Given the nonlinear relationship between the increase in compression depth and rescuer height, the benefit of a step stool may outweigh the risks of incomplete release for rescuers ≤167 cm in height. The benefit is less clear in taller rescuers.
Authors: David A Fried; Marion Leary; Douglas A Smith; Robert M Sutton; Dana Niles; Daniel L Herzberg; Lance B Becker; Benjamin S Abella Journal: Resuscitation Date: 2011-04-08 Impact factor: 5.262
Authors: Jim M Clemons; Charles A Duncan; Oliver E Blanchard; Wendel H Gatch; Dan B Hollander; Janet L Doucet Journal: J Strength Cond Res Date: 2004-08 Impact factor: 3.775
Authors: Silvana Arciniegas Rodriguez; Robert M Sutton; Marc D Berg; Akira Nishisaki; Matthew Maltese; Peter A Meaney; Dana E Niles; Jessica Leffelman; Robert A Berg; Vinay M Nadkarni Journal: Resuscitation Date: 2013-09-12 Impact factor: 5.262