High-quality chest compressions are possible during intra-hospital transport, but depend on provider position: A manikin study.
Journal
European journal of anaesthesiology
ISSN: 1365-2346
Titre abrégé: Eur J Anaesthesiol
Pays: England
ID NLM: 8411711
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
pubmed:
25
1
2020
medline:
28
4
2021
entrez:
25
1
2020
Statut:
ppublish
Résumé
Treatment of reversible causes of cardiac arrest often requires intrahospital transportation during ongoing resuscitation. But high-quality chest compression with minimal interruption is the most essential prerequisite for an optimal outcome after cardiac resuscitation. We aimed to evaluate chest compression quality according to the provider position during intrahospital transportation. Manikin observational study. German Tertiary Care Hospital. A total of 20 paramedics (eight female, 12 male); average professional experience 4.8 ± 3.1 years since their initial enrolment for training. Participants performed chest compressions during simulated intrahospital transportation in four groups: provider kneeling beside manikin on the floor (control group), walking next to the bed (group 1), kneeling on the bed beside the manikin (group 2), kneeling astride the manikin on the bed (group 3). Quality metrics as European Resuscitation Council Guidelines 2015. Subsequently, the participants were asked to assess their own subjective feelings of safety, comfort and strain, and to recommend one position. The quality of chest compression in the control group and groups 2 and 3 did not differ significantly. Group 1 performed significantly worse in terms of the correct hand placement on the chest (P = 0.044 vs. control group) and compression depth (P = 0.004 vs. control group, P = 0.035 vs. group 2, P = 0.006 vs. group 3). Transport speed was faster in groups 2 and 3 vs. group 1 (P < 0.05 vs. group 1, P < 0.05 vs. group 2). The majority of participants rated position 1 as unsafe (90%), unpleasant (100%) and exhausting (100%). They predominantly favoured position 3 (70%). Performing guideline-compliant chest compressions during intra-hospital transportation is feasible with an appropriate provider position. Our results suggest, kneeling beside or astride the patient on the bed enables high-quality chest compressions, faster transport and is perceived by the providers as more pleasant. 'Walking next to the bed' while performing chest compressions should be avoided.
Sections du résumé
BACKGROUND
BACKGROUND
Treatment of reversible causes of cardiac arrest often requires intrahospital transportation during ongoing resuscitation. But high-quality chest compression with minimal interruption is the most essential prerequisite for an optimal outcome after cardiac resuscitation.
OBJECTIVE
OBJECTIVE
We aimed to evaluate chest compression quality according to the provider position during intrahospital transportation.
DESIGN
METHODS
Manikin observational study.
SETTING
METHODS
German Tertiary Care Hospital.
PARTICIPANTS
METHODS
A total of 20 paramedics (eight female, 12 male); average professional experience 4.8 ± 3.1 years since their initial enrolment for training.
INTERVENTION(S)
METHODS
Participants performed chest compressions during simulated intrahospital transportation in four groups: provider kneeling beside manikin on the floor (control group), walking next to the bed (group 1), kneeling on the bed beside the manikin (group 2), kneeling astride the manikin on the bed (group 3).
MAIN OUTCOME MEASURES
METHODS
Quality metrics as European Resuscitation Council Guidelines 2015. Subsequently, the participants were asked to assess their own subjective feelings of safety, comfort and strain, and to recommend one position.
RESULTS
RESULTS
The quality of chest compression in the control group and groups 2 and 3 did not differ significantly. Group 1 performed significantly worse in terms of the correct hand placement on the chest (P = 0.044 vs. control group) and compression depth (P = 0.004 vs. control group, P = 0.035 vs. group 2, P = 0.006 vs. group 3). Transport speed was faster in groups 2 and 3 vs. group 1 (P < 0.05 vs. group 1, P < 0.05 vs. group 2). The majority of participants rated position 1 as unsafe (90%), unpleasant (100%) and exhausting (100%). They predominantly favoured position 3 (70%).
CONCLUSION
CONCLUSIONS
Performing guideline-compliant chest compressions during intra-hospital transportation is feasible with an appropriate provider position. Our results suggest, kneeling beside or astride the patient on the bed enables high-quality chest compressions, faster transport and is perceived by the providers as more pleasant. 'Walking next to the bed' while performing chest compressions should be avoided.
Identifiants
pubmed: 31977629
doi: 10.1097/EJA.0000000000001154
pii: 00003643-202004000-00005
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
286-293Références
Park GJ, Song KJ, Shin SD, et al. Timely bystander CPR improves outcomes despite longer EMS times. Am J Emerg Med 2017; 35:1049–1055.
Fredriksson M, Aune S, Thorén AB, et al. In-hospital cardiac arrest – an Utstein style report of seven years experience from the Sahlgrenska University Hospital. Resucitation 2006; 68:351–358.
Sandroni C, Nolan J, Cavallaro F, et al. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 2007; 33:237–245.
Poole K, Couper K, Smyth MA, et al. Mechanical CPR: who? When? How? Crit Care 2018; 22:140.
Wibrandt I, Norsted K, Schmidt H, et al. Predictors for outcome among cardiac arrest patients: the importance of initial cardiac arrest rhythm versus time to return of spontaneous circulation, a retrospective cohort study. BMC Emerg Med 2015; 15:3.
Bürger A, Wnent J, Seewald S, et al. The impact of the auxiliary time on the resuscitation result. Anästh Intensivmed 2017; 58:43–45.
Fischer M, Lang S, Wnent J, et al. The resuscitation-free interval determines short and long-term survival - an analysis from the German Resuscitation Registry. Anästh Intensivmed 2017; 58:S60–S61.
Atwood C, Eisenberg MS, Herlitz J, et al. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 2005; 67:75–80.
Gässler H, Ventzke MM, Lampl L, et al. Transport with ongoing resuscitation: a comparison between manual and mechanical compression. Emerg Med J 2013; 30:589–592.
Gyory RA, Buchle SE, Rodgers D, et al. The efficacy of LUCAS in prehospital cardiac arrest scenarios: a crossover mannequin study. West J Emerg Med 2017; 18:437–445.
Olasveengen TM, Wik L, Steen PA. Quality of cardiopulmonary resuscitation before and during transport in out-of-hospital cardiac arrest. Resuscitation 2008; 76:185–190.
Ødegaard S, Olasveengen T, Steen PA, et al. The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Resuscitation 2009; 80:843–848.
Diepenseifen CJ, Heister U, Schewe JC. Cardiopulmonary Resuscitation Ongoing CPR During Transport – When Does it Make Sense? Anästhesiol Intensivmed Notfallmed Schmerzther 2011; 46:402–407.
Russo A, Gasparetto N, Favero L, et al. The use of mechanical chest compression devices for both out-of-hospital and in-hospital refractory cardiac arrest. G Ital Cardiol 2017; 18:305–312.
Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2018; 39:119–177.
Truhlář A, Deakin CD, Soar J, et al. Guidelines for Resuscitation 2015 Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148–201.
Brooks SC, Hassan N, Bigham BL, et al. Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev 2014; 27:CD007260.
Valenzuela TD, Kern KB, Clark LL, et al. Interruptions of chest compressions during emergency medical systems resuscitation. Circulation 2005; 112:1259–1265.
Darok M. Tsokos M. Injuries resulting from resuscitation procedures. Forensic pathology reviews. Vol 1. Totowa: Humana Press; 2004. 293–303.
Kaldırım U, Toygar M, Karbeyaz K, et al. Complications of cardiopulmonary resuscitation in nontraumatic cases and factors affecting complications. Egypt J Forensic Sci 2016; 6:270–274.
Eng M, Ong H, Mackey KE, et al. Mechanical CPR devices compared to manual CPR during out-of-hospital cardiac arrest and ambulance transport: a systematic review. Scand J Trauma Resusc Emerg Med 2012; 20:39.
Drennan IR, Lin S, Sidalak DE, et al. Survival rates in out-of-hospital cardiac arrest patients transported without prehospital return of spontaneous circulation: an observational cohort study. Resuscitation 2014; 85:1488–1493.
Xiong Y, Zhan H, Lu Y, et al. Out-of-hospital cardiac arrest without return of spontaneous circulation in the field: who are the survivors? Resuscitation 2017; 112:28–33.
Markl S, Zanner R, Kochs EF, et al. Cardiopulmonary resuscitation: knowledge and attitude of the population of a German city. Eur J Anaesthesiol 2010; 27:193–194.
Becker LB, Berg RA, Pepe PE, et al. A reappraisal of mouth-to-mouth ventilation during bystander-initiated cardiopulmonary resuscitation: a statement for healthcare professionals from the ventilation working group of the Basic Life Support and Pediatric Life Support Subcommittees, American Heart Association. Ann Emerg Med 1997; 30:654–666.
Abella BS, Alvarado JP, Myklebust H, et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 2005; 293:305.
Abella BS, Aufderheide TP, Eigel B, et al. Reducing barriers for implementation of bystander-initiated cardiopulmonary resuscitation – a scientific statement from the American Heart Association for healthcare providers, policymakers, and community leaders regarding the effectiveness of cardiopulmonary resuscitation. Circulation 2008; 117:704–709.
Fox J, Fiechter R, Gerstl P, et al. Mechanical versus manual chest compression CPR under ground ambulance transport conditions. Acute Cardiac Care 2013; 15:1–6.
Shin J, Hwang SY, Lee HJ, et al. Comparison of CPR quality and rescuer fatigue between standard 30:2 CPR and chest compression-only CPR: a randomized crossover manikin trial. Scand J Trauma Resusc Emerg Med 2014; 22:59.