CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial.
Asphyxia
Atypical rescuer position
Confined space
Resuscitation
Ventilation
Journal
Scandinavian journal of trauma, resuscitation and emergency medicine
ISSN: 1757-7241
Titre abrégé: Scand J Trauma Resusc Emerg Med
Pays: England
ID NLM: 101477511
Informations de publication
Date de publication:
04 Sep 2021
04 Sep 2021
Historique:
received:
09
06
2021
accepted:
23
08
2021
entrez:
5
9
2021
pubmed:
6
9
2021
medline:
8
9
2021
Statut:
epublish
Résumé
The aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position. In this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position. Only 28% of all tidal volumes conformed to the guidelines (400-800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s. Efficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position.
METHODS
METHODS
In this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position.
RESULTS
RESULTS
Only 28% of all tidal volumes conformed to the guidelines (400-800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s.
CONCLUSIONS
CONCLUSIONS
Efficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.
Identifiants
pubmed: 34481521
doi: 10.1186/s13049-021-00944-9
pii: 10.1186/s13049-021-00944-9
pmc: PMC8418718
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
129Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2021. The Author(s).
Références
Brugger H, Durrer B, Elsensohn F, Paal P, Strapazzon G, Winterberger E, et al. Resuscitation of avalanche victims: Evidence-based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM): intended for physicians and other advanced life support personnel. Resuscitation. 2013;84(5):539–46.
doi: 10.1016/j.resuscitation.2012.10.020
Wallner B, Moroder L, Brandt A, Mair P, Erhart S, Bachler M, et al. Extrication times during avalanche companion rescue: a randomized single-blinded manikin study. High Alt Med Biol. 2019;20(3):245–50.
doi: 10.1089/ham.2019.0021
Wallner B, Brugger H, Ellerton J, Paal P. In mountain and rural areas all CPR providers should perform chest compressions and rescue breaths for patients in cardiac arrest. Resuscitation. 2018;127:e5.
doi: 10.1016/j.resuscitation.2018.01.029
Handley AJ, Handley JA. Performing chest compressions in a confined space. Resuscitation. 2004;61(1):55–61.
doi: 10.1016/j.resuscitation.2003.11.012
Perkins GD, Stephenson BT, Smith CM, Gao F. A comparison between over-the-head and standard cardiopulmonary resuscitation. Resuscitation. 2004;61(2):155–61.
doi: 10.1016/j.resuscitation.2004.01.006
Bollig G, Steen PA, Wik L. Standard versus over-the-head cardiopulmonary resuscitation during simulated advanced life support. Prehosp Emerg Care. 2007;11(4):443–7.
doi: 10.1080/00207450701537050
Hupfl M, Duma A, Uray T, Maier C, Fiegl N, Bogner N, et al. Over-the-head cardiopulmonary resuscitation improves efficacy in basic life support performed by professional medical personnel with a single rescuer: a simulation study. Anesthesia Analgesia. 2005;101(1):200–5.
doi: 10.1213/01.ANE.0000154305.70984.6B
Procter E, Strapazzon G, Dal Cappello T, Zweifel B, Wurtele A, Renner A, et al. Burial duration, depth and air pocket explain avalanche survival patterns in Austria and Switzerland. Resuscitation. 2016;105:173–6.
doi: 10.1016/j.resuscitation.2016.06.001
Strapazzon G, Brugger H. On-site treatment of snow avalanche victims: from bench to mountainside. High Alt Med Biol. 2018;19(4):307–15.
doi: 10.1089/ham.2018.0036
Soar J, Bottiger BW, Carli P, Couper K, Deakin CD, Djarv T, et al. European resuscitation council guidelines 2021: adult advanced life support. Resuscitation. 2021;161:115–51.
doi: 10.1016/j.resuscitation.2021.02.010
Lott C, Truhlar A, Alfonzo A, Barelli A, Gonzalez-Salvado V, Hinkelbein J, et al. European resuscitation council guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021;161:152–219.
doi: 10.1016/j.resuscitation.2021.02.011
Kornhall DK, Logan S, Dolven T. Body positioning of buried avalanche victims. Wilderness Environ Med. 2016;27(2):321–5.
doi: 10.1016/j.wem.2016.02.008
Perkins GD, Gao F. Over-the-head CPR. Anesthesia Analgesia. 2006;103(2):498.
doi: 10.1213/01.ANE.0000227073.07034.D1
Perkins GD, Stephenson B, Smith C, Gao F. Over-the-head CPR. Resuscitation. 2004;62(3):315.
doi: 10.1016/j.resuscitation.2004.06.016
Maisch S, Gamon E, Ilisch A, Goetz AE, Schmidt GN. Comparison of the over-the-head, lateral and alternating positions during cardiopulmonary resuscitation performed by a single rescuer with a bag–valve–mask device. Emerg Med J. 2011;28(11):974–8.
doi: 10.1136/emj.2010.098251
Chi CH, Tsou JY, Su FC. Comparison of chest compression kinematics associated with over-the-head and standard cardiopulmonary resuscitation. Am J Emerg Med. 2009;27(9):1112–6.
doi: 10.1016/j.ajem.2008.08.029
Niles DE, Sutton RM, Nadkarni VM, Glatz A, Zuercher M, Maltese MR, et al. Prevalence and hemodynamic effects of leaning during CPR. Resuscitation. 2011;82(Suppl 2):S23–6.
doi: 10.1016/S0300-9572(11)70147-2
Fried DA, Leary M, Smith DA, Sutton RM, Niles D, Herzberg DL, et al. The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation. Resuscitation. 2011;82(8):1019–24.
doi: 10.1016/j.resuscitation.2011.02.032
Newell C, Grier S, Soar J. Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation. Crit Care. 2018;22(1):190.
doi: 10.1186/s13054-018-2121-y
Paal P, Falk M, Sumann G, Demetz F, Beikircher W, Gruber E, et al. Comparison of mouth-to-mouth, mouth-to-mask and mouth-to-face-shield ventilation by lay persons. Resuscitation. 2006;70(1):117–23.
doi: 10.1016/j.resuscitation.2005.03.024
Adelborg K, Bjornshave K, Mortensen MB, Espeseth E, Wolff A, Lofgren B. A randomised crossover comparison of mouth-to-face-shield ventilation and mouth-to-pocket-mask ventilation by surf lifeguards in a manikin. Anaesthesia. 2014;69(7):712–6.
doi: 10.1111/anae.12669