Chest compressions performed by ED staff: a randomized cross-over simulation study on the floor and on a stretcher

• Published in: The American journal of emergency medicine 2012-11, Vol.30 (9), p.1928-1934
• Main Authors: Sebbane, Mustapha, MD, PhD, Hayter, Megan, MD, Med, Romero, Joaquim, BSN, Lefebvre, Sophie, PhD, Chabrot, Colette, BSN, Mercier, Grégoire, MD, Eledjam, Jean-Jacques, MD, PhD, Dumont, Richard, MD, Houston, Patricia L., MD, Med, FRCPC, Boet, Sylvain, MD, MEd
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac arrest; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - standards; CPR; Cross-Over Studies; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency medical care; Emergency Nursing; Emergency Service, Hospital; Female; Guideline Adherence; Heart Arrest - therapy; Heart Massage - methods; Heart Massage - standards; Humans; Intensive care medicine; Lifesaving; Male; Manikins; Medical personnel; Medical sciences; Nurses; Nurses' Aides; Posture
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2012.04.013

Abstract Background Multiple factors may contribute to the observed survival variability following in-hospital cardiopulmonary resuscitation (CPR). While in-hospital CPR is most often performed on patients lying on a bed or stretcher, CPR training uses primarily manikins placed on the floor. We analyzed the quality of external chest compressions (ECC) in simulated cardiac arrest scenarios occurring both on a stretcher and on the floor. Methods Prospective cross-over simulation study enrolling ED nurses and nurse's aides as part of an annual evaluation. Simulated CPR was performed in the 2 rescuer-mode for 2 min, both kneeling on the floor, and standing beside a knee high stretcher. The order of position was randomized. ECC parameters were compared. Results ED nurses (n = 48) and nurse's aides (n = 26) performed 128 scenarios. Mean ECC depth was 32 ± 13 mm on the floor and 27 ± 11 mm on a stretcher (∆: 5 mm, 95%CI [3-7], P < .001). Participants last trained within a year (n = 17) developed deeper ECCs than their colleagues (n = 47) in both positions (floor: 39 ± 12 mm vs stretcher: 34 ± 11 mm (p = 0.016) for those trained within the year, and floor: 29 ± 12 mm vs stretcher: 24 ± 10 mm ( P < .001) for those trained over a year ago). Conclusions The quality of chest compressions performed by ED staff was below 2005 guideline standards, with decreased ECC depth during CPR on a stretcher. Annual refresher courses should be implemented in the ED, with a focus on obtaining required ECC depth while standing next to a stretcher.