Positional Effects on the Quality of Chest Compression: A Simulation Study

Ko, Jaiwoog; Kim, Kyungwuk; Suh, Joohyun

Abstract

PURPOSE
In-hospital cardiopulmonary resuscitation (CPR) is often performed on patients lying on a bed or stretcher, which involves using a step stool. However, as current CPR training uses mannequins placed on a floor, the quality of CPR in simulated cardiac arrest scenarios on a stretcher versus the floor were analyzed.
METHODS
This study was performed during the Objective Structured Clinical Examination (OSCE) for sixth grade medical students. The students were trained using Basic Life Support (BLS) guidelines given by the American Heart Association (AHA) in 2010. Simulated CPR was performed in the 1 rescuer-mode (30:2 compression to ventilation ratio) for 5 cycles, while either standing atop a step stool beside the stretcher or kneeling on the floor, and the position order was randomized. The OSCE score and variables related to CPR quality were compared.
RESULTS
Among the 59 students enrolled, 47 students were included for analysis. No significant difference in OSCE scores was found between the groups that performed CPR on a stretcher versus the floor (89.4+/-9.1 vs. 88.1+/-8.4, respectively, p=0.610). In addition, variables related to CPR quality did not differ between the groups that performed CPR on a stretcher versus the floor (following results listed respectively): correct compression rate (%) (54.8+/-42.3 vs. 70.0+/-34.9, p=0.185); compression rate (n/min) (127+/-11.3 vs. 126+/-13.3, p=0.792); correct depth (%) (69.8+/-40.6 vs. 78.6+/-33.6, p=0.429); mean compression depth (mm) (51.1+/-7.2 vs. 53.0+/-6.0, p= 0.337); correct release (%) (99.3+/-2.9 vs. 99.1+/-3.0, p=0.875); correct hand position (%) (83.2+/-32.3 vs. 86.7+/-27.5, p=0.694); total hands off time (sec.) (79.9+/-19.5 vs. 70.4+/-15.6, p=0.077).
CONCLUSION
Medical students effectively perform CPR on a stretcher or the floor. Thus, current CPR training methods appear adequate and may be maintained.