Chest compressions performed by ED staff: a randomized cross-over simulation study on the floor and on a stretcher
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Fig. 1
Compression depth according to time since last CPR training. Participants last trained within the year, within the last 2 years, within the last 3-4 years, or within the last 5 years and beyond were compared. Compression depth is shown as mean and SD (error bars). The asterisk indicates significant difference (P<.05).
Fig. 2
Compression depth according to time since last BLS training and to position. Participants last trained within the year (n=17) or over a year ago (n=47) administered CPR both on floor and on the stretcher, order of position was randomized. Compression depth is shown as mean and SD (error bars). Asterisks indicate significant difference (P<.05).
Fig. 3
Compression depth according to the profession. Nurses (n=38) and nurse's aides (n=26) were compared, using data from CPR scenarios performed both on the floor or standing beside the strecher. Compression depth is shown as mean and SD (error bars). Asterisks indicate significant differences (P<.05).
Fig. 4
Compression rate according to the profession. Nurses (n=38) and nurse's aides (n=26) were compared, using data from CPR scenarios performed both on the floor or standing beside the strecher. Compression rate is shown as median and interquartile range and expressed as %.
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.
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