Not all compressions are the same
An evaluation of the quality of CPR chest compressions performed on football-equipped and obese simulation manikins.
Longo JA, Lyman KJ, Hanson TA, et. already. Prehosp Emergency Room. 2023 February 3:1-6. doi: 10.1080/10903127.2023.2172494. E-publishing prior to printing.
https://pubmed.ncbi.nlm.nih.gov/36692382/
Take home message
Rescuers provide more superficial CPR chest compressions to obese manikins wearing American Football chest/shoulder pads than to those without equipment or obesity.
Background
Immediate administration of high-quality CPR is a critical part of the cardiac chain of survival. Both body size and protective equipment influence the effectiveness of chest compressions. However, few researchers have examined how protective equipment (e.g., shoulder pads) affects the performance of chest compressions in obese individuals.
Study aim
The researchers conducted a study to assess the quality of CPR chest compressions by a rescuer during four randomized conditions that varied whether the manikin represented someone with obesity or was wearing American football equipment.
Methods
The researchers recruited a convenience sample of 50 first responders with varying levels of education (medical first responder to paramedic). The rescuers then made four resuscitation attempts. Each trial lasted 2 minutes, with a 3-minute break between each trial. Participants completed manikin testing simulating four conditions: (1) traditional manikin without equipment, (2) traditional manikin with American football chest/shoulder pads, (3) obese manikin with American football chest/shoulder pads, and (4) obese manikin without equipment. The researchers measured the effectiveness of the compressions using a Laerdal CPRmeter 2 device, which records compression rate, delivery and depth. During tests without equipment, rescuers had to remove protective equipment before starting chest compressions. This protocol allowed the research team to measure how long it took for a rescuer to remove protective equipment.
Results
The depth of chest compressions suffered when the obese manikin had American Football chest/shoulder pads. Rescuers used more force during chest compressions on the obese manikin without electrodes than in the other three conditions. The mean rate of delivery and number of compressions were similar regardless of excess weight and protective equipment. Regardless of manikin or protective equipment, rescuers only met the recommended compression rate at 40% (obese with electrodes) to 51% (non-obese with electrodes) of compressions and the recommended depth at 7% (obese with electrodes) to 22%. % non-obese with pads) of compressions.
Viewpoints
The hired, trained responders often failed to provide effective chest compressions to simulated patients, especially if they were obese and wearing American football chest/shoulder pads. Therefore, rescuers may benefit from additional training regarding CPR on different body types, with and without protective sports equipment. Furthermore, we need more research to reproduce these results, to look at other types of equipment that may influence the quality of chest compressions, and to investigate the benefit of regular training with on-field scenarios with first responders and athletic trainers.
Clinical implications
Clinicians must consider the patients they treat and how equipment, body types, and other factors can affect the quality of CPR chest compressions. Clinicians may benefit from incorporating bariatric resuscitation exercises into their training.
Questions for discussion
Do you include equipment-specific scenarios or obese manikins in your CPR training? If not, what barriers would you encounter when incorporating exercise models that are obese or in equipment-specific scenarios?
Written by Kyle Harris
Reviewed by Jeffrey Driban
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