Effect of mattress deflection on CPR quality assessment for older children and adolescents

• Published in: Resuscitation Vol. 80; no. 5; pp. 540 - 545
• Main Authors: Nishisaki, Akira, Nysaether, Jon, Sutton, Robert, Maltese, Matthew, Niles, Dana, Donoghue, Aaron, Bishnoi, Ram, Helfaer, Mark, Perkins, Gavin D, Berg, Robert, Arbogast, Kristy, Nadkarni, Vinay
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.05.2009; Elsevier
• Subjects: Acceleration; Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Beds; Biological and medical sciences; Cardiac arrest; Cardiopulmonary resuscitation (CPR); Cardiopulmonary Resuscitation - instrumentation; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - standards; Chest compression; Child; Closed chest cardiac massage; Compressive Strength; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Equipment Design; Guideline Adherence; Heart Massage - instrumentation; Heart Massage - methods; Heart Massage - standards; Humans; Intensive care medicine; Manikins; Medical sciences; Models, Theoretical; Pediatric resuscitation; Process Assessment (Health Care); Resuscitation; Thoracic Wall; Young Adult; Chest compression; Pediatric resuscitation; Cardiopulmonary resuscitation (CPR); Resuscitation; Cardiac arrest; Closed chest cardiac massage; Human; Pediatrics; Intensive cardiocirculatory care; Cardiocirculatory arrest; Intensive care; Cardiovascular disease; Cardiac massage; Adolescent; Quality control; Child
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2009.02.006

Abstract Appropriate chest compression (CC) depth is associated with improved CPR outcome. CCs provided in hospital are often conducted on a compliant mattress. The objective was to quantify the effect of mattress compression on the assessment of CPR quality in children. Methods A force and deflection sensor (FDS) was used during CPR in the Pediatric Intensive Care Unit and Emergency Department of a children's hospital. The sensor was interposed between the chest of the patient and hands of the rescuer and measured CC depth. Following CPR event, each event was reconstructed with a manikin and an identical mattress/backboard/patient configuration. CCs were performed using FDS on the sternum and a reference accelerometer attached to the spine of the manikin, providing a means to calculate the mattress deflection. Results Twelve CPR events with 14,487 CC (11 patients, median age 14.9 years) were recorded and reconstructed: 9 on ICU beds (9296 CC), 3 on stretchers (5191 CC). Measured mean CC depth during CPR was 47 ± 8 mm on ICU beds, and 45 ± 7 mm on stretcher beds with overestimation of 13 ± 4 mm and 4 ± 1 mm, respectively, due to mattress compression. After adjusting for this, the proportion of CC that met the CPR guidelines decreased from 88.4 to 31.8% on ICU beds ( p < 0.001), and 86.3 to 64.7% on stretcher ( p < 0.001). The proportion of appropriate depth CC was significantly smaller on ICU beds ( p < 0.001). Conclusion CC conducted on a non-rigid surface may not be deep enough. FDS may overestimate CC depth by 28% on ICU beds, and 10% on stretcher beds.