Instruction to compress chest approximately 6~7 cm for healthcare provider in hospital

Abstract

Background: 2010 AHA (American Heart Association) and ERC (European Resuscitation council) Guideline emphasize the high quality of chest compression (CC) in cardiopulmonary resuscitation (CPR). Unlikely the other element for high quality CC (i.e. compression rate, chest recoil, hand position), chest compression depth (CCD) is influenced by surface on which the patient is placed, especially in hospital. We hypothesized that training of 6~7 cm CCD for healthcare providers improve accurate CCD during CPR when manikin is placed on mattress in hospital. Methods: This study was a randomised controlled trial at 0000 university hospital (Seoul, Korea) from 20th February through 20th April, 2013. The hospital`s Institutional Review Board approved the study. Sixty-six, voluntary, junior medical students participated in this study. The participants were divided two groups randomly with drawing a lot. A control group was trained with 5~6 cm CCD (5~6 cm Group) for CPR education while the other group was done with 6~7 cm CCD (6~7 cm Group). Other techniques (i.e. posture, rate of CC, hand position et al.) were equally trained both groups. Each performer was tested for performing high quality CCD (i.e mean CCD is more than 5 cm) on manikins placed on the floor 10min later after the training (on the floor after training). And then, all participants did CCs on manikin placed on the bed 1 hour later after the test (on the bed after training). Finally, they did CCs on manikin on the bed 4 weeks later (on the bed after 4 weeks). CCs were performed over 2 minutes continuously without a manikin visual feedback system in each instance. We calculated CCD, rate of CC (CCR) for the three instances to assess the high quality CC at each evaluation. Additionally, the ratio of accurate CC was measured to determine a sufficient CCD which is ˃ 5 cm CCD based on the 2010 AHA guidelines. Results: Sixty six participants were eligible and all were enrolled without exclusion in this study. One participant at each group was lost to examine the test 4 weeks after training and data of two participants were recording error. Data of 62 participants were analyzed .The mean CCD (SD) decreased to 46.1 mm (6.1 mm) and 55.5 mm (7.6 mm) respectively on the bed 1hour later after training (95% CI of the mean difference of mean CCD 9.2~9.6 mm, p˂0.001). On the bed after 4 weeks, the mean CCD was 47.6 mm (7.0 mm) and 57.8 mm (7.8 mm) (95% CI of the mean difference 9.9~10.5 mm, p˂0.001). (Table 2.) The mean CCR (SD) was 118.0 times/min (8.1 times/min) in 5~6 cm group and 120.0 times/min (10.8 times/min) respectively on the bed after training ( 95% CI of the mean difference of mean CCR 2.8~6.9 times/min, p=0.41). On the bed after 4 weeks, the mean CCR was 104.3(18.1) times/min and 102.0(13.2) times/min (95% CI of the mean difference of mean CCR 5.7~10.3 times/min, p=0.57). The ratio of accurate CCD was 29.0% vs 78.8 % on the bed 1hour later after training, and 43.2 % vs 83.4% on the bed after 4 weeks in each group, respectively (all p values ˂ 0.001). Conclusion: Training of 6~7 cm CCD for healthcare providers might improves accurate CCD when performing CCs for the patient to be placed on mattress during CPR in hospital.