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

Authors:	Akira Nishisaki, Jon Nysaether, Robert Sutton, Matthew Maltese, Dana Niles, Aaron Donoghue, Ram Bishnoi, Mark Helfaer, Gavin D Perkins, Robert Berg, Kristy Arbogast, Vinay Nadkarni
Language:	Eng.
Date:	2009-05-04
Journal:	Resuscitation (0300-9572)
Release:	Resuscitation. 2009 May;80(5):540-5
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+/-8mm on ICU beds, and 45+/-7 mm on stretcher beds with overestimation of 13+/-4mm and 4+/-1mm, 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.
Copyright:	Resuscitation Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia (CHOP), USA. NISHISAKI email.chop.edu
Full text:	DOI - Resuscitation (DOI) EBSCO - HTML (needs subscription) Elsevier Science - HTML (needs subscription) OhioLINK Electronic Journal Center - HTML (needs subscription) Swets Information Services - HTML (needs subscription)
Terms:	Acceleration, Adolescent, Beds, Cardiopulmonary Resuscitation, Child, Compressive Strength, Equipment Design, Guideline Adherence, Heart Massage, Humans, Manikins, Models, Theoretical, Process Assessment (Health Care), Thoracic Wall, Young Adult