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Association of body weight and depth of chest compressions among female rescuers. Scatter plot showing the weights of female participants and chest compression depth. The insufficient compression depth is below the dotted line. The weight terciles are 56 and 62.5 kg.
Source publication
Aim To evaluate associations between rescuers' anthropometric characteristics and chest compressions (CC) depth according to 2010 resuscitation guidelines.
Methods 186 medical and pharmacy students, never trained in basic life support (BLS) before, underwent video self-instruction training. The participants were asked to perform a BLS test on a man...
Context in source publication
Context 1
... was a signifi- cant difference between the first and the other terciles in the number of cases with insufficient compression depth (table 1). The association between weight and compression depth is presented as a scatter plot in figure 1. We calculated ORs to illustrate the associations between anthropometric factors and insufficient compres- sion depth (table 2). ...
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Effective chest compression may improve the return of spontaneous circulation and neurologic outcome in arrest victims. For fear of rescuer's fatigue, guidelines for cardiopulmonary resuscitation (CPR) recommended that chest compression (CC) should be switched every 2 minutes, but there is little evidence. We investigated whether health personnel c...
Although Basic Life Support (BLS) and Cardiopulmonary Resuscitation (CPR) education is mandatory in secondary schools in Flanders, many schools do not programme this content because they lack teachers with expertise in this matter. This study aimed at investigating CPR skill performance and skill decay following reciprocal learning with task cards...
Optimizing chest compression (CC) performance during neonatal cardiopulmonary resuscitation (CPR) is critical to improving survival outcomes since current clinical protocols often achieve only a fraction of the native cardiovascular perfusion. This study presents the development of a diagnostic tool to unobtrusively measure the CC depth and force d...
Background
Providing adequate chest compression is essential during infant cardio-pulmonary-resuscitation (CPR) but was reported to be performed poor. The “new 2-thumb technique” (nTTT), which consists in using 2 thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist, was recently introduced. Therefore, t...
Background:
Providing high-quality chest compressions is a key element affecting the effectiveness of cardiopulmonary resuscitation (CPR).
Aim:
To evaluate the effectiveness of standard (manual) chest compressions (Standard BLS, standard basic life support) and those performed with the use of the Lifeline ARM chest compression system (ARM; Defib...
Citations
... A similar study found that lighter rescuers had difficulty in achieving the correct compression depth. [14] It has been previously shown that low rescuer weight causes a decrease in chest compression depth due to increased fatigue over time. [15] A study related to the impact of physical fitness reported that rescuers with a higher BMI and better physical fitness performed better external chest compression. ...
Objectives: This study aims to examine the effect of upper extremity performance using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) on cardiopulmonary resuscitation (CPR) quality criteria according to the European Resuscitation Council (ERC) Guidelines for Resuscitation 2015, including chest compression rate, depth, and recoil.
Patients and methods: This simulation-based study included 105 paramedic students (43 males, 62 females; median age: 19 years; range, 18 to 20 years) attending a two-year paramedic program between February 2018 and April 2018. The CKCUEST was used to determine upper extremity performance scores, including the touch number, normalized, and power score of the paramedic students. A TrueCPR® feedback device was used to measure CPR quality criteria throughout the study. The characteristics of the providers, such as height, weight, body mass index (BMI), and fat-free mass were also analyzed.
Results: Adequate compression depth had a positive correlation with body fat-free mass (r=0.397, p<0.001), power score (r=0.326, p=0.001), height (r=0.326, p=0.001), weight (r=0.314, p=0.001), and BMI (r=0.204, p=0.037). Full chest recoil had a negative correlation with the power score (r=-0.249, p=0.010) and height (r=-0.219, p=0.025). None of the variables were significantly different between the groups with and without the correct compression rate. In the receiver operating characteristic curve analysis for power score and correct compression depth as 100%, the area under the curve was 0.845 (p<0.001).
Conclusion: The power score combination of upper extremity functionality and the rescuer’s weight is the main factor affecting chest compression depth. However, this score is negatively correlated with full chest recoil.
... In a study examining the reasons for not performing adequate and effective chest compressions, weight, body mass index and female gender were found to be affecting factors. It is emphasized that individuals with higher body weight and body mass index perform more effective chest compression (5)(6)(7)(8)(9). ...
Aim: The purpose of this study is searching the effect of BMI and BMW on the quality of CPR and the state of exhaustion applied by the professionals in the emergency department. Material and Method: The software of the CPR education manikin was used in order to count and measure the number and the depth of the compressions and their correspondence to each other during the first and the second minutes of the procedure. Five cycles of chest compressions were asked to do from the rescurers. Each rescuer has handed the task of applying pressure over to his/her following team member after two minutes. Borg tiredness scores were asked to the rescuers and recorded at the end of each-minute period. Results: The mean depth of pressure, the number of pressure attempts applied and the number of superficial compressions of the participants who were grouped due to their BMI showed no statistically meaningful difference. Both in the mean values of Borg tiredness scores which were calculated at the end of the first and second minutes; the group with lower BMW showed higher exhaustion significantly and this group couldn’t make sufficient compressions by means of depth and number, and also the latter showed more exhaustion compared to the first. Conclusion: It is considered that choosing the health workers who are going to apply CPR among individuals with higher BMW or encouraging the workers in those departmnets who frequently apply CPR to be more interested in sports activities could be a promoting factor for having good quality CPR and reducing mortality as well.
... As muscle mass and back muscle strength are essential in physical activities and maintaining posture, their impact on the quality of chest compressions were also the subject of an analysis in a student group [13]. Moreover, based on current scientific research, the quality of CPR depends on other physiological parameters such as height [14], body weight [15,16], body mass index [14,17] or body fat [18]. Therefore, we aimed to evaluate the relationship between selected body composition components and chest compression and ventilation parameters provided by nurses in our study. ...
The provision of cardiopulmonary resuscitation (CPR) may be related to the physical parameters of the medical personnel, including fat mass (FM) and fat-free mass (FFM) components. In this study, we aimed to assess the relationship between selected body composition components and chest compression and ventilation parameters provided by medical staff. An observational simulation study was undertaken between December 2017 and January 2019 at the Center for Innovative Research in Medical and Natural Sciences of Rzeszów. In all participants (505 nurses, 37.71 y ± 12.16), the body weight and height were measured and the body mass index (BMI) was calculated. The body composition indicators were obtained using a bioelectrical impedance device, AKERN BIA 101. Afterwards, all participants performed CPR sequences (30 chest compressions and rescue for 2 breaths) for 2 min on a Laerdal Resusci Anne simulator placed on an examination couch with a self-inflating bag and a face mask. Our observations proved that high values of the anthropometric, nutritional and body composition parameters of the medical staff demonstrated a positive significant correlation with the depth and rate chest parameters and were inversely related to the chest adequate recoil. No statistically significant differences were found between the FM or FFM components and ventilation parameters. This study showed that nutritional status and body composition components may be important factors affecting the quality of CPR.
... Previous reports have also highlighted that females weighing < 56 kg had inadequate CCDs. 10 Furthermore, the CCD remained shallow even when lightweight rescuers adopted the correct posture. Given this, many researchers have concluded that underweight rescuers require additional attention and specialized training. ...
Aim
Chest compression depth (CCD) in cardiopulmonary resuscitation is important. However, lightweight rescuers have difficulty achieving an appropriate depth. Chest compression force (CCFORCE) can be increased by placing the arms at 100° to the patient’s frontal plane. In a simulation manikin study, we compared the CCD at 90° and 100° among lightweight Asian females and hypothesized that the CCD would be greater when the arms were placed at 100°.
Methods
We included 35 lightweight female students from Shimane University who performed compressions 30 times each at 90° and 100°. The CCFORCE and CCD and the residual force on the chest wall during decompression for each chest compression were compared using CPRmeter-2.
Results
Of the 35 participants, 3 were excluded because their angles deviated from the prescribed angle. Thirty-two participants were categorized according to CCD at 90°: ≤40 mm (group 1), 41–49 mm (group 2), and ≥ 50 mm (group 3). The overall mean CCD increased from 90° to 100° (44.3 ± 8.2 mm vs. 48.1 ± 7.2 mm; p < 0.05). The mean CCD changes between 90° and 100° were 34.4 ± 4.7 mm vs. 42.9 ± 4.8 mm (p < 0.05) in group 1, 44.9 ± 2.5 mm vs. 47.0 ± 4.2 mm (p = 0.17) in group 2, and 53.0 ± 2.7 mm vs. 55.4 ± 5.6 mm (p < 0.05) in group 3. The residual force was greater when the chest compression angle was 100°.
Conclusion
CCD can be increased for lightweight rescuers when using a forward leaning position of 100° to the frontal plane of the patient. Further research is required to obtain more realistic situations.
... Survival after cardiac arrest is directly related to the effectiveness of CPR, which must ensure adequate myocardial oxygen delivery (4,5) through adequate coronary perfusion pressure. This is generated by the difference between aortic and right atrium diastolic pressures during the relaxation phase of chest compressions (6,7). ...
Introduction: Cardiovascular accidents are the world's leading cause of death. A good quality cardiopulmonary resuscitation (CPR) can reduce cardiac arrest-associated mortality. This study aims to test the coaching system of a wearable glove, providing instructions during out-of-hospital CPR.
Materials and Methods: We performed a single-blind, controlled trial to test non-healthcare professionals during a simulated CPR performed on an electronic mannequin. The no-glove group was the control. The primary outcome was to compare the accuracy of depth and frequency of two simulated CPR sessions. Secondary outcomes were to compare the decay of CPR performance and the percentage of the duration of accurate CPR.
Results: About 130 volunteers were allocated to 1:1 ratio in both groups; mean age was 36 ± 15 years (min–max 21–64) and 62 (48%) were men; 600 chest compressions were performed, and 571 chest compressions were analyzed. The mean frequency in the glove group was 117.67 vs. 103.02 rpm in the control group ( p < 0.001). The appropriate rate cycle was 92.4% in the glove group vs. 71% in the control group, with a difference of 21.4% ( p < 0.001). Mean compression depth in the glove group was 52.11 vs. 55.17 mm in the control group ( p < 0.001). A mean reduction of compression depth over time of 5.3 mm/min was observed in the control group vs. 0.83 mm/min of reduction in the glove group.
Conclusion: Visual and acoustic feedbacks provided through the utilization of the glove's coaching system were useful for non-healthcare professionals' CPR performance.
... Performing CPR on a mattress in bed results in mattress and bedframe deflection and negatively influences compression depth on the sternum during manikin CPR (Lin et al., 2017;Nishisaki et al., 2012;Oh et al., 2016;Ruiz de Gauna et al., 2016;Sainio et al., 2014). Other factors that might influence compression quality are bed height (Perkins et al., 2003;Perkins et al., 2006), sex (Amacher et al., 2017;Jaafar et al., 2015) and body mass index (BMI) (Jaafar et al., 2015;Krikscionaitiene et al., 2013). ...
Introduction
Chest compression quality during in-hospital resuscitation is often suboptimal on a soft surface. Scientific evidence regarding the effectiveness of a backboard is scarce. This single-blinded manikin study evaluated the effect of a backboard on compression depth, rate and chest recoil performed by nurses. Sex, BMI, age and clinical department were considered as potential predictors.
Methods
Using self-learning, nurses were retrained to achieve a minimal combined compression score at baseline. This combined score consisted of ≥70% compressions with depth 50–60 mm, ≥70% compressions with complete release (≤5mm) and a mean compression rate of 100–120 bpm. Subsequently, nurses were allocated to a backboard or control group and performed a two-minute cardiopulmonary resuscitation test. The main outcome measure was the difference in proportion of participants achieving a combined compression score of ≥70%.
Results
In total 278 nurses were retrained, 158 nurses dropped out and 120 were allocated to the backboard (n = 61) or control group (n = 59). The proportion of participants achieving a combined compression score of ≥70% was not significantly different (p = 0.475) and suboptimal in both groups: backboard group 47.5% (backboard) versus 41.0% (control). Older age (≥51 years) was associated with a lower probability of achieving a combined compression score >70% [OR = 0.133; 95% confidence interval (CI), 0.037–0.479; p = 0.002].
Conclusion
Using a backboard did not significantly improve compression quality in our study. Important decay of compression skills was observed in both groups, highlighting the importance of frequent retraining, particularly in some age groups.
... Among these, the most researched determinants of high-quality CPR have been sex, body weight and height (including body mass index), physical fitness, and muscle strength [23]. Lightweight rescuers, especially women, have been proven not to perform adequate chest compression depth [24,25] and allow complete chest recoil [26]. Similarly, rescuers who are underweight perform CPR worse than those of normal weight or excess weight [27,28]. ...
... Regarding the effects of nursing students' physical characteristics, none of the physical characteristics measured in the training and control group participants had any impact on their CPR performance in any phase of our study. However, there is evidence that chest compression quality depends on the rescuer's body weight [23][24][25][26][27][28], since their mass is proportional to the force transferred to the patient's chest [44]. Furthermore, a force of 50 kg is needed to achieve 5 cm of chest compression, so lightweight rescuers need more muscle strength [45]. ...
Background
Cardiopulmonary resuscitation (CPR) skills decline rapidly and rescuers’ physical characteristics could impact on their performance. Our aim was to analyse the effects of deliberate practice using a feedback device (FD) on the CPR performance of nursing students prior to, immediately after, and three months after training, considering their physical characteristics.
Method
Sixty nursing students participated in this randomized clinical trial (control group n = 28; training group n = 32). Their physical characteristics (weight, height, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)% index, handgrip strength, and CPR position strength) were measured before starting the trial. The training group followed a CPR training programme based on deliberate practice, providing feedback on their performance using an FD. All participants were evaluated during two-minute CPR compression/ventilation cycles.
Results
The training group showed an improved ability to perform chest compressions (F(2, 115.2) = 13.3; p < .001; ω²p = 0.17) and ventilations (F(2, 115.3) = 102.1; p < .001; ω²p = 0.63), improving their overall quality of CPR (F(2, 115.2) = 40.1; p < .001; ω²p = 0.40). The physical characteristics of the participants did not affect CPR performance in any study phase.
Conclusions
A structured training programme based on deliberate practice using an FD had a positive effect on the acquisition of CPR skills by participants, while their physical characteristics had no impact on performance.
... Based on their regression equation, rescuers weighing more than 70.5 kg could achieve a chest compression depth of 50 mm, while lighter rescuers may have difficulty in achieving and maintaining adequate chest compressions. 21 A recent European Resuscitation Council guideline reported that the CPR skills deteriorate within months of training, and therefore, annual retraining strategies are recommended. However, the optimal intervals for retraining have not been determined and are likely to differ based on the characteristics of the participants. ...
Objective:
Cardiopulmonary resuscitation (CPR) education with a feedback device is known to result in better CPR skills compared to one without the feedback device. However, its long-term benefits have not been established. The purpose of this study was to evaluate the long-term CPR skill retention after training using real-time visual manikins in comparison to that of non-feedback manikins.
Methods:
We recruited 120 general university students who were randomly divided into the real-time feedback group (RTFG) and the non-feedback group. Of them, 95 (RTFG, 48; non-feedback group, 47) attended basic life support and automated external defibrillation training for 1 hour. For comparison of retention of CPR skills, the two groups were evaluated based on 2-minute chest compression performed immediately after training and at 3, 6, and 9 months. The CPR parameters between the two groups were also compared using a generalized linear model.
Results:
At immediately after training, the performance of RTFG was better in terms of average chest compression depth (51.9±1.1 vs. 45.5±1.1, p<0.001) and a higher percentage of adequate chest compression depth (51.0±4.1 vs. 26.9±4.2, p<0.001). This significant difference was maintained until 6 months after training, but there was no difference at 9 months after training. However, there was no significant difference in the chest compression rate and the correct hand position at any time point.
Conclusion:
CPR training with a real-time visual feedback manikin improved skill acquisition in chest compression depth, but only until 6 months after the training. It could be a more effective educational method for basic life support training in laypersons.
... This finding is consistent with previous studies that demonstrated a role of anthropometric variables on CPR quality. 38,39 On the other hand, the level of physical activity calculated with IPAQ was not related with the primary outcome. This could be the starting point for further studies, as no information is available on this topic involving laypeople. ...
Background:
Compression-only cardiopulmonary resuscitation (CPR) is a suggested technique for laypeople facing out-of-hospital cardiac arrest (OHCA). However, it is difficult performing high-quality CPR until emergency medical services arrival with this technique. We aimed to verify whether incorporating intentional interruptions of different frequency and duration increases laypeople's CPR quality during an 8-minute scenario compared with compression-only CPR.
Methods:
We performed a multicenter randomized manikin study selecting participants from 2154 consecutive laypeople who followed a basic life support/automatic external defibrillation course. People who achieved high-quality CPR in 1-minute test on a computerized manikin were asked to participate. Five hundred seventy-six were enrolled, and 59 were later excluded for technical reasons or incorrect test recording. Participants were randomized in an 8-minute OHCA scenario using 3 CPR protocols (30 compressions and 2-second pause, 30c2s; 50 compressions and 5-second pause, 50c5s; 100 compressions and 10-second pause, 100c10s) or compression-only technique. The main outcome was the percentage of chest compressions with adequate depth.
Results:
Five hundred seventeen participants were evaluated. There was a statistically significant difference regarding the percentage of compressions with correct depth among the groups (30c2s, 96%; 50c5s, 96%; 100c10s, 92%; compression only, 79%; P = 0.006). Post hoc comparison showed a significant difference for 30c2s (P = 0.023) and for 50c5s (P = 0.003) versus compression only. Regarding secondary outcome, there were a higher chest compression fraction in the compression-only group and a higher rate of pauses longer than 10 seconds in the 100c10s.
Conclusions:
In a simulated OHCA, 30c2s and 50c5s protocols were characterized by a higher rate of chest compressions with correct depth than compression only. This could have practical consequences in laypeople CPR training and recommendations.
Clinical trial registration:
NCT02632500.
... The study participants were allocated randomly to Group A or B with stratified randomization method according to their sex for the purpose of allocating the participants in each group with the same ratio of sex. We controlled for sex based on the following reasons: the CCD for women rescuers was inferior to those of men rescuers because factors such as lower body weight and low level of muscular fitness could decrease CCD [14][15][16][17]. The present study was a randomized controlled trial that included minimal number of participants. ...
Aim
This study was conducted to investigate the effect of resuscitation guideline terminology on the performance of infant cardiopulmonary resuscitation (CPR).
Methods
A total of 40 intern or resident physicians conducted 2-min CPR with the two-finger technique (TFT) and two-thumb technique (TT) on a simulated infant cardiac arrest model with a 1-day interval. They were randomly assigned to Group A or B. The participants of Group A conducted CPR with the chest compression depth (CCD) target of “approximately 4 cm” and those of Group B conducted CPR with the CCD target of “at least one-third the anterior-posterior diameter of the chest”. Single rescuer CPR was performed with a 15:2 compression to ventilation ratio on the floor.
Results
In both chest compression techniques, the average CCD of Group B was significantly deeper than that of Group A (TFT: 41.0 [range, 39.3–42.0] mm vs. 36.5 [34.0–37.9] mm, P = 0.002; TT: 42.0 [42.0–43.0] mm vs. 37.0 [35.3–38.0] mm, P < 0.001). Adequacy of CCD also showed similar results (Group B vs. A; TFT: 99% [82–100%] vs. 29% [12–58%], P = 0.001; TT: 100% [100–100%] vs. 28% [8–53%], P < 0.001).
Conclusions
Using the CCD target of “at least one-third the anterior-posterior diameter of the chest” resulted in deep and adequate chest compressions during simulated infant CPR in contrast to the CCD target of “approximately 4 cm”. Therefore, changes in the terminology used in the guidelines should be considered to improve the quality of CPR.
Trial registration
Clinical Research Information Service; cris.nih.go.kr/cris/en (Registration number: KCT0003486).
