Skip to main content Accessibility help
×
Home

The effect of step stool use and provider height on CPR quality during pediatric cardiac arrest: A simulation-based multicentre study

  • Adam Cheng (a1), Yiqun Lin (a1), Vinay Nadkarni (a2), Brandi Wan (a1), Jonathan Duff (a3), Linda Brown (a4), Farhan Bhanji (a5), David Kessler (a6), Nancy Tofil (a7), Kent Hecker (a8) (a9) and Elizabeth A. Hunt (a10)...

Abstract

Objectives

We aimed to explore whether a) step stool use is associated with improved cardiopulmonary resuscitation (CPR) quality; b) provider adjusted height is associated with improved CPR quality; and if associations exist, c) determine whether just-in-time (JIT) CPR training and/or CPR visual feedback attenuates the effect of height and/or step stool use on CPR quality.

Methods

We analysed data from a trial of simulated cardiac arrests with three study arms: No intervention; CPR visual feedback; and JIT CPR training. Step stool use was voluntary. We explored the association between 1) step stool use and CPR quality, and 2) provider adjusted height and CPR quality. Adjusted height was defined as provider height + 23 cm (if step stool was used). Below-average height participants were ≤ gender-specific average height; the remainder were above average height. We assessed for interaction between study arm and both adjusted height and step stool use.

Results

One hundred twenty-four subjects participated; 1,230 30-second epochs of CPR were analysed. Step stool use was associated with improved compression depth in below-average (female, p=0.007; male, p<0.001) and above-average (female, p=0.001; male, p<0.001) height providers. There is an association between adjusted height and compression depth (p<0.001). Visual feedback attenuated the effect of height (p=0.025) on compression depth; JIT training did not (p=0.918). Visual feedback and JIT training attenuated the effect of step stool use (p<0.001) on compression depth.

Conclusions

Step stool use is associated with improved compression depth regardless of height. Increased provider height is associated with improved compression depth, with visual feedback attenuating the effects of height and step stool use.

Objectifs

L’étude visait à déterminer : a) si l’utilisation d’un marchepied était associée à une amélioration de la qualité des manœuvres de réanimation cardiorespiratoire (RCR); b) si la hauteur rajustée des fournisseurs de soins était associée à une amélioration de la qualité des manœuvres de RCR; et s’il existait des relations entre ces éléments c) si la formation juste-à-temps sur la RCR ou la rétroaction visuelle sur la RCR atténuaient les effets de la hauteur ou de l’utilisation du marchepied sur la qualité de la RCR.

Méthode

Ont été analysées des données provenant d’un essai d’arrêts cardiaques simulés, divisé en trois groupes : sans intervention, avec rétroaction visuelle sur la RCR et avec formation juste-à-temps sur la RCR. Les participants étaient libres d’utiliser ou non un marchepied. Les chercheurs ont tenté de déterminer s’il existait une relation entre 1) l’utilisation du marchepied et la qualité des manœuvres de RCR et 2) la hauteur rajustée des fournisseurs de soins et la qualité des manœuvres de RCR. La hauteur rajustée a été définie comme la taille du fournisseur de soins + 23 cm (en cas d’utilisation du marchepied). Les participants considérés comme petits avaient une taille égale ou inférieure à la moyenne de la taille liée au sexe; les autres étaient de taille supérieure à la moyenne. Les auteurs se sont penchés sur l’existence d’une interaction entre les groupes à l’étude et tant la hauteur rajustée que l’utilisation du marchepied.

Résultats

Cent vingt-quatre sujets ont participé à l’étude, et 1230 périodes de RCR, d’une durée de 30 secondes, ont été analysées. L’utilisation du marchepied a été associée à une profondeur accrue des compressions thoraciques chez les fournisseurs de soins de taille inférieure (femmes : p=0,007; hommes : p<0,001) et de taille supérieure (femmes : p=0,001; hommes : p<0,001) à la moyenne. Il existe une relation entre la hauteur rajustée et la profondeur des compressions (p<0,001). La rétroaction visuelle a atténué l’effet de la hauteur (p=0,025) sur la profondeur des compressions, mais pas la formation juste-à-temps (p=0,918). Par contre, la rétroaction visuelle et la formation juste-à-temps ont toutes deux atténué l’effet de l’utilisation du marchepied (p<0,001) sur la profondeur des compressions.

Conclusions

L’utilisation du marchepied a été associée à une profondeur accrue des compressions, indépendamment de la taille. Le fait de hausser la position des fournisseurs de soins a été associé à une profondeur accrue des compressions, mais la rétroaction visuelle a atténué les effets de la hauteur et de l’utilisation du marchepied.

Copyright

Corresponding author

* Correspondence to: Dr. Adam Cheng, Department of Pediatrics, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8; Email: chenger@me.com

References

Hide All
1. Meaney, PA, Bobrow, BJ, Mancini, ME, et al. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital. A consensus statement from the American Heart Association. Circulation 2013;128:417-435.
2. Cheskes, S, Schmicker, RH, Christenson, J, et al. Perishock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest. Circulation 2011;124:58-66.
3. Christenson, J, Andrusiek, D, Everson-Stewart, S, et al. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation 2009;120:1241-1247.
4. Stiell, IG, Brown, SP, Christenson, J, et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 2012;40:1192-1198.
5. Idris, AH, Guffey, D, Aufderheide, TP, et al. Relationship between chest compression rates and outcomes from cardiac arrest. Circulation 2012;125:3004-3012.
6. Wik, L, Steen, PA, Bircher, NG. Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest. Resuscitation 1994;28:195-203.
7. Sutton, RM, Wolfe, H, Nishisaki, A, et al. Pushing harder, pushing faster, minimizing interruptions… But falling short of 2010 cardiopulmonary resuscitation targets during in-hospital pediatric and adolescent resuscitation. Resuscitation 2013;84:1680-1684.
8. Abella, B, Alvarado, JP, Myklebust, H, et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 2005;293:305-310.
9. Wik, L, Kramer-Johansen, J, Myklebust, H, et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 2005;293:299-304.
10. Sutton, R, Niles, D, Nysaether, J, et al. Quantitative analysis of CPR quality during in-hospital resuscitation of older children and adolescents. Pediatrics 2009;124:1930-1938.
11. Sutton, R, Maltese, M, Niles, D, et al. Quantitative analysis of chest compression interruption during in-hospital resuscitation of older children and adolescents. Resuscitation 2009;80:1259-1263.
12. Sutton, RM, Niles, D, French, B, et al. First quantitative analysis of cardiopulmonary resuscitation quality during in-hospital cardiac arrests of young children. Resuscitation 2014;85:70-74.
13. Sutton, RM, Niles, D, Meaney, PA, et al. “Booster” training: evaluation of instructor-led bedside cardiopulmonary resuscitation skill training and automated corrective feedback to improve cardiopulmonary resuscitation compliance of pediatric basic life support providers during simulated cardiac arrest. Pediatr Crit Care Med 2011;12:e116-e121.
14. Sutton, RM, Niles, D, Meaney, PA, et al. Low-dose, high-frequency CPR training improves skill retention of in-hospital pediatric providers. Pediatrics 2011;128:e145-e151.
15. Cheng, A, Brown, L, Duff, J, et al.; for the INSPIRE CPR Investigators. Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): a multicenter, randomized trial. JAMA Pediatr 2015;169(2):1-9.
16. Cheng, A, Hunt, EA, Grant, D, et al. Variability in quality of chest compressions provided during simulated cardiac arrest across nine pediatric institutions. Resuscitation 2015;97:13-19.
17. Cheng, A, Overly, F, Kessler, D, et al. Perception of CPR quality: influence of CPR feedback, just-in-time training and provider role. Resuscitation 2015;87:44-50.
18. McNulty, T, Gallagher, P, Rice, BJ, et al. AS24 The relationship between healthcare staff height and the ability to perform effective chest compressions in adults. Resuscitation 2011;82(Supp 1):S7.
19. Ebbeling, LG, Esposito, EC, Fried, DA, et al. Abstract 245: Increasing rescuer height is associated with higher frequency of leaning during chest compressions. Circulation 2010;122:A245.
20. Lee, DH, Kim, CW, Kim, SE, et al. Use of step stool during resuscitation improved the quality of chest compression in simulated resuscitation. Emerg Med Australas 2012;24:369-373.
21. Edelson, DP, Call, SL, Tuen, TC, et al. The impact of a step stool on cardiopulmonary resuscitation: a cross-over mannequin study. Resuscitation 2012;83:874-878.
22. Niles, D, Donoghue, A, Kalsi, MS, et al. “Rolling Refreshers”: a novel approach to maintain CPR psychomotor skill competence. Resuscitation 2009;80:909-912.
23. Yeung, J, Meeks, R, Edelson, D, et al. The use of CPR feedback/prompt devices during training and CPR performance: a systematic review. Resuscitation 2009;80:743-751.
24. Kirkbright, S, Finn, J, Tohira, H, et al. Audiovisual feedback device use by health care professionals during CPR: a systematic review and meta-analysis of randomized and non-randomised trials. Resuscitation 2014;85:460-471.
25. Bhanji, F, Donoghue, A, Wolff, M, et al. Part 14: Education. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S561-S573.
26. Cheng, A, Auerbach, M, Chang, T, et al. Designing and conducting simulation-based research. Pediatrics 2014;133(6):1091-1101.
27. Nishisaki, A, Nysaether, J, Maltese, M, et al. Effect of mattress deflection on CPR quality assessment for older children and adolescents. Resuscitation 2009;80:540-545.
28. Wikipedia. Average height around the world. Available at: https://en.wikipedia.org/wiki/Template:Average_height_around_the_world (accessed 1 July 2015).
29. Sutton, RM, French, B, Niles, DE, et al. 2010. American Heart Association recommended compression depth during pediatric in-hospital resuscitations are associated with survival. Resuscitation 2014;85:1179-1184.
30. Vadeboncoeur, T, Stolz, U, Panchal, A, et al. Chest compression depth and survival in out-of-hospital cardiac arrest. Resuscitation 2014;85:182-188.
31. Edelson, DP, Abella, BS, Kramer-Johansen, J, et al. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation 2006;71:137-145.
32. Kramer-Johansen, J, Myklebust, H, Wik, L, et al. Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study. Resuscitation 2006;71:283-292.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed