Quality of cardiopulmonary resuscitation on manikins: on the floor and in the bed

Background: In general, in-hospital resuscitation is performed in a bed and out-of-hospital resuscitation on the floor. The surface under the patient may affect the cardiopulmonary resuscitation (CPR) quality; therefore, we evaluated CPR quality (the percentage of chest compressions of correct depth) and rescuer's fatigue (the mean compression depth minute by minute) when CPR is performed on a manikin on the floor or in the bed.
Methods: Forty-four simulated cardiac arrest scenarios of 10 min were treated by intensive care unit (ICU) nurses in pairs using a 30 : 2 chest compression-to-ventilation ratio. The rescuer who performed the compressions was changed every 2 min. CPR was randomly performed either on the floor or in the bed without a backboard; in both settings, participants kneeled beside the manikin.
Results: A total number of 1060 chest compressions, 44% with correct depth, were performed on the floor; 1068 chest compressions were performed in the bed, and 58% of these were the correct depth. These differences were not significant between groups. The mean compression depth during the scenario was 44.9±6.2 mm (mean±SD) on the floor and 43.0±5.9 mm in the bed ( P =0.3). The mean chest compression depth decreased over time on both surfaces ( P <0.001), indicating rescuer fatigue, but this change was not different between the groups ( P =0.305).
Conclusions: ICU nurses perform chest compression as effectively on the floor as in the bed. The mean chest compression depth decreases over time, but the surface had no significant effect.     

Gastric mucosal pH does not reflect changes in splanchnic blood flow after cardiac surgery

Despite the widespread use of gastric tonometry to assess splanchnicoxygen transport, no human data are available on the relationshipbetween splanchnic blood flow, splanchnic oxygen delivery andgastric mucosal pH. We have studied the effect of splanchnicblood flow and oxygen delivery on gastric mucosal pH after cardiacsurgery. During the first postoperative hours of intensive care,dopexamine was infused to increase cardiac output in eight patients,while six patients served as controls. Gastric mucosal pH (gastrictonometry), splanchnic blood flow and splanchnic oxygen deliveryand consumption (dye dilution) were measured. Dopexamine administrationsignificantly increased splanchnic blood flow (0.72 vs 1 .02litre min^–1 m^–2 (P < 0.05) and oxygen delivery(117 vs 161 ml min^–1 m^–2 (P < 0.05) comparedwith base line values. However, splanchnic oxygen consumptionremained unchanged and gastric mucosal pH levels decreased (7.30vs 7.25) (P < 0.05). The proportion of splanchnic blood flowof cardiac output did not change in response to infusion ofdopexamine, that is dopexamine did not favour blood flow distributionto the splanchnic region. In the control group there were nochanges in splanchnic blood flow and oxygen delivery, whilesplanchnic oxygen consumption increased (36 vs 39 ml min^–1m^–2 (P < 0.05) and gastric mucosal pH tended to decrease(7.33 vs 7.29) (ns). We conclude that after cardiac surgerygastric mucosal pH did not reflect changes in splanchnic bloodflow and oxygen delivery suggesting heterogeneous or inadequateblood flow distribution within the splanchnic region.