Chest compressions performed by ED staff: a randomized cross-over simulation study on the floor and on a stretcher |
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Authors: | Mustapha Sebbane,Megan Hayter,Joaquim Romero,Sophie Lefebvre,Colette Chabrot,Gré goire Mercier,Jean-Jacques Eledjam,Richard Dumont,Patricia L. Houston,Sylvain Boet |
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Affiliation: | 1. Département des urgences, Centre Hospitalier Régional Universitaire Lapeyronie - 371, avenue du doyen Gaston Giraud -34295 - MONTPELLIER Cedex 5;2. Research into Teaching (SMART) Simulation Group, St. Michael''s Hospital, and Department of Anesthesia, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada M5B1W8;3. Département d''information médicale, Centre Hospitalier Régional Universitaire Lapeyronie - 371, avenue du doyen Gaston Giraud -34295 - MONTPELLIER Cedex 5;4. Department of Anesthesiology, General Campus, The Ottawa Hospital and University of Ottawa Skills and Simulation Centre (uOSSC) University of Ottawa, 501 Smyth Road, Ottawa, K1H 8L6, Ontario, Canada |
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Abstract: | BackgroundMultiple factors may contribute to the observed survival variability following in-hospital cardiopulmonary resuscitation (CPR). While in-hospital CPR is most often performed on patients lying on a bed or stretcher, CPR training uses primarily manikins placed on the floor. We analyzed the quality of external chest compressions (ECC) in simulated cardiac arrest scenarios occurring both on a stretcher and on the floor.MethodsProspective cross-over simulation study enrolling ED nurses and nurse's aides as part of an annual evaluation. Simulated CPR was performed in the 2 rescuer-mode for 2 min, both kneeling on the floor, and standing beside a knee high stretcher. The order of position was randomized. ECC parameters were compared.ResultsED nurses (n = 48) and nurse's aides (n = 26) performed 128 scenarios. Mean ECC depth was 32 ± 13 mm on the floor and 27 ± 11 mm on a stretcher (?: 5 mm, 95%CI [3-7], P < .001). Participants last trained within a year (n = 17) developed deeper ECCs than their colleagues (n = 47) in both positions (floor: 39 ± 12 mm vs stretcher: 34 ± 11 mm (p = 0.016) for those trained within the year, and floor: 29 ± 12 mm vs stretcher: 24 ± 10 mm (P < .001) for those trained over a year ago).ConclusionsThe quality of chest compressions performed by ED staff was below 2005 guideline standards, with decreased ECC depth during CPR on a stretcher. Annual refresher courses should be implemented in the ED, with a focus on obtaining required ECC depth while standing next to a stretcher. |
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