BACKGROUND
Treatment of reversible causes of cardiac arrest often requires intrahospital transportation during ongoing resuscitation. But high-quality chest compression with minimal interruption is the most essential prerequisite for an optimal outcome after cardiac resuscitation.
OBJECTIVE
We aimed to evaluate chest compression quality according to the provider position during intrahospital transportation.
DESIGN
Manikin observational study.
SETTING
German Tertiary Care Hospital.
PARTICIPANTS
A total of 20 paramedics (eight female, 12 male); average professional experience 4.8 ± 3.1 years since their initial enrolment for training.
INTERVENTION(S)
Participants performed chest compressions during simulated intrahospital transportation in four groups: provider kneeling beside manikin on the floor (control group), walking next to the bed (group 1), kneeling on the bed beside the manikin (group 2), kneeling astride the manikin on the bed (group 3).
MAIN OUTCOME MEASURES
Quality metrics as European Resuscitation Council Guidelines 2015. Subsequently, the participants were asked to assess their own subjective feelings of safety, comfort and strain, and to recommend one position.
RESULTS
The quality of chest compression in the control group and groups 2 and 3 did not differ significantly. Group 1 performed significantly worse in terms of the correct hand placement on the chest (P = 0.044 vs. control group) and compression depth (P = 0.004 vs. control group, P = 0.035 vs. group 2, P = 0.006 vs. group 3). Transport speed was faster in groups 2 and 3 vs. group 1 (P < 0.05 vs. group 1, P < 0.05 vs. group 2). The majority of participants rated position 1 as unsafe (90%), unpleasant (100%) and exhausting (100%). They predominantly favoured position 3 (70%).
CONCLUSION
Performing guideline-compliant chest compressions during intra-hospital transportation is feasible with an appropriate provider position. Our results suggest, kneeling beside or astride the patient on the bed enables high-quality chest compressions, faster transport and is perceived by the providers as more pleasant. ‘Walking next to the bed’ while performing chest compressions should be avoided.
BackgroundTo evaluate the effects of European Resuscitation Council (ERC) Covid-19-guidelines on resuscitation quality.MethodsIn an observational manikin study paramedics and emergency physicians performed Advanced-Cardiac-Life-Support in three settings: ERC guidelines 2015 (Control), Covid-19-guidelines as suggested with minimum staff (Covid-19-minimal-personnel); Covid-19-guidelines with paramedics and an emergency physician (Covid-19-advanced-airway-manager). Main outcome measures were no-flow-time, quality metrics as defined by ERC and time intervals to first chest compression, oxygen supply, intubation and first rhythm analysis. Data were presented as mean (standard deviation).Results30 resuscitation scenarios were completed. No-flow-time was markly prolonged in Covid-19-minimal-personnel [113±37 sec] compared to Control [55±9 sec; p<0.001] and Covid-19-advanced-airway-manager [76±38 sec; p<0.001]. In both Covid-19-groups chest compressions started later [Control: 21±5 sec, Covid-19-minimal-personnel: 32±6 sec; Covid-19-advanced-airway-manager: 37±7 sec; each p<0.001 vs. control], but oxygen supply [Control: 77±19 sec; Covid-19-minimal-personnel: 29±5 sec; Covid-19-advanced-airway-manager: 34±7 sec; each p<0.001 vs. control] and first intubation attempt [Control: 178±44 sec; Covid-19-minimal-personnel: 111±14 sec; Covid-19-advanced-airway-manager: 131±20 sec; each p<0.001 vs. control] were earlier than in the control group. However, succesful intubation was similar [Control: 198±48 sec; Covid-19-minimal-personnel: 181±42 sec; Covid-19-advanced-airway-manager: 130±25 sec] due to a longer intubation time in Covid-19-minimal-personnel [61±35 sec] compared to Covid-19-advanced-airway-manager (p=0.002) and control [19±6 sec; p<0.001]. Time to first rhythm analysis was more than doubled in Covid-19-minimal-personnel [138±96 sec] compared to control [50±12 sec, p<0.001].ConclusionCovid-19-guidelines led to earlier attempts at intubation, delay in starting chest compressions, longer interruption in chest compression and markedly worsen the quality of resuscitation. These negative effects are attenuated by increasing the number of staff and addition of an experienced airway manager. Specific indications for Covid-19-guidelines are urgently required to carefully balance the risk of infection with SARS-CoV-2 for the staff vs. the potentially worse outcome for the patients.
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