Clinical pilot study of different hand positions during manual chest compressions monitored with capnography

Qvigstad, Erik; Kramer‐Johansen, Jo; Tømte, Øystein; Skålhegg, Tore; Sørensen, Øyvar; Sunde, Kjetil; Olasveengen, Theresa M.

doi:10.1016/j.resuscitation.2013.03.010

Cited by 66 publications

(38 citation statements)

References 30 publications

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“…A pilot study by Qvigstad evaluating ETCO 2 as a surrogate marker for cardiac output during CPR on patients indicates that there is no specific hand placement that gives optimal cardiac output for all patients [32]. The purpose of our study was to test if a new set of instructions would avoid lay people placing their hands in epigastrium.…”

Section: Discussionmentioning

confidence: 99%

New pre-arrival instructions can avoid abdominal hand placement for chest compressions

Birkenes

Myklebust

Kramer‐Johansen

2013

Scand J Trauma Resusc Emerg Med

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ObjectiveTo investigate if modified pre-arrival instructions using patient’s arm and nipple line as landmarks could avoid abdominal hand placements for chest compressions.MethodVolunteers were randomized to one of two telephone instructions: “Kneel down beside the chest. Place one hand in the centre of the victim’s chest and the other on top” (control) or “Lay the patient’s arm which is closest to you, straight out from the body. Kneel down by the patient and place one knee on each side of the arm. Find the midpoint between the nipples and place your hands on top of each other” (intervention). Hand placement was conducted on an adult male and documented by laser measurements. Hand placement, quantified as the centre of the compressing hands in the mid-sagittal plane, was compared to the inter-nipple line (INL) for reference and classified as above or below. Fisher’s exact test was used for comparison of proportions.ResultsThirty-six lay people, age range 16–60, were included. None in the intervention group placed their hands in the abdominal region, compared to 5/18 in the control group (p = 0.045). Using INL as a reference, the new instructions resulted in less caudal hand placement, and the difference in mean hand position was 47 mm [95% CI 21,73], p = 0.001.ConclusionNew pre-arrival instructions where the patient’s arm and nipple line were used as landmarks resulted in less caudal hand placements and none in the abdominal region.

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Section: Discussionmentioning

confidence: 99%

New pre-arrival instructions can avoid abdominal hand placement for chest compressions

Birkenes

Myklebust

Kramer‐Johansen

2013

Scand J Trauma Resusc Emerg Med

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“…124 A second crossover study in 30 adults observed no difference between ETCO 2 values and hand placement. 125 A further crossover study in 10 children observed higher peak systolic pressure and higher mean arterial blood pressure when compressions were performed on the lower third of the sternum compared with the middle of the sternum.…”

Section: Consensus On Sciencementioning

confidence: 93%

“…[124][125][126] One crossover study in 17 adults with prolonged resuscitation from nontraumatic cardiac arrest observed improved peak arterial pressure during compression systole (114 ± 51 mm Hg versus 95 ± 42 mm Hg) and end-tidal carbon dioxide (ETCO 2 ; 11.0 ± 6.7 mm Hg versus 9.6 ± 6.9 mm Hg) when compressions were performed in the lower third of the sternum compared with the center of the chest, whereas arterial pressure during compression recoil, peak right atrial pressure and coronary perfusion pressure did not differ. 124 A second crossover study in 30 adults observed no difference between ETCO 2 values and hand placement.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 3: Adult Basic Life Support and Automated External Defibrillation

Travers¹,

Perkins²,

Berg³

et al. 2015

Circulation

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234

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Introduction This Part of the 2015 International Consensus on Cardiopul monary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) presents the consensus on science and treatment recommendations for adult basic life support (BLS) and automated external defibrillation (AED). After the publication of the 2010 CoSTR, the Adult BLS Task Force developed review questions in PICO (population, intervention, comparator, outcome) format.1 This resulted in the generation of 36 PICO questions for systematic reviews. The task force discussed the topics and then voted to prioritize the most important questions to be tackled in 2015. From the pool of 36 questions, 14 were rated low priority and were deferred from this round of evidence evaluation. Two new questions were submitted by task force members, and 1 was submitted via the public portal. Two of these (BLS 856 and BLS 891) were taken forward for evidence review. The third question (368: ForeignBody Airway Obstruction) was deferred after a preliminary review of the evidence failed to identify compelling evidence that would alter the treatment recommendations made when the topic was last reviewed in 2005. 2 Each task force performed a systematic review using detailed inclusion and exclusion criteria, based on the recommendations of the Institute of Medicine of the National Academies.3 With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).Reviewers were unable to identify any relevant evidence for 3 questions (BLS 811, BLS 373, and BLS 348), and the evidence review was not completed in time for a further question (BLS 370). A revised PICO question was developed for the opioid question (BLS 891). The task force reviewed 23 PICO questions for the 2015 consensus on science and treatment recommendations, including BLS 811, BLS 373, and BLS 348. The PICO flow is summarized in Figure 1.Using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group, 4 the reviewers for each question created a reconciled risk-of-bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 5 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 6 and GRADE for observational studies that inform both therapy and prognosis questions.7 GRADE evidence profile tables 8 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. Critical outcomes were defined as neurologically favorable outcome (level 9), survival (level 8), and return of spontaneous circulation (ROSC; level 7). Given the heterogeneity of time points evaluated in the studies related to BLS/AED, time intervals were pooled across outcomes. For neurologic outcome and survival, we considered the outcomes at discharge,...

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“…[52][53][54] These investigations assessed hand placement on the lower third of the sternum compared with the center of the chest in a crossover design, and they measured physiologic endpoints, such as blood pressure and end-tidal carbon dioxide (ETCO 2 ). The studies have not provided conclusive or consistent results about the effects of hand placement on resuscitation outcomes.…”

Section: Summary Of Evidencementioning

confidence: 99%