Effect of a backboard on compression depth during cardiac arrest in the ED: a simulation study.

RESEARCH PURPOSE: We evaluated the impact of a backboard on chest compression depth during cardiac arrest practice sessions conducted using a high-fidelity mannequin on a standard emergency department stretcher. METHODS: Forty-three health care trainees completed cardiac resuscitation simulations requiring 2 minutes of uninterrupted chest compressions. Twenty-one were randomly allocated to the intervention group in which a backboard was concealed by placement between the stretcher mattress and a top sheet and, 22 were allocated to the control group in which no backboard was placed. The mannequin software automatically recorded mean chest compression depth in 10-second intervals for the 2 minutes of compressions. RESULTS: The backboard group achieved a mean compression depth of 41.2 mm (95% confidence interval, 37.8-44.6). The no-backboard group's mean compression depth was 41.4 mm (95% confidence interval, 38.7-44.2). Most subjects in both groups did not achieve the 50-mm compression depth threshold recommended by the American Heart Association. CONCLUSIONS: Use of a backboard as an adjunct during cardiopulmonary resuscitation of a simulated patient lying on a standard emergency department stretcher did not improve the mean chest compression depth achieved by advanced life support rescuers. Most rescuers did not achieve the minimum compression depth of 50 mm recommended by the American Heart Association.

A Simulation-based Randomized Controlled Study of Factors Influencing Chest Compression Depth.

INTRODUCTION: Current resuscitation guidelines emphasize a systems approach with a strong emphasis on quality cardiopulmonary resuscitation (CPR). Despite the American Heart Association (AHA) emphasis on quality CPR for over 10 years, resuscitation teams do not consistently meet recommended CPR standards. The objective is to assess the impact on chest compression depth of factors including bed height, step stool utilization, position of the rescuer's arms and shoulders relative to the point of chest compression, and rescuer characteristics including height, weight, and gender. METHODS: Fifty-six eligible subjects, including physician assistant students and first-year emergency medicine residents, were enrolled and randomized to intervention (bed lowered and step stool readily available) and control (bed raised and step stool accessible, but concealed) groups. We instructed all subjects to complete all interventions on a high-fidelity mannequin per AHA guidelines. Secondary end points included subject arm angle, height, weight group, and gender. RESULTS: Using an intention to treat analysis, the mean compression depths for the intervention and control groups were not significantly different. Subjects positioning their arms at a 90-degree angle relative to the sagittal plane of the mannequin's chest achieved a mean compression depth significantly greater than those compressing at an angle less than 90 degrees. There was a significant correlation between using a step stool and achieving the correct shoulder position. Subject height, weight group, and gender were all independently associated with compression depth. CONCLUSION: Rescuer arm position relative to the patient's chest and step stool utilization during CPR are modifiable factors facilitating improved chest compression depth.