Chest compressions by ambulance personnel on chests with variable stiffness: abilities and attitudes.
BACKGROUND
Quality of cardiopulmonary resuscitation (CPR) performed by professionals is reported to be substandard even with automated corrective feedback. We hypothesised that lack of quality is not due to physical capabilities.


METHODS
Eighty ambulance personnel from the same services where the quality of clinical CPR was investigated, performed two-rescuer CPR with similar corrective feedback for 5min on each of four manikins with different chest stiffness. The personnel also scored their agreement with statements on clinical CPR performance.


RESULTS
All study subjects performed CPR well within Guidelines recommendations on all four manikins with mean compression depth 44+/-3mm, compression rate 101+/-3min(-1), and 7+/-2 ventilations per minute. Three quarters stated that during CPR on patients their personal sense of correct depth and force determined their performance. Fifty-five percent believed that too deep chest compressions could cause serious injury to the patient, and 39% that compressing to Guidelines recommended depth may often result in severe patient injury. A quarter felt that the potential benefits of compressing to the Guidelines depth could not justify the injuries it would cause. Breaking ribs made 54% feel very uncomfortable.


CONCLUSIONS
Ambulance personnel were physically capable of consistently compressing to the Guidelines depth even on the stiffest chest. These laboratory results cannot be directly compared to the clinical out-of-hospital ALS situation, but strongly indicate that the inadequate chest compressions found in our clinical study were not due to lack of physical capability. We speculate that this may at least partly be explained by their fear of causing patient injury and trust in their own opinion of what is the correct compression depth and force in preference to the feedback.
Ødegaard
Silje
S
University of Oslo, Faculty Division Ulleval University Hospital, N-0407 Oslo, Norway. silje.odegaard@studmed.uio.no
Kramer-Johansen
Jo
J
Bromley
Allan
A
Myklebust
Helge
H
Nysaether
Jon
J
Wik
Lars
L
Steen
Petter Andreas
PA
D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000379:methods*; D017408:Guidelines as Topic; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008348:Manikins; D011312:Pressure; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D035441:Thoracic Wall