title: Effect of mattress deflection on CPR quality assessment for older children and adolescents.
abstract: Appropriate chest compression (CC) depth is associated with improved CPR outcome. CCs provided in hospital are often conducted on a compliant mattress. The objective was to quantify the effect of mattress compression on the assessment of CPR quality in children.
  
  
  METHODS
  A force and deflection sensor (FDS) was used during CPR in the Pediatric Intensive Care Unit and Emergency Department of a children's hospital. The sensor was interposed between the chest of the patient and hands of the rescuer and measured CC depth. Following CPR event, each event was reconstructed with a manikin and an identical mattress/backboard/patient configuration. CCs were performed using FDS on the sternum and a reference accelerometer attached to the spine of the manikin, providing a means to calculate the mattress deflection.
  
  
  RESULTS
  Twelve CPR events with 14,487 CC (11 patients, median age 14.9 years) were recorded and reconstructed: 9 on ICU beds (9296 CC), 3 on stretchers (5191 CC). Measured mean CC depth during CPR was 47+/-8mm on ICU beds, and 45+/-7 mm on stretcher beds with overestimation of 13+/-4mm and 4+/-1mm, respectively, due to mattress compression. After adjusting for this, the proportion of CC that met the CPR guidelines decreased from 88.4 to 31.8% on ICU beds (p<0.001), and 86.3 to 64.7% on stretcher (p<0.001). The proportion of appropriate depth CC was significantly smaller on ICU beds (p<0.001).
  
  
  CONCLUSIONS
  CC conducted on a non-rigid surface may not be deep enough. FDS may overestimate CC depth by 28% on ICU beds, and 10% on stretcher beds.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia (CHOP), USA. NISHISAKI@email.chop.edu
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.forename: Jon
authors.initials: J
authors.lastname: Nysaether
authors.forename: Robert
authors.initials: R
authors.lastname: Sutton
authors.forename: Matthew
authors.initials: M
authors.lastname: Maltese
authors.forename: Dana
authors.initials: D
authors.lastname: Niles
authors.forename: Aaron
authors.initials: A
authors.lastname: Donoghue
authors.forename: Ram
authors.initials: R
authors.lastname: Bishnoi
authors.forename: Mark
authors.initials: M
authors.lastname: Helfaer
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Perkins
authors.forename: Robert
authors.initials: R
authors.lastname: Berg
authors.forename: Kristy
authors.initials: K
authors.lastname: Arbogast
authors.forename: Vinay
authors.initials: V
authors.lastname: Nadkarni