Advanced life support performance with manual and mechanical chest compressions in a randomized, multicentre manikin study.
OBJECTIVE
Clinical mechanical chest compression studies report diverging outcomes. Confounding effects of variability in hands-off fraction (HOF) and timing of necessary tasks during advanced life support (ALS) may contribute to this divergence. Study site variability in these factors coupled to randomization of cardiopulmonary resuscitation (CPR) method was studied during simulated cardiac arrest prior to a multicentre clinical trial.


METHODS
Ambulance personnel from four sites were tested in randomized, simulated cardiac arrest scenarios with manual CPR or load-distributing band CPR (LDB-CPR) on manikins. Primary emphasis was on HOF and time spent before necessary predefined ALS task (ALS milestones). Results are presented as mean differences (confidence interval).


RESULTS
At the site with lowest HOF during manual CPR, HOF deteriorated with LDB-CPR by 0.06 (0.005, 0.118, p=0.04), while it improved at the two sites with highest HOF during manual CPR by 0.07 (0.019, 0.112, p=0.007) and 0.08 (0.004, 0.165, p=0.042). Initial defibrillation was 29 (3, 55, p=0.032)s delayed for LDB-CPR vs. manual CPR. Other ALS milestones trended toward earlier completion with LDB-CPR; only significant for intravenous access, mean difference 70 (24, 115, p=0.003)s.


CONCLUSIONS
In this manikin study, HOF for manual vs. mechanical chest compressions varied between sites. Study protocol implementation should be simulation tested before launching multicentre trials, to optimize performance and improve reliability and scientific interpretation.
Tomte
Oystein
O
Institute for Experimental Medical Research, Surgical Division, University of Oslo, Norway. oystetom@medisin.uio.no
Sunde
Kjetil
K
Lorem
Tonje
T
Auestad
Bjorn
B
Souders
Chris
C
Jensen
Jeff
J
Wik
Lars
L
D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods*; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008348:Manikins; D015337:Multicenter Studies as Topic