Chest compressions performed by ED staff: a randomized cross-over simulation study on the floor and on a stretcher.
BACKGROUND
Multiple factors may contribute to the observed survival variability following in-hospital cardiopulmonary resuscitation (CPR). While in-hospital CPR is most often performed on patients lying on a bed or stretcher, CPR training uses primarily manikins placed on the floor. We analyzed the quality of external chest compressions (ECC) in simulated cardiac arrest scenarios occurring both on a stretcher and on the floor.


METHODS
Prospective cross-over simulation study enrolling ED nurses and nurse's aides as part of an annual evaluation. Simulated CPR was performed in the 2 rescuer-mode for 2 min, both kneeling on the floor, and standing beside a knee high stretcher. The order of position was randomized. ECC parameters were compared.


RESULTS
ED nurses (n=48) and nurse's aides (n=26) performed 128 scenarios. Mean ECC depth was 32 ± 13 mm on the floor and 27 ± 11 mm on a stretcher (∆: 5 mm, 95%CI [3-7], P<.001). Participants last trained within a year (n=17) developed deeper ECCs than their colleagues (n=47) in both positions (floor: 39 ± 12 mm vs stretcher: 34 ± 11 mm (p=0.016) for those trained within the year, and floor: 29 ± 12 mm vs stretcher: 24 ± 10 mm (P<.001) for those trained over a year ago).


CONCLUSIONS
The quality of chest compressions performed by ED staff was below 2005 guideline standards, with decreased ECC depth during CPR on a stretcher. Annual refresher courses should be implemented in the ED, with a focus on obtaining required ECC depth while standing next to a stretcher.
Département des Urgences, Centre Hospitalier Régional Universitaire Lapeyronie - 371, Avenue du doyen Gaston Giraud, 34295 - Montpellier Cedex 5. m-sebbane@chu-montpellier.fr
Mustapha
M
Sebbane
Megan
M
Hayter
Joaquim
J
Romero
Sophie
S
Lefebvre
Colette
C
Chabrot
Grégoire
G
Mercier
Jean-Jacques
JJ
Eledjam
Richard
R
Dumont
Patricia L
PL
Houston
Sylvain
S
Boet
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards; D018592:Cross-Over Studies; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000628:therapy; D006336:Heart Massage / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008348:Manikins; D009728:Nursing Assistants; D011187:Posture