title: Forensic analysis of crib mattress properties on pediatric CPR quality--can we balance pressure reduction with CPR effectiveness?
abstract: BACKGROUND
  Single mode, pressure reduction (PR) crib mattresses are increasingly employed in hospitals to prevent skin injury and infection. However, single mode PR mattresses risk large mattress deflection during CPR chest compressions, potentially leading to inadequate chest compressions.
  
  
  OBJECTIVE
  New, dual mode PR crib mattress technology provides less mattress deflection during chest compressions (CCs) with similar PR characteristics for prevention of skin injury.
  
  
  METHODS
  Epochs of 50 high-quality CCs (target sternum-spine compression depth ≥ 38 mm) guided by real-time force/deflection sensor (FDS) feedback were delivered to CPR manikin with realistic CC characteristics on two PR crib mattresses for four conditions: (1) single mode+backboard; (2) dual mode+backboard; (3) single mode-no backboard; and (4) dual mode-no backboard. Mattress displacement was measured using surface reference accelerometers. Mattress displacement ≥ 5 mm was prospectively defined as minimal clinically important difference. PR qualities of both mattresses were assessed by tissue interface pressure mapping.
  
  
  RESULTS
  During simulated high quality CC, single mode had significantly more mattress displacement compared to dual mode (mean difference 16.5 ± 1.4mm, p<0.0001) with backboard. This difference was greater when no backboard was used (mean difference 31.7 ± 1.5mm, p<0.0001). Both single mode and dual mode met PR industry guidelines (mean surface pressure <50 mm Hg).
  
  
  CONCLUSIONS
  Chest compressions delivered on dual mode pressure reduction crib mattresses resulted in substantially smaller mattress deflection compared to single mode pressure reduction mattresses. Skin pressure reduction qualities of dual mode pressure reduction crib mattress were maintained. We recommend that backboards continue to be used in order to mitigate mattress deflection during CPR on soft mattresses.
authors: Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. niles@email.chop.edu
authors: Dana E
authors: DE
authors: Niles
authors: Matthew R
authors: MR
authors: Maltese
authors: Akira
authors: A
authors: Nishisaki
authors: Thomas
authors: T
authors: Seacrist
authors: Jessica
authors: J
authors: Leffelman
authors: Larissa
authors: L
authors: Hutchins
authors: Nancy
authors: N
authors: Schneck
authors: Robert M
authors: RM
authors: Sutton
authors: Kristy B
authors: KB
authors: Arbogast
authors: Robert A
authors: RA
authors: Berg
authors: Vinay M
authors: VM
authors: Nadkarni
mesh_terms: D061725:Accelerometry; D001513:Beds / Q000009:adverse effects / Q000592:standards; D004867:Equipment Design; D019544:Equipment Failure Analysis / Q000379:methods; D004865:Equipment and Supplies, Hospital / Q000592:standards*; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007223:Infant; D015370:Infant Equipment; D008348:Manikins; D055595:Mechanical Phenomena; D017063:Outcome Assessment, Health Care; D003668:Pressure Ulcer / Q000209:etiology / Q000517:prevention & control; D017211:Treatment Failure
keywords: CPR; CPR manikins; CPR training; Cardiac arrest; Cardiopulmonary resuscitation; Chest compression; Children; Mattress; Mattress compliance; Mattress deflection; Pediatric; Pressure reduction; Skin injury