title: Adequate performance of cardiopulmonary resuscitation techniques during simulated cardiac arrest over and under protective equipment in football.
abstract: OBJECTIVE
  To investigate (1) cardiopulmonary resuscitation (CPR) adequacy during simulated cardiac arrest of equipped football players and (2) whether protective football equipment impedes CPR performance measures.
  
  
  METHODS
  Exploratory crossover study performed on Laerdal SimMan 3 G interactive manikin simulator.
  
  
  METHODS
  Temple University/St Luke's University Health Network Regional Medical School Simulation Laboratory.
  
  
  METHODS
  Thirty BCLS-certified ATCs and 6 ACLS-certified emergency department technicians.
  
  
  METHODS
  Subjects were given standardized rescuer scenarios to perform three 2-minute sequences of compression-only CPR. Baseline CPR sequences were captured on each subject.
  
  
  METHODS
  Experimental conditions included 2-minute sequences of CPR either over protective football shoulder pads or under unlaced pads. Subjects were instructed to adhere to 2010 American Heart Association guidelines (initiation of compressions alone at 100/min to 51 mm). Dependent variables included average compression depth, average compression rate, percentage of time chest wall recoiled, and percentage of hands-on contact during compressions.
  
  
  RESULTS
  Differences between subject groups were not found to be statistically significant, so groups were combined (n = 36) for analysis of CPR compression adequacy. Compression depth was deeper under shoulder pads than over (P = 0.02), with mean depths of 36.50 and 31.50 mm, respectively. No significant difference was found with compression rate or chest wall recoil.
  
  
  CONCLUSIONS
  Chest compression depth is significantly decreased when performed over shoulder pads, while there is no apparent effect on rate or chest wall recoil. Although the clinical outcomes from our observed 15% difference in compression depth are uncertain, chest compression under the pads significantly increases the depth of compressions and more closely approaches American Heart Association guidelines for chest compression depth in cardiac arrest.
authors.affiliation: *St Luke's University Hospital and Health Network, Bethlehem, Pennsylvania; †East Stroudsburg University, East Stroudsburg, Pennsylvania; and ‡Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Waninger
authors.forename: Andrew
authors.initials: A
authors.lastname: Goodbred
authors.forename: Keith
authors.initials: K
authors.lastname: Vanic
authors.forename: John
authors.initials: J
authors.lastname: Hauth
authors.forename: Joshua
authors.initials: J
authors.lastname: Onia
authors.forename: Jill
authors.initials: J
authors.lastname: Stoltzfus
authors.forename: Scott
authors.initials: S
authors.lastname: Melanson
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D018592:Cross-Over Studies; D005260:Female; D005538:Football; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D011481:Protective Clothing