title: The quality of manual chest compressions during transport--effect of the mattress assessed by dual accelerometers.
abstract: BACKGROUND
  The quality of cardiopulmonary resuscitation (CPR) has an impact on survival. The quality may be impaired if the patient needs to be transported to the hospital with ongoing CPR. The aim of this study was to analyse whether the quality of CPR can be improved during transportation by using real-time audiovisual feedback. In addition, we sought to evaluate the real compression depths taking into account the mattress and stretcher effect.
  
  
  METHODS
  Paramedics (n = 24) performed standard CPR on a Resusci Anne Mannequin in a moving ambulance. Participants were instructed to perform CPR according to European Resuscitation Council Resuscitation guidelines 2010. Each pair acted as their own controls performing CPR first without and then with the feedback device. Compression depth, rate and no-flow fraction and also the mattress effect were recorded by using dual accelerometers by two Philips, HeartStart MRx Q-CPR defibrillators.
  
  
  RESULTS
  In the feedback phase, the mean compression depth increased from 51 (10) to 56 (5) mm (P < 0.001), and the percentage of compression fractions with adequate depth was 60% vs. 89% (P < 0.001). However, taking account of the mattress effect, the real depth was only 41 (8) vs. 44 (5) mm without and with feedback, respectively (P < 0.001). The values for compression rate did not differ.
  
  
  CONCLUSIONS
  CPR quality was good during transportation in general. However, the results suggest that the feedback system improves CPR quality. Dual accelerometer measurements show, on the other hand, that the mattress effect may be a clinically relevant impediment to high quality CPR.
authors.affiliation: School of Medicine, University of Tampere, Finland; Department of Intensive Care Medicine, Critical Care Medicine Research Group, Tampere University Hospital and University of Tampere, Tampere, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Hellevuo
authors.forename: M
authors.initials: M
authors.lastname: Sainio
authors.forename: H
authors.initials: H
authors.lastname: Huhtala
authors.forename: K T
authors.initials: KT
authors.lastname: Olkkola
authors.forename: J
authors.initials: J
authors.lastname: Tenhunen
authors.forename: S
authors.initials: S
authors.lastname: Hoppu
mesh_terms: D061725:Accelerometry / Q000295:instrumentation; D000488:Allied Health Personnel; D001513:Beds; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D023381:Endpoint Determination; D005246:Feedback; D006801:Humans; D008348:Manikins; D011312:Pressure; D013909:Thorax; D014187:Transportation of Patients