Quality between mechanical compression on reducible stretcher versus manual compression on standard stretcher in small elevator.
OBJECTIVE
Manual cardiopulmonary resuscitation (CPR) during vertical transport in small elevators using standard stretcher for out-of-hospital cardiac arrest can raise concerns with diminishing quality. Mechanical CPR on a reducible stretcher (RS-CPR) that can be shortened in the length was tested to compare the CPR quality with manual CPR on a standard stretcher (SS-CPR).


METHODS
A randomized crossover manikin simulation was designed. Three teams of emergency medical technicians were recruited to perform serial CPR simulations using two different protocols (RS-CPR and SS-CPR) according to a randomization; the first 6 minutes of manual CPR at the scene was identical for both scenarios and two different protocols during vertical transport in a small elevator followed on a basis of cross-over assignment. The LUCAS-2 Chest Compression System (Zolife AB, Lund, Sweden) was used for RS-CPR. CPR quality was measured using a resuscitation manikin (Resusci Anne QCPR, Laerdal Medical, Stavanger, Norway) in terms of no flow fraction, compression depth, and rate (median and IQR).


RESULTS
A total of 42 simulations were analyzed. CPR quality did not differ significantly at the scene. No flow fraction (%) was significantly lower when the stretcher was moving in RS-CPR then SS-CPR (36.0 (33.8-38.7) vs 44.0 (36.8-54.4), P< .01). RS-CPR showed significantly better quality than SS-CPR; 93.2 (50.6-95.6) vs 14.8 (0-20.8) for adequate depth (P< 0.01), and 97.5 (96.6-98.2) vs 68.9(43.4-78.5) for adequate rate (P< .01).


CONCLUSIONS
Mechanical CPR on a reducible stretcher during vertical transport showed significant improvement in CPR quality in terms of no-flow fraction, compression depth, and rate compared with manual CPR on a standard stretcher.
Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea. Electronic address: adoong2001@gmail.com.
Tae Han
TH
Kim
Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea. Electronic address: emkjhong@gmail.com.
Ki Jeong
KJ
Hong
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea. Electronic address: shinsangdo@medimail.co.kr.
Shin
S
Sang Do
Department of Emergency Medicine, Inje University Seoul Pak Hospital, Seoul, Korea. Electronic address: juliannnn@hanmail.net.
Chu Hyun
CH
Kim
Department of Emergency Medicine, Jeju National University Hospital, Jejudo, Korea. Electronic address: sungwook78@gmail.com.
Sung Wook
SW
Song
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea. Electronic address: skciva@gmail.com.
Kyoung Jun
KJ
Song
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea. Electronic address: Ro.youngsun@gmail.com.
Young Sun
YS
Ro
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea. Electronic address: arendt75@gmail.com.
Ki Ok
KO
Ahn
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea. Electronic address: dy.jang@gmail.com.
Dayea Beatrice
DB
Jang
D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000379:methods*; D018592:Cross-Over Studies; D004607:Elevators and Escalators; D004632:Emergency Medical Services / Q000379:methods; D004634:Emergency Medical Technicians / Q000193:education*; D005240:Feasibility Studies; D006801:Humans; D008348:Manikins; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011312:Pressure; D058254:Stretchers; D014187:Transportation of Patients