title: The effect of step stool use and provider height on CPR quality during pediatric cardiac arrest: A simulation-based multicentre study.
abstract: We aimed to explore whether a) step stool use is associated with improved cardiopulmonary resuscitation (CPR) quality; b) provider adjusted height is associated with improved CPR quality; and if associations exist, c) determine whether just-in-time (JIT) CPR training and/or CPR visual feedback attenuates the effect of height and/or step stool use on CPR quality.
  
  
  
  We analysed data from a trial of simulated cardiac arrests with three study arms: No intervention; CPR visual feedback; and JIT CPR training. Step stool use was voluntary. We explored the association between 1) step stool use and CPR quality, and 2) provider adjusted height and CPR quality. Adjusted height was defined as provider height + 23 cm (if step stool was used). Below-average height participants were ≤ gender-specific average height; the remainder were above average height. We assessed for interaction between study arm and both adjusted height and step stool use.
  
  
  
  One hundred twenty-four subjects participated; 1,230 30-second epochs of CPR were analysed. Step stool use was associated with improved compression depth in below-average (female, p=0.007; male, p<0.001) and above-average (female, p=0.001; male, p<0.001) height providers. There is an association between adjusted height and compression depth (p<0.001). Visual feedback attenuated the effect of height (p=0.025) on compression depth; JIT training did not (p=0.918). Visual feedback and JIT training attenuated the effect of step stool use (p<0.001) on compression depth.
  
  
  
  Step stool use is associated with improved compression depth regardless of height. Increased provider height is associated with improved compression depth, with visual feedback attenuating the effects of height and step stool use.
authors.affiliation: *KidSIM-ASPIRE Research Program,Department of Pediatrics,Alberta Children's Hospital,Calgary,AB.
authors.forename: Adam
authors.initials: A
authors.lastname: Cheng
authors.affiliation: *KidSIM-ASPIRE Research Program,Department of Pediatrics,Alberta Children's Hospital,Calgary,AB.
authors.forename: Yiqun
authors.initials: Y
authors.lastname: Lin
authors.affiliation: †Children's Hospital of Philadelphia,University of Pennsylvania Perelman School of Medicine,Philadelphia,PA.
authors.forename: Vinay
authors.initials: V
authors.lastname: Nadkarni
authors.affiliation: *KidSIM-ASPIRE Research Program,Department of Pediatrics,Alberta Children's Hospital,Calgary,AB.
authors.forename: Brandi
authors.initials: B
authors.lastname: Wan
authors.affiliation: ‡Stollery Children's Hospital,University of Alberta,Edmonton,AB.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Duff
authors.affiliation: §Hasbro Children's Hospital,Alpert Medical School of Brown University, Providence,RI.
authors.forename: Linda
authors.initials: L
authors.lastname: Brown
authors.affiliation: ¶Montreal Children's Hospital,McGill University,Montreal,QC.
authors.forename: Farhan
authors.initials: F
authors.lastname: Bhanji
authors.affiliation: **Columbia University College of Physicians and Surgeons,New York,NY.
authors.forename: David
authors.initials: D
authors.lastname: Kessler
authors.affiliation: ††Children's of Alabama,University of Alabama at Birmingham,Birmingham,AL.
authors.forename: Nancy
authors.initials: N
authors.lastname: Tofil
authors.affiliation: ‡‡Department of Veterinary and Diagnostic Sciences,University of Calgary,Calgary,AB.
authors.forename: Kent
authors.initials: K
authors.lastname: Hecker
authors.affiliation: ¶¶Charlotte R. Bloomberg Children's Center,Division of Pediatric Anesthesiology and Critical Care Medicine,Johns Hopkins University School of Medicine,Baltimore,MD.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008348:Manikins; D011446:Prospective Studies; D011787:Quality of Health Care; D000066908:Simulation Training / Q000379:methods*
keywords: cardiac arrest; cardiopulmonary resuscitation; chest compressions; height; pediatric; step stool