Resuscitation
Volume 80, Issue 5 , Pages 540-545, May 2009

Effect of mattress deflection on CPR quality assessment for older children and adolescents

  • Akira Nishisaki

      Affiliations

    • Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia (CHOP), USA
    • Center for Simulation, Advanced Education and Innovation, CHOP, USA
    • Corresponding Author InformationCorresponding author at: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia (CHOP), 34th Street and Civic Center Blvd., Philadelphia, PA 19104, USA. Tel.: +1 215 590 5505; fax: +1 215 590 4327.
  • ,
  • Jon Nysaether

      Affiliations

    • Laerdal Medical Cooperation, Stavanger, Norway
  • ,
  • Robert Sutton

      Affiliations

    • Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia (CHOP), USA
    • University of Pennsylvania School of Medicine, USA
  • ,
  • Matthew Maltese

      Affiliations

    • Center for Injury Research and Prevention, CHOP, USA
  • ,
  • Dana Niles

      Affiliations

    • Center for Simulation, Advanced Education and Innovation, CHOP, USA
  • ,
  • Aaron Donoghue

      Affiliations

    • Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia (CHOP), USA
    • Center for Simulation, Advanced Education and Innovation, CHOP, USA
    • Department of Pediatrics, CHOP, USA
  • ,
  • Ram Bishnoi

      Affiliations

    • Center for Simulation, Advanced Education and Innovation, CHOP, USA
  • ,
  • Mark Helfaer

      Affiliations

    • Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia (CHOP), USA
    • University of Pennsylvania School of Medicine, USA
  • ,
  • Gavin D. Perkins

      Affiliations

    • University of Warwick Medical School, Warwick, UK
  • ,
  • Robert Berg

      Affiliations

    • Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia (CHOP), USA
    • University of Pennsylvania School of Medicine, USA
  • ,
  • Kristy Arbogast

      Affiliations

    • University of Pennsylvania School of Medicine, USA
    • Center for Injury Research and Prevention, CHOP, USA
  • ,
  • Vinay Nadkarni

      Affiliations

    • Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia (CHOP), USA
    • University of Pennsylvania School of Medicine, USA
    • Center for Simulation, Advanced Education and Innovation, CHOP, USA

Received 17 September 2008; received in revised form 18 December 2008; accepted 9 February 2009. published online 02 April 2009.

Abstract 

Appropriate chest compression (CC) depth is associated with improved CPR outcome. CCs provided in hospital are often conducted on a compliant mattress. The objective was to quantify the effect of mattress compression on the assessment of CPR quality in children.

Methods

A force and deflection sensor (FDS) was used during CPR in the Pediatric Intensive Care Unit and Emergency Department of a children's hospital. The sensor was interposed between the chest of the patient and hands of the rescuer and measured CC depth. Following CPR event, each event was reconstructed with a manikin and an identical mattress/backboard/patient configuration. CCs were performed using FDS on the sternum and a reference accelerometer attached to the spine of the manikin, providing a means to calculate the mattress deflection.

Results

Twelve CPR events with 14,487 CC (11 patients, median age 14.9 years) were recorded and reconstructed: 9 on ICU beds (9296 CC), 3 on stretchers (5191 CC). Measured mean CC depth during CPR was 47±8mm on ICU beds, and 45±7mm on stretcher beds with overestimation of 13±4mm and 4±1mm, respectively, due to mattress compression. After adjusting for this, the proportion of CC that met the CPR guidelines decreased from 88.4 to 31.8% on ICU beds (p<0.001), and 86.3 to 64.7% on stretcher (p<0.001). The proportion of appropriate depth CC was significantly smaller on ICU beds (p<0.001).

Conclusion

CC conducted on a non-rigid surface may not be deep enough. FDS may overestimate CC depth by 28% on ICU beds, and 10% on stretcher beds.

Keywords: Cardiac arrest, Cardiopulmonary resuscitation (CPR), Chest compression, Closed chest cardiac massage, Pediatric resuscitation, Resuscitation

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 A Spanish translated version of the summary of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2009.02.006.

PII: S0300-9572(09)00101-4

doi:10.1016/j.resuscitation.2009.02.006

Resuscitation
Volume 80, Issue 5 , Pages 540-545, May 2009