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

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