Rescuer fatigue and cardiopulmonary resuscitation positions: A randomized controlled crossover trial☆

Abstract 

Background

During cardiopulmonary resuscitation (CPR), it is recommended to alternate rescuers every 2min when two or more rescuers are available, regardless of the rescuer's position. It is unclear, however, whether rescuer fatigue depends on the rescuer's position.

Purpose

To compare rescuer fatigue by doing CPR in different positions.

Methods

This randomized controlled crossover trial studied 24 experienced health-care providers from a teaching hospital in southern Taiwan. Each participant performed CPR for 10min on days 1, 8, and 15 of the study in three different positions: kneeling, standing on a taboret, and standing on the floor. Effective compression was recorded using the Laerdal Resusci-Anne Skillreporter manikin. The range of motion (ROM) of the elbows and lower back were detected using a flexible goniometer, and the severity of back pain was scored using the Brief Pain Inventory short-form.

Results

Rescuers maintained adequate effective compressions for 2min while kneeling and standing on a taboret, but only for 1min while standing on the floor. The ROM for elbows and lower back during CPR while kneeling were significantly lower than for standing on the floor. Moreover, the total pain (p<0.001) and social interference (p=0.004) scores 24h after CPR were significantly lower for the kneeling position.

Conclusions

CPR is best performed in a kneeling position. In order to minimize rescuer fatigue, we recommend alternating rescuers every 2min while kneeling or standing on a taboret, and every 1min while standing on the floor.

Keywords: Rescuer fatigue, Cardiopulmonary resuscitation, Position, Back pain, Flexible goniometer, Range of motion