349 The Effect of Athletic Chest Protective Equipment on the Performance of Manual and Mechanical Cardiopulmonary Resuscitation: A Simulation Study

Abstract

Sudden cardiac arrest in athletes is a rare event, yet remains a leading causes of death in athletes. A small percent of these events is due to commotio cordis (CC), secondary to direct striking trauma to the chest. Many athletes wear various types of athletic chest protectors (ACP) to help prevent the incidence of CC. Studies indicate that almost 40% of cases occurred despite the use of ACPs. There has been little research to evaluate the impact of these ACPs on the quality of cardiopulmonary resuscitation (CPR) compressions. Numerous studies have indicated that the quality of CPR during a cardiac arrest is correlated to patient outcome and overall mortality. In this study, we aim to observe: (1) whether the presence of ACPs will impact the quality of bystander CPR performance (2) whether the use of a LUCAS (mechanical compression) device will lead to a difference in CPR performance as compared to traditional compressions (3) whether the presence of ACP gear will have a detrimental effect on depth, rate, and hand positioning of both bystander and LUCAS CPR. This study was an observational, prospective study of a convenience sample of 26 residents of all levels of training, from a single emergency medicine residency. Residents performed CPR on a high fidelity Laerdal mannequin that provided real-time computer feedback and measured compression depth, rate, and proper hand placement. Multiple trials of CPR were performed: baseline CPR for both 1 minute and 2 minute cycles, and CPR on a mannequin wearing the ACP. The ACP used was a common, commercially available HEART-GARD. We also measured the time required to remove the ACP prior to initiating CPR. LUCAS CPR performance was measured both at baseline and over the ACP. For bystander CPR, there was a statistically significant difference in both percentage of correct hand placement and compression rate for baseline versus ACP compressions (85% versus 57%, p<0.05; 138 versus 142, p<0.05, respectively). Difference in compression depth were not significant (51.08 versus 50.08mm, p=0.39). With LUCAS CPR, there was no significant difference noted in aspects of CPR performance with or without an ACP in place. When comparing bystander versus LUCAS CPR quality, a significant difference was noted in compression rate (138 versus 101, p<0.01), but not in overall depth or hand placement when compressions were performed either at baseline or with ACP in place. Lastly, average time to remove the ACP prior to CPR initiation was noted to be 5.4 seconds. Previous research has shown that many variables have a critical impact on overall CPR quality, including compression depth, rate and hand placement. In our study, the use of an ACP had a significant impact on hand placement during bystander CPR. This may have a detrimental effect on bystander CPR quality. Considering ACP removal required only 5.4 seconds, it may be beneficial to remove the ACP prior to starting of bystander CPR. However, ACP equipment was shown to have no significant impact when a LUCAS device is utilized for mechanical CPR. In addition, there was a significant difference between resident and LUCAS CPR in rate of compressions, which plays a critical role in CPR quality.