Abstract 88: Simple Stepstool Adjuncts Improve Depth and Duration of AHA Guideline-Compliant Chest Compressions

Abstract

Introduction AHA guideline-compliant chest compressions (CCs) during cardiac arrest improve survival. Few studies assess optimal use of stepstools (adjuncts) to improve compliance of these guidelines. Hypothesis Stepstool use will increase the depth and duration of AHA guideline-compliant CC delivery in a pediatric cardiac arrest manikin model. Methods IRB-approved prospective, randomized trial conducted on healthcare providers who routinely deliver CCs at work. Volunteers performed 2 sessions of continuous CCs on a pediatric manikin, in random order on separate days. CCs were performed with vs. without use of a 13cm stepstool on a standard-height hospital stretcher (70cm) until maximal fatigue or 10 min. Quality parameters (CC depth, rate, % CCs with residual leaning force >2.5kg) were recorded using a CPR-sensing automated feedback-enabled defibrillator. Data were analyzed in 30-second epochs. “AHA guideline-compliant” CCs were defined by achieving all 3 criteria: average depth ≥38mm, rate 90-120 CC/min, and residual leaning force in <20% of CCs. “Time to failure” was defined as the first epoch where AHA guideline-compliant CC criteria were not met. Analysis included descriptive summaries, Student's t-test, Poisson regression, and Cox regression to produce a failure-time analysis. Results All 21 providers completed both sessions: 62.5% male; median age 34 years, range 28-60; median height 173cm, range 163-190cm. With stepstool adjunct, subjects attained goal mean CC depth ≥38mm in over twice as many epochs (RR 2.26; CI: 1.24, 4.12; p=0.008), without significant difference in mean rate or % CCs with leaning force >2.5kg. Median time to failure (duration) to perform AHA guideline-compliant CCs was significantly longer with stepstools (3.5min) than without stepstools (6.0min) (HR 1.53; CI: 1.06, 2.21; p=0.023). Conclusions Stepstool adjunct increased the frequency of attaining goal depth, and time to failure (duration) of AHA guideline-compliant CCs, without increasing residual leaning force in this pediatric cardiac arrest manikin model. With stepstools, AHA guideline-compliant CCs were delivered for close to twice as long. Assessment in the clinical setting is warranted to evaluate the utility of these findings.