Evaluation of the Quality of Manual, Compression-Only Cardiopulmonary Resuscitation in a Moving Ski Patrol Toboggan.

Abstract

Introduction: Cardiopulmonary resuscitation (CPR) quality may be impacted by location and setting of an out of hospital cardiac arrest. This study compared the quality of CPR performed on a moving ski patrol toboggan versus stationary CPR, both performed outdoors in winter. Materials and Methods: Compression-only CPR was performed on a manikin attached to a backboard secured into a toboggan. A CPR device was used to measure compression rate, depth and recoil, and elapsed time. A convenience sample of 30 patrollers, in weather-appropriate clothing, participated in this nonrandomized, crossover study. Each first performed 5 continuous sets of 30 compressions of stationary CPR straddling the manikin while kneeling. After 15 minutes rest, participants performed CPR while moving down the designated ski run (fixed length, vertical drop, and slope angles). Each ski run was video captured with a GoPro camera. Quality was defined as compliance with 2015 International Liaison Committee on Resuscitation (ILCOR) guidelines for CPR. Results: Overall, stationary and moving chest compressions complied with ILCOR guidelines, but there was a statistically significant degradation of CPR quality while moving and over time. Fewer compressions met ILCOR guidelines in comparison to stationary CPR compressions: (1) stationary mean depth 87% compliant, moving mean depth 35% compliant, 95% confidence interval: 39-65 (p < 0.001); (2) stationary mean rate 90% while moving mean rate 64% compliant; and (3) stationary recoil 74%, while moving recoil 77% compliant. Noncompliant compressions were typically too shallow, and noncompliance for rate was typically too fast. There were no pauses over 10 seconds once compressions were started. Conclusions: Despite CPR quality being reduced while moving, there were sufficient compliant compressions to support the use of CPR in this setting. Maintaining regular CPR training in a working environment and optimal body position in relation to the patient may be keys to performing high quality CPR on a moving toboggan.