High-quality chest compressions are possible during intra-hospital transport, but depend on provider position: A manikin study.

Abstract

Treatment of reversible causes of cardiac arrest often requires intrahospital transportation during ongoing resuscitation. But high-quality chest compression with minimal interruption is the most essential prerequisite for an optimal outcome after cardiac resuscitation. We aimed to evaluate chest compression quality according to the provider position during intrahospital transportation. Manikin observational study. German Tertiary Care Hospital. A total of 20 paramedics (eight female, 12 male); average professional experience 4.8 ± 3.1 years since their initial enrolment for training. Participants performed chest compressions during simulated intrahospital transportation in four groups: provider kneeling beside manikin on the floor (control group), walking next to the bed (group 1), kneeling on the bed beside the manikin (group 2), kneeling astride the manikin on the bed (group 3). Quality metrics as European Resuscitation Council Guidelines 2015. Subsequently, the participants were asked to assess their own subjective feelings of safety, comfort and strain, and to recommend one position. The quality of chest compression in the control group and groups 2 and 3 did not differ significantly. Group 1 performed significantly worse in terms of the correct hand placement on the chest (P = 0.044 vs. control group) and compression depth (P = 0.004 vs. control group, P = 0.035 vs. group 2, P = 0.006 vs. group 3). Transport speed was faster in groups 2 and 3 vs. group 1 (P < 0.05 vs. group 1, P < 0.05 vs. group 2). The majority of participants rated position 1 as unsafe (90%), unpleasant (100%) and exhausting (100%). They predominantly favoured position 3 (70%). Performing guideline-compliant chest compressions during intra-hospital transportation is feasible with an appropriate provider position. Our results suggest, kneeling beside or astride the patient on the bed enables high-quality chest compressions, faster transport and is perceived by the providers as more pleasant. 'Walking next to the bed' while performing chest compressions should be avoided.