The high impulse, palm lift technique for chest compression: Prospective, experimental, pilot study.

Abstract

The classic technique of high quality chest compression (HQCC) during cardiopulmonary resuscitation (CPR) is based on the International Liaison Committee on Resuscitation (ILCOR) guidelines which specify that the rescuer's hands should maintain constant contact with the chest surface but should not lean upon it, in order to provide full chest recoil. Since end-tidal CO2 (EtCO2) values have been shown to be a reliable indicator of CPR quality, we examined a method where classic HQCC was modified by a high impulse and palm lifting (HIPL) technique which merged rapid forceful compression with disconnection of the rescuer's palm from the patient's sternum during the recoil phase. The object of the study was to detect any differences in HIPL EtCO2 values in comparison with those from classic HQCC. We report a prospective pilot study in which we compared EtCO2 readings achieved during 2min of classic HQCC technique with readings after implementing 2min of the HIPL technique during out-of-hospital CPR, provided by medical emergency response teams for cases of cardiac arrest. EtCO2 values obtained from16 cases who received HQCC followed by HIPL compressions showed a significant difference (p=0.037) between the two techniques. Mean±SD EtCO2 values after 2min of each technique were: HQCC: 18±9mmHg; HIPL: 27±11mmHg; followed by a further 2min of HQCC: 19±11mmHg. Linear regression showed that the differences in EtCO2 were associated with non - significant changes in ventilation rate (p=0.493) and chest compression rate (p=0.889). The results obtained suggest that modifying HQCC with the HIPL technique led to a significant increase in EtCO2 values in comparison with classic HQCC, indicating an improvement in circulation during CPR. We think that these encouraging early results warrant a larger multi - centre study of HIPL.