THE USE OF A STEP STOOL DURING CHEST COMPRESSIONS: DOES IT MAKE A DIFFERENCE, AND DO CLINICIANS CHOOSE TO USE IT?

Abstract

SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: High quality cardiopulmonary resuscitation (CPR) is the most important factor in surviving cardiac arrest. Using a step stool to improve chest compressions is universally recommended yet under-researched. This observational, simulation-based study sought to answer two questions: first, is CPR performance improved with the use of a step stool? Second, how often do adult healthcare providers use a step stool for chest compressions, and does the frequency increase following a brief educational session demonstrating the advantages of step stool use? METHODS: Over 3 years (2018-2020), 535 interdisciplinary providers (nurses, house staff, attendings, and pharmacists from internal medicine, intensive care, anesthesiology, and obstetrics) participated in this observational study. Participants first performed one minute of CPR on Resusci-Anne ®, a CPR mannequin, and were scored from 0-100 on their performance. A step stool was available for use next to Resusci-Anne ® if the participant desired. Thereafter, participants underwent an educational intervention on the advantages of using a step stool while performing CPR. They watched a demonstration by an instructor and were then given time to practice CPR with and without a step stool. Each participant was then asked to do another minute of CPR on the Resusci-Anne ® and again scored from 0-100 on their performance. A step stool was again in close proximity for use, if the participant desired. RESULTS: Participants were selected via convenience sampling at a large academic hospital with a pre-existing cardiac arrest simulation course. A total of 535 participants were tested pre-intervention, and 520 participants were tested post-intervention. Prior to the intervention, only 16.6% (n=89) of providers elected to use a step stool for chest compressions, compared to 97.5% (n=507) post-intervention (p=<0.001). The average CPR performance score (0-100) significantly improved from pre-intervention to post-intervention (74 vs. 95; p=<0.001). CONCLUSIONS: Our study demonstrates that the quality of CPR improves significantly with the use of a step stool. However, without education on the benefits of using a step stool and demonstration of the proper technique, few adult healthcare providers will elect to do so. A brief, hands-on intervention teaching adult healthcare providers about the benefits of CPR with a step stool significantly increased its use and the quality of chest compressions. CLINICAL IMPLICATIONS: This study demonstrates that adult healthcare providers across multiple disciplines can quickly and easily be taught to use a step stool during CPR, and that doing so significantly improves the quality of CPR they provide. Given that early and high-quality CPR is the cornerstone of advanced cardiovascular life support (ACLS), this intervention has the potential to improve the mortality of in-hospital cardiac arrest. DISCLOSURES: No relevant relationships by Timothy Clapper, source=Web Response No relevant relationships by Imaani Easthausen, source=Web Response No relevant relationships by Kelly Griffin, source=Web Response No relevant relationships by Elyse LaFond, source=Web Response No relevant relationships by Melissa Moulton, source=Web Response No relevant relationships by Kapil Rajwani, source=Web Response No relevant relationships by Nina Rusiewski, source=Web Response No relevant relationships by Samantha Smith, source=Web Response