Manual versus Mechanical Chest Compressions on Surfaces of Varying Softness with or without Backboards: A Randomized, Crossover Manikin Study

Publication date: April 2016
Source:The Journal of Emergency Medicine, Volume 50, Issue 4
Author(s): Gabriel Putzer, Anna Fiala, Patrick Braun, Sabrina Neururer, Karin Biechl, Bernhard Keilig, Werner Ploner, Ernst Fop, Peter Paal
BackgroundChest compression quality is decisive for overall outcome after cardiac arrest. Chest compression depth may decrease when cardiopulmonary resuscitation (CPR) is performed on a mattress, and the use of a backboard does not necessarily improve compression depth. Mechanical chest compression devices may overcome this problem.ObjectivesWe sought to investigate the effectiveness of manual chest compressions both with and without a backboard compared to mechanical CPR performed on surfaces of different softness.MethodsTwenty-four advanced life support (ALS)–certified rescuers were enrolled. LUCAS2 (Physio-Control, Redmond, WA) delivers 52 ± 2 mm deep chest compressions and active decompressions back to the neutral position (frequency 102 min⁻¹; duty cycle, 50%). This simulated CPR scenario was performed on a Resusci-Anne manikin (Laerdal, Stavanger, Norway) that was lying on 3 different surfaces: 1) a concrete floor, 2) a firm standard mattress, and 3) a pressure-relieving mattress. Data were recorded by the Laerdal Skill Reporting System.ResultsManual chest compression with or without a backboard were performed correctly less often than mechanical chest compressions (floor: 33% [interquartile range {IQR}, 27–48%] vs. 90% [IQR, 86–94%], p < 0.001; standard mattress: 32% [IQR, 20–45%] vs. 27% [IQR, 14–46%] vs. 91% [IQR, 51–94%], p < 0.001; and pressure-relieving mattress 29% [IQR, 17–49%] vs. 30% [IQR, 17–52%] vs. 91% [IQR, 87–95%], p < 0.001). The mean compression depth on both mattresses was deeper with mechanical chest compressions (floor: 53 mm [range, 47–57 mm] vs. 56 mm [range, 54–57 mm], p = 0.003; standard mattress: 50 mm [range, 44–55 mm] vs. 51 mm [range, 47–55 mm] vs. 55 mm [range, 54–58 mm], p < 0.001; and pressure-relieving mattress: 49 mm [range, 44–55 mm] vs. 50 mm [range, 44–53 mm] vs. 55 mm [range, 55–56 mm], p < 0.001). In this ∼6-min scenario, the mean hands-off time was ∼15 to 20 s shorter in the manual CPR scenarios.ConclusionsIn this experimental study, only ∼30% of manual chest compressions were performed correctly compared to ∼90% of mechanical chest compressions, regardless of the underlying surface. Backboard use did not influence the mean compression depth during manual CPR. Chest compressions were deeper with mechanical CPR. The mean hands-off time was shorter with manual CPR.



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