CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial

Abstract Background The aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position. Methods In this prospective, randomised cr...

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Main Authors: Bernd Wallner, Luca Moroder, Hannah Salchner, Peter Mair, Stefanie Wallner, Gabriel Putzer, Giacomo Strapazzon, Markus Falk, Hermann Brugger
Format: Article
Language:English
Published: BMC 2021-09-01
Series:Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Subjects:
Online Access:https://doi.org/10.1186/s13049-021-00944-9
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spelling doaj-43d2e4a275e8432b89ddab2a71d9454d2021-09-05T11:25:16ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412021-09-012911810.1186/s13049-021-00944-9CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burialBernd Wallner0Luca Moroder1Hannah Salchner2Peter Mair3Stefanie Wallner4Gabriel Putzer5Giacomo Strapazzon6Markus Falk7Hermann Brugger8Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of InnsbruckDepartment of Anaesthesiology and Critical Care Medicine, Hospital of BolzanoDepartment of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of InnsbruckDepartment of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of InnsbruckDepartment of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of InnsbruckDepartment of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of InnsbruckInstitute of Mountain Emergency Medicine, Eurac ResearchInstitute of Mountain Emergency Medicine, Eurac ResearchInstitute of Mountain Emergency Medicine, Eurac ResearchAbstract Background The aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position. Methods In this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position. Results Only 28% of all tidal volumes conformed to the guidelines (400–800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s. Conclusions Efficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.https://doi.org/10.1186/s13049-021-00944-9ResuscitationConfined spaceAtypical rescuer positionVentilationAsphyxia
collection DOAJ
language English
format Article
sources DOAJ
author Bernd Wallner
Luca Moroder
Hannah Salchner
Peter Mair
Stefanie Wallner
Gabriel Putzer
Giacomo Strapazzon
Markus Falk
Hermann Brugger
spellingShingle Bernd Wallner
Luca Moroder
Hannah Salchner
Peter Mair
Stefanie Wallner
Gabriel Putzer
Giacomo Strapazzon
Markus Falk
Hermann Brugger
CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Resuscitation
Confined space
Atypical rescuer position
Ventilation
Asphyxia
author_facet Bernd Wallner
Luca Moroder
Hannah Salchner
Peter Mair
Stefanie Wallner
Gabriel Putzer
Giacomo Strapazzon
Markus Falk
Hermann Brugger
author_sort Bernd Wallner
title CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial
title_short CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial
title_full CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial
title_fullStr CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial
title_full_unstemmed CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial
title_sort cpr with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the cpr scenario after avalanche burial
publisher BMC
series Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
issn 1757-7241
publishDate 2021-09-01
description Abstract Background The aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position. Methods In this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position. Results Only 28% of all tidal volumes conformed to the guidelines (400–800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s. Conclusions Efficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.
topic Resuscitation
Confined space
Atypical rescuer position
Ventilation
Asphyxia
url https://doi.org/10.1186/s13049-021-00944-9
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