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Effect of mattress deflection on CPR quality assessment for older children and adolescents

Akira Nishisaki1, Jon Nysaether, Robert Sutton

  • 1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia (CHOP), USA. NISHISAKI@email.chop.edu

Resuscitation
|April 4, 2009
PubMed

Insights

Chest compression depth during CPR is often overestimated on hospital beds due to mattress compression. This significantly reduces the proportion of adequate compressions, potentially impacting CPR outcomes in children.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiopulmonary Resuscitation (CPR) Quality Assessment
  • Biomedical Engineering

Background:

  • Appropriate chest compression (CC) depth is crucial for effective cardiopulmonary resuscitation (CPR) and improved patient outcomes.
  • Hospital environments, particularly compliant mattresses, can interfere with accurate CC depth assessment during resuscitation efforts.
  • The impact of mattress compression on CPR quality metrics in pediatric patients remains incompletely understood.

Purpose of the Study:

  • To quantify the effect of mattress compression on the assessment of CPR quality in children.
  • To determine the overestimation of CC depth caused by mattress deflection during CPR.
  • To evaluate the impact of mattress compression on the proportion of CCs meeting established guidelines.

Main Methods:

  • A force and deflection sensor (FDS) was utilized during actual CPR events in a pediatric intensive care unit and emergency department.
  • CPR events were reconstructed using a manikin with an identical mattress/backboard/patient configuration to measure mattress deflection.
  • CC depth was measured using the FDS placed between the rescuer's hands and the patient's chest, with simultaneous accelerometer data to calculate mattress deflection.

Main Results:

  • Twelve CPR events (14,487 CCs) from 11 pediatric patients were analyzed, with compressions performed on ICU beds and stretchers.
  • Mattress compression led to an overestimation of CC depth by 13+/-4mm on ICU beds and 4+/-1mm on stretcher beds.
  • After adjusting for mattress compression, the proportion of adequate CCs meeting CPR guidelines decreased significantly from 88.4% to 31.8% on ICU beds (p<0.001) and 86.3% to 64.7% on stretchers (p<0.001).

Conclusions:

  • Chest compressions performed on non-rigid surfaces like hospital mattresses may not achieve adequate depth.
  • Force and deflection sensors can overestimate CC depth by up to 28% on ICU beds and 10% on stretcher beds due to mattress compression.
  • The findings highlight the critical need to account for mattress properties when assessing CPR quality in pediatric patients to ensure effective resuscitation.
Abstract

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