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Updated: May 14, 2026
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Forensic analysis of crib mattress properties on pediatric CPR quality--can we balance pressure reduction with CPR
Dana E Niles1, Matthew R Maltese, Akira Nishisaki
1Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. niles@email.chop.edu
Insights
Dual mode pressure reduction crib mattresses significantly reduce mattress deflection during CPR chest compressions compared to single mode. This innovation maintains skin pressure reduction benefits, enhancing patient safety during critical care. Backboards remain recommended.
Area of Science:
- Biomedical Engineering
- Materials Science
- Medical Device Technology
Background:
- Pressure reduction (PR) crib mattresses are vital for preventing skin injury and infection in hospitals.
- Single mode PR mattresses may experience excessive deflection during cardiopulmonary resuscitation (CPR) chest compressions (CCs), potentially compromising effectiveness.
Purpose of the Study:
- To evaluate a new dual mode PR crib mattress technology designed to minimize mattress deflection during CCs.
- To assess if the dual mode mattress maintains similar pressure reduction characteristics for skin injury prevention.
Main Methods:
- High-quality CCs were simulated on a CPR manikin using two types of PR crib mattresses (single and dual mode) with and without a backboard.
- Mattress displacement was measured using accelerometers, with ≥ 5 mm defined as a clinically significant difference.
- Tissue interface pressure mapping assessed the PR qualities of both mattress types.
Main Results:
- Dual mode PR mattresses exhibited significantly less mattress displacement during CCs compared to single mode mattresses, both with and without a backboard.
- The difference in displacement was more pronounced when no backboard was used.
- Both single and dual mode mattresses met industry guidelines for pressure reduction (<50 mm Hg).
Conclusions:
- Dual mode PR crib mattresses substantially reduce mattress deflection during CPR CCs compared to single mode.
- The skin pressure reduction capabilities of the dual mode mattress are preserved.
- Continued use of backboards is recommended to mitigate mattress deflection during CPR on soft mattresses.
Introduction:
Single mode, pressure reduction (PR) crib mattresses are increasingly employed in hospitals to prevent skin injury and infection. However, single mode PR mattresses risk large mattress deflection during CPR chest compressions, potentially leading to inadequate chest compressions.
Hypothesis:
New, dual mode PR crib mattress technology provides less mattress deflection during chest compressions (CCs) with similar PR characteristics for prevention of skin injury.
Methods:
Epochs of 50 high-quality CCs (target sternum-spine compression depth ≥ 38 mm) guided by real-time force/deflection sensor (FDS) feedback were delivered to CPR manikin with realistic CC characteristics on two PR crib mattresses for four conditions: (1) single mode+backboard; (2) dual mode+backboard; (3) single mode-no backboard; and (4) dual mode-no backboard. Mattress displacement was measured using surface reference accelerometers. Mattress displacement ≥ 5 mm was prospectively defined as minimal clinically important difference. PR qualities of both mattresses were assessed by tissue interface pressure mapping.
Results:
During simulated high quality CC, single mode had significantly more mattress displacement compared to dual mode (mean difference 16.5 ± 1.4mm, p<0.0001) with backboard. This difference was greater when no backboard was used (mean difference 31.7 ± 1.5mm, p<0.0001). Both single mode and dual mode met PR industry guidelines (mean surface pressure <50 mm Hg).
Conclusions:
Chest compressions delivered on dual mode pressure reduction crib mattresses resulted in substantially smaller mattress deflection compared to single mode pressure reduction mattresses. Skin pressure reduction qualities of dual mode pressure reduction crib mattress were maintained. We recommend that backboards continue to be used in order to mitigate mattress deflection during CPR on soft mattresses.
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