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The effect of step stool use and provider height on CPR quality during pediatric cardiac arrest: A simulation-based
Adam Cheng1, Yiqun Lin1, Vinay Nadkarni2
1*KidSIM-ASPIRE Research Program,Department of Pediatrics,Alberta Children's Hospital,Calgary,AB.
Insights
Using step stools and increasing provider height improve cardiopulmonary resuscitation (CPR) quality. CPR visual feedback, but not just-in-time (JIT) training, enhances these effects, particularly for compression depth.
Area of Science:
- Emergency Medicine
- Cardiopulmonary Resuscitation
- Human Factors Engineering
Background:
- Cardiopulmonary resuscitation (CPR) quality is critical for patient survival.
- Provider height and use of assistive devices like step stools can influence CPR technique.
- Optimizing CPR delivery requires understanding factors affecting provider performance.
Purpose of the Study:
- To investigate the association between step stool use and CPR quality.
- To examine the relationship between provider adjusted height and CPR quality.
- To determine if just-in-time (JIT) CPR training or CPR visual feedback training mitigates the impact of height and step stool use on CPR quality.
Main Methods:
- Analysis of simulated cardiac arrest data from 124 participants across three study arms: no intervention, CPR visual feedback, and JIT CPR training.
- Voluntary step stool use was recorded; adjusted height was calculated as provider height + 23 cm when a step stool was used.
- Associations between step stool use, adjusted height, and CPR quality (compression depth) were assessed, with interaction analyses for study arm.
Main Results:
- Step stool use significantly improved compression depth for both below-average and above-average height providers.
- A significant association was found between adjusted provider height and improved compression depth.
- CPR visual feedback attenuated the effect of height on compression depth, while JIT training did not.
- Both visual feedback and JIT training attenuated the effect of step stool use on compression depth.
Conclusions:
- Step stool use enhances CPR compression depth irrespective of provider height.
- Increased provider height is linked to better compression depth, an effect moderated by CPR visual feedback.
- Visual feedback and JIT training can improve the impact of step stool use on CPR compression depth.
Objectives:
We aimed to explore whether a) step stool use is associated with improved cardiopulmonary resuscitation (CPR) quality; b) provider adjusted height is associated with improved CPR quality; and if associations exist, c) determine whether just-in-time (JIT) CPR training and/or CPR visual feedback attenuates the effect of height and/or step stool use on CPR quality.
Methods:
We analysed data from a trial of simulated cardiac arrests with three study arms: No intervention; CPR visual feedback; and JIT CPR training. Step stool use was voluntary. We explored the association between 1) step stool use and CPR quality, and 2) provider adjusted height and CPR quality. Adjusted height was defined as provider height + 23 cm (if step stool was used). Below-average height participants were ≤ gender-specific average height; the remainder were above average height. We assessed for interaction between study arm and both adjusted height and step stool use.
Results:
One hundred twenty-four subjects participated; 1,230 30-second epochs of CPR were analysed. Step stool use was associated with improved compression depth in below-average (female, p=0.007; male, p<0.001) and above-average (female, p=0.001; male, p<0.001) height providers. There is an association between adjusted height and compression depth (p<0.001). Visual feedback attenuated the effect of height (p=0.025) on compression depth; JIT training did not (p=0.918). Visual feedback and JIT training attenuated the effect of step stool use (p<0.001) on compression depth.
Conclusions:
Step stool use is associated with improved compression depth regardless of height. Increased provider height is associated with improved compression depth, with visual feedback attenuating the effects of height and step stool use.