Caregiver Characteristics Associated With Quality of Cardiac Compressions on an Adult Mannequin With Real-Time Visual Feedback: A Simulation-Based Multicenter Study
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Published on: February 5, 2019
David O Kessler1, Daniel S Lemke, Priti Jani
1From the Department of Emergency Medicine (D.O.K.), Columbia University Vagelos College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York, NY; Department of Pediatrics (D.S.L.), Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Department of Pediatrics (P.J.), Section of Critical Care Medicine, University of Chicago, Chicago, IL; Division of Critical Care Medicine (M.L.D.), Cincinnati Children's Hospital Medical Center; University of Cincinnati School of Medicine (M.L.D.), Cincinnati, OH; Biostatistics Core and Division of Critical Care Medicine (M.M.C.), Nationwide Children's Hospital, Columbus, OH; Division of Emergency Medicine (T.P.C.), Children's Hospital of Los Angeles/University of Southern California, Los Angeles, CA; Division of Emergency Medicine, Hospital for Sick Children (J.P.), University of Toronto, Toronto, Ontario, Canada; Division of Critical Care Medicine (M.E.L.), Nationwide Children's Hospital, Columbus, OH; Division of Critical Care Medicine (I.H.J.), Stony Brook Children's Hospital, Stony Brook University, Stony Brook, NY; Division of Critical Care Medicine (H.A.W.), The Children's Hospital of Philadelphia; and The University of Pennsylvania Perlman School of Medicine (H.A.W.), Philadelphia, PA.
Introduction:
Chest compression (CC) quality directly impacts cardiac arrest outcomes. Provider body type can influence the quality of cardiopulmonary resuscitation (CPR); however, the magnitude of this impact while using visual feedback is not well described. The aim of the study was to determine the association between provider anthropometric variables on fatigue and CC adherence to 2015 American Heart Association CPR while receiving visual feedback.
Methods:
This was a planned secondary analysis of healthcare professionals from multiple hospitals performing continuous CC for 2 minutes on an adult CPR mannequin with dynamic visual feedback. Main outcome measures include compression data (depth, rate, and lean) evaluated in 30-second epochs to explore performance fatigue. Multivariable models examined the relationship of provider anthropometrics to CC quality. Binomial mixed effects models were used to characterize fatigue by examining performance for 4 epochs.
Results:
Three hundred seventy-seven 2-minute CC episodes were analyzed. Extreme (low and high) BMI and weight are associated with poorer CC. Larger size (height, weight, and BMI) is associated with better depth but worse lean compliance. Performance fatigued for all providers for 2 minutes, but shorter, lighter weight, female participants had the greatest decline. On multivariable analysis, rate compliance did not deteriorate regardless of provider anthropometrics.
Conclusions:
Anthropometrics impact provider CC quality. Despite visual feedback, variable effects are seen on compression depth, rate, recoil, and fatigue depending on the provider sex, weight, and BMI. The 2-minute interval for changing chest compressors should be reconsidered based on individual provider characteristics and risk of fatigue's impact on high-quality CPR.
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