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A Multicenter International Randomized Controlled Manikin Study on Different Protocols of Cardiopulmonary
Enrico Baldi1, Enrico Contri, Roman Burkart
1From the Pavia nel Cuore (E.B., E.C., M.P., C.B.), Pavia; Robbio nel Cuore (E.B., E.C., D.B.), Robbio; Department of Molecular Medicine (E.B.), Section of Cardiology, University of Pavia; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology (E.B.), Fondazione IRCCS Policlinico San Matteo; AAT 118 Pavia (E.C.), AREU Lombardia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Swiss Resuscitation Council (R.B.), Bern, Switzerland; Fondazione Ticino Cuore (R.B.), Breganzona, Switzerland; Department of Public Health, Experimental and Forensic Medicine (P.B., O.E.F.), Unit of Biostatistics and Clinical Epidemiology, University of Pavia; Department of Clinical-Surgical, Pediatric and Diagnostic Sciences-Anesthesia, Intensive Care and Pain Therapy (M.P.), University of Pavia, Pavia; Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Department of Anesthesia Intensive Care and Emergency (M.P., A.C.), Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy; Federazione Cantonale Ticinese Servizi Autoambulanze (C.T.), Lugano; Accademia di Medicina d'Urgenza Ticinese (AMUT) (C.T.), Breganzona, Switzerland; Emergency Training Center (D.L.), Cugy, Switzerland; Centro Studi e Formazione Gymnasium (S.B.), Pordenone, Italy; École Supérieure d'Ambulancier et Soins d'Urgence Romande (ES-ASUR) (S.D.), Lausanne; and Formamed Sàrl (M.T.), Cortaillod, Switzerland.
Background:
Compression-only cardiopulmonary resuscitation (CPR) is a suggested technique for laypeople facing out-of-hospital cardiac arrest (OHCA). However, it is difficult performing high-quality CPR until emergency medical services arrival with this technique. We aimed to verify whether incorporating intentional interruptions of different frequency and duration increases laypeople's CPR quality during an 8-minute scenario compared with compression-only CPR.
Methods:
We performed a multicenter randomized manikin study selecting participants from 2154 consecutive laypeople who followed a basic life support/automatic external defibrillation course. People who achieved high-quality CPR in 1-minute test on a computerized manikin were asked to participate. Five hundred seventy-six were enrolled, and 59 were later excluded for technical reasons or incorrect test recording. Participants were randomized in an 8-minute OHCA scenario using 3 CPR protocols (30 compressions and 2-second pause, 30c2s; 50 compressions and 5-second pause, 50c5s; 100 compressions and 10-second pause, 100c10s) or compression-only technique. The main outcome was the percentage of chest compressions with adequate depth.
Results:
Five hundred seventeen participants were evaluated. There was a statistically significant difference regarding the percentage of compressions with correct depth among the groups (30c2s, 96%; 50c5s, 96%; 100c10s, 92%; compression only, 79%; P = 0.006). Post hoc comparison showed a significant difference for 30c2s (P = 0.023) and for 50c5s (P = 0.003) versus compression only. Regarding secondary outcome, there were a higher chest compression fraction in the compression-only group and a higher rate of pauses longer than 10 seconds in the 100c10s.
Conclusions:
In a simulated OHCA, 30c2s and 50c5s protocols were characterized by a higher rate of chest compressions with correct depth than compression only. This could have practical consequences in laypeople CPR training and recommendations.Clinical Trial Registration: NCT02632500.
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