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The Effect of Using a Step Stool on Chest Compressions Quality During Cardiopulmonary Resuscitation: A Systemic
Sudha Chandelia1, Pragati Sahu1, Sarthak Kaushik1
1Department of Pediatrics, Division of Pediatric Critical Care, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER [Post Graduate Institute of Medical Education and Research]) and Dr Ram Manohar Lohia (RML) Hospital, New Delhi, India.
Background:
A successful cardiopulmonary resuscitation (CPR) requires quality chest compressions (CCs). Use of a step stool during CPR might improve CC quality, though there is no consensus.
Objectives:
To analyze the effects of a rescuer using a step stool on CC during CPR.
Methods:
We conducted a systematic review and searched five databases (PubMed, Embase, Cochrane, Web of Science, and Scopus). Two independent authors did screening, data extraction, risk of bias, and GRADE (Grading of Recommendations, Assessments, Development, and Evaluation) assessment. Random effects model was used for data analysis. Risk of bias was assessed using theCochrane tools (RoB 2 for randomized and ROBINS-1 V2 for nonrandomized studies.
Results:
Six studies (four adult and two pediatric) were included in the meta-analysis. Most domains in studies were at serious risk of bias. Overall, using a step stool during CPR may slightly increase depth of CC (mm) (mean difference [MD], 95% confidence interval [CI]; 2.74, 1.26-4.21; p < 0.0003; I2 = 35%; low certainty); pediatric (MD 1.63, 95% CI 0.33-2.93; p = 0.01; I2 = 24%; low certainty); adult (MD 4.24, 95% CI 2.18-6.31; p = 0.0001; I2 = 0%; low certainty). Overall, using a step stool may slightly increase CC rates toward 120/min (MD 2.97, 95% CI 0.74-5.20; p = 0.009; I2 = 49%; low certainty); adult (MD 5.61, 95% CI 3.0-8.22; p = 0.0001; I2 = 0%; low certainty); but in children effects are uncertain (MD 1.30, 95% CI (-1.52-4.12; p = 0.37; I2 = 69%; very low certainty). Effects on chest recoil (MD 0.18, 95% CI 0.04-0.32; p = 0.01; I2 = 0%; two studies; very low certainty) and angle between rescuer and manikin (MD 10.43, 95% CI 8.14-12.72; p = 0.0001; I2 = 0%; one study; very low certainty) are very uncertain. Minimized interruption and excessive ventilation were not reported in any studies.
Conclusion:
Low certainty evidence suggests rescuer use of a step stool may slightly increase depth and rate of CCs in simulation set-up, with unclear clinical implications. Effects of using a step stool on chest recoil, angle between the rescuer and manikin, duty cycle, minimized interruption, and excessive ventilation are very uncertain in view of very low certainty/no evidence.
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01:24Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...