Effect of Compression Surfaces on Cardiopulmonary Resuscitation Quality and Clinician Fatigue

Current American Heart Association (AHA) guidelines recommend moving patients to a hard surface, when possible, to improve cardiopulmonary resuscitation (CPR) quality. However, the time to move a patient detracts from the time actively performing CPR. Studies show mixed results on the effect of a soft surface on CPR quality. The primary objective of this study was to compare the fatiguability of performing CPR on the floor versus a standard mattress.

This pilot randomized trial enrolled currently employed emergency medical services (EMS) clinicians from two EMS agencies in North Carolina from 10/2022 to 12/2022. Participants performed continuous compressions on a CPR manikin with integrated electronic feedback, randomized 1:1 to a floor or a mattress. The primary outcome was time to failure, defined as voluntary cessation of compressions by the participant or 30 s of inadequate compressions. Adequate compressions were defined using the current AHA recommendations for high-quality CPR, including a compression rate of 100-120/min and depth of at least 2 in. We describe time to failure and compression rate with median and interquartile range (IQR), and compare them between surfaces with the Wilcoxon Rank-Sum test. We constructed a survival curve of the time to failure by surface and compared them with a log-rank test.

Among 40 participants, 47.5% (19/40) were female and 90.0% (36/40) were White with an average age of 28 (IQR 24-33) years. The time to failure for floor CPR was 145 s (IQR 65-240) vs. 140 s (IQR 100-420) for mattress CPR (p = 0.64). Floor participants performed compressions at a median rate of 112 (IQR 104-118) compressions per minute vs. 105 (IQR 101-113) compressions per minute for mattress participants (p = 0.12). Using a survival analysis, the time to failure was not statistically different between surfaces (p = 0.4).

This prospective pilot study suggests no difference in fatigability of a person performing CPR on a mattress versus a floor. Further study is necessary to validate our findings.