Impact of Step Stool in the Delivery of CPR by Healthcare Providers: a Simulation-Based Study

To assess the impact of using a standard height step stool on the quality of pediatric cardiopulmonary resuscitation (CPR) for health care providers (HCP) of different heights in a simulated environment.

A simulation-based prospective cross-sectional study was conducted in a tertiary care referral hospital in Eastern India using a quantitative CPR (QCPR) training manikin (Little Junior QCPR, Laerdal Medical, Norway). A total of 8 min of CPR session was conducted, where 2 compressors performed alternatively in every 2-min segment without a step stool. After a 15-min rest, the session was repeated using a standard step stool (21.5 cm). The quality of chest compression was assessed using Q-CPR Review software v2.0 in three defined height tertiles (short, medium and tall). Compression rate, depth, good release percentage, and app-derived total scores were assessed as the primary outcome. Every compressor provided feedback regarding the level of their comfort, fatigue, and bodyache, graded on a Likert scale.

Out of 80 healthcare providers (HCPs) who were screened, 72 participated in 36 CPR sessions; each CPR session had two cycles of CPR, one without and one with step stool. The mean (SD) participant height was 167 (6.5) cm. Overall, mean compression depth increased by 4.5 mm, adequate compression depth improved by 20%, and adequate recoil improved by 13%. In the shortest height tertile, compression depth increased by 10 mm. Additionally, 83.3% of participants reported greater comfort while performing CPR with the step stool.

Step stool improved the compression depth, reduced incomplete recoils, and improved CPR quality among HCPs in simulation setting, with a greater advantage among the shorter HCPs.