Abstract P40: Improved Chest Recoil Using a Novel Device for Active Chest Decompressions in Child Manikin CPR
Introduction: Current CPR guidelines emphasize complete chest recoil. Incomplete chest recoil impedes venous return and thus cardiac output. In animals active compression-decompression CPR (ACD-CPR) improves hemodynamics compared with standard CPR (S-CPR). We developed a novel, simple, inexpensive Adhesive Glove Device (AGD) to perform ACD-CPR.
Hypothesis: We hypothesized that ACD-CPR using an AGD provides better chest decompression compared to S-CPR in a child manikin without increased rescuer fatigue.
Methods: Laerdal™ Resusci Junior manikin was modified to digitally record compression pressure (CP), compression depth (CD) and decompression depth (DD). AGD consisted of a modified oven mitt exposing the fingers and thumb allowing interlocking. A wide Velcro patch was sewn to the palmer aspect and the counter Velcro patch was glued to the manikin chest wall. Certified healthcare providers (16/group) were prospectively randomized to perform either S-CPR or AGD-ACD-CPR for 5 minutes with 30:2 C:V ratio using crossover design with both one hand (OH) and two hand (TH) techniques. AGD subjects were asked to actively pull up during decompression. Subjects were blinded to data recordings. Rescuer heart rate (HR), respiratory rate (RR), recovery time (RT) and actual compressions delivered per minute were recorded. Data (mean±SEM) was analyzed using 2 sided paired t-test; p-value ≤0.05 was considered significant.
Results: Chest decompression was greater with AGD-ACD-CPR; the mean decompression difference was 0.098±0.02 inches, p=<0.001 in OH and 0.099± 0.02 inches, p=<0.001 in TH. Compressions delivered per minute were 85±22 (S-CPR) vs.74±23 (AGD-CPR), p=0.02 in OH group and 92±23 vs. 79±22, p=0.003 in TH. Among AGD-ACD-CPR groups, 56% of subjects in OH and 38% in TH decompressed to or beyond baseline. In S-CPR group, only 12% of subjects in OH and 18% in TH achieved complete chest recoil. No significant difference was observed in CD, CP, HR, RR and RT between the groups.
Conclusions: Use of our simple inexpensive AGD resulted in improved chest decompression with out excessive rescuer fatigue. Most rescuers did not achieve complete chest recoil during standard CPR. The clinical significance of 10 –12/min less compressions with AGD needs to be determined.