Performing chest compressions in a confined space
Introduction
The guidelines for basic life support (BLS) published by the Resuscitation Council (UK) [1], the European Resuscitation Council (ERC) [2], and the International Liaison Committee on Resuscitation (ILCOR) [3], all describe the technique for manual chest compression. Although none of the publications state that the rescuer giving chest compressions should kneel by the side of the victim, this is implied in the text and shown in the accompanying illustrations.
There are situations when cardiac arrest may occur in a confined space, making it difficult to kneel by the side of the victim; examples are in an aircraft or in an ambulance. Anecdotally, rescuers have performed chest compression whilst kneeling at the head of the victim or straddling the upper part of the legs, leaning forwards to give the compressions.
Two studies of one-person over-the-head (OTH) cardiopulmonary resuscitation (CPR) have been reported. In the first, it was concluded that the quality of CPR using this technique was as good as that during two-person standard CPR, except that fewer chest compressions were delivered each minute [4]. In the second study, over-the-head chest compression was combined with bag-valve-mask ventilation; this resulted in CPR that conformed closely to ERC guidelines [5].
Airline cabin crew in the UK are taught basic life support in accordance with the guidelines of the ERC, but use a two-person mouth-to-mask technique with added oxygen for ventilation [6], [7]. In the confines of an aircraft aisle, it may be difficult to perform standard CPR with one or two rescuers kneeling at the side of the victim. An alternative for a single rescuer is to ventilate and compress whilst at the head of the victim. For two rescuers, it is possible for one rescuer to ventilate from the head and the other to perform chest compression whilst straddling the victim’s legs.
The purpose of this study was to compare, on a manikin, the efficacy of chest compression during four methods of CPR, two of which would potentially be easier to perform in a confined space, specifically the aisles of an aircraft.
Section snippets
Ethics
For a previous similar study (comparing the outcome of training) the local (Colchester) Ethics Committee Chairman declared that such a study did not require ethical approval. No database was kept that would allow identification of the individuals concerned. All those acting as volunteers were from the training department of one of the airlines interested in the practical aspects of resuscitation on board an aircraft.
Material and methods
A total of 19 volunteers were recruited from the crew training staff of Virgin Atlantic Airways Ltd. Six of these taught CPR as part of their duties but all nineteen had received training and regular re-training in standard one- and two-person CPR.
The nature of the study was explained to each volunteer, and his or her verbal consent to participate was obtained.
Although names were recorded for identification purposes, these were deleted from the subsequent analysis sheets to maintain
Data recording
The Laerdal AED Resusci© Anne manikin has sensing devices and computer software that allowed continuous recording of the following data:
- (a)
total number of compressions given;
- (b)
average rate of chest compression per minute;
- (c)
average number of compressions given per minute;
- (d)
depth of each chest compression: correct; too shallow; too deep (parameters for mm to 51±2 mm);
- (e)
position of hands on manikin chest (each compression): correct; high; low; left; right (“correct” = over lower half of sternum;
Statistical methods
The data were analyzed using two-way analysis of variance (ANOVA), the two factors being the individual and the CPR technique. Pair-wise analysis, using each individual as their own control and transformation of the percentage data to stabilize variance estimates, did not produce any different conclusions and are not presented.
Results
A total of 19 volunteers took part, 9 male and 10 female, ranging in age from 26 to 52 years. Each was tested performing four cycles of CPR (60 compressions) using each of the four methods (St-1; OTH; St-2; STR). Three volunteers inadvertently gave a total of 61 compressions, one gave 62 compressions and one gave 58 compressions, each on one occasion only. These small errors were ignored as being insignificant as far as overall performance was concerned, particularly as errors in compression
Discussion
The manikin was able to record variables in performance of ventilation (number of ventilations; rate of delivery; volume of air), but these are not included in the results for two reasons. First, the main objective of the study was to compare the differences in chest compression technique during the four methods of CPR. Second, none of the volunteers had been taught the use of a Pocket Mask as a single rescuer.
Certain aspects of performance were common to all four methods. Thus, around 50% of
Conclusions
The quality of chest compression during the straddle method, performed as part of two-person CPR, appears to be as good as that during standard two-person CPR. It may be a more useful method in situations where space is limited, for example in an aircraft aisle.
In this study, chest compressions were performed as well during over-the-head as during standard one-person CPR with the exception of hand position on the chest. Sufficient of the compressions were placed dangerously low to conclude that
Acknowledgements
The authors are very grateful for the statistical help given by David Irvine, Epidemiologist, of British Airways Plc, and to the members of the AirCrew Training Department of Virgin Atlantic Airways Ltd who acted as volunteers. Laerdal Medical Ltd kindly loaned the manikin and laptop used in the study and provided the necessary software. The project was supported by a research grant from the Resuscitation Council (UK).
Conflict of interests: Dr. Anthony Handley is Chairman of the BLS/AED
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