CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial

Abstract

Background The aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position. Methods In this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position. Results Only 28% of all tidal volumes conformed to the guidelines (400–800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s. Conclusions Efficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.

Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update

“…In a manikin study simulating a restricted environment CPR in an over-the-head or straddle position had comparable quality CPR to a standard CPR position. 155 All victims who are extricated should be assessed for airway, breathing, and circulation. Victims with witnessed cardiac arrest should undergo immediate CPR.…”

Serum SCUBE-1 Levels and Return of Spontaneous Circulation Following Cardiopulmonary Resuscitation in Adult Patients

“… 13 14 Studies on CPR are limited due to environmental conditions and ethical considerations, and recommendations concerning the application of CPR are mostly based on retrospective studies, meta-analyses, and animal models. 15 …”

“…13,14 Studies on CPR are limited due to environmental conditions and ethical considerations, and recommendations concerning the application of CPR are mostly based on retrospective studies, meta-analyses, and animal models. 15 A great number of factors have been previously examined to determine the long-term prognosis of patients with cardiac arrest. The initial shockable rhythm (ventricular tachycardia or ventricular fibrillation), immediate initiation of CPR, early defibrillation, and effective intensive care have been found to be associated with improved outcomes.…”

Herz-Kreislauf-Stillstand im alpinen Gelände

“…Sobald der/die Verschüttete durch das Ausgraben erreicht wurde, muss seine/ihre Lage unter der Schneedecke eingeschätzt und schnellstmöglich das Gesicht und die Atemwege freigelegt werden. Während der restliche Körper freigelegt wird, sollten bereits die Vitalparameter überprüft und die Reanimation bestmöglich begonnen werden 22 .…”