New pre-arrival instructions can avoid abdominal hand placement for chest compressions

Abstract

ObjectiveTo investigate if modified pre-arrival instructions using patient’s arm and nipple line as landmarks could avoid abdominal hand placements for chest compressions.MethodVolunteers were randomized to one of two telephone instructions: “Kneel down beside the chest. Place one hand in the centre of the victim’s chest and the other on top” (control) or “Lay the patient’s arm which is closest to you, straight out from the body. Kneel down by the patient and place one knee on each side of the arm. Find the midpoint between the nipples and place your hands on top of each other” (intervention). Hand placement was conducted on an adult male and documented by laser measurements. Hand placement, quantified as the centre of the compressing hands in the mid-sagittal plane, was compared to the inter-nipple line (INL) for reference and classified as above or below. Fisher’s exact test was used for comparison of proportions.ResultsThirty-six lay people, age range 16–60, were included. None in the intervention group placed their hands in the abdominal region, compared to 5/18 in the control group (p = 0.045). Using INL as a reference, the new instructions resulted in less caudal hand placement, and the difference in mean hand position was 47 mm [95% CI 21,73], p = 0.001.ConclusionNew pre-arrival instructions where the patient’s arm and nipple line were used as landmarks resulted in less caudal hand placements and none in the abdominal region.

Interventions to improve the quality of bystander cardiopulmonary resuscitation: A systematic review

“…The different study designs, interventions and types of data presentations in included articles precluded further meta-analysis. For example, the authors tried to evaluate whether changing some instructional content of telephone dispatcher-assisted CPR would improve bystander CPR quality in some included studies, but those changes were different among studies [22,26,27,33–35,37,40,41,52]. In other studies, the authors tried to compare the effect of compression-only CPR with that of conventional CPR on bystander CPR quality, but they presented different types of outcome data [18,25,32].…”

“…Among 42 studies included, 32 were RCTs, 6 studies [18,36,45,54,55,57] were randomized crossover controlled trials and 4 studies [24,48,49,53] were non-randomized studies. There were 13 studies conducted in North America [18,22–24,34,35,37,40,44,49,52,53,58], 19 in Europe [17,25–27,29–31,33,38,39,41–43,45,46,48,51,55,57], and 10 in the Asia-Pacific region [19–21,28,32,36,47,50,54,56]. The years of publication ranged from 1989 to 2018.…”

Quality of dispatch‐assisted cardiopulmonary resuscitation by lay rescuers following a standard protocol in Japan: an observational simulation study

“…In this study, eight lay rescuers performed CPR with abdominal hand placement. Instructions for hand placement have been changed throughout the guidelines updates20 and have resulted in a significant rate of incorrect hand placement 21, 22. Birkenes et al .…”

“…Birkenes et al . observed that lay people understood the center of the chest to be the same as the center of the torso20 and nearly half of their study participants who learned CPR even 6–9 months ago placed their hands too low 21. Guidelines claim that CPR by lay rescuers is quite safe even for victims who are not in CA 23, 24.…”

“…The instruction for correct hand position, however, is another key component of EMS dispatch instruction for CPR, and this needs to be investigated. In this regard, Birkenes et al 20. tried a unique instruction for hand placement to avoid abdominal compression; instructing rescuers to straighten the patient's arm close to the rescuers out from the patient's body and sit astride the arm.…”