The physiological effects and quality of chest compressions during CPR at sea level and high altitude

Wang, Jen-Chun; Chen, Yu Long; Hsu, Chin Wang; Lai, Kuan Cheng; Li, Ling Yuan; Kao, Wei Fong; Fan, Ju Sing; Chen, Ying Hsin

doi:10.1016/j.ajem.2014.07.007

Cited by 24 publications

(17 citation statements)

References 27 publications

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“…We found no difference in compression frequency, hands-off time, and proportion of time performing chest compressions. No previous data exists on the latter two, but regarding compression frequency, our findings are consistent with those of Wang et al [9].…”

Section: Discussionsupporting

confidence: 93%

“…These findings are again distinctly different to previous reports. Wang et al, who studied health care professionals, who were however not professional mountaineers, found a severe increase in heart rate (81 before, 103 after CPR at sea level; 94 before, 115 after at high altitude, compared to 74 before and 84 after, and 126 before and 121 after in our study), as well as in BORG scale (6.7 at beginning, 13.8 at end on sea level; 9.6 at beginning, 14.4 at end on high altitude; 1.8, 2.7 and 2.4 and 2.6 in our study) [9]. Narahara reported similar findings in laymen, with BORG scales of 13 after CPR at sea level and 15 after CPR at 3700 [10].…”

Section: Discussionsupporting

confidence: 60%

“…This difference of 0.4 cm was distinctly less pronounced than our findings of a reduction of 1.0 cm. We believe this may be explained by the different scenario used in the study by Wang: Subjects were flown to the mountain and performed 5 min of chest compression-only CPR vs. a quick ascent from base camp to the mountain shelter, and 16 min of 30:2 CPR in groups of two [9]. Although this represents one common scenario, use of HEMS might often not be possible due to weather or daytime restrictions, as outlined before.…”

Section: Discussionmentioning

confidence: 99%

“…Wang et al [9] found a significant deterioration of quality of chest compressions at high altitude (3100 m). Participants were however flown to the mountain before performing CPR.…”

Section: Introductionmentioning

confidence: 99%

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Influence of physical strain at high altitude on the quality of cardiopulmonary resuscitation

Egger¹,

Niederer

Tscherny

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: High quality cardiopulmonary resuscitation is a key factor in survival with good overall quality of life after out-of-hospital cardiac arrest. Current evidence is predominantly based on studies conducted at low altitude, and do not take into account the special circumstances of alpine rescue missions. We therefore aimed to investigate the influence of physical strain at high altitude on the quality of cardiopulmonary resuscitation. Methods: Alpine field study. Twenty experienced mountaineers of the Austrian Mountain Rescue Service trained in Basic Life Support (BLS) performed BLS on a manikin in groups of two for 16 min. The scenario was executed at baseline altitude and immediately after a quick ascent over an altitude difference of 1200 m at 3454 m above sea level. The sequence of scenarios was randomised for a cross over analysis. Quality of CPR and exhaustion of participants (vital signs, Borg-Scale, Nine hole peg test) were measured and compared between high altitude and baseline using random-effects linear regression models. Results: The primary outcome of chest compression depth significantly decreased at high altitude compared to baseline by 1 cm (95% CI 0.5 to 1.3 cm, p < 0.01). There was a significant reduction in the proportion of chest compressions in the target depth (at least 5 cm pressure depth) by 55% (95% CI 29 to 82%, p < 0.01) and in the duration of the release phase by 75 ms (95% CI 48 to 101 ms, p < 0.01). No significant difference was found regarding hands-off times, compression frequency or exhaustion. Conclusion: Physical strain during a realistic alpine rescue mission scenario at high altitude led to a significant reduction in quality of resuscitation. Resuscitation guidelines developed at sea level are not directly applicable in the mountain terrain.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

“…Wang et al [9] found a significant deterioration of quality of chest compressions at high altitude (3100 m). Participants were however flown to the mountain before performing CPR.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Influence of physical strain at high altitude on the quality of cardiopulmonary resuscitation

Egger¹,

Niederer

Tscherny

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…Resuscitation at high altitude does not difer from standard CPR. CPR is more exhausting for a single rescuer than at sea level, due to lower pO 2 , and the average number of efective chest compressions may decrease within the irst minute [36].…”

Section: Special Environmentmentioning

confidence: 99%

Cardiopulmonary Resuscitation in Special Circumstances

Cimpoeşu¹,

Popa²

2017

Resuscitation Aspects

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Cardiopulmonary resuscitation (CPR) in special circumstances includes the emergency intervention for special causes, special environments and special patients. Special causes cover the potential reversible causes of cardiac arrest that must be identiied or excluded during any resuscitation, divided into two groups, 4Hs and 4Ts: hypoxia, hypo-/hyperkalaemia and other electrolyte disorders, hypo-/hyperthermia, hypervolemia, tension pneumothorax, tamponade (cardiac), thrombosis (coronary or pulmonary) and toxins. The special environments section includes recommendations for the treatment of cardiac arrest occurring in speciic locations: cardiac surgery, catheterisation laboratory, dialysis unit, dental surgery, commercial airplanes or air ambulances, ield of play, diicult environment (e.g. drowning, high altitude, avalanche and electrical injuries) or mass casualty incident. CPR for special patients gives guidance for the patients with severe comorbidities (asthma, heart failure with ventricular assist devices, neurological disease and obesity) and pregnancy women or elderly people.

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