The uniform chest compression depth of 50 mm or greater recommended by current guidelines is not appropriate for all adults

Sh, Lee; Kim, Dong Hoon; Kang, Tae-Sin; Kang, Changwoo; Jeong, Jin Hee; Kim, Sun Joo

doi:10.1016/j.ajem.2015.04.034

Cited by 19 publications

(18 citation statements)

References 29 publications

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“…26,27) The differences between sex and body size, including height, weight, and BMI, were not included in the current guidelines. Lee et al 28) noted that the internal and external chest depth increased with increase in BMI. However, the mean age of the patients was 46.1±9.2 years, not including elderly patients.…”

Section: Discussionmentioning

confidence: 98%

Comparison of Heart Proportions Compressed by Chest Compressions Between Geriatric and Nongeriatric Patients Using Mathematical Methods and Chest Computed Tomography: A Retrospective Study

Yoo

Lee

et al. 2018

Ann Geriatr Med Res

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Background Current guidelines recommended that chest compression depths during car-diopulmonary resuscitation (CPR) should be at least one-fifth of the external chest ante-riorposterior (AP) diameter. The chest AP diameter increases because of dorsal kyphosis, senile emphysema, and poor lung compliance associated with aging. This study aimed to compare the proportion of the heart compressed by chest compression (based on the ejection fraction [EF]) in geriatric and nongeriatric patients. Methods We performed a retrospective analysis of the chest computed tomography findings obtained between January 2010 and August 2016 and measured the chest anatomical parameters such as the perpendicular external and internal chest AP diameters with the heart AP diameter. Based on values of these parameters, EFs with 50- and 60-mm depths were obtained. In addition, we investigated and compared the proportion of 50- and 60-mm depths and heart AP to external chest AP diameter between the 2 groups. Results We randomly selected and analyzed 100 of 1,921 geriatric and 100 of 22,090 nongeriatric populations from a database. The means±standard deviations of EFs with 50- and 60-mm depths for geriatric and nongeriatric people were 37.1%±12.1% vs. 43.2%±13.8% and 47.5%±12.8% vs. 54.6%±14.8%, respectively (all p<0.001). The proportion of 50- and 60-mm depths and heart AP to external chest AP diameter were significantly different between the 2 groups (all p<0.05). Conclusion Chest compression depths based on current guidelines are not sufficient for geriatric patients during CPR; hence, deeper chest compressions would be considered.

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Section: Discussionmentioning

confidence: 98%

Comparison of Heart Proportions Compressed by Chest Compressions Between Geriatric and Nongeriatric Patients Using Mathematical Methods and Chest Computed Tomography: A Retrospective Study

Yoo

Lee

et al. 2018

Ann Geriatr Med Res

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“…The compressions greater than 6 cm likely resulted in iatrogenic injuries 12. Increasing the chest compression depth with increased body mass index was suggested to maintain the persistent ratio of anteroposterior chest diameter to the compression depth 13. Even though the optimal chest compression depth has not been determined, performing high-quality CPR is important to save a life 10.…”

Section: Introductionmentioning

confidence: 99%

CPR performance in the presence of audiovisual feedback or football shoulder pads

Tanaka

Rodrigues

Sotir

et al. 2017

BMJ Open Sport Exerc Med

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ObjectiveThe initiation of cardiopulmonary resuscitation (CPR) can be complicated by the use of protective equipment in contact sports, and the rate of success in resuscitating the patient depends on the time from incident to start of CPR. The aim of our study was to see if (1) previous training, (2) the presence of audiovisual feedback and (3) the presence of football shoulder pads (FSP) affected the quality of chest compressions.MethodsSix basic life support certified athletic training students (BLS-ATS), six basic life support certified emergency medical service personnel (BLS-EMS) and six advanced cardiac life support certified emergency medical service personnel (ACLS-EMS) participated in a crossover manikin study. A quasi-experimental repeated measures design was used to measure the chest compression depth (cm), rate (cpm), depth accuracy (%) and rate accuracy (%) on four different conditions by using feedback and/or FSP. Real CPR Help manufactured by ZOLL (Chelmsford, Massachusetts, USA) was used for the audiovisual feedback. Three participants from each group performed 2 min of chest compressions at baseline first, followed by compressions with FSP, with feedback and with both FSP and feedback (FSP+feedback). The other three participants from each group performed compressions at baseline first, followed by compressions with FSP+feedback, feedback and FSP.ResultsCPR performance did not differ between the groups at baseline (median (IQR), BLS-ATS: 5.0 (4.4–6.1) cm, 114(96–131) cpm; BLS-EMS: 5.4 (4.1–6.4) cm, 112(99–131) cpm; ACLS-EMS: 6.4 (5.7–6.7) cm, 138(113–140) cpm; depth p=0.10, rate p=0.37). A statistically significant difference in the percentage of depth accuracy was found with feedback (median (IQR), 13.8 (0.9–49.2)% vs 69.6 (32.3–85.8)%; p=0.0002). The rate accuracy was changed from 17.1 (0–80.7)% without feedback to 59.2 (17.3–74.3)% with feedback (p=0.50). The use of feedback was effective for depth accuracy, especially in the BLS-ATS group, regardless of the presence of FSP (median (IQR), 22.0 (7.3–36.2)% vs 71.3 (35.4–86.5)%; p=0.0002).ConclusionsThe use of audiovisual feedback positively affects the quality of the depth of CPR. Both feedback and FSP do not alter the rate measurements. Medically trained personnel are able to deliver the desired depth regardless of the presence of FSP even though shallower chest compressions depth can be seen in CPR with FSP. A feedback device must be introduced into the athletic training settings.

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“…Th ere are concerns regarding the effi cacy of resuscitation in obese patients related to the quality of chest compressions. In a 2015 study by Lee and colleagues, researchers found that during cardiopulmonary resuscitation (CPR) chest compression, depth decreased as patients' BMI increased, suggesting that the recommended depth of 5 cm may need to be reevaluated for obese patients (8). Th e fi rst aim of this study was to determine if the quality of chest compression for three adult simulation manikins (normal, obese, and morbidly obese) met the American Heart Association (AHA) guideline for quality chest compressions (28 compressions out of 30 at the appropriate depth of at least 5 cm as determined by an electronic skills reporter).…”

mentioning

confidence: 99%

Efficacy of Acute Care Health Care Providers in Cardiopulmonary Resuscitation Compressions in Normal and Obese Adult Simulation Manikins

Tellson¹,

Qin²,

Erwin³

et al. 2017

Baylor University Medical Center Proceedings

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Annually, over 350,000 persons require cardiopulmonary resuscitation (CPR), either in or outside of the hospital. With obesity a rising health issue in the United States, concerns exist regarding the efficacy of quality compressions for CPR in obese patients. The aims of this study were to determine if the compressions for three adult simulation manikins (normal, obese, and morbidly obese) met quality guidelines; to examine any differences in quality of chest compressions performed by health care providers between the three manikins; and to examine the effect of participant characteristics on the quality of chest compressions in obese and morbidly obese manikins. A randomized controlled design was used. Sixty-one health care providers performed chest compressions on the three simulation manikins. Results showed that performance on the normal-sized manikin was significantly better than that on both obese and morbidly obese manikins. Participant characteristics were significantly associated with quality of chest compressions. The effectiveness of compressions in obese and morbidly obese CPR recipients has yet to be determined.

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The uniform chest compression depth of 50 mm or greater recommended by current guidelines is not appropriate for all adults

Cited by 19 publications

References 29 publications

Comparison of Heart Proportions Compressed by Chest Compressions Between Geriatric and Nongeriatric Patients Using Mathematical Methods and Chest Computed Tomography: A Retrospective Study

Comparison of Heart Proportions Compressed by Chest Compressions Between Geriatric and Nongeriatric Patients Using Mathematical Methods and Chest Computed Tomography: A Retrospective Study

CPR performance in the presence of audiovisual feedback or football shoulder pads

Efficacy of Acute Care Health Care Providers in Cardiopulmonary Resuscitation Compressions in Normal and Obese Adult Simulation Manikins

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