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Randomized Controlled Trial
. 2020 Mar 6;28(1):19.
doi: 10.1186/s13049-020-0717-0.

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

Alexander Egger  1   2 , Maximilian Niederer  1   3 , Katharina Tscherny  3 , Josef Burger  1   4 , Verena Fuhrmann  3 , Calvin Kienbacher  3 , Dominik Roth  5 , Wolfgang Schreiber  3 , Harald Herkner  3
Affiliations
Randomized Controlled Trial

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

Alexander Egger et al. Scand J Trauma Resusc Emerg Med. .

Abstract

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.

Keywords: Cardiopulmonary resuscitation (CPR); Manikin; Mountain medicine; Out- of-hospital CPR.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Mean compression depth at baseline and high altitude
See this image and copyright information in PMC

References

    1. Perkins GD, Handley AJ, Koster RW, Castren M, Smyth MA, Olasveengen T, et al. European resuscitation council guidelines for resuscitation 2015: section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015;95:81–99. doi: 10.1016/j.resuscitation.2015.07.015. - DOI - PubMed
    1. Idris AH, Guffey D, Aufderheide TP, Brown S, Morrison LJ, Nichols P, et al. Relationship between chest compression rates and outcomes from cardiac arrest. Circulation. 2012;125(24):3004–3012. doi: 10.1161/CIRCULATIONAHA.111.059535. - DOI - PMC - PubMed
    1. Idris AH, Guffey D, Pepe PE, Brown SP, Brooks SC, Callaway CW, et al. Chest compression rates and survival following out-of-hospital cardiac arrest. Crit Care Med. 2015;43(4):840–848. doi: 10.1097/CCM.0000000000000824. - DOI - PubMed
    1. Stiell IG, Brown SP, Nichol G, Cheskes S, Vaillancourt C, Callaway CW, et al. What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients? Circulation. 2014;130(22):1962–1970. doi: 10.1161/CIRCULATIONAHA.114.008671. - DOI - PubMed
    1. McDonald CH, Heggie J, Jones CM, Thorne CJ, Hulme J. Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance. Emerg Med J. 2013;30(8):623–627. doi: 10.1136/emermed-2012-201610. - DOI - PubMed

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