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Randomized Controlled Trial
. 2021 Sep 4;29(1):129.
doi: 10.1186/s13049-021-00944-9.

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

Affiliations
Randomized Controlled Trial

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

Bernd Wallner et al. Scand J Trauma Resusc Emerg Med. .

Erratum in

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.

Keywords: Asphyxia; Atypical rescuer position; Confined space; Resuscitation; Ventilation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Setup for single-rescuer CPR in “straddle” position with restricted patient access. The participant sat on the pelvis of the manikin and remained in this position for the entire course of the experiment. Chest compressions and ventilation were provided by leaning forward towards the thorax and the mouth of the manikin
Fig. 2
Fig. 2
Setup for single-rescuer CPR in “over-the-head” position with restricted patient access. The participant kneeled above the manikin’s head and remained in this position for the entire course of the experiment. To perform chest compression the participant had to lean over the manikin’s head to reach the chest from above. In order to perform ventilation, the participant had to bend down to reach the mouth
Fig. 3
Fig. 3
Flow chart displaying the details of the study protocol. After inclusion each participant received instructions, and subsequently performed two test cycles in the STA position (ventilation with FC and then BM). Thereafter, participants were randomised and performed BLS in the OTH and STR positions with FC or PM in random sequence

References

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