Incomplete chest wall decompression: A clinical evaluation of CPR performance by trained laypersons and an assessment of alternative manual chest compression-decompression techniques

Tom P. Aufderheide, Ronald G. Pirrallo, Demetris Yannopoulos, John P. Klein, Chris von Briesen, Christopher W. Sparks, Kimberly A. Deja, David J. Kitscha, Terry A. Provo, Keith G. Lurie

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

Background: Complete chest wall recoil improves hemodynamics during CPR by generating relatively negative intrathoracic pressure, which draws venous blood back to the heart, providing cardiac preload prior to the next chest compression. Objective: This study was designed to assess the quality of CPR delivered by trained laypersons and to determine if a change in CPR technique or hand position would improve complete chest wall recoil, while maintaining adequate duty cycle, compression depth, and proper hand position placement. Standard manual CPR and three alternative manual CPR approaches were assessed. Methods: This randomized prospective trial was performed on an electronic test manikin. Thirty laypersons (mean age of 40.6 years (range 28-55)), who were trained in CPR within the last 24 months, signed an informed consent and participated in the trial. Subjects performed 3 min of CPR on a Laerdal Skill Reporter™ CPR manikin using the Standard Hand Position followed by 3 min of CPR (in random order) using three alternative CPR techniques: (1) Two-Finger Fulcrum Technique - lifting the heel of the hand slightly but completely off the chest during the decompression phase of CPR using the thumb and little finger as a fulcrum; (2) Five-Finger Fulcrum Technique - lifting the heel of the hand slightly but completely off the chest during the decompression phase of CPR using all five fingers as a fulcrum; (3) Hands-Off Technique - lifting the heel and all fingers of the hand slightly but completely off the chest during the decompression phase of CPR. The participants did not know the purpose of the study prior to, or during this investigation. Results: Adequate compression depth was poor for all hand positions tested and ranged only from 18.6 to 35.7% of all compressions. When compared with the Standard Hand Position, the Hands-Off Technique decreased the mean compression duty cycle from 39.0 ± 1.0 to 33.5 ± 1.0%, (P < 0.0001) but achieved the highest rate of complete chest wall recoil (92.5% versus 24.1%, P < 0.0001) and was 46.3 times more likely to provide complete chest wall recoil (OR: 46.3; CI: 16.4-130.3). There were no significant differences in accuracy of hand placement, adequate depth of compression, or perceived discomfort with its use compared with the Standard Hand Position. Conclusions: The Hands-Off Technique decreased compression duty cycle but was 46.3 times more likely to provide complete chest wall recoil (OR: 46.3; CI: 16.4-130.3) compared to the Standard Hand Position without differences in accuracy of hand placement, adequate depth of compression, or perceived discomfort with its use. All forms of manual CPR tested (including the Standard Hand Position) in trained laypersons produced an inadequate depth of compression for two-thirds of the time. These data support development and testing of more effective layperson CPR training programmes and more effective means to deliver manual as well as mechanical CPR.

Original languageEnglish (US)
Pages (from-to)341-351
Number of pages11
JournalResuscitation
Volume71
Issue number3
DOIs
StatePublished - Dec 2006

Bibliographical note

Funding Information:
This study would not have been possible without the expertise and support of Daniel Baumgartner, Todd A. Beadle, Geir Inge Tellnes and Laerdal Medical Corporation. Their assistance with this project is greatly appreciated. Funding for this study was provided by the National Institutes of Health (NIH) SBIR grant numbers 2-R44-HL65851-02 and 3-R44-HL65851-02-S1 to Advanced Circulatory Systems, Inc., Eden Prairie, MN; Keith Lurie, MD, principal investigator. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the NIH National Heart, Lung and Blood Institute.

Funding Information:
Funding support: National Institute of Health – SBIR Grant Numbers 2-R44-HL65851-02 and 3-R44-HL65851-02-S1 to Advanced Circulatory Systems, Inc.

Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.

Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation (CPR)
  • Chest compression

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