Skip to main content
Top
Published in: BMC Emergency Medicine 1/2019

Open Access 01-12-2019 | Cardiopulmonary Resuscitation | Research article

Comparison of standard and over-the-head method of chest compressions during cardiopulmonary resuscitation - a simulation study

Authors: Michał Ćwiertnia, Marek Kawecki, Tomasz Ilczak, Monika Mikulska, Mieczysław Dutka, Rafał Bobiński

Published in: BMC Emergency Medicine | Issue 1/2019

Login to get access

Abstract

Background

Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial ventilation using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient’s side with compression conducted from the ‘over-the-head’ position.

Methods

The subject of the study were two methods of CPR – ‘standard’ (STD) and ‘over-the-head’ (OTH). The STD method consisted of cycles of 30 chest compressions from the patient’s side, and two attempts at artificial ventilation after moving round to behind the patient’s head. In the OTH method, both compressions and ventilations were conducted from behind the patient’s head.

Results

Both CPR methods were conducted by 38 paramedics working in medical response teams. Statistical analysis was conducted on the data collected, giving the following results: the average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p < 0.001); the depth of compression 50–60 mm (STD 50.65%, OTH 60.22%, p < 0.001); the rate of compression 100–120/min. (STD 46.39%, OTH 53.78%, p < 0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p < 0.001); correct hand position (STD 99.32%, OTH method 99.66%, p < 0.001). A statistically significant difference was demonstrated in the results to the benefit of the OTH method in the above parameters. The remaining parameters showed no significant differences in comparison to reference values.

Conclusions

The higher quality of CPR in the simulated research using the OTH method by a single person justifies the use of this method in a wider range of emergency interventions.
Literature
1.
go back to reference Vadeboncoeur TF, Stolz U, Panchal A, Silver A, Venuti M, Tobin J, et al. Chest compression depth and survival in out-of-hospital cardiac arrest. Resuscitation. 2014;85(2):82–8.CrossRef Vadeboncoeur TF, Stolz U, Panchal A, Silver A, Venuti M, Tobin J, et al. Chest compression depth and survival in out-of-hospital cardiac arrest. Resuscitation. 2014;85(2):82–8.CrossRef
2.
go back to reference 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):840–8.CrossRef 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):840–8.CrossRef
3.
go back to reference Kovacs A, Vadeboncoeur TF, Stolz U, Spaite DW, Irisawa T, Silver A, et al. Chest compression release velocity: association with survival and favorable neurologic outcome after out-of-hospital cardiac arrest. Resuscitation. 2015;92:107–14.CrossRef Kovacs A, Vadeboncoeur TF, Stolz U, Spaite DW, Irisawa T, Silver A, et al. Chest compression release velocity: association with survival and favorable neurologic outcome after out-of-hospital cardiac arrest. Resuscitation. 2015;92:107–14.CrossRef
4.
go back to reference Ashoor HM, Lillie E, Zarin W, Pham B, Khan PA, Nincic V, et al. Effectiveness of different compression-to-ventilation methods for cardiopulmonary resuscitation: a systematic review. Resuscitation. 2017;118:112–25.CrossRef Ashoor HM, Lillie E, Zarin W, Pham B, Khan PA, Nincic V, et al. Effectiveness of different compression-to-ventilation methods for cardiopulmonary resuscitation: a systematic review. Resuscitation. 2017;118:112–25.CrossRef
5.
go back to reference 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.CrossRef 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.CrossRef
6.
go back to reference Fallaha JF, Spooner BB, Perkins GD. Does dual operator CPR help minimize interruptions in chest compressions? Resuscitation. 2009;80(9):1011–4.CrossRef Fallaha JF, Spooner BB, Perkins GD. Does dual operator CPR help minimize interruptions in chest compressions? Resuscitation. 2009;80(9):1011–4.CrossRef
7.
go back to reference Bossaert L, Van Hoeyweghen R. Evaluation of cardiopulmonary resuscitation (CPR) techniques. The Cerebral Resuscitation Study Group. Resuscitation. 1989;17:S99–109 discussion S199–206.CrossRef Bossaert L, Van Hoeyweghen R. Evaluation of cardiopulmonary resuscitation (CPR) techniques. The Cerebral Resuscitation Study Group. Resuscitation. 1989;17:S99–109 discussion S199–206.CrossRef
8.
go back to reference Maisch S, Gamon E, Ilisch A, Goetz AE, Schmidt GN. Comparison of the over-the-head, lateral and alternating positions during cardiopulmonary resuscitation performed by a single rescuer with a bag-valve-mask device. Emerg Med J. 2011;28(11):974–8.CrossRef Maisch S, Gamon E, Ilisch A, Goetz AE, Schmidt GN. Comparison of the over-the-head, lateral and alternating positions during cardiopulmonary resuscitation performed by a single rescuer with a bag-valve-mask device. Emerg Med J. 2011;28(11):974–8.CrossRef
9.
go back to reference Bolling G, Steen PA, Wik L. Standard versus over-the-head cardiopulmonary resuscitation during simulated advanced life support. Prehosp Emerg Care. 2007;11(4):443–7.CrossRef Bolling G, Steen PA, Wik L. Standard versus over-the-head cardiopulmonary resuscitation during simulated advanced life support. Prehosp Emerg Care. 2007;11(4):443–7.CrossRef
10.
go back to reference Handley AJ, Handley JA. Performing chest compressions in a confined space. Resuscitation. 2004;61(1):55–61.CrossRef Handley AJ, Handley JA. Performing chest compressions in a confined space. Resuscitation. 2004;61(1):55–61.CrossRef
11.
go back to reference Handley AJ. Teaching hands placement for chest compression – a simpler technique. Resuscitation. 2002;53:29–36.CrossRef Handley AJ. Teaching hands placement for chest compression – a simpler technique. Resuscitation. 2002;53:29–36.CrossRef
12.
go back to reference Perkins GD, Stephenson BT, Smith CM, Gao F. A comparison between over-the-head and standard cardiopulmonary resuscitation. Resuscitation. 2004;61(2):155–61.CrossRef Perkins GD, Stephenson BT, Smith CM, Gao F. A comparison between over-the-head and standard cardiopulmonary resuscitation. Resuscitation. 2004;61(2):155–61.CrossRef
13.
go back to reference Hupfl M, Duma A, Uray T, Maier C, Fiegl N, Bogner N, et al. Over-the-head cardiopulmonary resuscitation improves efficacy in basic life support performed by professional medical personnel with a single rescuer: a simulation study. Anesth Analg. 2005;101(1):200–5.CrossRef Hupfl M, Duma A, Uray T, Maier C, Fiegl N, Bogner N, et al. Over-the-head cardiopulmonary resuscitation improves efficacy in basic life support performed by professional medical personnel with a single rescuer: a simulation study. Anesth Analg. 2005;101(1):200–5.CrossRef
14.
go back to reference Chi CH, Tsou JY, Su FC. Comparison of chest compression kinematics associated with over-the-head and standard cardiopulmonary resuscitation. Am J Emerg Med. 2009;27(9):1112–6.CrossRef Chi CH, Tsou JY, Su FC. Comparison of chest compression kinematics associated with over-the-head and standard cardiopulmonary resuscitation. Am J Emerg Med. 2009;27(9):1112–6.CrossRef
15.
go back to reference Xanthos T, Karatzas T, Stroumpoulis K, Lelovas P, Simitsis P, Vlachos I, et al. Continuous chest compressions improve survival and neurologic outcome in a swine model of prolonged ventricular fibrillation. Am J Emerg Med. 2012;30(8):1389–94.CrossRef Xanthos T, Karatzas T, Stroumpoulis K, Lelovas P, Simitsis P, Vlachos I, et al. Continuous chest compressions improve survival and neurologic outcome in a swine model of prolonged ventricular fibrillation. Am J Emerg Med. 2012;30(8):1389–94.CrossRef
16.
go back to reference Perkins GD, Brace SJ, Smythe M, Ong G, Gates S. Out-of-hospital cardiac arrest: recent advances in resuscitation and effects on outcome. Heart. 2012;98(7):529–35.CrossRef Perkins GD, Brace SJ, Smythe M, Ong G, Gates S. Out-of-hospital cardiac arrest: recent advances in resuscitation and effects on outcome. Heart. 2012;98(7):529–35.CrossRef
17.
go back to reference Cunningham LM, Mattu A, O’Connor RE, Brady WJ. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med. 2012;30(8):1630–8.CrossRef Cunningham LM, Mattu A, O’Connor RE, Brady WJ. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med. 2012;30(8):1630–8.CrossRef
18.
go back to reference Cheskes S, Schmicker RH, Verbeek PR, Salcido DD, Brown SP, Brooks S, et al. The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the resuscitation outcomes consortium PRIMED trial. Resuscitation. 2014;85:336–42.CrossRef Cheskes S, Schmicker RH, Verbeek PR, Salcido DD, Brown SP, Brooks S, et al. The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the resuscitation outcomes consortium PRIMED trial. Resuscitation. 2014;85:336–42.CrossRef
19.
go back to reference Vaillancourt C, Everson-Stewart S, Christenson J, Andrusiek D, Powell J, Nichol G. The impact of increased chest compression fraction on return of spontaneous circulation for out-of-hospital cardiac arrest patients not in ventricular fibrillation. Resuscitation. 2011;82:1501–7.CrossRef Vaillancourt C, Everson-Stewart S, Christenson J, Andrusiek D, Powell J, Nichol G. The impact of increased chest compression fraction on return of spontaneous circulation for out-of-hospital cardiac arrest patients not in ventricular fibrillation. Resuscitation. 2011;82:1501–7.CrossRef
20.
go back to reference Souchtchenko SS, Benner JP, Allen JL, Brady WJ. A review of chest compression interruptions during out-of-hospital cardiac arrest and strategies for the future. J Emerg Med. 2013;45(3):458–66.CrossRef Souchtchenko SS, Benner JP, Allen JL, Brady WJ. A review of chest compression interruptions during out-of-hospital cardiac arrest and strategies for the future. J Emerg Med. 2013;45(3):458–66.CrossRef
21.
go back to reference Lampe JW, Yin T, Bratinov G, Weiland TR, Kaufman CL, Berg RA, et al. Developing a kinematic understanding of chest compressions: the impact of depth and release time on blood flow during cardiopulmonary resuscitation. Biomed Eng. 2015;14:1–16. Lampe JW, Yin T, Bratinov G, Weiland TR, Kaufman CL, Berg RA, et al. Developing a kinematic understanding of chest compressions: the impact of depth and release time on blood flow during cardiopulmonary resuscitation. Biomed Eng. 2015;14:1–16.
22.
go back to reference 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):1962–70.CrossRef 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):1962–70.CrossRef
23.
go back to reference Stiell IG, Brown SP, Christenson J, Cheskes S, Nichol G, Powell J, et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med. 2012;40(4):1192–8.CrossRef Stiell IG, Brown SP, Christenson J, Cheskes S, Nichol G, Powell J, et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med. 2012;40(4):1192–8.CrossRef
24.
go back to reference 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;125:3004–12.CrossRef 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;125:3004–12.CrossRef
25.
go back to reference Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al. European resuscitation council guidelines for resuscitation 2015: section 1. Executive summary. Resuscitation. 2015;95:1–80.CrossRef Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al. European resuscitation council guidelines for resuscitation 2015: section 1. Executive summary. Resuscitation. 2015;95:1–80.CrossRef
26.
go back to reference Fried DA, Leary M, Smith DA, Sutton RM, Niles D, Herzberg DL, et al. The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation. Resuscitation. 2011;82:1019–24.CrossRef Fried DA, Leary M, Smith DA, Sutton RM, Niles D, Herzberg DL, et al. The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation. Resuscitation. 2011;82:1019–24.CrossRef
27.
go back to reference Koeken Y, Aelen P, Noordergraaf GJ, Paulussen I, Woerlee P, Noordergraff A. The influence of nonlinear intra-thoracic vascular behavior and compression characteristics on cardiac output during CPR. Resuscitation. 2011;82:538–44.CrossRef Koeken Y, Aelen P, Noordergraaf GJ, Paulussen I, Woerlee P, Noordergraff A. The influence of nonlinear intra-thoracic vascular behavior and compression characteristics on cardiac output during CPR. Resuscitation. 2011;82:538–44.CrossRef
28.
go back to reference Dean JM, Koehler RC, Schleien CL, Atchinson D, Gervais H, Berkowitz I, et al. Improved blood flow during prolonged cardiopulmonary resuscitation with 30% duty cycle in infant pigs. Circulation. 1991;84:896–904.CrossRef Dean JM, Koehler RC, Schleien CL, Atchinson D, Gervais H, Berkowitz I, et al. Improved blood flow during prolonged cardiopulmonary resuscitation with 30% duty cycle in infant pigs. Circulation. 1991;84:896–904.CrossRef
29.
go back to reference Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, et al. Part 5: adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:414–35.CrossRef Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, et al. Part 5: adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:414–35.CrossRef
30.
go back to reference Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. Part 1: executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:315–67.CrossRef Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. Part 1: executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:315–67.CrossRef
31.
go back to reference Bouvet L, Albert ML, Augris C, Boselli E, Ecochard R, Rabilloud M, et al. Real-time detection of gastric insufflation related to facemask pressure-controlled ventilation using ultrasonography of the antrum and epigastric auscultation in nonparalyzed patients: a prospective, randomized, double-blind study. Anesthesiology. 2014;120(2):326–34.CrossRef Bouvet L, Albert ML, Augris C, Boselli E, Ecochard R, Rabilloud M, et al. Real-time detection of gastric insufflation related to facemask pressure-controlled ventilation using ultrasonography of the antrum and epigastric auscultation in nonparalyzed patients: a prospective, randomized, double-blind study. Anesthesiology. 2014;120(2):326–34.CrossRef
32.
go back to reference Piegeler T, Roessler B, Goliasch G, Fischer H, Schlaepfer M, Lang S, et al. Evaluation of six different airway devices regarding regurgitation and pulmonary aspiration during cardio-pulmonary resuscitation (CPR) - a human cadaver pilot study. Resuscitation. 2016;102:70–4.CrossRef Piegeler T, Roessler B, Goliasch G, Fischer H, Schlaepfer M, Lang S, et al. Evaluation of six different airway devices regarding regurgitation and pulmonary aspiration during cardio-pulmonary resuscitation (CPR) - a human cadaver pilot study. Resuscitation. 2016;102:70–4.CrossRef
33.
go back to reference Von Goedecke A, Mitterschiffthaler L, Paal P, Mitterlechner T, Wenzel V, Herff H. Optimizing the unprotected airway with a prototype Jaw-Thrust-Device – a prospective randomized cross-over study. Anesthesia. 2009;64(11):1236–40.CrossRef Von Goedecke A, Mitterschiffthaler L, Paal P, Mitterlechner T, Wenzel V, Herff H. Optimizing the unprotected airway with a prototype Jaw-Thrust-Device – a prospective randomized cross-over study. Anesthesia. 2009;64(11):1236–40.CrossRef
Metadata
Title
Comparison of standard and over-the-head method of chest compressions during cardiopulmonary resuscitation - a simulation study
Authors
Michał Ćwiertnia
Marek Kawecki
Tomasz Ilczak
Monika Mikulska
Mieczysław Dutka
Rafał Bobiński
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2019
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-019-0292-8

Other articles of this Issue 1/2019

BMC Emergency Medicine 1/2019 Go to the issue