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Title: An investigation of mechanisms determining depth of chest compression during a simulated in-hospital cardiac arrest
Author: Bain, Richard
ISNI:       0000 0004 6496 1564
Awarding Body: University of Southampton
Current Institution: University of Southampton
Date of Award: 2016
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Background. Survival from in-hospital cardiac arrests remains poor with 14-20% surviving to discharge. Resuscitation guidelines advocate an optimum rescuer posture to deliver chest compressions. Rescuer posture may be influenced by the height of the medical platform during a cardiac arrest. There are no national standards for the height of a medical platform during a cardiac arrest. Currently platform height is determined by the manufacturer. Evidence for the impact of platform height on the quality of resuscitation is limited and conflicting. Aim. To investigate the effects of platform height on rescuer posture and identify the mechanisms that determine the depth of chest compressions during an in-hospital cardiac arrest. Method. Forty-three staff trained in Basic Life Support (BLS) were instructed to deliver chest compressions on an instrumented manikin positioned on a medical platform across a range of clinically relevant heights (48-98 cm). Rescuer posture and forces were measured using motion analysis equipment (CODAmotion) and a ground force plate (Kistler, model 9281B). Depth of compression was measured on an instrumented manikin with a chest compliance similar to that of an adult chest. Results. Platform height determined rescuer posture and was associated with reduced depth of compression at a platform height of .68 cm (P=0.001). Increasing platform height demonstrated a reduced number of rescuers achieving the depth of compression specified in guidelines. At a platform height of 48 cm, rescuers were able to lean a maximum of 57.6% (SD 10.3) and push a maximum 41.1% (SD 8.2) of their upper body weight against the manikin. At the lowest platform height (48 cm) there was no significant difference between the depth of chest compression achieved through static leaning/pushing and that achieved when dynamically simulating chest compressions (P=0.9). Posture increasingly deviated from the recommended position as platform height increased, and was associated with a reduction in the static force developed through leaning and pushing but increased the dynamic component of chest compression. Conclusion. Platforms that are too high adversely affect the rescuer's ability to achieve the recommended depth of compression. Platform height influences rescuer posture and determines the relative contribution of the forces delivered using rescuer body weight. Increased dynamic effort is required to compensate for suboptimal posture. Further guidance on positioning medical platforms during an in-hospital cardiac arrest is needed in order to maximise application of rescuers' physical attributes for the delivery of optimal BLS. Resuscitation guidelines and British standards for medical platforms must be aligned.
Supervisor: Petley, Graham ; Clough, Geraldine Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available