Objective

To determine if the flex in mattresses, with or without a CPR board, affects the compression depth when delivered manually or mechanically.

Background

Sudden cardiac arrest is one of the leading causes of death in Europe and in the United States.2,3 When the heart suddenly stops pumping, effective and continuous chest compressions are needed to sustain blood circulation until the patient’s own heart function is restored. For high-quality CPR the AHA and ERC 2015 guidelines recommend the following:

• Compression depth of 2.0-2.4 inches / 5-6 cm

• Rate of 100-120 compressions per minute

• Allow for full chest recoil

• Hands-on time >60 %

It has been shown to be difficult to generate guidelines-consistent chest compression depth when the patient is lying in a bed.4,5 When you compress the chest the mattress receives a large share of the compression, not the patient.

Method

A study was set up to test compression depth during two minutes of chest compressions on a feedback manikin lying on a mattress, with and without a CPR board. To secure high-quality manual chest compressions, a special frame with a piston set at 2.1 inches / 5.3 cm depth was used.

These high-quality manual compressions were compared with mechanical chest compressions delivered by the LUCAS® 3 Chest Compression System that delivers a compression depth of 2.1 inches / 5.3 cm. The manikin was placed on a full size foam Stryker mattress with a thickness of 7 inches / 17.8 cm.

Results

Metrics

Manual CPR

without CPR board

Manual CPR with

CPR board

LUCAS CPR without

CPR board

LUCAS CPR with

CPR board

Overall CPR Simpad score 3% 44% 97% 97%

Depth 1.3 inches / 3.3 cm

1.6 inches / 4.0 cm

2.1 inches / 5.3 cm

2.1 inches / 5.4 cm

Deep enough 0% 0% 96%* 96%*

Full chest recoil 100% 100% 100% 100%

Compressions rate/min 95/min 102/min 101/min 101/min

Compression point 100% 100% 100% 100%

* Note: The LUCAS soft start explains why the depth is 96% and not 100% during 2 minutes.

Conclusion

The quality of manual CPR is adversely affected when performed on a mattress with or without a CPR board. The only method tested that delivered chest compressions according to the AHA/ ERC guidelines was the LUCAS device.

Take home messages

• Even when delivering perfect manual chest compressions on a manikin in a bed, the mattress effect results in too shallow chest compressions.

• Adding a CPR board did not overcome the mattress effect when delivering manual CPR. It resulted in too shallow chest compressions in the patient.

• The LUCAS device delivered guidelines-consistent chest compressions, independent on what surface the manikin lied upon, eliminating the mattress effect.

Technical report1

The mattress effect manikin study

References

1. Jolife AB internal test report on file FAD20181012-1 2. Monsieurs K, Nolan J, Bossaert L, et al. European Resuscitation Council Guidelines for Resuscitation 2015 Section 1. Executive summary. Resuscitation.

95 (2015) 1–803. Kleinman M, Brennan E, Goldberger Z, 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(suppl 2):S414–S435.)4. Perkins G, Benny R, Gilles S, et al. Do different mattresses affect the quality of cardiopulmonary resuscitation? Intensive Care Med. 2003;29:2330-23355. Perkins G, Kocierz L, Smith S, et al. Compression feedback devices over estimate chest compression depth when performed on a bed. Resuscitation

2009;80:79-82

Following equipment was used:

• A Laerdal ResusciAnne with Simpad CPR feedback

• A stiff CPR board

• Stryker ComfortGel 2850 mattress with a thickness of 7 inches / 17.8 cm

• A frame with a piston set to a compression depth of 2.1 inches / 5.3 cm

• LUCAS 3 chest compression system

LUCAS without a CPR board

Manual CPR without a CPR board

Green lines: Chest compressions are provided at recommended rate and depth - within guidelines (2.0-2.4 inches / 5-6 cm). Yellow lines in the beginning of the LUCAS sequence are due to the soft start.

Yellow lines: Chest compressions are not provided within guidelines.

For further information, please contact Stryker at 800 442 1142 (U.S.), 800 668 8323 (Canada) or visit our website at strykeremergencycare.com

Jolife ABScheelevägen 17Ideon Science ParkSE-223 70 LUND, SwedenToll free 800 442 1142strykeremergencycare.com

Stryker Canada2 Medicorum PlaceWaterdown, Ontario L8B 1W2CanadaToll free 800 668 8323

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