METHODS
- data from the resus outcomes consortium – one of the big cardiac arrests research networks
- this data was pulled from people not already in a trial
- the defibs and pads were used to calculate the compression depth numbers
- considered 4cm compression for >60% of the time as high quality (this is the 2005 guidelines)
- primary outcome was survival to hosp discharge
- excluded those who had arrest witinessed by EMS and who got an AED shock
RESULTS
- 25000 potential but only 1000 enrolled, largely because of no depth data available.
- the selected patients had a shorter time to CPR so no doubt they survived more because of it
- otherwise a fairly typical population
- CPR was outside of the guideline depth for 60% of the cases
- people were more likely to survive as compression depth increased
- survival to discharge was 4.9% overall so neuro survival probably wasn’t as good.
THOUGHTS/PROBLEMS
- Note the 2010 guidelines say 5cm and the data in this paper did not support that change.
- There are lots of problems with this and you could easily say that body habitus and chest wall compliance determined outcomes here rather than compression depth
- Despite all the flaws, I think we should be using some form of rate and depth feedback at the very least in ALS courses (it’s been 7 years since I’ve been to one…) and it would be fairly easily done in a hospital setting too.
Stiell, Ian G, Siobhan P Brown, James Christenson, Sheldon Cheskes, Graham Nichol, Judy Powell, Blair Bigham, et al. “What Is the Role of Chest Compression Depth During Out-of-Hospital Cardiac Arrest Resuscitation?..” Critical Care Medicine 40, no. 4 (April 2012): 1192–1198. PMID 22202708]