CPR Rescuer Fatigue on Chest Compression Effectiveness
Condition: Rescuer Fatigue During CPR
MeSH terms: Fatigue
Study type: Interventional

Summary: 
      This prospective, randomized experimental trial to determine whether the quality of
      healthcare provider/rescuer chest compressions (CC) deteriorates at the same rate in
      pediatric models as compared to adult models. To determine the relationship between
      physiologic/metabolic markers of work in rescuers and chest compression deterioration, and to
      determine the effect of stepstool use on the quality of chest compressions and metabolic
      demand. To determine whether the quality of chest compressions deteriorates at the same rate
      in participants using a stepstool compared to those not using a stepstool.
    

Detailed description: 
      Context:

      Pediatric cardiac arrests result in poor outcomes. Effective chest compressions improve
      survival in such patients. Unfortunately, compressions are generally inadequately performed
      and the quality of compressions given deteriorates rapidly with time. Current American Heart
      Association (AHA) guidelines call for faster and deeper chest compressions with minimization
      of interruptions. The effect of fatigue on operational performance while adhering strictly to
      these AHA guidelines is unknown. In addition, there is little pediatric data on rescuer
      fatigue and chest compression deterioration. Also, the use of a stepstool may affect the
      quality of chest compressions and may also have an impact on the fatigue of the rescuer.
      Understanding the biomechanics during optimal chest compression performance may prove useful
      in the recommendations of conditions and equipment for execution of more effective chest
      compressions during a cardiac arrest. We will aim to observe and understand the biomechanical
      qualities that allow for the most effective compressions.

      Objectives:

        1. To determine whether the quality of chest compressions deteriorates at the same rate in
           pediatric models as compared to adult models. To determine the relationship between
           physiologic/metabolic markers of work in rescuers and chest compression deterioration.

        2. To determine the effect of stepstool use on the quality of chest compressions and
           metabolic demand. To determine whether the quality of chest compressions deteriorates at
           the same rate in participants using a stepstool compared to those not using a stepstool.

      Study Design/Setting/Participants:

      This prospective, randomized experimental trial will be performed at the Children's Hospital
      of Philadelphia. Participants will be healthcare practitioners who routinely provide chest
      compressions in the course of their work. Lay practitioners will be excluded.

      Study Measures:

      Participants will be asked to perform continuous chest compressions on pediatric and adult
      sized manikins. Compression rate, depth, applied force as well as participant physiologic
      work efficiency and anaerobic threshold will be recorded. To evaluate the second objective, a
      new cohort of participants will perform continuous chest compressions on an adult sized
      manikin with and without a stepstool.. Compression rate, depth, applied force as well as
      participant physiologic work efficiency and anaerobic threshold will also be recorded.
      Videotaping of each subject will also be used for comparison of subjective assessment of
      chest compression quality and objective chest compression quality data.
    

Intervention name(s): Chest compression on adult and pedi manikins; Use of stepstool during chest compressions
Intervention type(s): Other; Other
Intervention description(s): Each participant will be required to perform chest compressions on all 2 manikins, one on each of 2 assigned days. Participants will be randomized to one of 2 groups differing only in the order of manikins compressed, i.e. pediatric-adult; adult-pediatric, etc.; In the additional arm of the study, a new cohort of participants will use only the adult manikin on two separate sessions. Participants will be randomized to one of two groups differing only in the use of a stepstool.
Other intervention name(s): chest compression on adult manikins; chest compression on pedi manikins; chest compression adult manikin
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: CPR; Rescuer fatigue; Chest Compression effectiveness