Measuring the effect of off-balancing vectors on the delivery of high-quality CPR during ambulance transport: A proof of concept study
Creators: name: Manoukian, Martin A.C.
name: Mumma, Bryn E.
name: Wagner, Jenny L.
name: Linvill, Matthew T.
name: Rose, John S.
Publisher: name: Taylor & Francis
Year: 2023
Subjects: subject: Space Science
subject: Medicine
subject: Physiology
subject: FOS: Biological sciences
subject: Evolutionary Biology
subject: Environmental Sciences not elsewhere classified
subject: Ecology
subject: Sociology
subject: FOS: Sociology
subject: Cancer
subject: Inorganic Chemistry
subject: FOS: Chemical sciences

description: This study aims to demonstrate the feasibility of quantifying the off-balancing vectors experienced during ambulance transport and comparing them to high-quality cardiopulmonary resuscitation (HQ-CPR) metrics. Ten participants completed a total of 20 evolutions of compression-only HQ-CPR in an ambulance driven in a manner that minimized or increased linear and angular off-balancing vectors. Linear and angular velocity, linear and angular acceleration, and linear jerk were recorded. HQ-CPR variables measured were compression fraction and proportion of compressions with depth &gt;5 cm (depth%), rate 100-120 (rate%), full chest recoil (recoil%), and hand position (hand%). A composite score was calculated: [(depth% + rate% + recoil% + hand%)/4) * compression fraction]. Difficulty of HQ-CPR performance was measured with the Borg rating of perceived exertion (RPE) Scale. A series of mixed effects models were fitted regressing each HQ-CPR metric on each off-balancing vector. HQ-CPR data and vector quantity data were successfully recorded in all evolutions. Rate% was negatively associated with increasing linear velocity (slope = -3.82, standard error [SE] 1.12, p = 0.005), linear acceleration (slope = -5.52, SE 1.93, p = 0.013), linear jerk (slope = -17.60, SE 5.78, p = 0.007), angular velocity (slope = -75.74, SE 22.72, p = 0.004), and angular acceleration (slope = -152.5, SE 59.6, p = 0.022). Compression fraction was negatively associated with increasing linear velocity (slope = -1.35, SE 0.37, p = 0.004), linear acceleration (slope = -1.67, SE 0.48, p = 0.003), linear jerk (slope = -4.90, SE 1.86, p = 0.018), angular velocity (slope = -25.66, SE 6.49, p = 0.001), and angular acceleration (slope = -45.35, SE 18.91, p = 0.031). Recoil% was negatively associated with increasing linear velocity (slope = -5.80, SE 2.21, p =0.023) and angular velocity (slope = -116.98, SE 44.24, p = 0.019)). Composite score was negatively associated with increasing linear velocity (slope = -4.49, SE 1.45, p = 0.009) and angular velocity (slope = -86.13, SE 31.24, p = 0.014) and approached a negative association with increasing magnitudes of linear acceleration (slope -5.54, SE 3.37, p = 0.075), linear jerk (slope = -17.43, SE 12.39, p = 0.064), and angular acceleration (slope = -170.43, SE 114.11, p = 0.051). Borg RPE scale was positively associated with all off-balancing vectors. Depth%, hand%, mean compression depth, and mean compression rate were not correlated with any off-balancing vector. Off-balancing vector data can be successfully quantified during ambulance transport and compared with HQ-CPR performance parameters. Increasing off-balancing vectors experienced during ambulance transport are associated with worse HQ-CPR metrics and increased perceived physical exertion. These data may help guide future drive styles, ambulance design, or use of mechanical CPR devices to improve HQ-CPR delivery during selected patient transport scenarios.