Page 23 - Delaware Medical Journal - July/August 2019

CASE REPORT
INTRODUCTION
Background
Since guidelines for CPR performance

numerous changes in recommendations as new data becomes available. While 2010 AHA guidelines recommended a rate of chest compressions of at least 100 compressions per minute, more recent data suggests a rate of 100 to 120 is optimal to achieve increased survival. Similarly, in 2010, AHA guidelines recommended compression depth of at least 2 inches; this was revised in 2015 to recommend a depth of 2 to 2.4 inches (5 to 6 cm) to prevent potential harm from excessive chest compression depth.1
A few studies have evaluated factors
that may affect the quality of chest compressions. A study by Perberdy et al. found that depth of chest compressions was greater for males and younger individuals than for females and older individuals, but it utilized 2005 AHA guidelines.2 Another study found an
index comprising the product of BMI
and average total exercise time per week predicted high-quality chest compressions on a simulator.3
Importance
High-quality CPR is an important,
life-saving tool utilized during the
most sensitive and dire moments for a patient. High-quality chest compressions (HQCC) can lead to successful survival
if performed adequately; however, nearly 90% of out-of-hospital cardiac arrests have unsuccessful recovery despite high-quality CPR efforts. An emphasis has been placed on rapid initiation of chest compressions because this may double or triple chances of survival. It has been demonstrated that 15% of patients with in-hospital cardiac arrest survive to hospital discharge and high-quality CPR is essential for survival.4 Team structure is a key component of successful cardiopulmonary resuscitation. When directing such a resuscitation, it is necessary to have numerous individuals perform a wide variety of roles, including chest compressions, medication administration, airway management,
and performance of procedures, documentation, and direction of the entire resuscitation. The manner in which these are assigned typically depends on the personnel available and their respective skill sets. It is unclear whether physicians are biased in terms of who would perform the highest-quality chest compressions. Gender bias does still exist within science, technology, engineering, and mathematic showing gender differences in regard to physician compensation.5, 6
Goals
The perception of a provider’s ability
to perform chest compressions during CPR may vary based on height, gender, physical fatigue, and perceived strength. Few studies have previously examined whether these factors actually affect the quality of compressions administered, and there have not been any studies on whether or not there is a perceived bias amongst physicians. We hypothesize that the quality of chest compressions does or sleep deprivation amongst emergency physicians; however, we suspect there
is a bias that exists amongst providers relating to these factors and the quality of compressions.
MATERIALS AND METHODS
Study Design and Setting
This was an observational study that utilized our hospital’s Virtual Education in Simulation Training (VEST) center and a patient simulator to create a scenario of resuscitation. The Zoll R series device was utilized to collect data for each participant with respect to chest compression rate and depth. The Zoll R series device is a soft- that attaches to a monitor displaying real-time CPR quality metrics such as rate
TABLE 1
Subject
Pre-Survey Identifiers
Compressions Mean/min
Depth
Mean in inches
Overall %
Meeting AHA guidelines
Females (N=13)
128
2.196
15.5%
Males (N=25)
129
2.320
9.6%
Tall (N=27)
128
2.278
10.8%
Short (N=11)
131
2.276
13.5%
Fatigue (N=21)
129
2.269
13.8%
No Fatigue (N=12)
128
2.296
6.8%
Exercise (N=15)
129
2.241
8.3%
No Exercise (N=23)
129
2.302
13.7%
Strength Training (N=9)
129
2.331
3.5%
No Strength Training (N=23)
129
2.261
14.1%
Del Med J | July/August 2019 | Vol. 91 | No. 4
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