Page 25 - Delaware Medical Journal - July/August 2019
P. 25
CASE REPORT
TABLE 2. Post-Survey Bias Data
N (%) Bias
N (%) Opposite Bias
N (%) Unbiased
Fatigue Bias
33 (84.84%)
0
5 (13.6)
Height Bias
31 (81.6%)
0
7 (18.4)
Gender Bias
35 (92%)
0
3 (8%)
Majority of subjects were biased that a well-rested, tall male would perform better HQCC. Note that 0% of subjects were in favor of fatigued, short female. Small percentage showed no bias for these three bias categories.
the six minutes, participants had a 2.5% increase towards meeting guidelines.
Participants expressed bias against medical personnel who were female, fatigued, and shorter than average height. The majority of residents indicated bias, with higher rates of bias reported when fatigue (86.8%) or gender (92%) were examined compared to height (81.6%) (see Table 2). There were
no differences in bias reporting by gender for any of the types of bias explored, or
for the three subtypes overall (all p-values
> 0.05). We then examined the number of residents who reported any type of bias. of the 11 measures of bias. The majority of residents (95%; 36/38) expressed some bias. The percentage of residents with any type of bias did not differ by gender (Males: 96% (24/25); Females: 92% (12/13); p-value = 0.63).
LIMITATIONS
This sample included a limited number
of emergency medicine residents. The inclusion of medical professionals from various specialties would provide a more inclusive subject group. Another limitation were not blinded to the Zoll device monitor, which displayed depth and rate of compressions. Although the participants were not familiar with the Zoll device
or with its monitor display, based on our observation, one participant pair began to alter their compression rate and depth based
on feedback from the Zoll device, which improved their performance. Previous research has demonstrated that use of a quality of chest compressions.2, 9,10,11 In one study, the percentage of chest compressions performed within the AHA guidelines improved from 15% to 78% with feedback.2 The monitor was subsequently covered with a blanket so as to not interfere with individual performance. Finally, we were limited in determining whether the level was accurate or not, as we relied on self-report for these data points.
DISCUSSION
Although Emergency Physicians are
chest compressions are performed during CPR, only 11.6% of the residents in
this study performed within the AHA guidelines. In general, the AHA depth recommendation was accomplished and remained between 2.0-2.4 inches. The residents did not stay within guidelines due to an excessive compression rate, averaging in all categories 128-131 compressions per minute, as seen in
Table 1. Over the six total minutes each resident was asked to perform chest compressions, depth did begin to slowly decline as the physicians presumably became more fatigued. This occurred despite alternating compressors every two minutes as is currently recommended.
A previous study found that a six-
minute rest period after two minutes of chest compressions was vital to sustain the quality of compressions during a 30-minute CPR cycle.12 This suggested that the ideal number of personnel performing chest compressions to
retain quality would be four rather than two, which is not often feasible. We
only performed CPR for a total of 12 minutes rather than the longer duration of 30 minutes in the prior study, but it is possible that the six-minute rest period would remain ideal even for a shorter duration of CPR. Perhaps, if participants slowed down their rate initially, the depth would not suffer over time. 2010 AHA guidelines recommended a compression rate of “at least” 100, and depth of “at least” two inches. The idea of harder, deeper, faster was adopted around this time and this mantra still exists among many providers. The new 2015 AHA guidelines have narrowed the window
for depth and rate, to 2.0-2.4 inches and 100-120 respectively.1 This implies that perhaps the harder, deeper, faster mantra is not in the patient’s best interest. It has been demonstrated that increased chest compression rate results in inadequate depth and rescuer fatigue.13 We observed from our study that a rate faster than
120 led to inadequate depth. It was also demonstrated that if participants focused on depth, then rate was inadequate. There appears to be a balance that is needed
to provide the epitome of CPR care, and perhaps setting strict parameters, as the majority of participants did not perform
Del Med J | July/August 2019 | Vol. 91 | No. 4
169
