PURPOSE:Chest compressions (CC) are a critical part of cardiopulmonary resuscitation. CC require strength, endurance, and proper technique. We examined whether gender and/or body mass index (BMI) were determinants of medical housestaff ability to perform adequate CC and the length of time during which housestaff can maintain adequate CC.
METHODS:Comparison of CC technique of 28 male and 30 female PGY-1 medical housestaff was conducted using a patient simulator equipped with a calibrated CC measurement device. Subjects were tested in the first 2 weeks of their PGY-1 year and subsequently trained in effective CC technique. They were retested 2 weeks later when they also went through an endurance test where they attempted to perform adequate CC for 120 seconds, or until fatigue prevented further effort.
RESULTS:Pre-training, 14/28 (50%) of the male group performed adequate CC and 0/30 (0%) of the female group performed adequate CC. Post-training, 25/28 (89%) of the male group performed adequate CC and 11/30 (37%) of the female group performed adequate CC. There was no correlation between BMI and adequate CC in either group. Taller females achieved better CC than shorter females. In males, there was no correlation of height with adequacy of CC. Regardless of gender, only 8/58 (14%) of subjects were able to maintain adequate CC for 120 seconds.
CONCLUSION:Assessing adequacy of CC with a patient simulator followed by training is an effective means of improving housestaff ability at CC. Despite training, a significant number of females were unable to perform adequate CC compared with males; BMI was not a determining factor. ACLS guidelines recommend rescuers switching compressor roles every 120 seconds to prevent fatigue. Only a small minority of PGY-1 housestaff were able to meet this guideline with satisfactory CC for one cycle of 120 seconds.
CLINICAL IMPLICATIONS:ACLS guidelines should be changed to decrease the amount of time between compressor switching. Housestaff CC effectiveness can be improved with training. Female housestaff may need more intense training to achieve and perform adequate CC.
DISCLOSURE:Yonatan Greenstein, None.