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student paramedic
teaching methods

Lateral versus over-the-head chest compression quality in student paramedic

02 November 2022
Features
02 November 2022
Volume 14 · Issue 11

Abstract

Background: Chest compressions are one of the few interventions proven to improve survival from out-of-hospital cardiac arrest. While rescuer position has been investigated before, few studies have sought to assess how rescuer position affects the quality of chest compressions in a cohort of student paramedics. Aim: This study sought to determine if chest compressions performed from an over-the-head (OTH) position were more effective than those performed from a lateral (LAT) position in a cohort of student paramedics. Methods: Seventy-five student paramedics performed both OTH and LAT chest compressions in this randomised, crossover study. Metrics including chest compression rate, depth and recoil were used in the assessment of quality. Findings: No significant differences were observed between performance in the two positions in this study. Conclusion: There was no significant difference in the quality of chest compressions between the two positions studied. It seems OTH compressions are equally effective and are a viable alternative in the difficult-to-access arrested patient.

Good-quality chest compressions have been the cornerstone of cardiac arrest management since the 1960s and are one of the few interventions proven to improve survival from out-of-hospital cardiac arrest (Feneley et al, 1988; Stiell et al, 2014a). Defining the ‘quality’ of chest compressions, however, can be challenging, although international guidelines and the UK Resuscitation Council emphasise quality in respect particularly to chest compression rate, depth and recoil (Olasveengen et al, 2021; Soar et al, 2021).

Chest compressions should be performed at a rate of 100–120 per minute to maintain coronary perfusion pressure (CPP). Rates that are too slow will allow CPP to fall, reducing perfusion, and rates that are too high will cause reduced cardiac filling and subsequent falls in CPP. This recommended rate is based upon two studies with a combined population of 13 469 patients who achieved higher rates of survival at this compression rate (Idris et al, 2015). Very high chest compression rates were associated with decreased chest compression depth and suboptimal cardiopulmonary resuscitation (CPR) (Stiell et al, 2014a).

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Cardiopulmonary resuscitation
Chest compressions
Student paramedics
Manikin
Lateral
Over the head