A Comparison of CPR on a Hard Surface Compared to CPR on a Mattress

Background: High-quality cardiopulmonary resuscitation (CPR) is critical for improving survival outcomes in cardiac arrest patients. However, the compliance of surfaces like hospital mattresses and household beds may compromise CPR effectiveness by reducing compression depth and increasing rescuer f...

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Main Authors: Kara Stout, Lee Doernte, Riley Phipps
Format: Article
Language:English
Published: Aperio 2024-12-01
Series:International Journal of First Aid Education
Subjects:
Online Access:https://firstaidjournal.org/article/id/2746/
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author Kara Stout
Lee Doernte
Riley Phipps
author_facet Kara Stout
Lee Doernte
Riley Phipps
author_sort Kara Stout
collection DOAJ
description Background: High-quality cardiopulmonary resuscitation (CPR) is critical for improving survival outcomes in cardiac arrest patients. However, the compliance of surfaces like hospital mattresses and household beds may compromise CPR effectiveness by reducing compression depth and increasing rescuer fatigue. Objective: To investigate the metabolic and performance differences of CPR performed on a hard surface versus a standard hospital mattress and discuss implications for lay responders performing CPR in out-of-hospital settings. Methods: A randomized cross-over study involving 34 trained participants assessed CPR quality and rescuer physiological responses on two surfaces: a hard floor and a hospital mattress. Participants performed continuous chest compressions on a manikin for 24 minutes under each condition. Measurements included heart rate (HR), oxygen consumption (VO₂), ventilatory equivalent for oxygen (Ve/VO₂), fraction of expired oxygen (FeO₂), compression depth and rate, and ratings of perceived exertion (RPE). Results: Performing CPR on a mattress significantly increased HR (mean difference: -4.1 ± 9.8 bpm; p = 0.020) and VO₂ (mean difference: -14.8 ± 7.2 mL/kg/min; p < 0.001) compared to the hard surface. Compression depth was significantly reduced on the mattress (mean difference: 3.4 ± 3.5 mm; p < 0.001). Ve/VO₂ difference increased (mean difference: -3.3 ± 8.3; p = 0.025), and FeO₂ difference decreased (mean difference: 0.7 ± 1.3%; p < 0.001) on the mattress, indicating increased metabolic demands and reduced ventilatory efficiency. RPE scores were higher on the mattress at both midpoint (mean difference: -0.5 ± 1.3; p = 0.006) and completion (mean difference: -0.2 ± 1.0; p < 0.001). No significant difference in compression rate was observed (p = 0.843). Conclusions: CPR performed on a compliant surface like a hospital mattress or household bed increases the rescuer's metabolic demands and reduces compression depth, potentially compromising resuscitation effectiveness. Strategies to mitigate the effects of surface compliance, such as moving the patient to a hard surface or using backboards, should be considered to improve CPR quality in both clinical and out-of-hospital settings.
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series International Journal of First Aid Education
spelling doaj-art-dac521ee2b9a4477afcf5e8667866ddf2025-01-31T16:27:43ZengAperioInternational Journal of First Aid Education2514-71532024-12-017110.25894/ijfae.2746A Comparison of CPR on a Hard Surface Compared to CPR on a MattressKara Stout0https://orcid.org/0000-0002-2004-8015Lee Doernte1https://orcid.org/0000-0003-4075-9751Riley Phipps2https://orcid.org/0000-0001-6716-0058Nursing and Health Sciences, West Tesas A&M UniversityNursing andHealth Sciences, West Tesas A&M UniversityUT SouthwesternBackground: High-quality cardiopulmonary resuscitation (CPR) is critical for improving survival outcomes in cardiac arrest patients. However, the compliance of surfaces like hospital mattresses and household beds may compromise CPR effectiveness by reducing compression depth and increasing rescuer fatigue. Objective: To investigate the metabolic and performance differences of CPR performed on a hard surface versus a standard hospital mattress and discuss implications for lay responders performing CPR in out-of-hospital settings. Methods: A randomized cross-over study involving 34 trained participants assessed CPR quality and rescuer physiological responses on two surfaces: a hard floor and a hospital mattress. Participants performed continuous chest compressions on a manikin for 24 minutes under each condition. Measurements included heart rate (HR), oxygen consumption (VO₂), ventilatory equivalent for oxygen (Ve/VO₂), fraction of expired oxygen (FeO₂), compression depth and rate, and ratings of perceived exertion (RPE). Results: Performing CPR on a mattress significantly increased HR (mean difference: -4.1 ± 9.8 bpm; p = 0.020) and VO₂ (mean difference: -14.8 ± 7.2 mL/kg/min; p < 0.001) compared to the hard surface. Compression depth was significantly reduced on the mattress (mean difference: 3.4 ± 3.5 mm; p < 0.001). Ve/VO₂ difference increased (mean difference: -3.3 ± 8.3; p = 0.025), and FeO₂ difference decreased (mean difference: 0.7 ± 1.3%; p < 0.001) on the mattress, indicating increased metabolic demands and reduced ventilatory efficiency. RPE scores were higher on the mattress at both midpoint (mean difference: -0.5 ± 1.3; p = 0.006) and completion (mean difference: -0.2 ± 1.0; p < 0.001). No significant difference in compression rate was observed (p = 0.843). Conclusions: CPR performed on a compliant surface like a hospital mattress or household bed increases the rescuer's metabolic demands and reduces compression depth, potentially compromising resuscitation effectiveness. Strategies to mitigate the effects of surface compliance, such as moving the patient to a hard surface or using backboards, should be considered to improve CPR quality in both clinical and out-of-hospital settings.https://firstaidjournal.org/article/id/2746/Compression depth Cardiopulmonary resuscitation (CPR) Rescuer fatigue Metabolic demands In-hospital cardiac arrest Hospital mattress
spellingShingle Kara Stout
Lee Doernte
Riley Phipps
A Comparison of CPR on a Hard Surface Compared to CPR on a Mattress
International Journal of First Aid Education
Compression depth
Cardiopulmonary resuscitation (CPR)
Rescuer fatigue
Metabolic demands
In-hospital cardiac arrest
Hospital mattress
title A Comparison of CPR on a Hard Surface Compared to CPR on a Mattress
title_full A Comparison of CPR on a Hard Surface Compared to CPR on a Mattress
title_fullStr A Comparison of CPR on a Hard Surface Compared to CPR on a Mattress
title_full_unstemmed A Comparison of CPR on a Hard Surface Compared to CPR on a Mattress
title_short A Comparison of CPR on a Hard Surface Compared to CPR on a Mattress
title_sort comparison of cpr on a hard surface compared to cpr on a mattress
topic Compression depth
Cardiopulmonary resuscitation (CPR)
Rescuer fatigue
Metabolic demands
In-hospital cardiac arrest
Hospital mattress
url https://firstaidjournal.org/article/id/2746/
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