Good Working Position Tops Best Practices for CPR in Hospitals

When performing cardiopulmonary resuscitation in a hospital bed, getting into the bed or leaning on the bed optimizes the working position.

In the hospital setting, working position such as lowering a patient's bed optimizes cardiopulmonary resuscitation (CPR), researchers say.

Using manikins in hospital beds and on the floor, the research compared clinicians' CPR performance based on depth of chest compressions. Although no difference in chest compressions was noted—both groups were too shallow—work position improved chest compression depth.

"Participants who optimized their working position for CPR (defined as jumping onto or lowering the bed) performed chest compressions with a median depth of 39mm, while participants who did not optimize their working position performed chest compressions with a median depth of 29mm," the researchers wrote.

In hospitals, most resuscitation attempts are made in a bed.

Working position boosts CPR performance, according to the researchers, who published their article in the American Journal of Emergency Medicine. The study included 108 healthcare professionals.

"Lowering the height of the bed or kneeling on the bed increases the force delivered and leads to deeper chest compression depth. Our pooled data support these findings as participants who optimized their position, by lowering the bed or jumping onto the bed, performed deeper chest compressions," the researchers wrote.

An earlier study found that a small increase in bed height to 20 cm above the knee decreased chest compression depth.

Hospitals have room for CPR improvement.

"Survival from in-hospital cardiac arrest carries a poor prognosis,

with less than a 30% chance of survival to discharge. International

resuscitation guidelines stress the importance of CPR with high-quality chest compressions with minimal interruptions," the AJEM researchers wrote.

Earlier research has found healthcare professionals often perform CPR poorly during actual cardiac arrests.

In addition to using an effective working position, the AJEM researchers highlighted three best practices for resuscitation in the hospital setting:

• Compressions must be performed at the correct depth and rate, with full recoil
   
• Hand placement is crucial. Earlier research has found that placing the dominant hand first generates a significant improvement in chest compression depth. Other research found a quick and straightforward way to place the hands on the chest properly.
   
• Put metrics in place to help healthcare professionals evaluate their CPR performance during training and actual cardiac arrests

Most healthcare professionals in the AJEM study overestimated the effectiveness of their chest compressions, indicating the need for performance monitoring, the researchers wrote.

"The majority reported no difficulties in achieving sufficient chest compression depth, suggesting that these participants were unaware of their sub-optimal chest compression performance."

Until there is more clarity about best practices for resuscitation in the hospital setting, the researchers give two options for CPR training:

• Focus resources on simple but more frequent CPR training with a manikin on the floor
   
• Create a more realistic training environment that emphasizes CPR working position