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The 2005 International Liaison Committee on Resuscitation gave a detailed update on best practice for CPR with a discussion around appropriate patient and rescuer position, based largely on expert opinion . The objectives of this study were: to demonstrate a difference in chest compression effectiveness with bed height, and provide a suggestion for an optimal and achievable bed height for effective chest compressions; and to demonstrate fatigue during chest compressions, and provide a suggestion for an upper time limit for effective chest compressions.
Exclusion criterion for this trial; no previous basic life support training in the past 4 years, or refused consent to participate. A modified Laerdal manikin was connected to a Dragor ventilator (to measure intrathoracic pressures generated). The manikin was placed on a hospital trolley, and CPR was performed by candidates at three different bed heights: mid thigh; anterior superior iliac spine; and xiphisternal area. Chest compressions were continuous and asynchronous with ventilation, and allowed to continue for 30 seconds before recordings were taken.
One hundred and one subjects took part. The differences in intrathoracic pressures generated at different bed heights were compared using ANOVA variance testing for multiple groups, and were statistically significant with P < 0.01 (Figure (Figure1).1). We also found that the effectiveness of CPR decreased 17% over a 2-minute period (Figure (Figure22).
The most effective bed height position, allowing rescuers to achieve the highest intrathoracic pressures during CPR, was with the patient chest in line with the rescuer's mid-thigh. The rescuer performing CPR should change every 2 minutes.