Comparison of standard and over-the-head method of chest compressions during cardiopulmonary resuscitation - a simulation study

Background: Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial ventilation using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient's side with compression conducted from the 'over-the-head' position.

Methods: The subject of the study were two methods of CPR - 'standard' (STD) and 'over-the-head' (OTH). The STD method consisted of cycles of 30 chest compressions from the patient's side, and two attempts at artificial ventilation after moving round to behind the patient's head. In the OTH method, both compressions and ventilations were conducted from behind the patient's head.

Results: Both CPR methods were conducted by 38 paramedics working in medical response teams. Statistical analysis was conducted on the data collected, giving the following results: the average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p < 0.001); the depth of compression 50-60 mm (STD 50.65%, OTH 60.22%, p < 0.001); the rate of compression 100-120/min. (STD 46.39%, OTH 53.78%, p < 0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p < 0.001); correct hand position (STD 99.32%, OTH method 99.66%, p < 0.001). A statistically significant difference was demonstrated in the results to the benefit of the OTH method in the above parameters. The remaining parameters showed no significant differences in comparison to reference values.

Conclusions: The higher quality of CPR in the simulated research using the OTH method by a single person justifies the use of this method in a wider range of emergency interventions.