Effects of a backboard, bed height, and operator position on compression depth during simulated resuscitation

OBJECTIVE: To investigate the effect of a backboard, cardiopulmonary resuscitation (CPR) provider body position and bed height on the quality of chest compression during simulated in-hospital resuscitation. DESIGN AND SETTING: Randomised controlled cross-over trial in a university hospital. PARTICIPANTS: Second-year medical student basic life support instructors. INTERVENTIONS: Chest compressions performed on a resuscitation manikin placed on a hospital bed with/without a CPR backboard, kneeling on the bed adjacent to the manikin and lowering the height of the bed. MEASUREMENTS AND RESULTS: Sub-optimal chest compressions were performed on all surfaces. There were no differences in compression depth: standard CPR, 29+/-7 mm; backboard CPR, 31+/-10 mm; kneeling on the bed, 30+/-7 mm; lowering bed height, 32+/-10 mm. Compression rate and duty cycle were similar on each surface. Participants failed to recognise their poor quality CPR, and there was no difference in assessment of fatigue or efficacy of CPR between surfaces. CONCLUSIONS: In contrast to current guidelines, the use of a CPR backboard did not improve chest compressions. Furthermore, kneeling on the bed adjacent to the victim or lowering bed height did not impact materially on the quality of chest compression. These findings should be validated in clinical studies.