To Evaluate Quality of Cardiopulmonary Resuscitation (CPR) Performed At Scene and During Transport After Out-of-Hospital Cardiac Arrest: A Crossover Trial
DOI:
https://doi.org/10.52609/jmlph.v5i2.132Keywords:
Emergency Medical Services, Manikins, Out-of-Hospital Cardiac Arrest, Patient Transport, Quality of Health Care, Randomized Controlled TrialAbstract
Background: High-quality cardiopulmonary resuscitation (CPR) is essential to improve survival rates in out-of-hospital cardiac arrest. Previous research suggests that the quality of CPR may decline during ambulance transport.
Aims: To evaluate the quality of CPR performed at the scene and during transport after out-of-hospital cardiac arrest.
Methods: A randomised, controlled, crossover trial was conducted to compare the performance of CPR on a manikin, both at the scene and in a moving ambulance. CPR quality was measured using a QCPR system, capturing parameters including compression depth, rate, recoil, and ventilation sufficiency. Participants alternated between the two scenarios after a one-hour recovery period.
Results: 18 participants were enrolled, with a mean score for CPR quality of 52.94% in the ambulance and 53.25% at the scene. A t-test revealed no statistically significant difference (t(34) = -0.033, p = 0.97) in scores; furthermore, we observed no statistically significant differences in relation to the following parameters: flow fraction, cycles performed, total number of compressions, compression score, percentage of compressions performed with proper release, percentage of compressions performed with adequate depth, total number of ventilations, and ventilation score (p>0.05).
Conclusion: The quality of CPR provided at the scene and in the ambulance is comparable, suggesting that competent CPR providers can deliver high-quality care in both settings.
References
Kiguchi T, Okubo M, Nishiyama C, Ma- conochie I, Ong MEH, Kern KB, Wyckoff MH, McNally B, Christensen EF, Tjelmeland I, Herlitz J, Perkins GD, Booth S, Finn J, Sha- hidah N, Shin SD, Bobrow BJ, Morrison LJ, Salo A, Baldi E, Burkart R, Lin CH, Jouven X, Soar J, Nolan JP, Iwami T. Out-of-hospital car- diac arrest across the world: First report from the International Liaison Committee on Resus- citation (ILCOR). Resuscitation. 2020 Jul;152:39-49. doi:10.1016/j.resuscitation.2020.02.044. Epub 2020 Apr 6. PMID: 32272235.
Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, Zong Q, Chen S, Lv C. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020 Feb 22;24(1):61. doi: 10.1186/s13054-020-2773-2.PMID: 32087741; PMCID: PMC7036236.
Lee J, Lee W, Lee YJ, Sim H, Lee WK. Effectiveness of bystander cardiopulmonary resuscitation in improving the survival and neurologic- cal recovery of patients with out-of-hospital cardiac arrest: A nationwide patient cohort study. PLoS One. 2020 Dec 16;15(12):e0243757. doi: 10.1371/journal.pone.0243757. PMID: 33326454; PMCID: PMC7744051.
Roosa JR, Vadeboncoeur TF, Dommer PB, Pan- chal AR, Venuti M, Smith G, Silver A, Mullins M, Spaite D, Bobrow BJ. CPR variability during ground ambulance transport of patients in cardiac arrest. Resuscitation. 2013 May;84(5):592-5. doi: 10.1016/j.resuscita- tion.2012.07.042. Epub 2012 Nov 21. PMID: 23178870.
Wallace SK, Abella BS, Becker LB. Quantifying the effect of cardiopulmonary resuscitation quality on cardiac arrest outcome: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2013 Mar 1;6(2):148-56. doi: 10.1161/CIRCOUTCOMES.111.000041. Epub 2013 Mar 12. PMID: 23481533.
Abella BS. High-quality cardiopulmonary resuscitation: current and future directions. Curr Opin Crit Care. 2016 Jun;22(3):218-24. doi: 10.1097/MCC.0000000000000296. PMID: 27054627.
American Heart Association. 2020 American Heart Association Guidelines for Cardiopulmonary- nary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S337-S357. doi: 10.1161/CIR.0000000000000916.
Kurz MC, Dante SA, Puckett BJ. Estimating the impact of off-balancing forces upon cardiopulmonary resuscitation during ambulance transport. Resuscitation. 2012 Sep;83(9):1085- doi: 10.1016/j.resuscitation.2012.01.033. Epub 2012 Feb 1. PMID: 22306258
Kim JA, Vogel D, Guimond G, Hostler D, Wang HE, Menegazzi JJ. A randomised, controlled comparison of cardiopulmonary resuscitation performed on the floor and on a moving ambulance stretcher. Prekops Emerg Care. 2006 Jan- Mar;10(1):68-70. doi: 10.1080/10903120500373108.PMID: 16418093.
Schmidbauer S, Yates EJ, Andréll C, Bergström D, Olson H, Perkins GD, Friberg H. Outcomes and interventions in patients transported to hospital with ongoing CPR after out-of-hospital cardiac arrest - An observational study. Resusc Plus. 2021 Oct 16;8:100170. doi: 10.1016/j.re- splu.2021.100170. PMID: 34901895; PMCID: PMC8640866.
Cheskes S, Byers A, Zhan C, Verbeek PR, Ko D, Drennan IR, Buick JE, Brooks SC, Lin S, Taher A, Morrison LJ; Rescu Epistry Investiga- tors. CPR quality during out-of-hospital cardiac arrest transport. Resuscitation. 2017 May;114:34-39. doi: 10.1016/j.resuscita- tion.2017.02.016. Epub 2017 Feb 24. PMID: 28242210.
Sunde K, Wik L, Steen PA. Quality of mechanical, manual standard and active compression-decompression CPR on the arrest site and during transport in a manikin model. Resuscitation. 1997 Jun;34(3):235-42. doi: 10.1016/s0300-9572(96)01087-8. PMID: 9178384.
Perkins GD, Lall R, Quinn T, Deakin CD, Cooke MW, Horton J, Lamb SE, Slowther AM, Woollard M, Carson A, Smyth M, Whitfield R, Williams A, Pocock H, Black JJ, Wright J, Han K, Gates S; PARAMEDIC trial collaborators. Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARA-MEDIC): a pragmatic, cluster randomised controlled trial. Lancet. 2015 Mar 14;385(9972):947-55. doi: 10.1016/S0140-6736(14)61886-9. Epub 2014 Nov 16. PMID: 25467566.
Manoukian MAC, Rose JS, Brown SK, Wynia EH, Julie IM, Mumma BE. Development of a model to measure the effect of off-balancing vectors on the delivery of high-quality CPR in a moving vehicle. Am J Emerg Med. 2022 Nov;61:158-162.doi: 0.1016/j.ajem.2022.08.059. Epub 2022 Sep 6. PMID: 36137329.
Ødegaard S, Olasveengen T, Steen PA, Kramer- Johansen J. The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospi- tal cardiac arrest. Resuscitation. 2009 Aug;80(8):843-8. doi: 10.1016/j.resuscita- tion.2009.03.032. Epub 2009 May 27. PMID: 19477573.
Lindner TW, Sunde K, Løfstad R. Gender dif- differences in bystander CPR and outcomes in out-of-hospital cardiac arrest. J Am Heart Assoc. 2020 Nov 17;9(22):e035794. doi: 10.1161/JAHA.124.035794.
Blom MT, Oving I, Berdowski J, van Valken- goed IGM, Bardai A, Tan HL. Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest. Eur Heart J. 2019 Dec 14;40(47):3824-3834. doi: 10.1093/eurheartj/ehz297. PMID: 31112998; PMCID: PMC6911168.
Malta Hansen C, Kragholm K, Dupre ME, Pear-son DA, Tyson C, Monk L, Rea TD, Starks MA, Nelson D, Jollis JG, McNally B, Corbett CM, Granger CB. Association of bystander and first-responder efforts and outcomes according to sex: Results from the North Carolina HeartRescue Statewide Quality Improvement Initiative. J Am Heart Assoc. 2018 Sep 18;7(18):e009873. doi: 10.1161/JAHA.118.009873. PMID: 30371210; PMCID: PMC6222952.
Labuschagne MJ, Arbee A, de Klerk C, de Vries E, de Waal T, Jhetam T, Piest B, Prins J, Uys S, van Wyk R, van Rooyen C. A comparison of the effectiveness of QCPR and conventional CPR training in final-year medical students at a South African university. Afr J Emerg Med. 2022 Jun;12(2):106-111.doi: 10.1016/j.afjem.2022.02.001. Epub 2022 Feb 27. PMID: 35251921; PMCID: PMC8885445.
Ong ME, Mackey KE, Zhang ZC, Tanaka H, Ma MH, Swor R, Shin SD. Mechanical CPR devices compared to manual CPR during out-of-hospital cardiac arrest and ambulance transport: a systematic review. Scand J Trauma Resusc Emerg Med. 2012 Jun 18;20:39. doi: 10.1186/1757-7241-20-39. PMID: 22709917; PMCID: PMC3416709.
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Copyright (c) 2025 Maya Almutairi, Rahaf Margushi, Shahad Abdullah Alotaibi, Khadijah Banjar, Adel Alanazi, Sharafaldeen Bin Nafisah, Bandr Mzahim
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