A randomized, controlled comparison of cardiopulmonary resuscitation performed on the floor and on a moving ambulance stretcher

Background. Recent studies have demonstrated that cardiopulmonary resuscitation (CPR) of poor quality is associated with worsened outcomes. Objective. To compare the quality of CPR delivered on the floor with the quality of CPR delivered on a moving stretcher. The authors hypothesized that CPR performed on the floor would be superior to that performed on a moving stretcher. Methods. A randomized, crossover experimental design was used. Subjects included emergency medical technician students, paramedic students, and emergency medicine residents. Two-member teams were randomly assigned to perform two-rescuer CPR on a manikin either on the floor or on a moving stretcher. After a 5-minute rest, the teams performed CPR under the opposite condition. Compression and ventilation data were collected using a recording resuscitation manikin. Dependent variables were compression depth, compression rate per minute, percentage of correct chest compressions, tidal volume, and percentage of correct ventilations. Data were compared using two-tailed paired t-test. Results. Sixty-two subjects completed the study. The mean compression depth performed on the floor (39 ± 9 mm) was greater than that on a moving stretcher (28 ± 9 mm) (p < 0.001). The mean rates of chest compressions on the floor (110 ± 17 beats/min) and on a moving stretcher (113 ± 21 beats/min) were not different (p = 0.49). The percentage of correct compressions performed on the floor (54% ± 40%) exceeded that on a moving stretcher (21% ± 29%)(p < 0.001). The percentage of correct ventilations performed on the floor (43% ± 26%) was greater than that on a moving stretcher (24% ± 21%)(p < 0.04). Conclusions. Chest compression and ventilation quality of CPR performed on the floor was superior to that of CPR performed on a moving stretcher in this manikin model. The quality of CPR while moving was significantly compromised.