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THE USE OF A STEP STOOL DURING CHEST COMPRESSIONS: DOES IT MAKE A DIFFERENCE, AND DO CLINICIANS CHOOSE TO USE IT?

2020; Elsevier BV; Volume: 158; Issue: 4 Linguagem: Inglês

10.1016/j.chest.2020.08.1223

1931-3543

Elyse LaFond, Timothy C. Clapper, Imaani Easthausen, Samantha Smith, Melissa Moulton, Nina Rusiewski, Kelly Griffin, Kapil Rajwani,

Disaster Response and Management

PURPOSE: High quality cardiopulmonary resuscitation (CPR) is the most important factor in surviving cardiac arrest.Using a step stool to improve chest compressions is universally recommended yet under-researched.This observational, simulation-based study sought to answer two questions: first, is CPR performance improved with the use of a step stool?Second, how often do adult healthcare providers use a step stool for chest compressions, and does the frequency increase following a brief educational session demonstrating the advantages of step stool use?METHODS: Over 3 years (2018-2020), 535 interdisciplinary providers (nurses, house staff, attendings, and pharmacists from internal medicine, intensive care, anesthesiology, and obstetrics) participated in this observational study.Participants first performed one minute of CPR on Resusci-Anne Ò, a CPR mannequin, and were scored from 0-100 on their performance.A step stool was available for use next to Resusci-Anne Ò if the participant desired.Thereafter, participants underwent an educational intervention on the advantages of using a step stool while performing CPR.They watched a demonstration by an instructor and were then given time to practice CPR with and without a step stool.Each participant was then asked to do another minute of CPR on the Resusci-Anne Ò and again scored from 0-100 on their performance.A step stool was again in close proximity for use, if the participant desired.RESULTS: Participants were selected via convenience sampling at a large academic hospital with a pre-existing cardiac arrest simulation course.A total of 535 participants were tested pre-intervention, and 520 participants were tested post-intervention.Prior to the intervention, only 16.6% (n¼89) of providers elected to use a step stool for chest compressions, compared to 97.5% (n¼507) post-intervention (p¼<0.001).The average CPR performance score (0-100) significantly improved from preintervention to post-intervention (74 vs. 95; p¼<0.001). CONCLUSIONS:Our study demonstrates that the quality of CPR improves significantly with the use of a step stool.However, without education on the benefits of using a step stool and demonstration of the proper technique, few adult healthcare providers will elect to do so.A brief, hands-on intervention teaching adult healthcare providers about the benefits of CPR with a step stool significantly increased its use and the quality of chest compressions.CLINICAL IMPLICATIONS: This study demonstrates that adult healthcare providers across multiple disciplines can quickly and easily be taught to use a step stool during CPR, and that doing so significantly improves the quality of CPR they provide.Given that early and high-quality CPR is the cornerstone of advanced cardiovascular life support (ACLS), this intervention has the potential to improve the mortality of in-hospital cardiac arrest.