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Optimal procedure for high-quality chest compression during cardiac arrest resuscitation of a patient in Japanese bathtub: Manikin-based randomized trial

Tamotsu Ichiryu, Koji Fujita, Yoshinori Wakita, Yukihiro Shima, Seiya Kato, Hiroshi Nonogi

Background: In Japan, the outcome from treatment of bath-related cardiac arrest patients has been poor, because of difficulties with performing Cardiopulmonary Resuscitation (CPR) of sitting patients in small bathtubs. To clarify the most appropriate CPR in bathtubs, our study was conducted in order to compare the differences in chest compression quality when CPR is performed on sitting and supine patients in a bathtub.

Methods: A total of 52 fire academy students were randomly assigned as ‘rescuers’ to perform chest compression on either a sitting manikin (“Sitting Group”) or a supine manikin (“Supine Group”) in a bathtub. The quality of chest compression performed for 2 minutes by the two different groups was investigated.

Results: The rate of chest compressions with the correct hand position was better in the Supine Group (96.1%) than in the Sitting Group (94.6%; p<0.01). The rate of total chest compressions with correct recoil was greater in the Sitting Group than in the Supine Group (60.5% versus 13.5%, p<0.001). In the Supine Group, the average depth of chest compression (48.4 mm) was better than in the Sitting Group (40.8 mm; p<0.001). Although in both groups, the depth of chest compressions gradually attenuated significantly with time, the optimal compression depth for survival was nearly maintained. In the Supine Group, the number of participants with appropriate chest compression depth was kept during 2-minute CPR.

Conclusion: The rescuer’s chest compression quality during CPR in the bathtub was better with supine patients than with sitting patients due to the difference in accumulated fatigue of the rescuer.