Team Size and Stretching-Exercise Effects on Simulated Chest Compression Performance and Exertion
Abstract
Introduction: Investigators conducted a prospective experimental study to evaluate the effectof team size and recovery exercises on individual providers’ compression quality and exertion.Investigators hypothesized that 1) larger teams would perform higher quality compressions withless exertion per provider when compared to smaller teams; and 2) brief stretching and breathingexercises during rest periods would sustain compressor performance and mitigate fatigue.
Methods: In Phase I, a volunteer cohort of pre-clinical medical students performed four minutesof continuous compressions on a Resusci-Anne manikin to gauge the spectrum of compressorperformance in the subject population. Compression rate, depth, and chest recoil weremeasured. In Phase II, the highest-performing Phase I subjects were placed into 2-, 3-, and/or4-compressor teams; 2-compressor teams were assigned either to control group (no recoveryexercises) or intervention group (recovery exercises during rest). All Phase II teams participatedin 20-minute simulations with compressor rotation every two minutes. Investigators recordedcompression quality and real-time heart rate data, and calculated caloric expenditure fromcontact heart rate monitor measurements using validated physiologic formulas.
Results: Phase I subjects delivered compressions that were 24.9% (IQR1-3: [0.5%-74.1%])correct with a median rate of 112.0 (IQR1-3: [103.5-124.9]) compressions per minute anddepth of 47.2 (IQR1-3: [35.7-55.2]) mm. In their first rotations , all Phase II subjects deliveredcompressions of similar quality and correctness (p=0.09). Bivariate analyses of 2-, 3-, and4-compressor teams’ subject compression characteristics by subsequent rotation did notidentify significant differences within or across teams. On multivariate analyses, only subjects in2-compressor teams exhibited significantly lower compression rat es (control subjects; p<0.01),diminished chest release (intervention subjects; p=0.03), and greater exertion over successiverotations (both control [p≤0.03] and intervention [p≤0.02] subj ects).
Conclusion: During simulated resuscitations, 2-compressor teams exhibited increased levels ofexertion relative to 3- and 4-compressor teams for comparable compression delivery. Stretchingand breathing exercises intended to assist with compressor recovery exhibited mixed effects oncompression performance and subject exertion.