| E1 - Effect of bed width on the quality of compressions in simulated resuscitation: a randomized crossover manikin study |
To investigate the effects of bed width on the quality of chest compressions during resuscitation. |
Randomized crossover study with a manikin |
There were no significant differences between the chest compression maneuvers carried out on an emergency stretcher (narrow bed) when compared to a standard hospital bed (wide bed), with regard to mean depth (44.27±8.62 mm vs 43.54±10.48 mm, p=0.56) or percentage of compressions with adequate depth (54.85±37.35% vs 61.22±34.71%, p=0.27). |
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16
16 Zhou XL, Sheng LP, Wang J, Li SQ, Wang HL, Ni SZ et al. Effect of bed width on the quality of compressions in simulated resuscitation: a randomized crossover manikin study. Am J Emerg Med. 2016 dez;34(12):2272-6. http://dx.doi.org/10.1016/j.ajem.2016.08.020. PMid:27592725.
http://dx.doi.org/10.1016/j.ajem.2016.08...
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Human performer (97 fourth-year medical students) |
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Manikin: Resusci Anne QCPR |
| American Journal of Emergency Medicine. |
Bed: PARAMOUNT BED®, 940 mm × 2,180 mm, PARAMOUNT Co BED |
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Stretcher: Stryker®, 715 mm × 2,100 mm |
| China. English, 2016. University Hospital. |
Mattress: it was removed for the study |
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Backboard: not used |
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The height of the bed and stretcher in relation to the floor was 55 cm (no ladder was used). |
| E2 - Chest compressions performed by ED staff: a randomized cross-over simulation study on the floor and on a stretcher. |
To analyze the quality of the external chest compressions in simulated cardiac arrest scenarios, comparing the stretcher with the floor. |
Randomized prospective simulation study, of the crossover type |
There was a significant superiority of chest compression quality when carried out on the floor, revealing a 15% reduction in the depth of chest compressions when carried out in the hospital bed. |
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5
5 Sebbane M, Hayter M, Romero J, Lefebvre S, Chabrot C, Mercier G et al. Chest compressions performed by ED staff: a randomized cross-over simulation study on the floor and on a stretcher. Am J Emerg Med. 2012;30(9):1928-34. http://dx.doi.org/10.1016/j.ajem.2012.04.013. PMid:22795420.
http://dx.doi.org/10.1016/j.ajem.2012.04...
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Human performer (38 nurses and 26 nursing assistants) |
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Manikin: Rescusci Anne Laerdal Skill Reporter Modular system |
| American Journal of Emergency Medicine. |
Stretcher: Promotal armeo hydraulic biplane (107 cm x 190 cm) |
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Mattress: 5 cm thickness |
| Canada. English, 2012. University Hospital. |
Backboard: it was used, but without description |
| E3 - Effect of a backboard on compression depth during cardiac arrest in the ED: a simulation study. |
To assess the impact of a board on chest compression depth during cardiac arrest practice sessions. |
Randomized, blind study |
Using a rigid surface as an adjuvant during cardiopulmonary resuscitation did not improve the mean chest compression depth achieved by the first responders. |
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17
17 Fischer EJ, Mayrand K, Ten Eyck RP. Effect of a backboard on compression depth during cardiac arrest in the ED: a simulation study. Am J Emerg Med. 2016;34(2):274-7. http://dx.doi.org/10.1016/j.ajem.2015.10.035. PMid:26589462.
http://dx.doi.org/10.1016/j.ajem.2015.10...
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Human performer (43 health professionals) |
| American Journal of Emergency Medicine. |
Manikin: SimMan Essencial |
| USA. English, 2016. University. |
Stretcher: Stryker Medical |
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Mattress: 10 cm, foam |
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Backboard: it was used, but no specifications are described |
| E4 - A flexible pressure sensor could correctly measure the depth of chest compression on a mattress. |
To evaluate the depth of chest compressions carried out on a manikin placed on a mattress through a flexible pressure sensor. |
Experimental study |
On the floor, the actual chest compression depth was 5.0±0.0 cm (n=100). On the mattress, the actual chest compression depth measured by the sensor was 4.4±0.0 cm (n=100), showing the impact of the mattress on the quality of chest compression. |
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18
18 Minami K, Kokubo Y, Maeda L, Hibino S. A flexible pressure sensor could correctly measure the depth of chest compression on a mattress. Am J Emerg Med. 2016 maio;34(5):899-902. http://dx.doi.org/10.1016/j.ajem.2016.02.052. PMid:26979259.
http://dx.doi.org/10.1016/j.ajem.2016.02...
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Automatic compressor. |
| American Journal of Emergency Medicine. |
Manikin: Little Anne™ manikin (Laerdal, Stavanger, Norway) |
| Japan. English, 2016. Private research lab. |
Bed: not used |
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Stretcher: not used |
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Mattress: urethane foam mattress. Mattress thickness: 8.5 cm. The mattress was placed on the floor. |
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Backboard: not used |
| E5 - Effects of a backboard, bed height, and operator position on compression depth during simulated resuscitation. |
To investigate the effect of a rigid surface, body position in cardiopulmonary resuscitation (CPR), and bed height on chest compression quality during simulated hospital resuscitation. |
Randomized, controlled and crossover study |
In contrast to the current guidelines, the data showed that using a rigid surface did not improve the depth of chest compressions. |
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19
19 Perkins GD, Smith CM, Augre C, Allan M, Rogers H, Stephenson B et al. Effects of a backboard, bed height, and operator position on compression depth during simulated resuscitation. Intensive Care Med. 2006;32(10):1632-5. http://dx.doi.org/10.1007/s00134-006-0273-8. PMid:16826385.
http://dx.doi.org/10.1007/s00134-006-027...
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Human performer (20 second-year medical students who were Basic Life Support instructors) |
CPR without a board, 29±7 mm; CPR with a board, 31±10 mm; kneeling on the bed, 30±7 mm; with lowered bed height, 32±10 mm. The participants could not recognize their low quality CPR and there was no difference in the evaluation of fatigue or efficacy of CPR between the surfaces. |
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Manikin: resuscitation manikin (Laerdal Medical, Orpington, UK) |
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| Intensive Care Medicine. |
Bed: “standard hospital bed”, without specifications |
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| United Kingdom. English, 2006. University. |
Stretcher: not used |
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Mattress: Height (cm): 17.5; Length (cm): 195; Weight (kg): 12.5. Width (cm): 88. |
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Backboard: it was used, but without specifications |
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| E6 - Increasing compression depth during manikin CPR using a simple backboard. |
To compare chest compression depth with and without a backboard. |
Randomized, double blind, crossover study |
It was observed that the use of a backboard significantly increased chest compression depth, increasing the mean values from 43 mm to 48 mm using the board. |
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8
8 Andersen LØ, Isbye DL, Rasmussen LS. Increasing compression depth during manikin CPR using a simple backboard. Acta Anaesthesiol Scand. 2007;51(6):747-50. http://dx.doi.org/10.1111/j.1399-6576.2007.01304.x. PMid:17425617.
http://dx.doi.org/10.1111/j.1399-6576.20...
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Human performer (23 hospital duty members of the CPR team) |
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Manikin: Resusci Anne; |
| Acta Anaesthesiologica Scandinavica. |
Laerdal Medical, Stavanger, Norway |
| Denmark. English, 2007. University Hospital. |
Bed: hospital standard (without specifications) |
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Stretcher: not used |
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Mattress: Trend Madras Cris CollectionApS, Randers, Denmark, 83 cm x 203 cm x 14 cm, viscoelastic |
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Backboard: wood, 44 cm x 58 cm x 1 cm |
| E7 - The impact of compliant surfaces on in-hospital chest compressions: Effects of common mattresses and a backboard. |
To evaluate, in a hospital environment, the influence of different mattresses, with and without a backboard and with or without additional weights (20 kg and 40 kg), on the chest compression movement (sternum-spine). |
Experimental study |
Using the backboard reduced by nearly 50% the impact of mattress deflection on chest compression depth and reduced the rescuer's effort. The backboard doubles the contact area of force transfer, leading to an increased effective rigidity and less mattress compression with the same force applied. |
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6
6 Noordergraaf GJ, Paulussen IW, Venema A, van Berkom PF, Woerlee PH, Scheffer GJ et al. The impact of compliant surfaces on in-hospital chest compressions: effects of common mattresses and a backboard. Resuscitation. 2009;80(5):546-52. http://dx.doi.org/10.1016/j.resuscitation.2009.03.023. PMid:19409300.
http://dx.doi.org/10.1016/j.resuscitatio...
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Human performer (01 rescuer) |
The results showed that foam mattresses and tube systems act as springs and follow the movement of the hands, while the "slow foam" mattresses incorporate delays, making it challenging to detect depth and strength. The movement of the rescuer's hands was significantly higher (up to 111 mm to 50 mm compression depth, p<0.0001) when the sternum-spine compressions were carried out without a backboard than with a board, and this variable also depended on the type of mattress and on the compression force. |
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Manikin: Standard System Resusci Anne (Laerdal, Stavanger N) adapted with a linear pot (Type S13FLP100A, Sakae TsushinKogyo Co., Japan) |
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| Resuscitation. |
Bed: it does not specify the bed model or its characteristics. It informs that the steel platforms for hospital beds have a stiffness of 2,500 N/cm. |
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Stretcher: not used |
|
| Norway. English, 2009. Hospital. |
Mattress: A - Cliniplot III (Hill Rom) 192 cm × 85 cm × 16 cm, plain foam |
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B - Meditherm (Medibol, Valkenswaard) 198 cm × 84 cm× 14 cm. Construction in two layers, with different rigidity: 70 N/cm upper and 105 N/cm lower, and 40% of the total depth of the mattress. |
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C - Atmos Air 9000 (Hill Rom) 202 cm × 82 cm × 18 cm, it includes centrally located air: 145 cm × 70 cm × 12 cm. |
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- EMS folding stretcher thickness ±5 cm. |
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Backboard: the lower bed frame, semi-rigid synthetic TrespaTM brand (Trespa Internacional, Weert, NL) was used. Width and height are 80 cm and 30 cm, respectively. It has a stiffness of 200 N/cm. |
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| E8 - The use of dual accelerometers improves measurement of chest compression depth. |
To compare the depth of chest compressions using two double accelerometers (a1) and a single accelerometer (A2) on the inflatable air and foam mattress. |
Experimental study |
When chest compression was carried out with the manikin lying on the floor, there was no significant difference between the measurement techniques (p>0.05) but, when the manikin was lying on the foam and the inflated air mattress support system, the use of the feedback system by means of two accelerometers significantly improved the estimate for the depth of chest compressions, regardless of the presence or absence of a backboard (p<0.001). It was concluded that, when PCR is carried out with the feedback system using an accelerometer, using a backboard can increase chest compression accuracy on a foam mattress. |
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20 Oh J, Song Y, Kang B, Kang H, Lim T, Suh Y et al. The use of dual accelerometers improves measurement of chest compression depth. Resuscitation. 2012;83(4):500-4. http://dx.doi.org/10.1016/j.resuscitation.2011.09.028. PMid:22001002.
http://dx.doi.org/10.1016/j.resuscitatio...
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Human performer (8 rescuers trained in BLS) |
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Manikin: Repusci Anne Modular System Skill Reporter |
| Resuscitation. |
Bed: not used (the experiment was carried out on the floor) |
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Bed: not used |
| Korea. English, 2012. University. |
Mattress: 1 - Hard floor |
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2 - Stryker foam mattress measuring 66 cm × 192 cm and with a thickness of 7.5, soft foam made with polyurethane coating. |
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3 - Foam mattress + backboard |
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4 - Inflated air mattress (23 mmHg pressure, 80 cm × 10 cm × 180 cm, MD-300 TPU2, polyurethane, Eunhye Medical Co., Korea |
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5 - Air mattress + backboard |
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Backboard:
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45 cm × 60 cm × 1 cm; Plastic Lifeline, SungShimMed-Co., Korea |
| E9 - The impact of backboard size and orientation on sternum-to-spine compression depth and compression stiffness in a manikin study of CPR using two mattress types. |
To explore how backboard orientation and size affect chest compressions during cardiopulmonary resuscitation (CPR). |
Experimental study |
It was verified that the effect of backboard size on the performance of chest compressions during CPR was considered significant with the larger board producing deeper chest compressions and greater lumbar support rigidity than the smaller board. |
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9
9 Cloete G, Dellimore KH, Scheffer C, Smuts MS, Wallis LA. The impact of backboard size and orientation on sternum-to-spine compression depth and compression stiffness in a manikin study of CPR using two mattress types. Resuscitation. 2011;82(8):1064-70. http://dx.doi.org/10.1016/j.resuscitation.2011.04.003. PMid:21601344.
http://dx.doi.org/10.1016/j.resuscitatio...
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Automatic compressor |
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Manikin: ALS Trainer Manikin, Laerdal |
| Resuscitation. |
Bed: Arjo-Hunt |
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Stretcher: N/A |
| South Africa English, 2012. University. |
Mattress:
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1 - Mattress 1 (Mat1) was 190 cm x 92 cm x 17 cm and had a density of 0.4038 g/cm3
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2 - Mattress 2 (Mat2) was 198 cm x 86 cm x 17.2 cm with a density of 0.4097 g/cm3
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Backboard:
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the dimensions of both backboards used were as follows: |
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A: 86 cm x 50 cm x 1.2 cm |
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B: 56 cm x 43 cm x 1.1 cm, and had densities of 0.800 and 1.410 g/cm3, respectively. |
| E10 - Comparison of experimental chest compression data to a theoretical model for the mechanics of constant peak displacement cardiopulmonary resuscitation. |
To validate an existing theoretical model for the constant peak displacement mechanics of cardiopulmonary resuscitation, using experimental data obtained for several different support surfaces and chest compression rates. |
Experimental study |
The predictions of the model showed that, when the rigidity of the support surface is less than 250 N/cm, the benefit of using a backboard is higher than in more rigid support surfaces. |
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21
21 Cloete G, Dellimore KH, Scheffer C. Comparison of experimental chest compression data to a theoretical model for the mechanics of constant peak displacement cardiopulmonary resuscitation. Acad Emerg Med. 2011 nov;18(11):1167-76. http://dx.doi.org/10.1111/j.1553-2712.2011.01213.x. PMid:22092898.
http://dx.doi.org/10.1111/j.1553-2712.20...
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Automatic compressor |
| Academic Emergency Medicine. |
Manikin: Trainer ALS Manikin, Laerdal |
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Bed: Arjo-Hunt |
| South Africa. English, 2011. University. |
Stretcher: N/A |
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Mattress:
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1 - Mattress 1 (Mat1) was 190 cm x 92 cm x 17 cm and had a density of 0.4038 g/cm3
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2 - Mattress 2 (Mat2) was 198 cm x 86 cm x 17.2 cm, with a density of 0.4097 g/cm3
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Backboard: the dimensions of both backboards used were as follows: |
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A: 86 cm x 50 cm x 1.2 cm |
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B: 56 cm x 43 cm x 1.1 cm, respectively, with densities of 0.800 and 1.410 g/cm3
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| E11 - Use of backboard and deflation improve quality of chest compression when cardiopulmonary resuscitation is performed on a typical air inflated mattress configuration. |
The study compared the depth of chest compressions in four settings: |
Randomized experimental study |
Deflation of the air mattress significantly reduced mattress deflection (B: 14.74±1.36 vs C: 30.16±3.96, p<0.001). Using a backboard also reduced mattress deflection (C: 30.16±3.96 vs D: 25.46±2.89, p=0.002). However, the air mattress deflection reduced mattress deflection more than using a backboard (B: 14.74±1.36 vs D: 25.46±2.89, p=0.002). Using a deflated air mattress and the backboard simultaneously reduces mattress deflection; thus, it helps to obtain the necessary chest compression depth during CPR. |
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22
22 Oh J, Kang H, Chee Y, Lim T, Song Y, Cho Y et al. Use of backboard and deflation improve quality of chest compression when cardiopulmonary resuscitation is performed on a typical air inflated mattress configuration. J Korean Med Sci. 2013 fev;28(2):315-9. http://dx.doi.org/10.3346/jkms.2013.28.2.315. PMid:23399985.
http://dx.doi.org/10.3346/jkms.2013.28.2...
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A - Bed frame without mattress |
Human performer (08 CPR providers) |
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B - Empty air mattress resting on a foam mattress on the bed frame |
Manikin: Resusci Anne Modular System Skill Reporter |
| Journal of Korean Medical Science. |
C - Inflated air mattress resting on a foam mattress on the bed frame |
Bed: not used |
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D - Same as C inserting a backboard between the manikin and the inflated mattress |
Stretcher: Striker |
| Korea. English, 2013. University. |
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Mattress:
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1 - Foam mattress measuring 192 cm x 66 cm x 8 cm |
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2 - Inflatable mattress measuring 80 cm x 180 cm x 10 cm |
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Backboard: 45 cm x 60 cm x 1 cm |
| E12 - Does the bed frame deflection occur along with mattress deflection during in-hospital cardiopulmonary resuscitation? An experiment using mechanical devices. |
A study evaluating deflection of the bed frame during chest compressions. A “firm bed” model (ER-ST) referred to as floor-like bed was designed to compare deflection of the structure of another 2 beds X a Firm Bed. |
Experimental study |
The deflections of the Stryker and ER-SC mattresses were measured at 11.2 mm and 0.67 mm, respectively. The deflection of the bed frame for STS and ER-SC was 0.95 mm and 5.17 mm, respectively. The study confirmed that deflection of the bed frame occurs while performing chest compressions on a manikin placed on a bed and can reduce chest compression depth during CPR, increasing the rescuer's workload. |
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23
23 Oh JH, Kim CW, Kim SE, Lee DH. Does the bed frame deflection occur along with mattress deflection during in-hospital cardiopulmonary resuscitation? An experiment using mechanical devices. Hong Kong J Emerg Med. 2016;23(2):35-41. http://dx.doi.org/10.1177/102490791602300205.
http://dx.doi.org/10.1177/10249079160230...
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Human performer (01 rescuer trained in Basic Life Support) |
The deflection of the soft mattress was higher than that of the hard mattress and, by using a board, deflection was reduced, but not completely removed. |
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Manikin: Resusci Anne QCPR |
|
| Hong Kong Journal of Emergency Medicine. |
Bed: a “floor-like bed” model was designed = made with plywood board coupled to a bed measuring 50 cm wide x 60 cm long x 70 cm in height |
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Stretcher: Stryker Stretcher (STS) and SK-180 emergency room stretcher cart (RE-ST; Hanlim Medical Equipment) |
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| Korea. English, 2016. University. |
Mattress: mattresses from the manufacturers was used, the first with 9 cm and the second with 5 cm |
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Backboard: 55 cm wide x 42 long x 1.5 cm in height |
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Source: Research data.