The impact of resuscitation guideline terminology on quality of dispatcher-assisted cardiopulmonary resuscitation: a randomised controlled manikin study.

Abstract

BACKGROUND\nCardiopulmonary resuscitation (CPR) guidelines vary in the terminology used to describe target chest compression depth, which may impact CPR quality. We investigated the impact of using different chest compression depth instruction terminologies on CPR quality.\n\n\nMETHODS\nWe conducted a parallel group, three-arm, randomised controlled manikin trial in which individuals without recent CPR training were instructed to deliver compression-only CPR for 2-minutes based on a standardised dispatcher-assisted CPR script. Participants were randomised in a 1:1:1 ratio to receive CPR delivery instructions that instructed them to deliver chest compressions based on the following terminologies: press at least 5cm , press approximately 5cm or press hard and fast. The primary outcome was compression depth, measured in millimetres.\n\n\nRESULTS\nBetween October 2017 and June 2018, 330 participants were randomised to at least 5cm (n=109), approximately 5cm (n=110) and hard and fast (n=111), in which mean chest compression depth was 40.9mm (SD 13.8), 35.4mm (SD 14.1), and 46.8mm (SD 15.0) respectively. Mean difference in chest compression depth between at least 5cm and approximately 5cm was 5.45 (95% confidence interval (95%CI) 0.78 to 10.12), between hard and fast and approximately 5cm was 11.32 (95% CI 6.65 to 15.99), and between hard and fast and at least 5cm was 5.87 (95% CI 1.21 to 10.53). Chest compression rate and count were both highest in the hard and fast group.\n\n\nCONCLUSIONS\nThe use of hard and fast terminology was superior to both at least 5cm and approximately 5cm terminologies.\n\n\nTRIAL REGISTRATION\nISRCTN15128211.