I didn´t know what a gurney was (I do now), but I did know that performing effective CPR while transporting a patient, through a hospital or in a road ambulance, is hard. I didn´t know it was this bad though. According to a study in Anest Analg the percentage of correctly rendered compressions sank from 93% in a stationary control group to only 32% while moving the patient on a trolley.
The study
The study is a CPR mannequin study simulating CPR in maternal cardiac arrest (MCA) and having to move that ´patient´, on a gurney, from a maternity ward to an OR in order perform an emergency caesarian. Ideally the cesarean should be done within 5 minutes of an MCA.
The team consisted of obstetricians, nurses and anaesthesiologists, which probably negatively impacts on CPR quality when compared to prehospital providers.
Your typical ´gurney´...
Each team consisted of two persons providing the CPR and two persons moving the trolley. They were randomised into either a ´stationary´or ´transport´group. The study was divided into three phases.
Phase 1: Stationary in the labor room
Phase 2: Either stationary or while transporting the patient on a trolley from a labor room to the OR.
Phase 3: Again stationary on a trolley.
Primary outcome was the percentage of correctly delivered compressions as reported by the Laerdal SkillReporter ™ mannequin.
The Results
The ´stationary´group maintained a high rate (90%) of correctly administered compressions.
The ´moving´ group delivered a consistently lower percentage of correct compressions already in phase 1.
Then in phase 2 the rate drops to 32%
Take-home message
CPR can´t be performed effectively while moving a patient. In strengthens the case for the cesarean being done in the labor room or perhaps even prehospitally instead of moving the patient to the OR.
Study lives here:
