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 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.
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 ´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%
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:
Anesth Analg. 2013 Jan;116(1):162-7. doi: 10.1213/ANE.0b013e31826dd889. Epub 2012 Dec 7. Transport decreases the quality of cardiopulmonary resuscitation during simulated maternal cardiac arrest. Lipman SS, Wong JY, Arafeh J, Cohen SE, Carvalho B.