478 - Side vs Over-The-Head Chest Compressions in Neonates: Does Rescuer Height alter efficacy?

Poster Number: 478

Gretell Gomez, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Jayasree Nair, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States

Background: Current recommendations for neonatal chest compressions (CC) recommend the 2-thumb technique which may be performed from the side or from above the head (Wykoff, 2015) to facilitate easy placement of umbilical catheters. CC from ‘over the head’ (Head) appears as effective as the lateral position (Side) in a small manikin study (Cheung, 2020). Ergonomic factors such as rescuer and bed height may affect efficacy of neonatal CC.

Objective: We hypothesized that in a simulated resuscitation, rescuer height would influence efficacy of CC, both at the Head and Side positions

Design/Methods: NRP certified providers performed CC on a manikin (Baby Hal, Gaumard® Scientific), from the head and side of the bed. Participant height was categorized into “below-average” (BA) vs. “above-average”(AA) height groups using average US male and female heights (175.4 cm and 161.5 cm, CDC/National Center for Health Statistics data, 2017). Each provider performed 2min of CC at a 3:1 C:V ratio from both Head and Side positions. Outcomes measured were target CD (at least 1/3rd of AP diameter) achievement, on target CC (%) - the percentage of adequate CC and rate of CC. Providers’ performance was evaluated using OMNI® 2 control tablet (Gaumard® Scientific), featuring CPR feedback. A 5-point Likert scale assessed perception of fatigue and difficulty after CC in each position. Graphpad Prism software was used for statistical analysis.

Results: 27 participants were recruited. Complete CC feedback data was available for 25 participants. Overall there was difference between head vs side on target CC%, target CD achievement or CC rate. However, AA group had a higher on target CC% (Fig 1a) and target CD achievement (Fig 1b) from the side vs head. No significant differences were noted in BA group. More BA rescuers expressed moderate to severe fatigue than AA, in both positions. Both AA and BA reported more fatigue in the side compared to head (AA: 15.4% vs 38.5%, BA: 33.4% vs 83.4%) (Fig 2).Conclusion(s): Rescuer height can impact CC efficacy, with AA demonstrating increased on target CC percentage as well as target CD achievement. Height also influenced fatigue perception with BA expressing more fatigue than AA. However CC in side position increased fatigue perception significantly after 2 min in both height groups. We conclude that while AA rescuers had a slightly increased efficacy of CC from side, increased fatigue perception in this position may limit these benefits in a longer resuscitation. Awareness of height differences could determine specific roles for resuscitation team members
Gretell Gomez CVCV_GretellGomez_January2022.pdf
Fig 2: Fatigue survey in Above average height rescuers from a)Head and b)side of bed, Below average height rescuers from c)head and d) side of bed.Fig 2 Fatigue survey_2022.jpeg