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Abstract: PO1224

Optimal Patient Positioning for Chest Compressions in Dialysis Clinics: A Randomized Cross-Over Simulation Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Pun, Patrick H., Duke University School of Medicine, Durham, North Carolina, United States
  • McNamara, Kevin T., Durham Veterans Administration Medical Center, Durham, North Carolina, United States
Background

Sudden cardiac arrest is the leading cause of death for hemodialysis patients, and often occurs during treatment in hemodialysis units. Resuscitation guidelines emphasize the need for rapid delivery of effective chest compressions to improve survival. How different methods of patient positioning (in the dialysis chair or on the floor) affects chest compression quality is unknown.

Methods

This was a prospective randomized cross-over study to assess the quality of chest compressions performed on a simulation manikin(Laerdal SimMan3G). Dialysis staff were recruited from a single center and asked to perform 2 minutes of compressions on the manikin positioned: 1) on a gurney with a code-cart backboard (baseline); 2) on the floor; 3 )in a reclined dialysis chair; and 4) in a reclined dialysis chair with a backboard placed underneath. The sequence of manikin positions was randomized to reduce carryover effects and assessments were conducted ≥48 hours apart to reduce participant fatigue. Mean compression depth, %compressions at appropriate depth, %compressions fully released and %compressions at adequate rate were assessed for each position and for each participant. Paired sample T-tests were performed to assess the mean differences in compression measures between positions and baseline.

Results

13 dialysis staff members including 7 RNs, 3 MITs and 3 providers participated in the study. Compared to baseline, mean compression depth (-6.5 mm) and % compressions fully released (-26%) were significantly worse for compressions performed in the dialysis chair, and quality reductions persisted even when a backboard was utilized in the dialysis chair (see Figure 1). No significant differences in compression quality measures were observed with manikin positioning on the floor compared to baseline.

Conclusion

Performing CPR in a reclining dialysis chair results in significant reductions in CPR quality. This should be considered in developing dialysis-specific CPR protocols, and further studies should investigate the relative merits of different patient positioning options for optimal CPR delivery.

Figure 1: Summary of Results

Funding

  • NIDDK Support