Effect of Metronome, Hospital Mattress, and Step Stool Usage on Chest Compression Rate and Depth During Cardiopulmonary Resuscitation (CPR): A Collection of Systematic Reviews and Meta-Analyses
Doctor of Philosophy (PhD)
First Committee Member
Second Committee Member
Third Committee Member
Fourth Committee Member
Number of Pages
We conducted a systematic review and meta-analysis to evaluate the effects of: (1) a metronome, (2) a hospital mattress, and (3) a step stool on chest compression rate and chest compression depth during cardiopulmonary resuscitation (CPR). These studies comply with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for searches and reporting systematic reviews. We utilized the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) to categorize the certainty of evidence.The first analysis focused on metronome usage while performing CPR. Our methods for this study were to conduct literature searches for studies comparing metronome usage to a control condition. After examining 582 records (after duplicates were removed), 23 studies were included for analysis. The primary outcome examined was compression rate, and the secondary was compression depth. The results indicate that a metronome does not affect compression rate (p=0.20). The metronome condition weighted a mean of 104±6 compressions per minute (cpm), and the control condition weighted a mean of 108±14 cpm. Eighteen studies were included in the analysis of the effect of metronome usage on compression depth during CPR. The results indicate that metronome usage does not affect compression depth (p=0.18). We conclude that the presence of a metronome has no statistically significant affect on CPR compression rate or depth. However, it may improve CPR rate consistency and reduce the number of below-recommended range occurrences, illustrated by the standard deviation of the control being 2.3 times larger than the metronome condition. Given this evidence, the use of metronomes is warranted and could positively affect CPR quality and patient survivability rates. The second analysis focused on adjusting the provider's height to using a step stool while performing CPR. Again, we performed literature searches of studies comparing step stool usage to a control condition. After examining 1814 records (after duplicates were removed), 5 studies were included for analysis. The primary outcome examined was compression depth, and the secondary was compression rate. The results were that 10 of the 927 examined studies were included. The overall results indicate that step stool usage positively affects compression depth, with a MD=3 mm (95% CI, 2–5 mm, p50 mm and 100-120 cpm) of the American Heart Association. However, the difference in compression depth is both statistically significant and meaningful, in accordance with Stiel et al. (2014), Talikowska et al. (2015), and Wallace et al. (2013). According to research, the compression depth of the step stool condition could place people in the survival group, while the control condition depth could place people in the non-survival group. Therefore, our opinion is that implementing step stools would positively affect CPR quality and patient survivability rates. The third analysis focused on performing CPR on a hospital mattress. We performed literature searches for studies analyzing performing CPR on a mattress compared to a hard surface. After examining 690 records (after duplicates were removed), 10 studies were included for analysis. The primary outcome examined was compression depth, and the secondary was compression rate. The results indicate that compressions on a mattress negatively affected the compression rate with a mean difference (MD) = -5 cpm, (95% CI, -9–0 cpm, p=0.05). Additionally, compressions on a mattress significantly decreased the compression depth, MD = -3 mm, (95% CI, -7–0 mm, p=0.04). When CPR was performed on a mattress, the average weighted mean compression rate decreased from 121 to 116 cpm. However, both rates are above the AHA minimum recommendation of 100. Therefore, while these results are statistically significant, they likely do not affect CPR quality. Conversely, the difference in compression depth was both statistically significant and meaningful, in accordance with the minimum mean survival depth of 40mm and the MD in survival of 2 mm to 3 mm found by Stiel et al. (2014), Talikowska et al. (2015), and Wallace et al. (2013). Compared to the hard surface condition, the compression depth decreased from 45 mm to 42 mm when performed on a mattress. With the difference between survivors and non-survivors reported to be only 2-3 mm, CPR on a mattress could negatively affect resuscitation efforts. Therefore, we recommend that CPR not be performed on a mattress and implement an alternative method to improve the patient's survival odds.
Cardiopulmonary Resuscitation; Cerebral vascular circulation; CPR; Mattress; Metronome; Step Stool
University of Nevada, Las Vegas
Doernte, Lee A., "Effect of Metronome, Hospital Mattress, and Step Stool Usage on Chest Compression Rate and Depth During Cardiopulmonary Resuscitation (CPR): A Collection of Systematic Reviews and Meta-Analyses" (2022). UNLV Theses, Dissertations, Professional Papers, and Capstones. 4500.
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