697 - Neonatal Resuscitation Ergonomics – Effect of Stepstool Use During Chest Compressions

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 697
Publication Number: 697.445

Valerie Vernot, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Deepali Handa, 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

Presenting Author(s)

Valerie Vernot, MD (she/her/hers)

Resident Physician
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Background: Physical ergonomic factors could affect efficacy of neonatal chest compressions (CC). Several factors such as rescuer arm position, height, location and bed height may impact effectiveness of CC. In a simulated resuscitation, we have previously shown that taller resuscitators demonstrated higher efficacy of CC with reduced fatigue perception (Gomez et al, PAS 2021). Here, we hypothesize that using a standard stepstool (ST) to enhance resuscitator height would improve CC efficacy and decrease fatigue, specifically in average/below average height resuscitators.

Objective:

To assess the effect of ST in both above average (AA) and average/below average (BA) height resuscitators on 1. efficacy of CC (depth and percentage of on-target CC percentage) and 2. resuscitator fatigue perception in a simulated resuscitation.

Design/Methods: 30 NRP certified providers performed CC on a manikin (Baby Hal, Gaumard® Scientific). Providers were stratified into “average/below-average” vs. “above-average” height groups using specific cut-off points representing average US male and female heights (175.4 cm in males and 161.5 cm in females, CDC/National Center for Health Statistics data, 2017). Each provider performed 2min of CC at 3:1 C:V ratio from the head of the bed (kept at a fixed height of 98 cm) while using a ST (16 cm). Outcomes measured were compression depth (CD) (at least 1/3rd of AP diameter), CC rate and on-target CC %- the percentage of adequate compressions. Providers’ performance was evaluated using OMNI® 2 control tablet (Gaumard® Scientific), featuring CPR feedback. A 5-point Likert scale-based fatigue questionnaire recorded fatigue, satisfaction and difficulty experienced. Graphpad PRISM software was used for statistical analysis using appropriate tests.

Results: 30 participants were recruited. Paired CC feedback data with and without a ST was available for 27 participants (AA n=17, BA n=10). Enhanced height using a ST showed equal efficacy of CC with no difference in CC depth, rate or on-target CC % (Fig 1) in either height group. Lower fatigue perception and higher level of satisfaction was observed with ST use in both groups, significantly in BA (Fig 2).

Conclusion(s): Use of a ST during CC in a 2-min resuscitation resulted in lower fatigue perception with a higher degree of satisfaction, without affecting CC efficacy, in both above and below-average height resuscitators. We speculate that this could have an impact on longer resuscitation scenarios with limited personnel. A stepstool in the delivery room is a simple ergonomic aid that could mitigate fatigue perception and optimize resuscitation.