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Does the use of BariBoard™ improve adequacy of chest compressions in morbid obesity? A pilot study using a simulation model

Published:December 17, 2021DOI:https://doi.org/10.1016/j.aucc.2021.09.009

      Abstract

      Background

      Obesity is a growing health problem worldwide. Morbid obesity has been associated with significant barriers to effective thoracic cage compression during cardiopulmonary resuscitation.

      Objective

      The BariBoard™ purports to improve adequacy of chest compressions in morbidly obese patients. This study uses a simulation model to evaluate this.

      Methods

      This was a prospective blinded randomised-controlled crossover pilot trial using a simulation model of obesity. Participants, recruited from hospital departments and prehospital services, performed 2 minutes of continuous compressions on mannequins modified to emulate a morbidly obese patient. Participants were randomised by coin toss to a sequence of either control/intervention or intervention/control, with the BariBoard™ in the intervention arm. Accelerometers measured chest wall movement during compressions. The primary endpoint was a composite measure of compression adequacy (rate, depth, and recoil). Secondary endpoints comprised the individual components of the composite outcome, as both dichotomous outcomes (adequate vs. inadequate) and continuous variables. All endpoints were adjusted for potential confounders.

      Results

      Of 205 participants recruited, 201 were analysed. There was a significant difference in the primary outcome between the control and intervention arms (13.4% vs. 4.5%, respectively, p = 0.001) and between the control and intervention arms for the secondary endpoints of adequate compression depth (31.3% vs. 15.9%, p < 0.001) and recoil (63.7% vs. 41.3%, p < 0.001). After adjustment for confounders and interactions, there was no difference in overall efficacy (odds ratio: 0.62, 95% confidence interval: 0.20–1.90, p = 0.40).

      Conclusion

      This pilot study describes the successful assessment of a device using a simulation model of obesity. Within these constraints and after adjustment for confounders, use of the BariBoard ™ did not improve efficacy of chest compressions.

      Keywords

      Abbreviations:

      ASH (Alice Springs Hospital), ALS (Advanced Life Support), BLS (Basic Life Support), BMI (body mass index), cm (centimetres), CPM (compressions per minute), CPR (cardiopulmonary resuscitation), ICU (intensive care unit), MRV (mean recoil velocity)
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      References

        • Dube D.S.
        Influence of overweight on ICU mortality: a prospective study.
        Chest. 2005; 127 (author reply 4): 683
        • Plourde B.
        • Sarrazin J.F.
        • Nault I.
        • Poirier P.
        Sudden cardiac death and obesity.
        Expert Rev Cardiovasc Ther. 2014; 12: 1099-1110
        • Finocchiaro G.
        • Papadakis M.
        • Dhutia H.
        • Cole D.
        • Behr E.R.
        • Tome M.
        • et al.
        Obesity and sudden cardiac death in the young: clinical and pathological insights from a large national registry.
        Eur J Prev Cardiol. 2018; 25: 395-401
        • Poirier P.
        • Giles T.D.
        • Bray G.A.
        • Hong Y.
        • Stern J.S.
        • Pi-Sunyer F.X.
        • et al.
        Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American heart association scientific statement on obesity and heart disease from the obesity committee of the Council on nutrition, physical activity, and metabolism.
        Circulation. 2006; 113: 898-918
        • Kannel W.B.
        • Plehn J.F.
        • Cupples L.A.
        Cardiac failure and sudden death in the Framingham Study.
        Am Heart J. 1988; 115: 869-875
        • World Health Organisation
        Obesity and overweight.
        WHO, 2018
        • Afshin A.
        • Forouzanfar M.H.
        • Reitsma M.B.
        • Sur P.
        • Estep K.
        • Lee A.
        • et al.
        • Global Burden of Disease (Obesity) Collaborators
        Health effects of overweight and obesity in 195 countries over 25 years.
        N Engl J Med. 2017; 377: 13-27
        • Resuscitation TAaNZCo
        ANZCOR guideline 8: cardiopulmonary resuscitation.
        2016
        • Lurie K.G.
        • Nemergut E.C.
        • Yannopoulos D.
        • Sweeney M.
        The physiology of cardiopulmonary resuscitation.
        Anesth Analg. 2016; 122: 767-783
        • Yannopoulos D.
        • McKnite S.
        • Aufderheide T.P.
        • Sigurdsson G.
        • Pirrallo R.G.
        • Benditt D.
        • et al.
        Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest.
        Resuscitation. 2005; 64: 363-372
        • Resuscitation TAaNZCo
        ANZCOR guideline 6: compressions.
        2016
        • Field J.M.
        • Hazinski M.F.
        • Sayre M.R.
        • Chameides L.
        • Schexnayder S.M.
        • Hemphill R.
        • et al.
        Part 1: executive summary: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2010; 122: S640-S656
        • Talikowska M.
        • Tohira H.
        • Finn J.
        Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: a systematic review and meta-analysis.
        Resuscitation. 2015; 96: 66-77
        • Weinberg G.
        • O'Connor M.
        Focus on physiology to improve cardiopulmonary resuscitation.
        Anesth Analg. 2016; 122: 587-589
        • Secombe P.
        • Sutherland R.
        • Johnson R.
        Body mass index and thoracic subcutaneous adipose tissue depth: possible implications for adequacy of chest compressions.
        BMC Res Notes. 2017; 10: 575
        • Secombe P.J.
        • Sutherland R.
        • Johnson R.
        Morbid obesity impairs adequacy of thoracic compressions in a simulation-based model.
        Anaesth Intensive Care. 2018; 46: 171-177
        • Tellson A.
        • Qin H.
        • Erwin K.
        • Houston S.
        Efficacy of acute care health care providers in cardiopulmonary resuscitation compressions in normal and obese adult simulation manikins.
        Proc (Bayl Univ Med Cent). 2017; 30: 415-418
        • Beger S.
        • Sutter J.
        • Vadeboncoeur T.
        • Silver A.
        • Hu C.
        • Spaite D.W.
        • et al.
        Chest compression release velocity factors during out-of-hospital cardiac resuscitation.
        Resuscitation. 2019; 145: 37-42
        • Cheskes S.
        • Common M.R.
        • Byers A.P.
        • Zhan C.
        • Silver A.
        • Morrison L.J.
        The association between chest compression release velocity and outcomes from out-of-hospital cardiac arrest.
        Resuscitation. 2015; 86: 38-43
        • Indik J.H.
        • Conover Z.
        • McGovern M.
        • Silver A.E.
        • Spaite D.W.
        • Bobrow B.J.
        • et al.
        Amplitude-spectral area and chest compression release velocity independently predict hospital discharge and good neurological outcome in ventricular fibrillation out-of-hospital cardiac arrest.
        Resuscitation. 2015; 92: 122-128
        • Kovacs A.
        • Vadeboncoeur T.F.
        • Stolz U.
        • Spaite D.W.
        • Irisawa T.
        • Silver A.
        • et al.
        Chest compression release velocity: association with survival and favorable neurologic outcome after out-of-hospital cardiac arrest.
        Resuscitation. 2015; 92: 107-114
        • Lampe J.W.
        • Tai Y.
        • Bratinov G.
        • Weiland T.R.
        • Kaufman C.L.
        • Berg R.A.
        • et al.
        Developing a kinematic understanding of chest compressions: the impact of depth and release time on blood flow during cardiopulmonary resuscitation.
        Biomed Eng Online. 2015; 14: 102
        • Kornaker K.M.
        Inventor cardiopulmonary assist device. United States.
        2011
      1. BariBoard - 35725. 2020
        atironduck.com/product/bariboard/
        Date accessed: February 13, 2020
        • Schulz K.F.A.D.
        • Moher D.
        • for the CONSORT Group
        CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials.
        BMJ. 2010; : c332
        • Longhi S.N.
        A practical guide to using panel data 2015.
        2017
        • Lund-Kordahl I.
        • Mathiassen M.
        • Melau J.
        • Olasveengen T.M.
        • Sunde K.
        • Fredriksen K.
        Relationship between level of CPR training, self-reported skills, and actual manikin test performance-an observational study.
        Int J Emerg Med. 2019; 12: 2
        • Krasteva V.
        • Jekova I.
        • Didon J.P.
        An audiovisual feedback device for compression depth, rate and complete chest recoil can improve the CPR performance of lay persons during self-training on a manikin.
        Physiol Meas. 2011; 32: 687-699
        • Wattenbarger S.
        • Silver A.
        • Hoyne T.
        • Kuntsal K.
        • Davis D.
        Real-time cardiopulmonary resuscitation feedback and targeted training improve chest compression performance in a cohort of international healthcare providers.
        J Emerg Med. 2019; (Epub ahead of print. https://doi.org/10.1016/j.jemermed.2019.09.027.)
        • Wang J.
        • Zhuo C.N.
        • Zhang L.
        • Gong Y.S.
        • Yin C.L.
        • Li Y.Q.
        Performance of cardiopulmonary resuscitation during prolonged basic life support in military medical university students: a manikin study.
        World J Emerg Med. 2015; 6: 179-185
        • Hasegawa T.
        • Daikoku R.
        • Saito S.
        • Saito Y.
        Relationship between weight of rescuer and quality of chest compression during cardiopulmonary resuscitation.
        J Physiol Anthropol. 2014; 33: 16
        • Lee H.
        • Oh J.
        • Lee J.
        • Kang H.
        • Lim T.H.
        • Ko B.S.
        • et al.
        Retrospective study using computed tomography to compare sufficient chest compression depth for cardiopulmonary resuscitation in obese patients.
        J Am Heart Assoc. 2019; 8e013948
        • Galatianou I.
        • Karlis G.
        • Apostolopoulos A.
        • Intas G.
        • Chalari E.
        • Gulati A.
        • et al.
        Body mass index and outcome of out-of-hospital cardiac arrest patients not treated` by targeted temperature management.
        Am J Emerg Med. 2017; 35: 1247-1251
        • Geri G.
        • Savary G.
        • Legriel S.
        • Dumas F.
        • Merceron S.
        • Varenne O.
        • et al.
        Influence of body mass index on the prognosis of patients successfully resuscitated from out-of-hospital cardiac arrest treated by therapeutic hypothermia.
        Resuscitation. 2016; 109: 49-55
        • Breathett K.
        • Mehta N.
        • Yildiz V.
        • Abel E.
        • Husa R.
        The impact of body mass index on patient survival after therapeutic hypothermia after resuscitation.
        Am J Emerg Med. 2016; 34: 722-725
        • Sung C.W.
        • Huang C.H.
        • Chen W.J.
        • Chang W.T.
        • Wang C.H.
        • Wu Y.W.
        • et al.
        Obesity is associated with poor prognosis in cardiogenic arrest survivors receiving coronary angiography.
        J Formos Med Assoc. 2020; 119: 861-868
        • Beesems S.G.
        • Koster R.W.
        Accurate feedback of chest compression depth on a manikin on a soft surface with correction for total body displacement.
        Resuscitation. 2014; 85: 1439-1443