CPR is Tired Work, But Best Not Done in Bed

May 1, 2023

Written by Nick Zelt

Spoon Feed
CPR performed by laymen benefits from being done on a hard surface rather than on a mattress, though neither group met the AHA recommended depth of 5cm.

Why does this matter?
Are you familiar with Dr. Glaucomflecken? Real name, Will Flanary, is an ophthalmologist who makes hilarious, satirical, medicine related videos on social media. In 2021 he had a sudden cardiac arrest in his sleep, and his wife (Kristin Flanary, aka Lady Glaucomflecken) did 10 minutes of CPR in their bed (kind of defying the premise of this article). Heroics of Kristin Flanary notwithstanding, where is the best place for CPR in this scenario? The bed or the floor?

Push hard on the heart, but not in a soft place.
At home OHCAs have worse outcomes than those in public, likely due to the absence of defibrillators. When emergency phone operators give instructions for laypersons to administer CPR, they must first decided if the location is appropriate. To provide accurate advice, we need to know if compression quality would benefit from repositioning. 

This was a prospective, cross-over RCT that recruited 80 volunteers without professional medical training to perform CPR on a manikin on both a mattress and the floor. All participants were coached on CPR over the phone to simulate the role of a 911 operator. 66% of participants were female and a median age of 55. The mattress used was a Sealy Response Essentials Castra IV Firm, if you were curious.

The primary outcome of compression depth was significantly less when performed on the mattress, -0.62 cm (95%CI CI 0.23 to 1.01) or by females, –1.42 cm (95%CI –2.59 to –0.25). The sex-related difference was more pronounced on the mattress.

The study was likely biased towards a difference, as compression depths of zero were used if the minimum depth of measurement for the manikin was not met, a somewhat unfair extrapolation, since we know that poor compressions are better than no compressions.

Source
Effectiveness of Lay Bystander Hands-Only Cardiopulmonary Resuscitation on a Mattress versus the Floor: A Randomized Cross-Over Trial. Ann Emerg Med. 2023 Feb 23;S0196-0644(23)00026-4. doi: 10.1016/j.annemergmed.2023.01.012. Online ahead of print.