A two-rescuer-method significantly alters CPR-quality during cardiopulmonary resuscitation in an airliner cabin - a randomized, controlled manikin trial

Between 1/15,000-1/50,000 passengers suffer in-flight medical emergencies (IFME) with cardiac arrest accounting for 0.3 %. Confined space can have a negative impact on quality of chest compressions during cardiopulmonary resuscitation (CPR), thus we have conducted a randomized controlled study to find the most effective approach of performing CPR in a one - vs. two-rescuer method in a simulated airliner cabin. We randomized 20 healthcare professionals to perform a set of 10 min Basic Life Support (BLS, chest compressions and bag-mask-ventilation) in a one- vs. two-rescuer scenario and in confined space vs. open space in a randomized order using a full-body manikin. The primary outcome was compression depth as sensitive marker for differences in CPR-quality. The study was registered on clinicaltrials.gov (NCT02002481). Mixed ANOVAs with post-hoc false-discovery-rate adjusted pairwise comparisons indicated that one- vs. two-rescuer method showed differences in no-flow-time (confined: 8.05 ± 0.17 vs. 24.25 ± 1.05 s/2min and open space: 7.51 ± 0.02 vs. 21.31 ± 0.43 s/2min; p < 0.001) and missing releases (confined: 27.09 ± 5.55 vs. 46.64 ± 9.66 number/10 minutes and open space: 27.09 ± 2.44 vs. 43.36 ± 6.4 number/10minutes; p < 0.001). A confined space significantly elevated no-flow-time in the two-rescuer-method vs. the one-rescuer-method (24.24 ± 1.06 s/2min vs. 21.26 ± 0.44 s/2min; p < 0.001), whereas compression frequency and compression depth were different but still within the current recommendations of ERC/AHA in both methods per condition. Limited space in an airliner cabin has significant impact on no-flow-time in a two-rescuer-method. In case of CPR and limited access to the patient, we recommend a one-rescuer-method as first approach to ensure early and high-quality CPR for experienced personnel.