Impact of elbow supports use on chest compression quality: a crossover simulation study

Abstract
During chest compressions, a downward force is generated by the rescuer’s body through straightened arms to the patient’s chest. If the elbows are not straight, the depth of chest compressions could be reduced. Such a situation could occur during
prolonged chest compressions or when the rescuer must wear protective equipment, such as during the coronavirus disease 2019 (COVID-19) pandemic, and can lead to reduced chest compression quality. This study aimed to compare the quality of chest compressions performed using elbow supports to limit the elbows’ range of motion with that of standard chest compression (SCC). This prospective, randomized controlled, crossover simulation trial was conducted from October to December 2018. It included 34 participants who were certified in Basic Life Support with an overall compression score of ≥80% in the preliminary evaluation. They were randomly assigned to the immediate intervention (elbow support chest compression (ESCC)) or wait-list control (SCC) groups, and were asked to perform hands-only cardiopulmonary resuscitation for 8 minutes with and without elbow supports, respectively. After 1 week, the participants were made to switch groups, and the quality of chest compressions between the two groups was compared. The study findings showed that the ESCC group had a significantly higher overall compression score than the SCC group (82.85 ± 13.73% vs. 76.11 ± 19.19%, respectively, p = 0.044). No difference was observed in the chest compression depth between men and women in the ESCC group (53.12 ± 6.14 mm vs.
49.13 ± 3.23 mm, respectively, p = 0.053), but a significant difference was observed between those of the SCC group (53.18 ± 6.58 mm vs. 47.87 ± 5.23 mm, respectively, p = 0.026). Thus, elbow supports could assist rescuers in performing more effective
chest compressions, especially for females or in situations where compression quality could be affected.