PMID- 37718290
OWN - NLM
STAT- MEDLINE
DCOM- 20230919
LR  - 20231026
IS  - 1833-3516 (Print)
IS  - 2209-1491 (Electronic)
IS  - 1833-3516 (Linking)
VI  - 53
IP  - 3
DP  - 2023 Sep 30
TI  - Delivering manual cardiopulmonary resuscitation (CPR) in a diving bell: an 
      analysis of head-to-chest and knee-to-chest compression techniques.
PG  - 172-180
LID - 10.28920/dhm53.3.172-180 [doi]
AB  - INTRODUCTION: Chest compression often cannot be administered using conventional 
      techniques in a diving bell. Multiple alternative techniques are taught, 
      including head-to-chest and both prone and seated knee-to-chest compressions, but 
      there are no supporting efficacy data. This study evaluated the efficacy, safety 
      and sustainability of these techniques. METHODS: Chest compressions were 
      delivered by a team of expert cardiopulmonary resuscitation (CPR) providers. The 
      primary outcome was proportion of chest compressions delivered to target depth 
      compared to conventional CPR. Techniques found to be safe and potentially 
      effective by the study team were further trialled by 20 emergency department 
      staff members. RESULTS: Expert providers delivered a median of 98% (interquartile 
      range [IQR] 1.5%) of chest compressions to the target depth using conventional 
      CPR. Only 32% (IQR 60.8%) of head-to-chest compressions were delivered to depth; 
      evaluation of the technique was abandoned due to adverse effects. No study team 
      member could register sustained compression outputs using prone knee-to-chest 
      compressions. Seated knee-to-chest were delivered to depth 12% (IQR 49%) of the 
      time; some compression providers delivered > 90% of compressions to depth. 
      CONCLUSIONS: Head-to-chest compressions have limited efficacy and cause harm to 
      providers; they should not be taught or used. Prone knee-to-chest compressions 
      are ineffective. Seated knee-to-chest compressions have poor overall efficacy but 
      some providers deliver them well. Further research is required to establish 
      whether this technique is feasible, effective and sustainable in a diving bell 
      setting, and whether it can be taught and improved with practise.
CI  - Copyright: This article is the copyright of the authors who grant Diving and 
      Hyperbaric Medicine a non-exclusive licence to publish the article in electronic 
      and other forms.
FAU - Johnson, Graham
AU  - Johnson G
AD  - University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby 
      Hospital, Derby, UK.
AD  - University of Nottingham Medical School, East Block, Lenton, Nottingham, UK.
AD  - Corresponding author: Dr Graham Johnson, University Hospitals of Derby and Burton 
      NHS Foundation Trust, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK, 
      ORCiD ID: 0000-0001-6004-6244, graham.johnson4@nhs.net.
FAU - Bryson, Philip
AU  - Bryson P
AD  - International SOS, Forest Grove House, Forrester Hill Road, Aberdeen, UK.
FAU - Tilbury, Nicholas
AU  - Tilbury N
AD  - University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby 
      Hospital, Derby, UK.
FAU - McGregor, Benjamin
AU  - McGregor B
AD  - International SOS, Forest Grove House, Forrester Hill Road, Aberdeen, UK.
FAU - Wesson, Alistair
AU  - Wesson A
AD  - No specified affiliation.
FAU - Hughes, Gareth D
AU  - Hughes GD
AD  - University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby 
      Hospital, Derby, UK.
FAU - Hughes, Gareth R
AU  - Hughes GR
AD  - University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby 
      Hospital, Derby, UK.
FAU - Tabner, Andrew
AU  - Tabner A
AD  - University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby 
      Hospital, Derby, UK.
AD  - University of Nottingham Medical School, East Block, Lenton, Nottingham, UK.
LA  - eng
PT  - Journal Article
PL  - Australia
TA  - Diving Hyperb Med
JT  - Diving and hyperbaric medicine
JID - 101282742
SB  - IM
MH  - Humans
MH  - *Diving
MH  - *Cardiopulmonary Resuscitation
PMC - PMC10597601
OTO - NOTNLM
OT  - Cardiovascular
OT  - Deaths
OT  - Diving deaths
OT  - Diving incidents
OT  - Diving medicine
OT  - Diving research
OT  - Resuscitation
COIS- Conflict of interest and funding: The project would not have been possible 
      without generous support from the following organisations. Equinor, Total 
      Energies, Shelf Subsea, TechnipFMC, KD Marine, Rever, Boskalis, K-Subsea, DFS 
      Diving and Unique Hydra (PTY) Ltd. These funders had no role in the design or 
      implementation of the protocol or the decision to publish. International SOS 
      sponsored the work of one of the authors: Dr P Bryson.
EDAT- 2023/09/18 00:41
MHDA- 2023/09/19 06:42
PMCR- 2023/09/30
CRDT- 2023/09/17 22:53
PHST- 2023/03/24 00:00 [received]
PHST- 2023/05/21 00:00 [accepted]
PHST- 2023/09/19 06:42 [medline]
PHST- 2023/09/18 00:41 [pubmed]
PHST- 2023/09/17 22:53 [entrez]
PHST- 2023/09/30 00:00 [pmc-release]
AID - 10.28920/dhm53.3.172-180 [doi]
PST - ppublish
SO  - Diving Hyperb Med. 2023 Sep 30;53(3):172-180. doi: 10.28920/dhm53.3.172-180.