Should dispatchers instruct lay bystanders to undress patients before performing CPR? A randomized simulation study

Abstract

Objective: Dispatch-assisted CPR instructions frequently direct bystanders to remove a cardiac arrest patient's clothing prior to starting chest compressions. Removing clothing may delay compressions and it is uncertain whether CPR quality is influenced by the presence of clothing. We measured how instructions to remove clothing impacted the time to compressions and CPR performance by lay responders in a simulated arrest.

Subjects and methods: We conducted a randomized dispatch-assisted CPR simulation trial. Fifty two lay participants were instructed to remove the manikin's clothing (3 layers: a t-shirt, button-down shirt, and fleece vest) prior to starting chest compressions as part of dispatcher instructions, while 47 individuals received no instruction about clothing removal. Instructions were otherwise identical.

Results: The two groups were comparable with regard to demographic characteristics and prior CPR training. Time to first compression was 109 s among the group randomized to instruction to remove clothing and 79 s among those randomized to forgo instruction regarding clothing removal, (p<0.001). Among those randomized to remove clothing instructions, mean compression depth was 41 mm, compression rate was 97 per minute, and the percentage with complete compression release was 95%. Among those randomized to forgo clothing removal instruction, mean compression depth was 40 mm, compression rate was 99 per minute, and the percentage with complete compression release was 91% (p>0.05 for each CPR metric comparison).

Conclusion: These findings suggest that eliminating instruction to remove a victim's clothing in dispatcher-assisted CPR will save time without compromising performance, which may improve survival from cardiac arrest.