Factors Influencing Performance of Cardiopulmonary Resuscitation (CPR) by Foundation Year 1 Hospital Doctors

BACKGROUND Foundation Year One (FY1) doctors are often the first medical staff responders at in-hospital cardiac arrests. The study objectives were to assess the cardiopulmonary resuscitation (CPR) skills of FY1 doctors at a Belfast teaching hospital and to highlight factors that influence their performance. METHODS A group of FY1 doctors working in a Belfast teaching hospital were asked to participate in this study. These junior doctors were regularly on-call for acute medical emergencies including cardiac arrest. Participants were instructed to perform two, 3 minute sessions of CPR on a skills reporter manikin. Each session was separated by a 5 minute rest period, one session using a compression-to-ventilation ratio of 15:2 and the other using a ratio of 30:2. Performance was gauged both objectively, by measuring the depth of chest compressions, and subjectively by a panel of 5 Advanced Life Support (ALS) instructors who reviewed the tracings of each CPR session. RESULTS Overall, 85% of medical FY1's working in the hospital participated in the study. Objective results determined that males performed significantly better than their female counterparts using both the 15:2 and 30:2 ratios. The male FY1 doctors performed equally well using both 15:2 and 30:2 ratios, in comparison to female doctors who were noted to be better using the 15:2 ratio. Individuals with a Body mass index (BMI) greater than the mean for the group, performed significantly better than those with a lower BMI when using the 30:2 ratio. BMI was an important factor and correlated with chest compression depth. Females with a low BMI performed less well when using a ratio of 30:2. Overall, expert opinion significantly favoured the 15:2 ratio for the FY1 doctor group. CONCLUSION CPR performance can be influenced by factors such as gender and BMI, as such the individual rescuer should take these into account when determining which compression to ventilation ration to perform in order to maximise patient outcome. This study showed that males and those females with a BMI of >24 performed satisfactory CPR when using the recommended Resuscitation Council guidelines. Females with a BMI <24 performed CPR more effectively when using the 15:2 ratio. FY1 doctors should be fully assessed prior to performing CPR at in-hospital cardiac arrests. Remedial teaching should be given to those less than satisfactory until they are shown to be competent.