Chest compression quality decreases in hypoxic conditions simulating an airliner cabin at cruising altitude: a randomized, controlled, double-blind Manikin Study

Scientific Reports, vol. 14, pp. 25971

Abstract

Abstract Air traveler numbers are predicted to reach 4.0 billion in 2024. Between 1/15,000–50,000 passengers will experience acute medical problems inflight with cardiac arrests requiring cardiopulmonary resuscitation (CPR) accounting for 0.3% of medical emergencies. Hypoxia in airplane cabins could impair oxygenation and physical performance of caregivers. We conducted a randomized controlled, double-blind study to test the hypothesis that hypoxia decreases the effectiveness in performing CPR. We randomized 24 healthcare professionals to two different study arms, each consisting of two conditions: arm (1) ‘hypoxia (FiO2 15%, equivalent to 2400 m altitude)’ versus ‘normoxia’; arm (2) ‘hypoxia + supplemental oxygen’ versus ‘normoxia + supplemental oxygen’. The order of conditions was counterbalanced and a minimum wash-out period of 24 h was granted between conditions. In each condition participants performed a 5-min cardiac compression only CPR (CCO-CPR) using a full-body manikin after one, three and six hours in an altitude chamber. Mixed ANOVAs with post-hoc false-discovery-rate adjusted pairwise comparisons indicated that although compression frequency was maintained, the number of compressions with correct depth was decreased at all times during hypoxia compared to normoxia (all p < 0.002). After 6 h hypoxia exposure, mean compression depth was below the recommended compression depth defined by ERC/AHA guidelines and reduced compared to normoxia (42.4 ± 12.6 mm vs. 54.6 ± 4.3 mm, p < 0.0001). Supplemental oxygen during CCO-CPR in hypoxia prevented the decrease of compression-depth (55.3 ± 3 mm). Extended hypoxia exposure akin to conditions in airplane cabins can reduce quality of chest compressions during CPR. Supplemental oxygen for healthcare providers is an effective countermeasure.

Authors 12

1. Jan Schmitz corresponding

   Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR) · University Hospital Cologne

   Affiliation as printed

   Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. jan.schmitz1@uk-koeln.de

   Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center, 51147, Cologne, Germany. jan.schmitz1@uk-koeln.de

   Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

2. Daniel Aeschbach

   Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR)

   Affiliation as printed

   Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center, 51147, Cologne, Germany

3. Inga Beccard

   Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR) · University Hospital Cologne

   Affiliation as printed

   Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

   Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center, 51147, Cologne, Germany

4. Nina Frings

   University Hospital Cologne

   Affiliation as printed

   Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

5. Jochen Hinkelbein

   University Hospitals of the Ruhr-University of Bochum · Johannes Wesling Klinikum Minden

   Affiliation as printed

   Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Johannes Wesling Klinikum Minden, University Hospital, Ruhr-University Bochum, Minden, Germany

6. Tobias Kammerer

   University Hospital Cologne

   Affiliation as printed

   Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

7. Felix Liebold

   University Hospital Leipzig · Leipzig University

   Affiliation as printed

   Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, 04103, Leipzig, Germany

8. Ulrich Limper

   Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR)

   Affiliation as printed

   Department of Anesthesiology and Intensive Care Medicine, Krankenhaus Merheim, Köln, Germany

   Department of Cardiovascular Medicine, Institute of Aerospace Medicine, German Aerospace Center, 51147, Cologne, Germany

9. Titiaan E. Post

   Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR)

   Affiliation as printed

   Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center, 51147, Cologne, Germany

10. Volker C. Schick

    University Hospital Cologne

    Affiliation as printed

    Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

11. Jens Tank

    Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR)

    Affiliation as printed

    Department of Cardiovascular Medicine, Institute of Aerospace Medicine, German Aerospace Center, 51147, Cologne, Germany

12. Eva-Maria Elmenhorst Aachen Institute for Occupational, Social and Environmental Medicine Medical Faculty

    Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR) · RWTH Aachen University

    Affiliation as printed

    Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center, 51147, Cologne, Germany

    Institute for Occupational, Social, and Environmental Medicine, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany