Sports Medicine Research: In the Lab & In the Field: To Remove or not to Remove? That is the Question When Dealing with CPR Emergencies in Football (Sports Med Res)


Thursday, November 20, 2014

To Remove or not to Remove? That is the Question When Dealing with CPR Emergencies in Football

Adequate performance of cardiopulmonary resuscitation techniques during simulated cardiac arrest over and under protective equipment in football.

Waningner KN, Goodbred A, Vanic K, Hauth J, Onia J, Stoltzfus J, Scott J. Clin J Sports Med. 2014;24(4):280. DOI: 10.1097/JSM.0000000000000022

Take Home Message: Football shoulder pads create a barrier for a rescuer who has to perform cardiopulmonary resuscitation on an athlete who is suffering from sudden cardiac arrest (SCA). Performing chest compressions under the shoulder pads, which increases compression depth, may be more effective in saving an SCA victim’s life.

Performing sufficient cardiopulmonary resuscitation (CPR) on an athlete who is suffering from sudden cardiac arrest (SCA) could prove to be life saving. Along with adequacy, the time it takes to initiate CPR is also a vital in emergency care of SCA incidents. American football and other collision sports present an obstacle for emergency rescuers in the form of protective shoulder pads that cover the chest of an athlete. Therefore, the authors of this study evaluated CPR adequacy during a simulated cardiac arrest of an equipped player and to test if CPR implemented over protective football equipment would impede effectiveness, which could decrease the chance of survival for a victim suffering from SCA. Thirty CPR-certified athletic trainers and 6 CPR-certified emergency department technicians followed the American Heart Association (AHA) CPR guidelines for chest compressions (100 compressions/min and a depth of 51 mm) to perform three 2-minute cycles of chest compression-only CPR, alternating between over the protective football shoulder pads or under the equipment on a manikin simulator. The authors found that chest compression depth performed over shoulder pads was less (depth = 31.5 mm) than under the shoulder pads (36.5 mm). Chest wall recoil and compression rate were not different under the two different conditions.

Although the CPR compression depth in both groups was shallower than the recommended AHA guideline of 51 mm, it was evident that executing chest compressions under shoulder pads is more efficient by up to 15%. It is unclear if the difference between strategies is clinically relevant but it could prove to be inadequate for maintaining circulation of blood to and from the heart. In an emergency situation, such as an SCA, it is vital to the patient’s life to take the best course of action that adeptly utilizes both time and quality of care. Although this study presents that the removal of the shoulder pads is needed to get close to the recommendations of the American Heart Association for chest compression depth, removal of the shoulder pads could cost valuable time that could decrease the rate of survival. It is presently unknown whether time to initiation of CPR or chest compression quality is more valued in an emergency situation. However, it should be noted that another benefit of removing the shoulder pads for CPR is that it exposes the chest of the athlete for defibrillation when emergency responders arrive on the scene with an automated external defibrillator (AED). Although the timing of CPR is imperative, it is evident that it may be more essential to remove the shoulder pads of an SCA victim for higher quality chest compressions and pre-exposure of the chest for future defibrillation.

Questions for Discussion: If you were the first responder to an SCA event would your first reaction be to take the shoulder pads off the athlete off or leave them on? Which do you believe would create a greater rate of survival? This study focused on football, what about other sports that wear shoulder pads? Would the same results be relevant?

Written by: Daniel Wager and Erin Oliver
Reviewed by: Kim Pritchard

Related Articles:

Waninger, K., Goodbred, A., Vanic, K., Hauth, J., Onia, J., Stoltzfus, J., & Melanson, S. (2014). Adequate Performance of Cardiopulmonary Resuscitation Techniques During Simulated Cardiac Arrest Over and Under Protective Equipment in Football Clinical Journal of Sport Medicine, 24 (4), 280-283 DOI: 10.1097/JSM.0000000000000022


Liz said...

If the shoulder pads lace up the front, cutting the laces can provide better direct access to the chest without spending a lot of time removing the helmet and shoulder pads. If the pads do not lace in the front then compressions over pads may be the best option unless there is a team readily available who is trained in equipment removal and can help expedite the removal process.

Daniel Wager said...

You bring up a very good point, Liz. However, if the emergency responders take up to 45 minutes to arrive at the scene and there is an automated electronic defibrillator on site, then the football shoulder pads need to be removed immediately to administer a shock. This is why it might be wise for all athletic trainers and emergency responders to have electric powered cordless shears or scissors at their disposal in case there are no laces on the front of the shoulder pads. These shears will allow for the ATs to be able to cut through any straps or material that is impeding the placement of the AED pads as well as allow for proper chest compressions to be performed.

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