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
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