• Bernd Wallner, Luca Moroder, Hannah Salchner, Peter Mair, Stefanie Wallner, Gabriel Putzer, Giacomo Strapazzon, Markus Falk, and Hermann Brugger.
• Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. bernd.wallner@i-med.ac.at.
• Scand J Trauma Resus. 2021 Sep 4; 29 (1): 129.

BackgroundThe aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position.MethodsIn this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position.ResultsOnly 28% of all tidal volumes conformed to the guidelines (400-800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s.ConclusionsEfficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.© 2021. The Author(s).

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