Surviving the storm:manual vs. mechanical chest compressions onboard a lifeboat during bad weather conditions

Objective: It is challenging for rescuers to perform cardiopulmonary resuscitation (CPR) onboard lifeboats, particularly during rough weather. A mechanical chest compression device (MCD) may provide better quality chest compressions. The aim of this study was to compare the quality of chest compressions performed by lifeboat-crewmembers with those of a MCD during rough-sea conditions.Methods: Lifeboat-crewmembers were scheduled to provide compression-onlyCPR on a resuscitation-mannequin during two sets of five 6-min epochs on alifeboat at sea in two different weather-conditions. Simultaneously a MCD wasused for compression-only CPR on another mannequin onboard the lifeboat. Ona third occasion compressions by MCD only were measured due to COVID-19restrictions. The primary outcome variable was the quality of chest compression,evaluated using published variables and standards (mean compression depthand compression frequency, percentage correct compression depth, percentageof not leaning on the thorax, percentage of correct hand placement on thethorax, hands-off-time).Results: Six male lifeboat-crewmembers (mean age 35 years) performed CPRduring two different weather conditions. In weather-conditions one (wind∼6–7 Beaufort/wave-height: 100–150 cm) quality of manual compressions wassignificantly worse than mechanical compressions for mean compression depth(p < 0.05) and compression frequency (p < 0.05), percentage correct compression depth (p < 0.05), percentage of not leaning on the thorax (p < 0.05), and hands off time (p < 0.05). Crewmembers could only perform CPR for a limited time-period (sea-conditions/seasickness) and after one set of five epochs measurements were halted. In weather-condition two (wind ∼9 Beaufort/wave-height ∼200 cm) similar results were found during two epochs, after which measurements were halted (sea-conditions/seasickness). In weather-condition three (wind ∼7 Beaufort/wave-height ∼300–400 cm) MCD compressions were according to resuscitation-guidelines except for three epochs during which the MCD was displaced.Conclusion: Crewmembers were only able to perform chest-compressions for alimited time because of the weather-conditions. The MCD was able to providegood quality chest compressions during all but three epochs during the studyperiod. More research is needed to determine whether MCD-use in real-lifecircumstances improves outcome. Inclusion of data on use of a MCD on lifeboatsshould be considered in future revisions of the USFD and resuscitation guidelines