001, effect size = 1.323) and lower percentage of optimal ventilations (all P values <. For both the bag-valve and pocket masks, the condition with the chinstrap in place had a lower mean ventilation volume (all P values <. 001) and the percentage of ventilations with optimal volume ( F 2,125 = 22.791, P <. We noted a main effect of equipment condition on the mean volume of ventilations ( F 2,125 = 44.435, P <. Thus, when a participant was able to demonstrate compression and ventilation proficiency for 30 seconds (as assessed by the Laerdal SkillReporter rating of “Advanced performer”), he or she was then block randomized to one of the following task scenarios: (1) chest compressions or (2) ventilations. The conditions within the task scenarios would be exclusively chest compressions or ventilations. The purpose of the familiarization session was to provide participants an opportunity to experience delivering chest compressions and ventilations to the patient simulator. They were then instructed to deliver ventilations using the pocket mask for 30 seconds at a rate of 8 to 10 breaths per minute, with each ventilation lasting 1 second. Participants were instructed to follow the 2015 American Red Cross CPR guidelines for compressions and ventilations 9: perform compressions for 30 seconds at a rate of 100 to 120 compressions per minute with a depth of at least 2 in (50 mm) and with full chest recoil between compressions. Participants then completed a CPR training session in which they viewed their CPR performance in real time using SkillReporter on a tablet wirelessly connected to the simulator. Although no time limit or minimum exposure time was imposed on the study participants, the familiarization sessions typically lasted 10 to 15 minutes. After being oriented to the equipment by a research assistant, participants had time to handle the airway adjuncts and patient simulator. Given the differences in lacrosse and football helmet designs, we believed that comparing these 2 ventilation methods across various equipment conditions was warranted.Įach participant completed a familiarization session in which he or she was oriented to the patient simulator technology, athletic equipment, and breathing apparatuses (bag-valve and pocket masks). Previous researchers 6 established that using a bag-valve mask was superior to using a pocket mask, regardless of whether the helmet was in place. Moreover, the choice of airway adjunct may affect ventilation quality. Differences in pad and shell thickness, as well as helmet shape, may affect the ability to gain airway access with a lacrosse helmet in place. ![]() One group 6 found that the presence of a football helmet, and especially a chinstrap, reduced ventilation quality, even when the facemask was removed. In addition to affecting chest compression quality, equipment may interfere with delivering ventilations. 4 Therefore, if optimal compression quality can be maintained, it may be preferable to deliver compressions over the equipment and delay equipment removal until an automated external defibrillator is ready to be applied. 5, 6 Whether the thinner pads used in lacrosse negatively affect compression quality is unknown, but evidence indicates that removing equipment delays the initiation of chest compressions. ![]() Mounting evidence suggests that the presence of football shoulder pads and a helmet with chinstrap reduces chest compression and ventilatory quality. 8 Given the sport's growing popularity and the gravity of this clinical problem, it is imperative to provide ATs with an evidence-based approach to emergency management of a lacrosse player in sudden cardiac arrest. 8 Unlike these sports, however, lacrosse athletes have a disproportionately high risk of commotio cordis, which accounts for 45 % of sudden deaths in the sport this is similar to what is observed in ice hockey. 7 The overall mortality rate in lacrosse is similar to that in other popular sports such as baseball, basketball, and football. Lacrosse is the most rapidly growing interscholastic and intercollegiate sport, with more than 800 000 participants in the United States. Lacrosse shoulder pads are thinner and more flexible than football shoulder pads, and lacrosse helmets have a different shape and fit compared with football helmets. Although a few authors 4– 6 have examined how football equipment affects the delivery of CPR, no reports have been published on lacrosse equipment.
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