Baylor University Medical Center Proceedings October 2017 - 415

Efficacy of acute care health care providers in cardiopulmonary
resuscitation compressions in normal and obese adult
simulation manikins
Alaina Tellson, PhD, RN-BC, NE-BC, Huanying Qin, MS, Kristin Erwin, BA, and Susan Houston, PhD, RN, NEA-BC

Annually, over 350,000 persons require cardiopulmonary resuscitation
(CPR), either in or outside of the hospital. With obesity a rising health
issue in the United States, concerns exist regarding the efficacy of quality
compressions for CPR in obese patients. The aims of this study were
to determine if the compressions for three adult simulation manikins
(normal, obese, and morbidly obese) met quality guidelines; to examine
any differences in quality of chest compressions performed by health
care providers between the three manikins; and to examine the effect
of participant characteristics on the quality of chest compressions in
obese and morbidly obese manikins. A randomized controlled design was
used. Sixty-one health care providers performed chest compressions on
the three simulation manikins. Results showed that performance on the
normal-sized manikin was significantly better than that on both obese
and morbidly obese manikins. Participant characteristics were significantly associated with quality of chest compressions. The effectiveness
of compressions in obese and morbidly obese CPR recipients has yet
to be determined.

besity, deﬁned as a body mass index (BMI) ≥30.0 kg/m2,
has been recognized for hundreds of years as a health
hazard (1). An estimated 79 million people are obese in
the US, and roughly 70% of US adults are considered
overweight (2, 3). Obesity increases the risk of cardiovascular
dysfunction and sudden cardiac arrest (4-7). There are concerns
regarding the eﬃcacy of resuscitation in obese patients related
to the quality of chest compressions. In a 2015 study by Lee
and colleagues, researchers found that during cardiopulmonary resuscitation (CPR) chest compression, depth decreased
as patients' BMI increased, suggesting that the recommended
depth of 5 cm may need to be reevaluated for obese patients
(8). The ﬁrst aim of this study was to determine if the quality of chest compression for three adult simulation manikins
(normal, obese, and morbidly obese) met the American Heart
Association (AHA) guideline for quality chest compressions (28
compressions out of 30 at the appropriate depth of at least 5 cm
as determined by an electronic skills reporter). The second aim
was to examine any diﬀerences in quality of chest compressions
performed between the three adult simulation manikins. The
third aim was to examine the contribution of participant characteristics of height, weight, gender, and upper body strength

Proc (Bayl Univ Med Cent) 2017;30(4):415-418

to the quality of chest compressions in obese and morbidly
obese manikins.
METHODS
A randomized controlled design was used for this study,
wherein the order of performing CPR on normal, obese, and
morbidly obese manikins was randomized using a randomization table. Each participant performed CPR in one of six orders
(123, 132, 213, 231, 312, 321), where 1 represented a normal
manikin; 2, an obese manikin; and 3, a morbidly obese manikin.
Obesity was deﬁned as a BMI ≥30 kg/m2 and morbid obesity,
as a BMI ≥40 kg/m2. The order was an issue since studies have
shown that rescuers become fatigued during CPR and the quality of their compressions can decrease (9).
This study was conducted in a 116-bed for-proﬁt cardiovascular specialty hospital located in North Texas. After obtaining institutional review board approval, all employees of this
hospital who provide direct patient care and were certiﬁed in
basic life support were invited to participate in the study. Only
those with any current impairment preventing the administration of CPR were excluded. A power analysis yielded a sample
size of 112. The study was discontinued early with a sample
of 61, as preliminary data analysis yielded obvious statistically
signiﬁcant results related to the research questions addressing
quality of compressions.
Adult simulation manikins with an electronic skill reporter
were used to determine chest compression quality. The electronic skill reporter contains lights that provide feedback on
compression depth and hand position. A printout was obtained
containing the same information. Since immediate feedback
has been shown to improve the quality of CPR (10), only the
research team could see the feedback indicator lights during the
trial. A standard adult CPR manikin with an electronic skill
reporter was used as the "normal-sized" manikin. This manikin
closely mimics the average size of an adult female of normal
From Professional Practice, The Heart Hospital Baylor Plano, Plano, Texas, and
The Heart Hospital Baylor Denton, Denton, Texas (Tellson); and the Departments
of Quantitative Sciences (Qin) and Nursing Research (Erwin, Houston), Baylor
Scott & White Health - North Texas, Dallas, Texas.
Corresponding author: Alaina Tellson, PhD, RN-BC, NE-BC, 3953 Wisteria Lane,
Haltom City, TX 76137 (e-mail: alaina@tellson.net).
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