Lacrosse Protective Equipment and the Initiation of Cardiopulmonary Resuscitation and Time to First Automated External Defibrillator Shock

Context: For an acute cardiac event, on-field equipment removal is suggested, although how lacrosse equipment removal may alter the time to first chest compression and time to first automated external defibrillator (AED) shock remains unknown. Objective: To determine the time to first chest compression and first AED shock in 2 chest-exposure procedures with 2 pad types. Design: Crossover study. Setting: Simulation laboratory. Patients or Other Participants: A total of 36 athletic trainers (21 women, 15 men; age = 30.58 6 7.81 years). Main Outcome Measure(s): Participants worked in pairs to provide 2 rescuer cardiopulmonary resuscitation (CPR) interventions on a simulation manikin outfitted with lacrosse pads and helmet. Participants completed 8 trials per pair (2 chestexposure procedures × 2 pad types × 2 participant roles). The dependent variables were the time to first compression (seconds) and time to first AED shock (seconds). The independent variables were chest-exposure procedure with 2 levels (procedure 1: removal of the helmet while initiating CPR over the pads, followed by pad retraction and AED application; procedure 2: removal of the helmet and pads, followed by CPR and AED application) and pad type (Warrior Burn Hitman shoulder pads; Warrior Nemesis chest protector). Results: We found a significant interaction between chestexposure procedure and pad type for the time to first compression (F_1,35= 4.66, P = .04, ω²_p= 0.10), with faster times during procedure 1 for both the Nemesis pads (16.1 ± 3.4 seconds) and Hitman pads (16.1 ± 4.5 seconds) than during procedure 2 (Nemesis pads: 49.6 ± 12.9 seconds, P < .0001; Hitman pads: 53.8 ± 14.5 seconds, P < .0001). Conclusions: Completing the initial cycle of chest compressions over either shoulder pads or a chest protector hastens the time to first chest compression without diminishing CPR quality, which may improve patient outcomes. The time to the first AED shock was not different between equipment procedures or pad types.