No competing interests declared. Table S1. Working under pressure. Table S2. Situation awareness and decision making. Table S3. Teamworking. Table S4. Global rating score. ""The Imatinib ic50
importance of minimising aortocaval compression during cardiopulmonary resuscitation in late pregnancy is widely accepted. Current European guidelines suggest employing manual displacement of the uterus with left lateral tilt to achieve this. Several methods for producing lateral tilt have been described; however, the optimum method is unknown. By performing simulated cardiopulmonary resuscitation on a manikin, we compared four of these methods: a folded labour ward pillow; a pre-formed foam wedge; a custom-made hard wooden wedge; and the ��human wedge��. Primary outcome measures were maintenance of adequate tilt, stability and effectiveness of chest compressions (rate, depth and adequate release). Overall, the foam and wooden wedges were significantly more stable and reliable at maintaining tilt than the pillow (p?<?0.0001); the wooden wedge was more stable and effective than the foam wedge (p?<?0.0001). Chest compressions <a href="http://www.selleckchem.com/products/VX-770.html
">CFTR activator were least effective with the human wedge (p?=?0.02). Effectiveness of chest compressions with lateral tilt was comparable to that reported previously in supine manikin studies. We recommend the use of dedicated foam or hard wedges rather than pillows or the human wedge for producing lateral tilt during cardiopulmonary resuscitation. Reports into maternal mortality highlight cardiopulmonary resuscitation (CPR) after cardiac arrest as a major area for improvement , with recent studies MI 773
identifying effective delivery of chest compressions with left uterine displacement as a particular area of concern [2, 3]. Minimal maternal aortocaval compression by the gravid uterus is accepted as an important component of effective CPR in this context and methods described to achieve this include manual displacement of the uterus and the application of left lateral tilt . Current guidance from the European Resuscitation Council recommends use of manual displacement with concurrent left lateral tilt of 15�C30��, if feasible , although it gives no specific advice as to how to achieve the latter. A recent national survey of UK obstetric units revealed wide variation in the methods used to achieve left lateral tilt for CPR . These include the use of soft pillows, a pre-formed foam wedge, a pre-formed rigid wedge (similar to the Cardiff wedge ) and resting the mother on the thighs of a kneeling assistant (the ��human wedge�� ). However, there is little published evidence on the effectiveness of any of these techniques and so the optimum method of producing left lateral tilt for CPR is unknown. The aim of this study was to evaluate the four methods described above for achieving left lateral tilt.