{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T16:37:01Z","timestamp":1793637421213,"version":"4.5.1"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,12,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Helicopter emergency medical services personnel operating in mountainous terrain are frequently exposed to rapid ascents and provide cardiopulmonary resuscitation (CPR) in the field. The aim of the present trial was to investigate the quality of chest compression only (CCO)\u2010CPR after acute exposure to altitude under repeatable and standardized conditions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Forty\u2010eight helicopter emergency medical services personnel were divided into 12 groups of 4 participants; each group was assigned to perform 5\u00a0minutes of CCO\u2010CPR on manikins at 2 of 3 altitudes in a randomized controlled single\u2010blind crossover design (200, 3000, and 5000\u00a0m) in a hypobaric chamber. Physiological parameters were continuously monitored; participants rated their performance and effort on visual analog scales. Generalized estimating equations were performed for variables of CPR quality (depth, rate, recoil, and effective chest compressions) and effects of time, altitude, carryover, altitude sequence, sex, qualification, weight, preacclimatization, and interactions were analyzed. Our trial showed a time\u2010dependent decrease in chest compression depth (\n              <jats:italic>P<\/jats:italic>\n              =0.036) after 20\u00a0minutes at altitude; chest compression depth was below the recommended minimum of 50\u00a0mm after 60 to 90\u00a0seconds (49 [95% CI, 46\u201352] mm) of CCO\u2010CPR.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">This trial showed a time\u2010dependent decrease in CCO\u2010CPR quality provided by helicopter emergency medical services personnel during acute exposure to altitude, which was not perceived by the providers. Our findings suggest a reevaluation of the CPR guidelines for providers practicing at altitudes of 3000\u00a0m and higher. Mechanical CPR devices could be of help in overcoming CCO\u2010CPR quality decrease in helicopter emergency medical services missions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT04138446.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.021090","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T12:34:36Z","timestamp":1638448476000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Effect of Acute Exposure to Altitude on the Quality of Chest Compression\u2010Only Cardiopulmonary Resuscitation in Helicopter Emergency Medical Services Personnel: A Randomized, Controlled, Single\u2010Blind Crossover Trial"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0295-787X","authenticated-orcid":false,"given":"Anna","family":"V\u00f6gele","sequence":"first","affiliation":[{"name":"Institute of Mountain Emergency Medicine Eurac Research Bolzano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2325-230X","authenticated-orcid":false,"given":"Michiel Jan","family":"van Veelen","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine Eurac Research Bolzano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5406-1998","authenticated-orcid":false,"given":"Tomas","family":"Dal Cappello","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine Eurac Research Bolzano 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Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0138-8724","authenticated-orcid":false,"given":"Martin","family":"Palma","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine Eurac Research Bolzano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5453-8792","authenticated-orcid":false,"given":"Katharina","family":"H\u00fcfner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy and Psychosomatics University Hospital for Psychiatry II Innsbruck Medical University Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2752-6929","authenticated-orcid":false,"given":"Hermann","family":"Brugger","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine Eurac Research Bolzano Italy"},{"name":"International 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