• Michael D Clark, Mikaela P Davis, Meredith A Petschauer, Erik E Swartz, and Jason P Mihalik.
• Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.
• J Athl Train. 2018 Apr 1; 53 (4): 416-422.

Context  Current management recommendations for equipment-laden athletes in sudden cardiac arrest regarding whether to remove protective sports equipment before delivering cardiopulmonary resuscitation are unclear.Objective  To determine the effect of men's lacrosse equipment on chest compression and ventilation quality on patient simulators.Design  Cross-sectional study.Setting  Controlled laboratory.Patients Or Other Participants  Twenty-six licensed athletic trainers (18 women, 8 men; age = 25 ± 7 years; experience = 2.1 ± 1.6 years).Intervention(S)  In a single 2-hour session, participants were block randomized to 3 equipment conditions for compressions and 6 conditions for ventilations on human patient simulators.Main Outcome Measure(S)  Data for chest compressions (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of optimal compressions) and ventilations (ventilation rate, mean ventilation volume, and percentage of ventilations delivering optimal volume) were analyzed within participants across equipment conditions.Results  Keeping the shoulder pads in place reduced mean compression depth (all P values < .001, effect size = 0.835) and lowered the percentages of both correctly released compressions ( P = .02, effect size = 0.579) and optimal-depth compressions (all P values < .003, effect size = 0.900). For both the bag-valve and pocket masks, keeping the chinstrap in place reduced mean ventilation volume (all P values < .001, effect size = 1.323) and lowered the percentage of optimal-volume ventilations (all P values < .006, effect size = 1.038). Regardless of equipment, using a bag-valve versus a pocket mask increased the ventilation rate (all P values < .003, effect size = 0.575), the percentage of optimal ventilations (all P values < .002, effect size = 0.671), and the mean volume ( P = .002, effect size = 0.598) across all equipment conditions.Conclusions  For a men's lacrosse athlete who requires cardiopulmonary resuscitation, the shoulder pads should be lifted or removed to deliver chest compressions. The facemask and chinstrap, or the entire helmet, should be removed to deliver ventilations, preferably with a bag-valve mask.

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