Hockey Protective Equipment as a Barrier to High-Quality Cardiopulmonary Resuscitation: A Randomized Simulation Trial

Context Sudden cardiac arrest is a leading cause of sport-related deaths, and survival depends on immediate, high-quality cardiopulmonary resuscitation (CPR). Ice hockey protective equipment presents unique barriers to effective resuscitation, yet little evidence exists to guide clinical practice in this sport. Objectives The primary objective of this study was to evaluate the effect of hockey protective equipment (helmet and shoulder pads) on CPR performance metrics. Secondary objectives were to assess responder fatigue and quantify delays associated with protective equipment removal. Design Crossover study. Setting Laboratory. Patients or Other Participants Twenty-five prehospital care clinicians (18 athletic trainers, 6 emergency medical technicians, and 1 paramedic) participated in this study. Intervention(s) Each participant performed 2 randomized, 4-minute CPR trials on a manikin. In 1 trial, CPR was initiated over hockey protective equipment; in the other, the helmet and shoulder pads were removed before initiating CPR. Main Outcome Measure(s) Measured variables included protective equipment removal time, Borg rating of perceived exertion, and CPR performance metrics (compression depth, chest recoil, ventilation volume, and chest compression fraction [CCF]). Results Descriptive statistics were calculated, and paired-samples t tests compared performance between conditions. Participants averaged 9.8 ± 9.1 years of professional experience, with 8 reporting prior real-life CPR experience. Protective equipment removal time averaged 25.1 seconds (range, 13.1–43.4). Performing CPR over equipment resulted in significantly shallower compressions ( P = .019, d = 0.50), lower CCF ( P = .008, d = 0.58), and reduced ventilation volume ( P < .001, d = 0.77). No significant differences were observed in chest recoil or rating of perceived exertion between conditions. Conclusions Cardiopulmonary resuscitation quality was compromised when performed over hockey protective equipment, particularly in compression depth, CCF, and ventilation volume. Because protective equipment removal required only approximately 25 seconds and did not increase responder fatigue, these findings support early removal of helmets and shoulder pads in hockey athletes experiencing sudden cardiac arrest to optimize resuscitation quality.