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Santos-Folgar M, Fernández-Méndez F, Otero-Agra M, Abelairas-Gómez C, Murciano M, Rodríguez-Núñez A, Barcala-Furelos R. Infant Cardiopulmonary Resuscitation Quality While Walking Fast: A Simulation Study. Pediatr Emerg Care 2022; 38:e973-e977. [PMID: 35100785 DOI: 10.1097/pec.0000000000002505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study focuses on the characteristics (feasibility, resuscitation quality, and physical demands) of infant cardiopulmonary resuscitation (CPR) on the forearm during fast walking, performed by a trained lay rescuer. METHODS Twenty-one university students from the infant education degree participated in a randomized crossover simulation study to compare a standard pediatric CPR versus a walking pediatric CPR with a manikin on the rescue forearm. Each rescuer performed 2 resuscitation tests of 2 minutes on the infant manikin. Cardiopulmonary resuscitation, physiological, and perceived effort variables were measured. RESULTS The quality of chest compressions was higher in standard pediatric CPR than in walking pediatric CPR (72% vs 51%; P < 0.001) and overall CPR quality (59% vs 49%; P = 0.02). There were no differences between ventilation quality (47% vs 46%). Walking pediatric CPR presented a higher percentage of maximum heart rate (52% vs 69%; P < 0.001) and perceived exertion rate (2 vs 5; P < 0.001). Participants walked an average of 197 m during the test. CONCLUSIONS In conclusion, pediatric walking CPR is feasible although it represents a slight quality decrease in a simulation infant CPR setting. The option "CPR while walking fast to a safe place" seems to be suitable in terms of safety both for the victim and the rescuer, as well as CPR quality in special circumstances.
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Affiliation(s)
| | | | | | | | - Manuel Murciano
- Emergency Pediatric Department, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
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Geerts A, Herbelet S, Borremans G, Coppens M, Christiaens-Leysen E, Van de Voorde P. Five vs. two initial rescue breaths during infant basic life support: A manikin study using bag-mask-ventilation. Front Pediatr 2022; 10:1067971. [PMID: 36582512 PMCID: PMC9792851 DOI: 10.3389/fped.2022.1067971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children are more likely to suffer a hypoxic-ischaemic cause for cardiac arrest. Early ventilation may provide an advantage in outcome during paediatric cardiopulmonary resuscitation [CPR]. European Resuscitation Council guidelines recommend five initial rescue breaths [IRB] in infants, stemming from the hypothesis that rescuers might need 5 attempts in order to deliver 2 effective ventilations. This study aimed to verify this hypothesis. METHODS Participants (n = 112, convenience sample) were medical students from the Faculty of Medicine and Health Sciences Ghent University, Belgium. Students were divided into duos and received a 15 min just-in-time training regarding the full CPR-cycle using BMV. Participants then performed five cycles of 2-person CPR. The IRB were given by 1-person BMV, as opposed to a 2-persons technique during the further CPR-cycle. Correct ventilations for the infant were defined as tidal volumes measured (Laerdal® Q-CPR) between 20 and 60 ml, with n = 94 participants included in the analysis. The primary outcome consisted of the difference in the % of medical student duos providing at least 2 effective IRB between 2 and 5 attempts. RESULTS Off all duos, 55,3% provided correct volumes during their first 2 initial ventilations. An increase up to 72,4% was noticed when allowing 5 ventilations. The proportional difference between 2 and 5 IRB allowed was thus significant [17,0%, 95% confidence interval (5.4; 28.0)]. CONCLUSION In this manikin study, 5 IRB attempts during infant CPR with BMV increased the success rate in delivering 2 effective ventilations. Besides, students received training emphasizing the need for 5 initial rescue breaths. This study provides evidence supporting European Resuscitation Council guidelines.
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Affiliation(s)
- Anke Geerts
- Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Sandrine Herbelet
- Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Gautier Borremans
- Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Marc Coppens
- Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium
| | | | - Patrick Van de Voorde
- Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium.,Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium.,Federal Department of Health, EMS Dispatch Centre 112 Flanders, Ghent, Belgium
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Handley AJ. Chest-compression-only after drowning: a call for more research. Resuscitation 2019; 145:194-195. [PMID: 31606396 DOI: 10.1016/j.resuscitation.2019.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
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Fukuda T, Ohashi-Fukuda N, Kobayashi H, Gunshin M, Sera T, Kondo Y, Yahagi N. Public access defibrillation and outcomes after pediatric out-of-hospital cardiac arrest. Resuscitation 2016; 111:1-7. [PMID: 27899017 DOI: 10.1016/j.resuscitation.2016.11.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/03/2016] [Accepted: 11/12/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Use of automated external defibrillators (AEDs) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA). However, there are no conclusive studies that elucidated the effectiveness of public-access defibrillation (PAD) in children. METHODS This was a nationwide, population-based, propensity score-matched study of pediatric OHCA in Japan from 2011 to 2012, based on data from the All-Japan Utstein Registry. We included pediatric OHCA patients (aged 1-17 years) who received bystander cardiopulmonary resuscitation. The primary outcome was a favorable neurological state 1 month after OHCA (defined as a CPC score of 1-2). RESULTS A total of 1193 patients were included in the final cohort; 57 received PAD and 1136 did not. Among 1193 patients, 188 (15.8%) survived with a favorable neurological status 1 month after OHCA. The odds of neurologically favorable survival were significantly higher for patients receiving PAD after adjusting for potential confounders: propensity score matching, OR 3.17 (95% CI 1.40-7.17), and multivariable logistic regression modeling, ORadjusted 5.10 (95% CI 2.01-13.70). Similar findings were observed for the secondary outcomes (i.e., neurologically favorable survival with a CPC score of 1, one-month survival, and prehospital return of spontaneous circulation). In subgroup analyses, there were no significant differences in neurologically favorable survival between the PAD group and non-PAD group in the unwitnessed cohort (ORadjusted 7.76 [0.75-81.90]) or the non-cardiac etiology cohort (ORadjusted 6.65 [0.64-66.24]). CONCLUSIONS PAD was associated with an increased chance of neurologically favorable survival in pediatric OHCA (aged 1-17 years) who received bystander CPR, except for in cases of unwitnessed or non-cardiac etiology.
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Affiliation(s)
- Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Naoko Ohashi-Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroaki Kobayashi
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Stephen M. Ross School of Business at the University of Michigan, 701 Tappan Street, Ann Arbor, MI 48109-1234, USA
| | - Masataka Gunshin
- Department of Disaster Medical Management, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; The Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Toshiki Sera
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yutaka Kondo
- Department of Emergency Medicine, Graduate School of Medicine, University of Ryukyus, 207, Uehara, Nishihara-cho, Okinawa 903-0215, Japan; Division of Acute Care Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Naoki Yahagi
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Understanding and improving low bystander CPR rates: a systematic review of the literature. CAN J EMERG MED 2015; 10:51-65. [DOI: 10.1017/s1481803500010010] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjectives:Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training.Methods:For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites. We performed hand searches and contacted 6 content experts. We reviewed without restriction all communications pertaining to who should learn CPR, what should be taught, when to repeat training, where to give CPR instructions and why people lack the motivation to learn and perform CPR. We used standardized forms to review papers for inclusion, quality and data extraction. We grouped publications by category and classified recommendations using a standardized classification system that was based on level of evidence.Results:We reviewed 2409 articles and selected 411 for complete evaluation. We included 252 of the 411 papers in this systematic review. Differences in their study design precluded a meta-analysis. We classified 22 recommendations; those with the highest scores were 1) 9-1-1 dispatch-assisted CPR instructions, 2) teaching CPR to family members of cardiac patients, 3) Braslow's self-training video, 4) maximizing time spent using manikins and 5) teaching the concepts of ambiguity and diffusion of responsibility. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by laymen and CPR using chest compressions alone.Conclusion:We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates.
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Blevin AE, McDouall SF, Rechner JA, Saunders TA, Barber VS, Young JD, Mason DG. A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children. Anaesthesia 2009; 64:1312-6. [DOI: 10.1111/j.1365-2044.2009.06105.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Durak HI, Certuğ A, Calişkan A, van Dalen J. Basic life support skills training in a first year medical curriculum: six years' experience with two cognitive-constructivist designs. MEDICAL TEACHER 2006; 28:e49-58. [PMID: 16707285 DOI: 10.1080/01421590600617657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
RATIONALE Although the Basic Life Support (BLS) ability of a medical student is a crucial competence, poor BLS training programs have been documented worldwide. Better training designs are needed. This study aims to share detailed descriptions and the test results of two cognitive-constructivist training models for the BLS skills in the first year of medical curriculum. METHOD A BLS skills training module was implemented in the first year curriculum in the course of 6 years (1997-2003). The content was derived from the European Resuscitation Council Guidelines. Initially, a competence-based model was used and was upgraded to a cognitive apprenticeship model in 2000. The main performance-content type that was expected at the end of the course was: competent application of BLS procedures on manikins and peers at an OSCE as well as 60% achievement in a test consisting of 25 MCQ items. A retrospective cohort survey design using exam results and a self-completed anonymous student ratings' questionnaire were used in order to test models. RESULTS Training time for individual students varied from 21 to 29 hours. One thousand seven hundred and sixty students were trained. Fail rates were very low (1.0-2.2%). The students were highly satisfied with the module during the 6 years. CONCLUSION In the first year of the medical curriculum, a competence-based or cognitive apprenticeship model using cognitive-constructivist designs of skills training with 9 hours theoretical and 12-20 hours long practical sessions took place in groups of 12-17 students; medical students reached a degree of competence to sufficiently perform BLS skills on the manikins and their peers. The cognitive-constructivist designs for skills training are associated with high student satisfaction. However, the lack of controls limits the extrapolation of this conclusion.
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Biarent D, Bingham R, Richmond S, Maconochie I, Wyllie J, Simpson S, Nunez AR, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2005. Resuscitation 2005; 67 Suppl 1:S97-133. [PMID: 16321719 DOI: 10.1016/j.resuscitation.2005.10.010] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stevenson AGM, McGowan J, Evans AL, Graham CA. CPR for children: one hand or two? Resuscitation 2005; 64:205-8. [PMID: 15680531 DOI: 10.1016/j.resuscitation.2004.07.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Revised: 07/23/2004] [Accepted: 07/28/2004] [Indexed: 10/26/2022]
Abstract
AIMS Current guidelines for chest compressions in CPR advocate a one handed technique in children (1-8 years old) and a two handed technique in adults (>8 years old). No previous study has examined whether these two techniques generate different compression pressures. This study assesses the relative difference in intrathoracic compression pressures generated by one- and two handed chest compression techniques in a paediatric manikin. METHODS Randomised crossover design. Subjects performed both types of chest compressions on an adapted paediatric resuscitation manikin connected to a pressure transducer and personal computer. Ethical approval was granted. RESULTS A 30 volunteer subjects (9 male, 21 female) participated in the study. Their mean age was 30.8 years (S.D. 8.6), and mean weight was 70.5 kg (S.D. 12.8). The mean compression pressure was 86.6 mmHg (S.D. 13.68) for two handed and 75.1 mmHg (S.D. 12.02) for one handed (P < 0.001, paired t-test). The average peak compression pressure was 133.5 mmHg (S.D. 26.36) for two handed and 116.8 mmHg (S.D. 21.48) for one handed (P = 0.001, paired t-test); 29 found the two handed technique easier to perform. CONCLUSION Two handed chest compression CPR seems to be easier to perform on a paediatric resuscitation manikin and produces significantly higher mean and peak pressures. Further work is needed to determine the comparative effects on children and which technique produces better clinical outcomes.
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von Ungern-Sternberg BS, Erb TO, Reber A, Frei FJ. Opening the upper airway--airway maneuvers in pediatric anesthesia. Paediatr Anaesth 2005; 15:181-9. [PMID: 15725313 DOI: 10.1111/j.1460-9592.2004.01534.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Salam AM, Azzam SB, Numan M, Al Haroob A, Al Musleh AW, Gehani AA. Updates in Pediatrics Basic Life Support:An Evidence-Based Review. Qatar Med J 2003. [DOI: 10.5339/qmj.2003.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The American Heart Association, together with representatives from the International Liaison Committee on Resuscitation (ILCOR), which is made up of leading resuscitation organizations from the Americas, Europe, Southern Africa, Australia, and New Zealand, undertook a series of evidence-based evaluations of the science of resuscitation which culminated in the publication of ’Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care’ in August 2000 tL2). Experts from non-ILCOR organizations from Asia and elsewhere also participated in drawing up the guidelines.
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Affiliation(s)
- A. M. Salam
- 1Department of Cardiology & Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
- 4Department of Qatar Resuscitation Council, Hamad Medical Corporation, Doha, Qatar
| | - S. B. Azzam
- 2Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - M. Numan
- 1Department of Cardiology & Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - A. Al Haroob
- 1Department of Cardiology & Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - A. W. Al Musleh
- 3Department of Accident & Emergency, Hamad Medical Corporation, Doha, Qatar
- 4Department of Qatar Resuscitation Council, Hamad Medical Corporation, Doha, Qatar
| | - A. A. Gehani
- 4Department of Qatar Resuscitation Council, Hamad Medical Corporation, Doha, Qatar
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Hachimi-Idrissi S, Biarent D, Huyghens L. Cardiopulmonary resuscitation in infants and children: new guidelines. Eur J Emerg Med 2002; 9:287-97. [PMID: 12394632 DOI: 10.1097/00063110-200209000-00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S Hachimi-Idrissi
- Department of Critical Care Medicine and Cerebral Resuscitation Research Group, Vrije Universiteit van Brussel (AZ VUB)
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