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Pireddu R, Ristagno G, Gianquintieri L, Bonora R, Pagliosa A, Andreassi A, Sechi GM, Signorelli C, Stirparo G. Out-of-Hospital Cardiac Arrest in the Paediatric Patient: An Observational Study in the Context of National Regulations. J Clin Med 2024; 13:3133. [PMID: 38892845 PMCID: PMC11172461 DOI: 10.3390/jcm13113133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: Cardiac arrest results in a high death rate if cardiopulmonary resuscitation and early defibrillation are not performed. Mortality is strongly linked to regulations, in terms of prevention and emergency-urgency system organization. In Italy, training of lay rescuers and the presence of defibrillators were recently made mandatory in schools. Our analysis aims to analyze Out-of-Hospital Cardiac Arrest (OHCA) events in pediatric patients (under 18 years old), to understand the epidemiology of this phenomenon and provide helpful evidence for policy-making. Methods: A retrospective observational analysis was conducted on the emergency databases of Lombardy Region, considering all pediatric OHCAs managed between 1 January 2016, and 31 December 2019. The demographics of the patients and the logistics of the events were statistically analyzed. Results: The incidence in pediatric subjects is 4.5 (95% CI 3.6-5.6) per 100,000 of the population. School buildings and sports facilities have relatively few events (1.9% and 4.4%, respectively), while 39.4% of OHCAs are preventable, being due to violent accidents or trauma, mainly occurring on the streets (23.2%). Conclusions: Limiting violent events is necessary to reduce OHCA mortality in children. Raising awareness and giving practical training to citizens is a priority in general but specifically in schools.
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Affiliation(s)
- Roberta Pireddu
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milano, Italy
| | - Giuseppe Ristagno
- Department of Medical and Surgical Pathophysiology and Transplantation, University of Milano, 20133 Milano, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20090 Milano, Italy
| | - Lorenzo Gianquintieri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milano, Italy
| | - Rodolfo Bonora
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
| | - Andrea Pagliosa
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
| | - Aida Andreassi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
| | | | - Carlo Signorelli
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milano, Italy
| | - Giuseppe Stirparo
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milano, Italy
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
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Ong GY, Kurosawa H, Ikeyama T, Park JD, Katanyuwong P, Reyes OC, Wu ET, Hon KLE, Maconochie IK, Shepard LN, Nadkarni VM, Ng KC. Comparison of paediatric basic life support guidelines endorsed by member councils of Resuscitation Council of Asia. Resusc Plus 2023; 16:100506. [PMID: 38033347 PMCID: PMC10685309 DOI: 10.1016/j.resplu.2023.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
Background Paediatric cardiac arrest outcomes, especially for infants, remain poor. Due to different training, resource differences, and historical reasons, paediatric cardiac arrest algorithms for various Asia countries vary. While there has been a common basic life support algorithm for adults by the Resuscitation Council of Asia (RCA), there is no common RCA algorithm for paediatric life support.We aimed to review published paediatric life support guidelines from different Asian resuscitation councils. Methods Pubmed and Google Scholar search were performed for published paediatric basic and advanced life support guidelines from January 2015 to June 2023. Paediatric representatives from the Resuscitation Council of Asia were sought and contacted to provide input from September 2022 till June 2023. Results While most of the components of published paediatric life support algorithms of Asian countries are similar, there are notable variations in terms of age criteria for recommended use of adult basic life support algorithms in the paediatric population less than 18 years old, recommended paediatric chest compression depth targets, ventilation rates post-advanced airway intra-arrest, and first defibrillation dose for shockable rhythms in paediatric cardiac arrest. Conclusion This was an overview and mapping of published Asian paediatric resuscitation algorithms. It highlights similarities across paediatric life support guidelines in Asian countries. There were some differences in components of paediatric life support which highlight important knowledge gaps in paediatric resuscitation science. The minor differences in the paediatric life support guidelines endorsed by the member councils may provide a framework for prioritising resuscitation research and highlight knowledge gaps in paediatric resuscitation.
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Affiliation(s)
- Gene Y. Ong
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Hiroshi Kurosawa
- Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children’s Hospital, Japan
| | - Takanari Ikeyama
- Center for Pediatric Emergency and Critical Care Medicine, Aichi Children's Health and Medical Center, Japan
- Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Japan
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Poomiporn Katanyuwong
- Department of Pediatrics, Division of Cardiology, Department of Pediatric, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Olivia C.F. Reyes
- Division of Pediatric Emergency Medicine, Philippine General Hospital, Manila, Philippines
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan
| | - Kam Lun Ellis Hon
- Department of Paediatrics, CUHKMC, The Chinese University of Hong Kong, Hong Kong
- Pediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
| | - Ian K. Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, London, United Kingdom
| | - Lindsay N. Shepard
- Department of Anesthesiology, Critical Care, and Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, United States of America
| | - Vinay M. Nadkarni
- Department of Anesthesiology, Critical Care, and Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, United States of America
| | - Kee Chong Ng
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
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Ong GY, Chen ZJ, Niles DE, Srinivasan V, Sen AI, Skellett S, Ikeyama T, Del Castillo J, Berg RA, Nadkarni VM. Poor Concordance of One-Third Anterior-Posterior Chest Diameter Measurements With Absolute Age-Specific Chest Compression Depth Targets in Pediatric Cardiac Arrest Patients. J Am Heart Assoc 2023:e028418. [PMID: 37421276 PMCID: PMC10382104 DOI: 10.1161/jaha.122.028418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 06/08/2023] [Indexed: 07/10/2023]
Abstract
Background Current pediatric cardiac arrest guidelines recommend depressing the chest by one-third anterior-posterior diameter (APD), which is presumed to equate to absolute age-specific chest compression depth targets (4 cm for infants and 5 cm for children). However, no clinical studies during pediatric cardiac arrest have validated this presumption. We aimed to study the concordance of measured one-third APD with absolute age-specific chest compression depth targets in a cohort of pediatric patients with cardiac arrest. Methods and Results This was a retrospective observational study from a multicenter, pediatric resuscitation quality collaborative (pediRES-Q [Pediatric Resuscitation Quality Collaborative]) from October 2015 to March 2022. In-hospital patients with cardiac arrest ≤12 years old with APD measurements recorded were included for analysis. One hundred eighty-two patients (118 infants >28 days old to <1 year old, and 64 children 1 to 12 years old) were analyzed. The mean one-third APD of infants was 3.2 cm (SD, 0.7 cm), which was significantly smaller than the 4 cm target depth (P<0.001). Seventeen percent of the infants had one-third APD measurements within the 4 cm ±10% target range. For children, the mean one-third APD was 4.3 cm (SD, 1.1 cm). Thirty-nine percent of children had one-third APD within the 5 cm ±10% range. Except for children 8 to 12 years old and overweight children, the measured mean one-third APD of the majority of the children was significantly smaller than the 5 cm depth target (P<0.05). Conclusions There was poor concordance between measured one-third APD and absolute age-specific chest compression depth targets, particularly for infants. Further study is needed to validate current pediatric chest compression depth targets and evaluate the optimal chest compression depth to improve cardiac arrest outcomes. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02708134.
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Affiliation(s)
- Gene Y Ong
- KK Women's and Children's Hospital Singapore
- Duke-NUS Graduate Medical School Singapore
| | - Zhao Jin Chen
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Saw Swee Hock School of Public Health National University of Singapore Singapore
| | - Dana E Niles
- Department of Anesthesiology, Critical Care, and Pediatrics, Children's Hospital of Philadelphia University of Pennsylvania School of Medicine Philadelphia PA USA
| | - Vijay Srinivasan
- Department of Anesthesiology, Critical Care, and Pediatrics, Children's Hospital of Philadelphia University of Pennsylvania School of Medicine Philadelphia PA USA
| | - Anita I Sen
- New York-Presbyterian Morgan Stanley Children's Hospital New York NY USA
| | - Sophie Skellett
- Department of Paediatric Intensive Care Great Ormond Street Hospital for Children NHS Foundation Trust London United Kingdom
| | - Takanari Ikeyama
- Center for Pediatric Emergency and Critical Care Medicine Aichi Children's Health and Medical Center Obu Aichi Japan
- Comprehensive Pediatric Medicine Nagoya University Graduate School of Medicine Nagoya Japan
| | | | - Robert A Berg
- Department of Anesthesiology, Critical Care, and Pediatrics, Children's Hospital of Philadelphia University of Pennsylvania School of Medicine Philadelphia PA USA
| | - Vinay M Nadkarni
- Department of Anesthesiology, Critical Care, and Pediatrics, Children's Hospital of Philadelphia University of Pennsylvania School of Medicine Philadelphia PA USA
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Brown SR, Frazier M, Roberts J, Wolfe H, Tegtmeyer K, Sutton R, Dewan M. CPR Quality and Outcomes After Extracorporeal Life Support for Pediatric In-Hospital Cardiac Arrest. Resuscitation 2023:109874. [PMID: 37327853 DOI: 10.1016/j.resuscitation.2023.109874] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/19/2023] [Accepted: 05/28/2023] [Indexed: 06/18/2023]
Abstract
AIM of Study: To determine outcomes in pediatric patients who had an in-hospital cardiac arrest and subsequently received extracorporeal cardiopulmonary resuscitation (ECPR). Our secondary objective was to identify cardiopulmonary resuscitation (CPR) event characteristics and CPR quality metrics associated with survival after ECPR. METHODS Multicenter retrospective cohort study of pediatric patients in the pediRES-Q database who received ECPR after in-hospital cardiac arrest between July 1, 2015 and June 2, 2021. Primary outcome was survival to ICU discharge. Secondary outcomes were survival to hospital discharge and favorable neurologic outcome at ICU and hospital discharge. RESULTS Among 124 patients included in this study, median age was 0.9 years (IQR 0.2-5) and the majority of patients had primarily cardiac disease (92 patients, 75%). Survival to ICU discharge occurred in 61/120 (51%) patients, 36/61 (59%) of whom had favorable neurologic outcome. No demographic or clinical variables were associated with survival after ECPR. CONCLUSION In this multicenter retrospective cohort study of pediatric patients who received ECPR for IHCA we found a high rate of survival to ICU discharge with good neurologic outcome.
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Affiliation(s)
- Stephanie R Brown
- Section of Pediatric Critical Care Medicine, Oklahoma Children's Hospital, Oklahoma City, OK, USA; Division of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Maria Frazier
- Division of Pediatric Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joan Roberts
- Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Heather Wolfe
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ken Tegtmeyer
- Division of Pediatric Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Robert Sutton
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Maya Dewan
- Division of Pediatric Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Cheng A, Davidson J, Wan B, St-Onge-St-Hilaire A, Lin Y. Data-informed debriefing for cardiopulmonary arrest: A randomized controlled trial. Resusc Plus 2023; 14:100401. [PMID: 37260809 PMCID: PMC10227448 DOI: 10.1016/j.resplu.2023.100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023] Open
Abstract
Aim To determine if data-informed debriefing, compared to a traditional debriefing, improves the process of care provided by healthcare teams during a simulated pediatric cardiac arrest. Methods We conducted a prospective, randomized trial. Participants were randomized to a traditional debriefing or a data-informed debriefing supported by a debriefing tool. Participant teams managed a 10-minute cardiac arrest simulation case, followed by a debriefing (i.e. traditional or data-informed), and then a second cardiac arrest case. The primary outcome was the percentage of overall excellent CPR. The secondary outcomes were compliance with AHA guidelines for depth and rate, chest compression (CC) fraction, peri-shock pause duration, and time to critical interventions. Results A total of 21 teams (84 participants) were enrolled, with data from 20 teams (80 participants) analyzed. The data-informed debriefing group was significantly better in percentage of overall excellent CPR (control vs intervention: 53.8% vs 78.7%; MD 24.9%, 95%CI: 5.4 to 44.4%, p = 0.02), guideline-compliant depth (control vs. intervention: 60.4% vs 85.8%, MD 25.4%, 95%CI: 5.5 to 45.3%, p = 0.02), CC fraction (control vs intervention: 88.6% vs 92.6, MD 4.0%, 95%CI: 0.5 to 7.4%, p = 0.03), and peri-shock pause duration (control vs intervention: 5.8 s vs 3.7 s, MD -2.1 s, 95%CI: -3.5 to -0.8 s, p = 0.004) compared to the control group. There was no significant difference in time to critical interventions between groups. Conclusion When compared with traditional debriefing, data-informed debriefing improves CPR quality and reduces pauses in CPR during simulated cardiac arrest, with no improvement in time to critical interventions.
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Affiliation(s)
- Adam Cheng
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, KidSIM-ASPIRE Research Program, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada
| | - Jennifer Davidson
- KidSIM Simulation Program, Alberta Children’s Hospital, University of Calgary, Canada
| | - Brandi Wan
- KidSIM Simulation Program, Alberta Children’s Hospital, University of Calgary, Canada
| | | | - Yiqun Lin
- KidSIM Simulation Program, Alberta Children’s Hospital, University of Calgary, Canada
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Mir T, Shafi OM, Uddin M, Nadiger M, Sibghat Tul Llah F, Qureshi WT. Pediatric Cardiac Arrest Outcomes in the United States: A Nationwide Database Cohort Study. Cureus 2022; 14:e26505. [PMID: 35923483 PMCID: PMC9339595 DOI: 10.7759/cureus.26505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background Knowledge about the causes and outcomes of pediatric cardiac arrest in the emergency department is limited. The aim of our study was to evaluate the characteristics and outcomes of pediatric cardiac arrest in the emergency department (EDCA) and inpatient (IPCA) settings in the United States using a large database designed to provide nationwide estimates. Methods We performed a retrospective cohort study using the Nationwide Emergency Department Sample (NEDS), a database that includes both ED and inpatient encounters. The NEDS was analyzed for episodes of cardiac arrest between 2016-2018 in patients aged ≤18 years. Patients with cardiac arrest were identified using the International Classification of Diseases, 10th revision codes. Results A total of 15,348 pediatric cardiac arrest events with cardiopulmonary resuscitation were recorded, of which 13,239 had EDCA and 2,109 had IPCA. A lower survival rate of 19% was observed for EDCA compared to 40.4% for IPCA. While more than half of the EDCA events had no associated diagnoses, trauma (15.6%), respiratory failure (5%), asphyxiation (2.7%), acidosis (2.4%), and ventricular arrhythmia (1.4%) were associated with the remaining events. In comparison, the most frequently associated diagnoses for IPCA were respiratory failure (75.8%), acidosis (43.9%), acute kidney injury (27.2%), trauma (27.1%), and sepsis (22.5%). Conclusions Survival rates for EDCA were less than half of that for IPCA. The low survival rates along with the distinctive characteristics of EDCA events suggest the need for further research in this area to identify remediable factors and improve survival.
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Takei Y, Miyazaki O, Matsubara K, Suzuki S, Muramatsu Y, Fukunaga M, Akahane M. [Scientific Research Group Report: Nationwide Survey on Radiation Exposure of Pediatric CT Examination in Japan (2018)]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:372-380. [PMID: 35236791 DOI: 10.6009/jjrt.2022-1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To understand the latest pediatric computed tomography (CT) exposure required for the revision of national DRLs. METHODS A questionnaire was sent to 409 facilities where the members of the Japanese Society of Radiological Technology and the Japanese Society of Pediatric Radiology are enrolled. We investigated the imaging conditions, CTDIvol, and DLP of the pediatric head, chest, and abdominal CT examinations. RESULTS In all, 43 facilities (11%) responded to our survey. multi detector-row CT (MDCT) systems were available in all surveyed facilities. More than 98% of the MDCT systems had more than 64 detector rows. The CTDIvol of all CT protocols was lower than the NDRL due to the progress of updating to MDCTs with radiation exposure reduction functions such as an iterative reconstruction, but the DLP of head and abdominal CT protocols of some age group were higher than NDRL. CONCLUSION It is necessary to review the imaging protocol with the attending physician and radiologist and consider further optimization of medical exposure.
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Affiliation(s)
- Yasutaka Takei
- Department of Radiological Technology, Faculty of Medical Science and Technology, Kawasaki University of Medical Welfare
| | - Osamu Miyazaki
- Department of Radiology, National Center for Child Health and Development
| | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Shoichi Suzuki
- Department of Radiological Technology, Faculty of Medical Sciences, Fujita Health University
| | | | - Masaaki Fukunaga
- Department of Radiological Technology, Kurashiki Central Hospital
| | - Masaaki Akahane
- Department of Medicine, International University of Health and Welfare
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Airway Management During Cardiopulmonary Resuscitation. CURRENT ANESTHESIOLOGY REPORTS 2022; 12:363-372. [PMID: 35370477 PMCID: PMC8951653 DOI: 10.1007/s40140-022-00527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/02/2022]
Abstract
Purpose of the review Recent Findings Summary
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Effect of rotating providers on chest compression performance during simulated neonatal cardiopulmonary resuscitation. PLoS One 2022; 17:e0265072. [PMID: 35286358 PMCID: PMC8920209 DOI: 10.1371/journal.pone.0265072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/22/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
Simulation studies in adults and pediatrics demonstrate improvement in chest compression (CCs) quality as providers rotate every two minutes. There is paucity of studies in neonates on this matter. This study hypothesized that frequent rotation while performing CCs improves provider performance and decreases fatigue.
Study design
Prospective randomized, observational crossover study where 51 providers performed 3:1 compression-ventilation CPR as a pair on a term manikin. Participants performed CCs as part of 3 simulation models, rotating every 3, 5 and 10 minutes. Data on various CC metrics were collected. Participant vitals were recorded at multiple points during the simulation and participants reported their level of fatigue at completion of simulation.
Results
No statistically significant difference was seen in any of the compression metrics. However, differences in the providers’ fatigue scores were statistically significant.
Conclusion
CC performance metrics did not differ significantly, however, providers’ vital signs and self-reported fatigue scores significantly increased with longer CC durations.
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Daniş F, Kudu E. The evolution of cardiopulmonary resuscitation: Global productivity and publication trends. Am J Emerg Med 2022; 54:151-164. [DOI: 10.1016/j.ajem.2022.01.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/19/2022] [Accepted: 01/30/2022] [Indexed: 01/03/2023] Open
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Tsou JY, Kao CL, Tu YF, Hong MY, Su FC, Chi CH. Biomechanical analysis of force distribution in one-handed and two-handed child chest compression- a randomized crossover observational study. BMC Emerg Med 2022; 22:13. [PMID: 35065602 PMCID: PMC8783411 DOI: 10.1186/s12873-022-00566-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background Even force distribution would generate efficient external chest compression (ECC). Little research has been done to compare force distribution between one-hand (OH) and two-handed (TH) during child ECC. Therefore, this study was to investigate force distribution, rescuer perceived fatigue and discomfort/pain when applying OH and TH ECC in children. Methods Crossover manikin study. Thirty-five emergency department registered nurses performed lone rescuer ECC using TH and OH techniques, each for 2 min at a rate of at least 100 compressions/min. A Resusci Junior Basic manikin equipped with a MatScan pressure measurement system was used to collect data. The perceived exertion scale (modified Borg scale) and numerical rating scale (NRS) was applied to evaluate the fatigue and physical pain of delivering chest compressions. Results The maximum compression force (kg) delivered was 56.58 ± 13.67 for TH and 45.12 ± 7.90 for OH ECC (p < 0.001). The maximum-minimum force difference force delivered by TH and OH ECC was 52.24 ± 13.43 and 41.36 ± 7.57, respectively (p < 0.001). The mean caudal force delivered by TH and OH ECC was 29.45 ± 16.70 and 34.03 ± 12.01, respectively (p = 0.198). The mean cranial force delivered by TH and OH ECC was 27.13 ± 11.30 and 11.09 ± 9.72, respectively (p < 0.001). The caudal–cranial pressure difference delivered by TH and OH ECC was 19.14 ± 15.96 and 26.94 ± 14.48, respectively (p = 0.016). The perceived exertion and NRS for OH ECC was higher than that of the TH method (p < 0.001, p = 0.004, respectively). Conclusions The TH method produced greater compression force, had more efficient compression, and delivered a more even force distribution, and produced less fatigue and physical pain in the rescuer than the OH method. Trial registration The Cheng Kung University Institutional Review Board A-ER-103-387. http://nckuhirb.med.ncku.edu.tw/sitemap.php
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Ong GYK, Ang AJF, Chen ZJ, Chan YH, Tang PH, Fong ESS, Tan JY, Aurangzeb AS, Pek JH, Maconochie I, Ng KC, Nadkarni V. Should paediatric chest compression depth targets consider body habitus? - A chest computed tomography imaging study. Resusc Plus 2022; 9:100202. [PMID: 35118434 PMCID: PMC8792407 DOI: 10.1016/j.resplu.2022.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 01/03/2023] Open
Abstract
AIM This study explored how body habitus in the paediatric population might potentially affect the use of one-third external anterior-posterior (APD) diameter when compared to age-appropriate absolute chest compression depth targets. It also explored how body habitus could potentially affect the relationship between one-third external and internal APD (compressible space) and if body habitus indices were independent predictors of internal APD at the lower half of the sternum. METHODS This was a secondary analysis of a retrospective study of chest computed tomography (CT) scans of infants and children (>24-hours-of-life to less-than-18-years-old) from 2005 to 2017. Patients' scan images were reviewed for internal and external APDs at the mid-point of the lower half of the sternum. Body habitus and epidemiological data were extracted from the electronic medical records. RESULTS Chest CT scans of 193 infants and 398 children were evaluated. There was poor concordance between one-third external APD measurements and age-specific absolute chest compression depth targets, especially in infants and overweight/obese adolescents. There was a co-dependent relationship between one-third external APD and internal APD measurements. Overweight/obese children's and adolescents' internal and external APDs were significant different from the normal/underweight groups. Body-mass-index (BMI) of children and adolescents (p = 0.009), but not weight-for-length (WFL) of infants (p = 0.511), was an independent predictor of internal APD at the compression landmark. CONCLUSION This study demonstrated correlations between external and internal APDs which were affected by BMI but not WFL (infants). Clinical studies are needed to validate current chest compression guidelines especially for infants and overweight/obese adolescents.(250 words).
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Affiliation(s)
- Gene Yong-Kwang Ong
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore,Duke-NUS Medical School, Singapore,Corresponding author at: Children’s Emergency, KK Women’s and Children’s Hospital (KKH), Singapore.
| | | | - Zhao Jin Chen
- Biostatistics Unit, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, National University of Singapore, Singapore
| | - Phua Hwee Tang
- Department of Diagnostic Imaging, KK Women’s and Children’s Hospital, Singapore
| | | | - Jun Yuan Tan
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore
| | | | - Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Ian Maconochie
- Accident and Emergency Service, St Mary’s Hospital, London, United Kingdom,Department of Medicine, Imperial College, Kensington, London, United Kingdom
| | - Kee Chong Ng
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore,Duke-NUS Medical School, Singapore
| | - Vinay Nadkarni
- Center for Pediatric Resuscitation, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, United States of America
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Michel J, Ilg T, Neunhoeffer F, Hofbeck M, Heimberg E. Implementation and Evaluation of Resuscitation Training for Childcare Workers. Front Pediatr 2022; 10:824673. [PMID: 35295697 PMCID: PMC8918630 DOI: 10.3389/fped.2022.824673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Children spend a large amount of time in daycare centers or schools. Therefore, it makes sense to train caregivers well in first-aid measures in children. The aim of this study is to evaluate whether a multimodal resuscitation training for childcare workers can teach adherence to resuscitation guidelines in a sustainable way. MATERIALS AND METHODS Caregivers at a daycare center who had previously completed a first-aid course received a newly developed multimodal resuscitation training in small groups of 7-8 participants by 3 AHA certified PALS instructors and providers. The 4-h focused retraining consisted of a theoretical component, expert modeling, resuscitation exercises on pediatric manikins (Laerdal Resusci Baby QCPR), and simulated emergency scenarios. Adherence to resuscitation guidelines was compared before retraining, immediately after training, and after 6 months. This included evaluation of chest compressions per round, chest compression rate, compression depth, full chest recoil, no-flow time, and success of rescue breaths. For better comparability and interpretation of the results, the parameters were evaluated both separately and summarized in a resuscitation score reflecting the overall adherence to the guidelines. RESULTS A total of 101 simulated cardiopulmonary resuscitations were evaluated in 39 participants. In comparison to pre-retraining, chest compressions per round (15.0 [10.0-29.0] vs. 30.0 [30.0-30.0], p < 0.001), chest compression rate (100.0 [75.0-120.0] vs. 112.5 [105-120.0], p < 0.001), correct compression depth (6.7% [0.0-100.0] vs. 100.0% [100.0-100.0], p < 0.001), no-flow time (7.0 s. [5.0-9.0] vs. 4.0 s. [3.0-5.0], p < 0.001), success of rescue breaths (0.0% [0.0-0.0] vs. 100.0% [100.0-100.0], p < 0.001), and resuscitation score were significantly improved immediately after training (3.9 [3.2-4.9] vs. 6.3 [5.6-6.7], p < 0.001). At follow-up, there was no significant change in chest compression rate and success of rescue breaths. Chest compressions per round (30.0 [15.0-30.0], p < 0.001), no-flow time (5.0 s. [4.0-8.0], p < 0.001), compression depths (100.0% [96.7-100.0], p < 0.001), and resuscitation score worsened again after 6 months (5.7 [4.7-6.4], p = 0.03). However, the results were still significantly better compared to pre-retraining. CONCLUSION Our multimodal cardiopulmonary resuscitation training program for caregivers is effective to increase the resuscitation performance immediately after training. Although the effect diminishes after 6 months, adherence to resuscitation guidelines was significantly better than before retraining.
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Affiliation(s)
- Jörg Michel
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Tim Ilg
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Ellen Heimberg
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
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14
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Hirayama Y, Ito Y, Ogawa M, Fukushima Y, Ikeyama T. Quantitative assessment of chest compression techniques on an infant manikin. Pediatr Int 2022; 64:e15118. [PMID: 35616194 DOI: 10.1111/ped.15118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/01/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Current cardiopulmonary resuscitation (CPR) guidelines recommend the two-finger technique (TFT) of chest compression (CC) in infants for a single rescuer. We hypothesized that healthcare providers cannot achieve adequate CC depth with TFT, even if using real-time visual feedback (RVF). METHODS This was a cross-over study, randomizing participants to perform three sets of 2-min continuous CC, comparing (i) TFT with RVF, (ii) the one-hand technique (OHT) without RVF, and (iii) OHT with RVF. A standard CPR trainer manikin of a 3-month-old infant and a monitor/defibrillator that displays and records the quantitative CC quality were used. We set a target compression depth of 40-50 mm and a target compression rate of 100-120/min. Data were analyzed using the Friedman test and Bonferroni correction. Statistical significance was defined as P-value of< 0.05. RESULTS Fifty-nine healthcare providers participated in the study. The mean compression depth was 24 mm (interquartile range [IQR], 22-26 mm) in TFT with RVF and 43 mm (IQR, 38-48 mm) in OHT without RVF, P < 0.001. The proportion of adequate CC depth was 0% (IQR, 0-0%) in TFT with RVF, 22% (IQR, 5-54%) in OHT without RVF, and 62% (IQR, 29-83%) in OHT with RVF. The mean compression rate was within the target range in all three techniques. CONCLUSIONS The TFT cannot produce the CC depth that meets the recommendation of the current CPR guidelines for an infant with RVF, whereas the OHT does.
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Affiliation(s)
- Yuji Hirayama
- Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Yurie Ito
- Division of Pediatric Emergency Medicine, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Mariko Ogawa
- Nursing Department, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Yasuhiro Fukushima
- Nursing Department, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Takanari Ikeyama
- Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
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15
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Derinoz-Guleryuz O, Uysal-Yazici M, Udurgucu M, Karacan C, Akça H, Ongun EA, Ekinci F, Duman M, Akça-Çaglar A, Vatansever G, Bilen S, Uysalol M, Akcan-Yıldız L, Saz EU, Bal A, Piskin E, Sahin S, Kurt F, Anil M, Besli E, Alakaya M, Gültekingil A, Yılmaz R, Temel-Koksoy O, Kesici S, Akcay N, Cebisli E, Emeksiz S, Kılınc MA, Köker A, Çoban Y, Erkek N, Gurlu R, Eksi-Alp E, Apa H. The skills of defibrillation practice and certified life-support training in the healthcare providers in Turkey. Int J Clin Pract 2021; 75:e14978. [PMID: 34669998 DOI: 10.1111/ijcp.14978] [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] [Received: 02/19/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022] Open
Abstract
AIM OF THE STUDY Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. METHODS This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. RESULTS A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). CONCLUSIONS The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.
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Affiliation(s)
| | - Mutlu Uysal-Yazici
- Department of Pediatric Intensive Care, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Muhammed Udurgucu
- Department of Pediatric Intensive Care, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Candemir Karacan
- Department of Pediatric Emergency, Dr. Sami Ulus Maternity and Children Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Halise Akça
- Department of Pediatric Emergency, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ebru Atike Ongun
- Department of Pediatric Intensive Care, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Faruk Ekinci
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Murat Duman
- Department of Pediatric Emergency, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ayla Akça-Çaglar
- Department of Pediatric Emergency, Dr. Sami Ulus Maternity and Children Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Goksel Vatansever
- Department of Pediatric Emergency, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sevcan Bilen
- Department of Pediatric Emergency, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Metin Uysalol
- Department of Pediatric Emergency, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Leman Akcan-Yıldız
- Department of Pediatric Emergency, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Eylem Ulas Saz
- Department of Pediatric Emergency, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Alkan Bal
- Department of Pediatric Emergency, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Etem Piskin
- Department of Pediatric Intensive Care, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Sabiha Sahin
- Department of Pediatric Emergency, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey
| | - Funda Kurt
- Department of Pediatric Emergency, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Murat Anil
- Department of Pediatric Emergency, Faculty of Medicine, İzmir Demokrasi University, Izmir, Turkey
| | - Esen Besli
- Department of Pediatric Emergency, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Alakaya
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ayse Gültekingil
- Department of Pediatric Emergency, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Resul Yılmaz
- Department of Pediatric Intensive Care, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Ozlem Temel-Koksoy
- Department of Pediatric Intensive Care, Konya Training and Research Hospital, Konya, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nihal Akcay
- Department of Pediatric Intensive Care, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Erdem Cebisli
- Department of Pediatric Intensive Care, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Serhat Emeksiz
- Department of Pediatric Intensive Care, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Mehmet Arda Kılınc
- Department of Pediatric Intensive Care, Diyarbakir Children Hospital, Diyarbakir, Turkey
| | - Alper Köker
- Department of Pediatric Intensive Care, Hatay State Hospital, Hatay, Turkey
| | - Yasemin Çoban
- Department of Pediatric Intensive Care, Hatay State Hospital, Hatay, Turkey
| | - Nilgün Erkek
- Department of Pediatric Emergency, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ramazan Gurlu
- Department of Pediatric Emergency, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Emel Eksi-Alp
- Department of Pediatric Emergency, İstanbul University, Istanbul, Turkey
| | - Hursit Apa
- Department of Pediatric Emergency, Dr. Behçet Uz Children's Hospital, University of Health Sciences, Izmir, Turkey
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Doroba JE. NRP Versus PALS for Infants Outside the Delivery Room: Not If, but When? Crit Care Nurse 2021; 41:22-27. [PMID: 34851384 DOI: 10.4037/ccn2021339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Both the Neonatal Resuscitation Program and Pediatric Advanced Life Support guidelines can be used for infants requiring cardiopulmonary resuscitation outside the delivery room. Each set of guidelines has supporting algorithms for resuscitation; however, there are no current recommendations for transitioning older infants outside the delivery room. OBJECTIVE To provide background information on the algorithms in the Neonatal Resuscitation Program and Pediatric Advanced Life Support guidelines and to discuss the role that nurses and advanced practice nurses play in advancing scientific research on resuscitation. CONTENT COVERED Summaries of both sets of guidelines, differences in practices, and recommendations for practice changes will be discussed. DISCUSSION Provider preference and unit practice determine which guidelines are used for infants outside the delivery room. Providers in pediatric intensive care units and pediatric cardiac intensive care units often use the Pediatric Advanced Life Support guidelines, whereas providers in neonatal intensive care units use the Neonatal Resuscitation Program guidelines for infants of the same age. The variation in resuscitation practices for infants outside the delivery room can negatively affect resuscitation outcomes.
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Affiliation(s)
- Jaime Esbensen Doroba
- Jaime Esbensen Doroba is a nurse practitioner in the pediatric cardiac intensive care unit at The Johns Hopkins Hospital, Baltimore, Maryland
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17
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Cioccari G, Sica da Rocha T, Piva JP. Two-Thumb Technique Is Superior to Two-Finger Technique in Cardiopulmonary Resuscitation of Simulated Out-of-Hospital Cardiac Arrest in Infants. J Am Heart Assoc 2021; 10:e018050. [PMID: 34612083 PMCID: PMC8751903 DOI: 10.1161/jaha.120.018050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background To compare the 2‐finger and 2‐thumb chest compression techniques on infant manikins in an out‐of‐hospital setting regarding efficiency of compressions, ventilation, and rescuer pain and fatigue. Methods and Results In a randomized crossover design, 78 medical students performed 2 minutes of cardiopulmonary resuscitation with mouth‐to‐nose ventilation at a 30:2 rate on a Resusci Baby QCPR infant manikin (Laerdal, Stavanger, Norway), using a barrier device and the 2‐finger and 2‐thumb compression techniques. Frequency and depth of chest compressions, proper hand position, complete chest recoil at each compression, hands‐off time, tidal volume, and number of ventilations were evaluated through manikin‐embedded SkillReporting software. After the interventions, standard Likert questionnaires and analog scales for pain and fatigue were applied. The variables were compared by a paired t‐test or Wilcoxon test as suitable. Seventy‐eight students participated in the study and performed 156 complete interventions. The 2‐thumb technique resulted in a greater depth of chest compressions (42 versus 39.7 mm; P<0.01), and a higher percentage of chest compressions with adequate depth (89.5% versus 77%; P<0.01). There were no differences in ventilatory parameters or hands‐off time between techniques. Pain and fatigue scores were higher for the 2‐finger technique (5.2 versus 1.8 and 3.8 versus 2.6, respectively; P<0.01). Conclusions In a simulation of out‐of‐hospital, single‐rescuer infant cardiopulmonary resuscitation, the 2‐thumb technique achieves better quality of chest compressions without interfering with ventilation and causes less rescuer pain and fatigue.
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Affiliation(s)
- Giani Cioccari
- Department of Pediatrics Universidade Federal da Fronteira Sul Passo Fundo Brazil
| | - Tais Sica da Rocha
- Department of Pediatrics Universidade Federal do Rio Grande do Sul Porto Alegre Brazil.,Department of Pediatric Critical Care Hospital de Clínicas de Porto Alegre Brazil
| | - Jefferson Pedro Piva
- Department of Pediatrics Universidade Federal do Rio Grande do Sul Porto Alegre Brazil.,Department of Pediatric Critical Care Hospital de Clínicas de Porto Alegre Brazil
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Vali P, Lesneski A, Hardie M, Alhassen Z, Chen P, Joudi H, Sankaran D, Lakshminrusimha S. Continuous chest compressions with asynchronous ventilations increase carotid blood flow in the perinatal asphyxiated lamb model. Pediatr Res 2021; 90:752-758. [PMID: 33469187 PMCID: PMC8286977 DOI: 10.1038/s41390-020-01306-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND The neonatal resuscitation program (NRP) recommends interrupted chest compressions (CCs) with ventilation in the severely bradycardic neonate. The conventional 3:1 compression-to-ventilation (C:V) resuscitation provides 90 CCs/min, significantly lower than the intrinsic newborn heart rate (120-160 beats/min). Continuous CC with asynchronous ventilation (CCCaV) may improve the success of return of spontaneous circulation (ROSC). METHODS Twenty-two near-term fetal lambs were randomized to interrupted 3:1 C:V (90 CCs + 30 breaths/min) or CCCaV (120 CCs + 30 breaths/min). Asphyxiation was induced by cord occlusion. After 5 min of asystole, resuscitation began following NRP guidelines. The first dose of epinephrine was given at 6 min. Invasive arterial blood pressure and left carotid blood flow were continuously measured. Serial arterial blood gases were collected. RESULTS Baseline characteristics between groups were similar. Rate of and time to ROSC was similar between groups. CCCaV was associated with a higher PaO2 (partial oxygen tension) (22 ± 5.3 vs. 15 ± 3.5 mmHg, p < 0.01), greater left carotid blood flow (7.5 ± 3.1 vs. 4.3 ± 2.6 mL/kg/min, p < 0.01) and oxygen delivery (0.40 ± 0.15 vs. 0.13 ± 0.07 mL O2/kg/min, p < 0.01) compared to 3:1 C:V. CONCLUSIONS In a perinatal asphyxiated cardiac arrest lamb model, CCCaV showed greater carotid blood flow and cerebral oxygen delivery compared to 3:1 C:V resuscitation. IMPACT In a perinatal asphyxiated cardiac arrest lamb model, CCCaV improved carotid blood flow and oxygen delivery to the brain compared to the conventional 3:1 C:V resuscitation. Pre-clinical studies assessing neurodevelopmental outcomes and tissue injury comparing continuous uninterrupted chest compressions to the current recommended 3:1 C:V during newborn resuscitation are warranted prior to clinical trials.
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Affiliation(s)
- Payam Vali
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA.
| | - Amy Lesneski
- Department of Pediatrics, University of California Davis, Sacramento, CA
| | - Morgan Hardie
- Department of Pediatrics, University of California Davis, Sacramento, CA
| | - Ziad Alhassen
- Department of Pediatrics, University of California Davis, Sacramento, CA
| | - Peggy Chen
- Department of Pediatrics, University of California Davis, Sacramento, CA
| | - Houssam Joudi
- Department of Pediatrics, University of California Davis, Sacramento, CA
| | - Deepika Sankaran
- Department of Pediatrics, University of California Davis, Sacramento, CA
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19
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Park SO, Shin DH, Kim C, Lee YH. Commencing one-handed chest compressions while activating emergency medical system using a handheld mobile device in lone-rescuer basic life support: a randomised cross-over simulation study. Emerg Med J 2021; 39:357-362. [PMID: 34400404 DOI: 10.1136/emermed-2021-211774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/07/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In conventional basic life support (c-BLS), a lone rescuer is recommended to start chest compressions (CCs) after activating the emergency medical system. To initiate earlier CCs in lone-rescuer BLS, we designed a modified BLS (m-BLS) sequence in which the lone rescuer commences one-handed CCs while calling for help using a handheld cellular phone with the other free hand. This study aimed to compare the quality of BLS between c-BLS and m-BLS. METHODS This was a simulation study performed with a randomised cross-over controlled trial design. A total of 108 university students were finally enrolled. After training for both c-BLS and m-BLS, participants performed a 3-minute c-BLS or m-BLS on a manikin with a SkillReporter at random cross-over order. The paired mean difference with SE between c-BLS and m-BLS was assessed using paired t-test. RESULTS The m-BLS had reduced lag time before the initiation of CCs (with a mean estimated paired difference (SE) of -35.0 (90.4) s) (p<0.001). For CC, a significant increase in compression fraction and a higher number of CCs with correct depth were observed in m-BLS (with a mean estimated paired difference (SE) of 16.2% (0.6) and 26.9% (3.3), respectively) (all p<0.001). However, no significant paired difference was observed in the hand position, compression rate and interruption time. For ventilation, the mean tidal volumes did not differ. However, the number of breaths with correct tidal volume was higher in m-BLS than in c-BLS. CONCLUSION In simulated lone-rescuer BLS, the m-BLS could deliver significantly earlier CCs than the c-BLS while maintaining high-quality cardiopulmonary resuscitation.
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Affiliation(s)
- Sang O Park
- Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Dong Hyuk Shin
- Emergency Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Changhoon Kim
- Department of Preventive Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Young Hwan Lee
- Emergency Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea .,Emergency Medicine, Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Republic of Korea
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20
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Abstract
Cardiac arrest results from a broad range of etiologies that can be broadly grouped as sudden and asphyxial. Animal studies point to differences in injury pathways invoked in the heart and brain that drive injury and outcome after these different forms of cardiac arrest. Present guidelines largely ignore etiology in their management recommendations. Existing clinical data reveal significant heterogeneity in the utility of presently employed resuscitation and postresuscitation strategies based on etiology. The development of future neuroprotective and cardioprotective therapies should also take etiology into consideration to optimize the chances for successful translation.
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21
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Ong GYK, Ngiam N, Tham LP, Mok YH, Ong JSM, Lee KP, Ganapathy S, Chong SL, Pek JH, Chew SY, Lim YC, Shen GQ, Kua J, Tan J, Ng KC. Singapore Paediatric Resuscitation Guidelines 2021. Singapore Med J 2021; 62:372-389. [PMID: 35001111 PMCID: PMC8804481 DOI: 10.11622/smedj.2021107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
We present the 2021 Singapore Paediatric Resuscitation Guidelines. The International Liaison Committee on Resuscitation's Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, which was published in October 2020, and the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council, were reviewed and discussed by the committee. These recommendations were derived after deliberation of peer-reviewed evidence updates on paediatric resuscitation and took into consideration the local setting and clinical practice.
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Affiliation(s)
- Gene Yong-Kwang Ong
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Nicola Ngiam
- Division of Paediatric Critical Care, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
| | - Lai Peng Tham
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Yee Hui Mok
- Children’s Intensive Care Unit, Department of Paediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
| | - Jacqueline SM Ong
- Division of Paediatric Critical Care, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
| | - Khai Pin Lee
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore
| | | | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Su Yah Chew
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
| | - Yang Chern Lim
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
| | | | - Jade Kua
- Department of Emergency Medicine, Woodlands Health Campus, Singapore
| | - Josephine Tan
- Department of Paediatric Anaesthesia, KK Women’s and Children’s Hospital, Singapore
| | - Kee Chong Ng
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore
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Corazza F, Arpone M, Snijders D, Cheng A, Stritoni V, Ingrassia PL, De Luca M, Tortorolo L, Frigo AC, Da Dalt L, Bressan S. PediAppRREST: effectiveness of an interactive cognitive support tablet app in reducing deviations from guidelines in the management of paediatric cardiac arrest: protocol for a simulation-based randomised controlled trial. BMJ Open 2021; 11:e047208. [PMID: 34321297 PMCID: PMC8319988 DOI: 10.1136/bmjopen-2020-047208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/01/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Paediatric cardiac arrest (PCA), despite its low incidence, has a high mortality. Its management is complex and deviations from guideline recommendations occur frequently. We developed a new interactive tablet app, named PediAppRREST, to support the management of PCA. The app received a good usability evaluation in a previous pilot trial. The aim of the study is to evaluate the effectiveness of the PediAppRREST app in reducing deviations from guideline recommendations in PCA management. METHODS AND ANALYSIS This is a multicentre, simulation-based, randomised controlled, three-parallel-arm study. Participants are residents in Paediatric, Emergency Medicine, and Anaesthesiology programmes in Italy. All 105 teams (315 participants) manage the same scenario of in-hospital PCA. Teams are randomised by the study statistician into one of three study arms for the management of the PCA scenario: (1) an intervention group using the PediAppRREST app or (2) a control group Paediatric Advanced Life Support (CtrlPALS+) using the PALS pocket reference card; or (3) a control group (CtrlPALS-) not allowed to use any PALS-related cognitive aid. The primary outcome of the study is the number of deviations (delays and errors) in PCA management from PALS guideline recommendations, according to a novel checklist, named c-DEV15plus. The c-DEV15plus scores will be compared between groups with a one-way analysis of variance model, followed by the Tukey-Kramer multiple comparisons adjustment procedure in case of statistical significance. ETHICS AND DISSEMINATION The Ethics Committee of the University Hospital of Padova, coordinating centre of the trial, deemed the project to be a negligible risk study and approved it through an expedited review process. The results of the study will be disseminated in peer-reviewed journals, and at national and international scientific conferences. Based on the study results, the PediAppRREST app will be further refined and will be available for download by institutions/healthcare professionals. TRIAL REGISTRATION NUMBER NCT04619498; Pre-results.
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Affiliation(s)
- Francesco Corazza
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Marta Arpone
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Deborah Snijders
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Adam Cheng
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Valentina Stritoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Pier Luigi Ingrassia
- Interdepartmental Centre for Innovative Didactics and Simulation in Medicine and Health Professions, SIMNOVA, University of Eastern Piedmont Amedeo Avogadro School of Medicine, Novara, Italy
| | - Marco De Luca
- Pediatric Emergency Medicine, Meyer University Hospital, University of Florence, Florence, Italy
| | - Luca Tortorolo
- Institute of Intensive Care Medicine and Anesthesiology, Agostino Gemelli University Hospital, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Rome, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
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Lee J, Lee DK, Oh J, Park SM, Kang H, Lim TH, Jo YH, Ko BS, Cho Y. Evaluation of the proper chest compression depth for neonatal resuscitation using computed tomography: A retrospective study. Medicine (Baltimore) 2021; 100:e26122. [PMID: 34190144 PMCID: PMC8257876 DOI: 10.1097/md.0000000000026122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/10/2021] [Indexed: 01/04/2023] Open
Abstract
This study was created to assess whether a 30-mm depth of chest compression (CC) is sufficient and safe for neonatal cardiopulmonary resuscitation.This retrospective analysis was performed with chest computed tomography scans of neonates in 2 hospitals between 2004 and 2018. We measured several chest parameters and calculated heart compression fraction (HCF) using the ejection fraction formula. We evaluated whether one-third of the external anterior-posterior (AP) diameter and HCF with them are the equivalent to 25-, 30-, 35 mm and HCF with them, respectively, and the number of individuals with over-compression (internal chest AP diameter - compressed depth <10 mm) to estimate a safe CC depth. We divided the patients into term and preterm groups and compared their outcomes.In total, 63 of the 75 included individuals were analyzed, and one-third of the external lengths was equivalent to 30 ± 3 mm (P < .001). When the patients were divided into term (n = 53) and preterm (n = 10) groups, the equivalent depth was 30 ± 3 mm in the term group (P < .001) and 25 ± 2.5 mm in the preterm group (P = .004). The HCF with 30 mm was equivalent to that for one-third of the external length (P < .001). When we simulated CCs with a 30-mm depth, over-compression occurred more frequently in the preterm group (20%) compared to the term group (1.9%) (P = .014).A 30-mm depth could be appropriate for sufficient and safe neonatal resuscitation. Shallower CC should be considered in preterm babies.
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Affiliation(s)
- Juncheol Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul
- Graduate School, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Dong Keon Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul
- Machine Learning Research Center for Medical Data, Hanyang University
| | - Seung Min Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do
| | - Byuk Sung Ko
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul
| | - Yongil Cho
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul
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Gugelmin-Almeida D, Clark C, Rolfe U, Jones M, Williams J. Dominant versus non-dominant hand during simulated infant CPR using the two-finger technique: a randomised study. Resusc Plus 2021; 7:100141. [PMID: 34223397 PMCID: PMC8244244 DOI: 10.1016/j.resplu.2021.100141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/10/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022] Open
Abstract
Aims The aim of this randomised study was to compare the two-finger technique (TFT) performance using dominant hand (DH) and non-dominant hand (NH) during simulated infant CPR (iCPR). Methods 24 participants performed 3-min iCPR using TFT with DH or NH followed by 3-min iCPR with their other hand. Perceived fatigue was rated using visual analogue scale. Primary outcomes - (i) difference between DH and NH for compression depth (CCD), compression rate (CCR), residual leaning (RL) and duty cycle (DC); (ii) difference between first and last 30 s of iCPR performance with DH and NH. Secondary outcomes - (i) perception of fatigue between DH and NH; (ii) relationship between perception of fatigue and iCPR performance. Results No significant difference between DH and NH for any iCPR metric. CCR (DH: P = 0.02; NH: P = 0.004) and DC (DH: P = 0.04; NH: P < 0.001) were significantly different for the last 30 s for DH and NH. Perception of fatigue for NH (76.8 ± 13.4 mm) was significantly higher (t = -3.7, P < 0.001) compared to DH (62.8 ± 12.5 mm). No significant correlation between iCPR metrics and perception of fatigue for DH. However, a significant correlation was found for CCR (r = 0.43; P = 0.04) and RL (r = -0.48; P = 0.02) for NH. Conclusion No difference in performance of iCPR with DH versus NH was determined. However, perception of fatigue is higher in NH and was related to CCR and RL, with no effect on quality of performance. Based on our results, individuals performing iCPR can offer similar quality of infant chest compressions regardless of the hand used or the perception of fatigue, under the conditions explored in this study.
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Affiliation(s)
- Debora Gugelmin-Almeida
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, England.,Department of Anaesthesiology, Main Theatres, Royal Bournemouth and Christchurch Hospitals, Castle Lane East, Bournemouth, BH7 7DW, England
| | - Carol Clark
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, England
| | - Ursula Rolfe
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, England
| | - Michael Jones
- Cardiff School of Engineering, Cardiff University, Cardiff, CF23 3AA, Wales
| | - Jonathan Williams
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, England
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Survival and Hemodynamics During Pediatric Cardiopulmonary Resuscitation for Bradycardia and Poor Perfusion Versus Pulseless Cardiac Arrest. Crit Care Med 2021; 48:881-889. [PMID: 32301844 DOI: 10.1097/ccm.0000000000004308] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to compare survival outcomes and intra-arrest arterial blood pressures between children receiving cardiopulmonary resuscitation for bradycardia and poor perfusion and those with pulseless cardiac arrests. DESIGN Prospective, multicenter observational study. SETTING PICUs and cardiac ICUs of the Collaborative Pediatric Critical Care Research Network. PATIENTS Children (< 19 yr old) who received greater than or equal to 1 minute of cardiopulmonary resuscitation with invasive arterial blood pressure monitoring in place. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 164 patients, 96 (59%) had bradycardia and poor perfusion as the initial cardiopulmonary resuscitation rhythm. Compared to those with initial pulseless rhythms, these children were younger (0.4 vs 1.4 yr; p = 0.005) and more likely to have a respiratory etiology of arrest (p < 0.001). Children with bradycardia and poor perfusion were more likely to survive to hospital discharge (adjusted odds ratio, 2.31; 95% CI, 1.10-4.83; p = 0.025) and survive with favorable neurologic outcome (adjusted odds ratio, 2.21; 95% CI, 1.04-4.67; p = 0.036). There were no differences in diastolic or systolic blood pressures or event survival (return of spontaneous circulation or return of circulation via extracorporeal cardiopulmonary resuscitation). Among patients with bradycardia and poor perfusion, 49 of 96 (51%) had subsequent pulselessness during the cardiopulmonary resuscitation event. During cardiopulmonary resuscitation, these patients had lower diastolic blood pressure (point estimate, -6.68 mm Hg [-10.92 to -2.44 mm Hg]; p = 0.003) and systolic blood pressure (point estimate, -12.36 mm Hg [-23.52 to -1.21 mm Hg]; p = 0.032) and lower rates of return of spontaneous circulation (26/49 vs 42/47; p < 0.001) than those who were never pulseless. CONCLUSIONS Most children receiving cardiopulmonary resuscitation in ICUs had an initial rhythm of bradycardia and poor perfusion. They were more likely to survive to hospital discharge and survive with favorable neurologic outcomes than patients with pulseless arrests, although there were no differences in immediate event outcomes or intra-arrest hemodynamics. Patients who progressed to pulselessness after cardiopulmonary resuscitation initiation had lower intra-arrest hemodynamics and worse event outcomes than those who were never pulseless.
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Senthil K, Morgan RW, Hefti MM, Karlsson M, Lautz AJ, Mavroudis CD, Ko T, Nadkarni VM, Ehinger J, Berg RA, Sutton RM, McGowan FX, Kilbaugh TJ. Haemodynamic-directed cardiopulmonary resuscitation promotes mitochondrial fusion and preservation of mitochondrial mass after successful resuscitation in a pediatric porcine model. Resusc Plus 2021; 6:100124. [PMID: 34223382 PMCID: PMC8244484 DOI: 10.1016/j.resplu.2021.100124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 01/09/2023] Open
Abstract
Objective Cerebral mitochondrial dysfunction is a key mediator of neurologic injury following cardiac arrest (CA) and is regulated by the balance of fusion and fission (mitochondrial dynamics). Under stress, fission can decrease mitochondrial mass and signal apoptosis, while fusion promotes oxidative phosphorylation efficiency. This study evaluates mitochondrial dynamics and content in brain tissue 24 h after CA between two cardiopulmonary resuscitation (CPR) strategies. Interventions Piglets (1 month), previously randomized to three groups: (1) Std-CPR (n = 5); (2) HD-CPR (n = 5; goal systolic blood pressure 90 mmHg, goal coronary perfusion pressure 20 mmHg); (3) Shams (n = 7). Std-CPR and HD-CPR groups underwent 7 min of asphyxia, 10 min of CPR, and standardized post-resuscitation care. Primary outcomes: (1) cerebral cortical mitochondrial protein expression for fusion (OPA1, OPA1 long to short chain ratio, MFN2) and fission (DRP1, FIS1), and (2) mitochondrial mass by citrate synthase activity. Secondary outcomes: (1) intra-arrest haemodynamics and (2) cerebral performance category (CPC) at 24 h. Results HD-CPR subjects had higher total OPA1 expression compared to Std-CPR (1.52; IQR 1.02-1.69 vs 0.67; IQR 0.54-0.88, p = 0.001) and higher OPA1 long to short chain ratio than both Std-CPR (0.63; IQR 0.46-0.92 vs 0.26; IQR 0.26-0.31, p = 0.016) and shams. Citrate synthase activity was lower in Std-CPR than sham (11.0; IQR 10.15-12.29 vs 13.4; IQR 12.28-15.66, p = 0.047), but preserved in HD-CPR. HD-CPR subjects had improved intra-arrest haemodynamics and CPC scores at 24 h compared to Std-CPR. Conclusions Following asphyxia-associated CA, HD-CPR exhibits increased pro-mitochondrial fusion protein expression, preservation of mitochondrial mass, improved haemodynamics and superior neurologic scoring compared to Std-CPR. Institutional protocol number IAC 16-001023.
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Affiliation(s)
- Kumaran Senthil
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | - Ryan W Morgan
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | - Marco M Hefti
- University of Iowa, Division of Pathology, United States
| | | | - Andrew J Lautz
- Cincinnati Children's Hospital Medical Center, Division of Critical Care Medicine, United States
| | - Constantine D Mavroudis
- Department of Neurosurgery, Righospitalet, Copenhagen, Denmark.,Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Division of Cardiothoracic Surgery, United States
| | - Tiffany Ko
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Division of Neurology, United States
| | - Vinay M Nadkarni
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | | | - Robert A Berg
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | - Robert M Sutton
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | - Francis X McGowan
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
| | - Todd J Kilbaugh
- Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, United States
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Chest compression by two-thumb encircling method generates higher carotid artery blood flow in swine infant model of cardiac arrest. Resusc Plus 2021; 6:100118. [PMID: 34223377 PMCID: PMC8244466 DOI: 10.1016/j.resplu.2021.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Two-Thumb(TT) technique provides superior quality chest compressions compared with Two-Finger(TF) in an instrumented infant manikin. Whether this translates to differences in blood flow, such as carotid arterial blood flow(CABF), has not been evaluated. We hypothesized that TT-CPR generates higher CABF and Coronary Perfusion Pressure(CPP) compared with TF-CPR in a neonatal swine cardiac arrest model. Methods Twelve anesthetized & ventilated piglets were randomized after 3 min of untreated VF to receive either TT-CPR or TF-CPR by PALS certified rescuers delivering a compression rate of 100/min. The primary outcome, CABF, was measured using an ultrasound transonic flow probe placed on the left carotid artery. CPP was calculated and end-tidal CO2(ETCO2) was measured during CPR. Data(mean ± SD) were analyzed and p-value ≤0.05 was considered statistically significant. Results Carotid artery blood flow (% of baseline) was higher in TT-CPR (66.2 ± 35.4%) than in the TF-CPR (27.5 ± 10.6%) group, p = 0.013. Mean CPP (mm Hg) during three minutes of chest compression for TT-CPR was 12.5 ± 15.8 vs. 6.5 ± 6.7 in TF-CPR, p = 0.41 and ETCO2 (mm Hg) was 29.0 ± 7.4 in TT-CPR vs. 20.7 ± 5.8 in TF-CPR group, p = 0.055. Conclusion TT-CPR achieved more than twice the CABF compared with TF-CPR in a piglet cardiac arrest model. Although CPP and ETCO2 were higher during TT-CPR, these parameters did not reach statistical significance. This study provides direct evidence of increased blood flow in infant swine using TT-CPR and further supports that TT chest compression is the preferred method for CPR in infants.
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Hinder M, Tracy M. Newborn resuscitation devices: The known unknowns and the unknown unknowns. Semin Fetal Neonatal Med 2021; 26:101233. [PMID: 33773952 DOI: 10.1016/j.siny.2021.101233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infant resuscitation devices used at birth must be capable of delivering adequate and consistent ventilation in a controlled and predictable manner to a wide patient weight range, and combinations of transitional lung states. Manual inflation resuscitation devices delivering positive pressure lung inflation at birth can be classified broadly into two types: 1) flow generating, ie silicone self-inflating bags (SIB) also known as bag valve mask (BVM) and 2) flow dependent, ie anaesthetic flow inflating bag (FIB) and t-piece resuscitator (TPR) systems (eg: Neopuff, GE Panda and Draeger Resuscitaires). Globalization, lower production costs, and an expanding market need for devices, has led to a proliferation of brands (both reusable and single use) within a class type. T-piece resuscitators have become the dominant device particularly in high income countries. There remains a paucity of information on the performance characteristics of these devices and their ability to provide the required respiratory parameters for effective and safe ventilation across the full-expected weight range and lung states to which they will be applied. This review aims to inform current clinical practise on the biomechanical efficiency, reliability and efficacy of the most common devices used to apply PPV to newborns and infants ≤10 kgs.
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Affiliation(s)
- Murray Hinder
- The Westmead Hospital Neonatal Intensive Care Unit, Australia; The University of Sydney, Department of Paediatrics and Child Health, Australia
| | - Mark Tracy
- The Westmead Hospital Neonatal Intensive Care Unit, Australia; The University of Sydney, Department of Paediatrics and Child Health, Australia.
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Ong GYK, Ang AJF, S O Aurangzeb A, Fong ESS, Tan JY, Chen ZJ, Chan YH, Tang PH, Pek JH, Maconochie I, Ng KC, Nadkarni V. What is the potential for over-compression using current paediatric chest compression guidelines? - A chest computed tomography study. Resusc Plus 2021; 6:100112. [PMID: 34223372 PMCID: PMC8244421 DOI: 10.1016/j.resplu.2021.100112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 02/03/2023] Open
Abstract
Aim We explored the potential for over-compression from current paediatric chest compression depth guidelines using chest computed tomography(CT) images of a large, heterogenous, Asian population. Methods A retrospective review of consecutive children, less than 18-years old, with chest CT images performed between from 2005 to 2017 was done. Demographic data were extracted from the electronic medical records. Measurements for internal and external anterior-posterior diameters (APD) were taken at lower half of the sternum. Simulated chest compressions were performed to evaluate the proportion of the population with residual internal cavity dimensions less than 0 mm (RICD < 0 mm, representing definite over-compression; with chest compression depth exceeding internal APD), and RICD less than 10 mm (RICD < 10 mm, representing potential over-compression). Results 592 paediatric chest CT studies were included for the study. Simulated chest compressions of one-third external APD had the least potential for over-compression; no infants and 0.3% children had potential over-compression (RICD < 10 mm). 4 cm simulated chest compressions led to 18% (95% CI 13%-24%) of infants with potential over-compression, and this increased to 34% (95% CI 27%-41%) at 4.4 cm (upper limit of "approximately" 4 cm; 4 cm + 10%). 5 cm simulated compressions resulted in 8% (95% CI 4%-12%) of children 1 to 8-years-old with potential over-compression, and this increased to 22% (95% CI 16%-28%) at 5.5 cm (upper limit of "approximately" 5 cm, 5 cm + 10%). Conclusion In settings whereby chest compression depths can be accurately measured, compressions at the current recommended chest compression of approximately 4 cm (in infants) and 5 cm (in young children) could result in potential for over-compression.
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Affiliation(s)
| | | | | | | | - Jun Yuan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhao Jin Chen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Phua Hwee Tang
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, Singapore
| | - Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Ian Maconochie
- Accident and Emergency Service, St Mary's Hospital, London, United Kingdom.,Department of Medicine, Imperial College, Kensington, London, United Kingdom
| | - Kee Chong Ng
- Children's Emergency, KK Women's and Children's Hospital, Singapore
| | - Vinay Nadkarni
- Center for Simulation, Advanced Education and Innovation, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
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Gugelmin-Almeida D, Tobase L, Polastri TF, Peres HHC, Timerman S. Do automated real-time feedback devices improve CPR quality? A systematic review of literature. Resusc Plus 2021; 6:100108. [PMID: 34223369 PMCID: PMC8244494 DOI: 10.1016/j.resplu.2021.100108] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/20/2022] Open
Abstract
Aim Automated real-time feedback devices have been considered a potential tool to improve the quality of cardiopulmonary resuscitation (CPR). Despite previous studies supporting the usefulness of such devices during training, others have conflicting conclusions regarding its efficacy during real-life CPR. This systematic review aimed to assess the effectiveness of automated real-time feedback devices for improving CPR performance during training, simulation and real-life resuscitation attempts in the adult and paediatric population. Methods Articles published between January 2010 and November 2020 were searched from BVS, Cinahl, Cochrane, PubMed and Web of Science, and reviewed according to a pre-defined set of eligibility criteria which included healthcare providers and randomised controlled trial studies. CPR quality was assessed based on guideline compliance for chest compression rate, chest compression depth and residual leaning. Results The selection strategy led to 19 eligible studies, 16 in training/simulation and three in real-life CPR. Feedback devices during training and/or simulation resulted in improved acquisition of skills and enhanced performance in 15 studies. One study resulted in no significant improvement. During real resuscitation attempts, three studies demonstrated significant improvement with the use of feedback devices in comparison with standard CPR (without feedback device). Conclusion The use of automated real-time feedback devices enhances skill acquisition and CPR performance during training of healthcare professionals. Further research is needed to better understand the role of feedback devices in clinical setting.
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Affiliation(s)
- Debora Gugelmin-Almeida
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, England, United Kingdom.,Department of Anaesthesiology, Main Theatres, Royal Bournemouth and Christchurch Hospitals, Castle Lane East, Bournemouth, BH7 7DW, England, United Kingdom
| | - Lucia Tobase
- Centro Universitário São Camilo, Rua Raul Pompeia, 144, São Paulo, Brazil
| | - Thatiane Facholi Polastri
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil
| | | | - Sergio Timerman
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil
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Duff JP, Bhanji F, Lin Y, Overly F, Brown LL, Bragg EA, Kessler D, Tofil NM, Bank I, Hunt EA, Nadkarni V, Cheng A. Change in Cardiopulmonary Resuscitation Performance Over Time During Simulated Pediatric Cardiac Arrest and the Effect of Just-in-Time Training and Feedback. Pediatr Emerg Care 2021; 37:133-137. [PMID: 33651758 DOI: 10.1097/pec.0000000000002359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Effective cardiopulmonary resuscitation (CPR) is critical to ensure optimal outcomes from cardiac arrest, yet trained health care providers consistently struggle to provide guideline-compliant CPR. Rescuer fatigue can impact chest compression (CC) quality during a cardiac arrest event, although it is unknown if visual feedback or just-in-time training influences change of CC quality over time. In this study, we attempt to describe the changes in CC quality over a 12-minute simulated resuscitation and examine the influence of just-in-time training and visual feedback on CC quality over time. METHODS We conducted secondary analysis of data collected from the CPRCARES study, a multicenter randomized trial in which CPR-certified health care providers from 10 different pediatric tertiary care centers were randomized to receive visual feedback, just-in-time CPR training, or no intervention. They participated in a simulated cardiac arrest scenario with 2 team members providing CCs. We compared the quality of CCs delivered (depth and rate) at the beginning (0-4 minutes), middle (4-8 minutes), and end (8-12 minutes) of the resuscitation. RESULTS There was no significant change in depth over the 3 time intervals in any of the arms. There was a significant increase in rate (128 to 133 CC/min) in the no intervention arm over the scenario duration (P < 0.05). CONCLUSIONS There was no significant drop in CC depth over a 12-minute cardiac arrest scenario with 2 team members providing compressions.
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Affiliation(s)
| | | | - Yiqun Lin
- University of Calgary, Calgary, Canada
| | | | | | | | - David Kessler
- Columbia University Vagelos College of Physicians and Surgeons New York, NY
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Morgan RW, Kirschen MP, Kilbaugh TJ, Sutton RM, Topjian AA. Pediatric In-Hospital Cardiac Arrest and Cardiopulmonary Resuscitation in the United States: A Review. JAMA Pediatr 2021; 175:293-302. [PMID: 33226408 PMCID: PMC8787313 DOI: 10.1001/jamapediatrics.2020.5039] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Pediatric in-hospital cardiac arrest (IHCA) occurs frequently and is associated with high morbidity and mortality. The objective of this narrative review is to summarize the current knowledge and recommendations regarding pediatric IHCA and cardiopulmonary resuscitation (CPR). OBSERVATIONS Each year, more than 15 000 children receive CPR for cardiac arrest during hospitalization in the United States. As many as 80% to 90% survive the event, but most patients do not survive to hospital discharge. Most IHCAs occur in intensive care units and other monitored settings and are associated with respiratory failure or shock. Bradycardia with poor perfusion is the initial rhythm in half of CPR events, and only about 10% of events have an initial shockable rhythm. Pre-cardiac arrest systems focus on identifying at-risk patients and ensuring that they are in monitored settings. Important components of CPR include high-quality chest compressions, timely defibrillation when indicated, appropriate ventilation and airway management, administration of epinephrine to increase coronary perfusion pressure, and treatment of the underlying cause of cardiac arrest. Extracorporeal CPR and measurement of physiological parameters are evolving areas in improving outcomes. Structured post-cardiac arrest care focused on targeted temperature management, optimization of hemodynamics, and careful intensive care unit management is associated with improved survival and neurological outcomes. CONCLUSIONS AND RELEVANCE Pediatric IHCA occurs frequently and has a high mortality rate. Early identification of risk, prevention, delivery of high-quality CPR, and post-cardiac arrest care can maximize the chances of achieving favorable outcomes. More research in this field is warranted.
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Affiliation(s)
- Ryan W. Morgan
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Matthew P. Kirschen
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Todd J. Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert M. Sutton
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alexis A. Topjian
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Chang CH, Hsu YJ, Li F, Chan YS, Lo CP, Peng GJ, Ho CS, Huang CC. The feasibility of emergency medical technicians performing intermittent high-quality cardiopulmonary resuscitation. Int J Med Sci 2021; 18:2615-2623. [PMID: 34104093 PMCID: PMC8176180 DOI: 10.7150/ijms.59757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Whether intermittent chest compressions have an effect on the quality of CPR is worthy of discussion. The purpose of this study was to investigate differences in the chest compression quality of emergency medical technicians (EMTs) performing cardiopulmonary resuscitation (CPR) with different rest intervals. Methods: Seventy male firefighters with EMT licenses participated in this study. Participants completed body composition measurements and three CPR quality tests, as follows: (1) CPR-uninterrupted for 10 minutes; (2) after 2 days of rest, CPR 10s-intermittent (CPR-10s), for 2 minutes each time and 5 cycles; (3) after another 2 days of rest, CPR 20s-intermittent (CPR-20s), for 2 minutes each time and 5 cycles. Results: Body composition results showed that body mass (BM), body mass index (BMI), upper limb muscle mass (ULMM), core muscle mass (CMM), and upper limb-core muscle mass (UL+CMM) were positively correlated with chest compression depth (CCD) (p < 0.05). Analysis of the three different modes of CPR quality analysis indicated significant differences in the chest compression fraction (CCF, F = 6.801, p = 0.001), chest compression rebound rate (CCRR, F = 3.919, p = 0.021), and ratings of perceived exertion (RPE, F = 23.815, p < 0.001). Among the different performance cycles of CPR-10s, significant differences were found in CCF, CCD, CCR (chest compression rate), and RPE (p < 0.05). On the other hand, among the different performance cycles of CPR-20s, significant differences were found in CCD, CCR, and RPE (p < 0.05). Moreover, the CCF, CCD, and RPE scores of the two tests reached significant differences in specific phases (p < 0.05). Conclusions: This study confirmed that the upper limb muscle mass or the weight of the upper body of EMTs is positively correlated with the quality of CPR. In addition, intermittent chest compressions with safe interruption intervals can reduce fatigue caused by long-term chest compressions and maintain better chest compression quality.
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Affiliation(s)
- Chun-Hao Chang
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Yi-Ju Hsu
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Fang Li
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Yuan-Shuo Chan
- Department of Special Education, National Taipei University of Education, Taipei, Taiwan
| | - Ching-Ping Lo
- College of Exercise and Health Science, National Taiwan Sport University, Taoyuan, Taiwan.,Ching Shuei Emergency Medical Service Team Of 5th Corps, Fire Department, New Taipei City Government, New Taipei City, Taiwan
| | - Guan-Jian Peng
- College of Exercise and Health Science, National Taiwan Sport University, Taoyuan, Taiwan.,Second Special Search and Rescue Branch, Special Search and Rescue Corps, Fire Department, Taoyuan City Government, Taoyuan City, Taiwan
| | - Chin-Shan Ho
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Chi-Chang Huang
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
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Nagler J, Auerbach M, Monuteaux MC, Cheek JA, Babl FE, Oakley E, Nguyen L, Rao A, Dalton S, Lyttle MD, Mintegi S, Mistry RD, Dixon A, Rino P, Kohn-Loncarica G, Dalziel SR, Craig S. Exposure and confidence across critical airway procedures in pediatric emergency medicine: An international survey study. Am J Emerg Med 2020; 42:70-77. [PMID: 33453618 DOI: 10.1016/j.ajem.2020.12.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Airway management procedures are critical for emergency medicine (EM) physicians, but rarely performed skills in pediatric patients. Worldwide experience with respect to frequency and confidence in performing airway management skills has not been previously described. OBJECTIVES Our aims were 1) to determine the frequency with which emergency medicine physicians perform airway procedures including: bag-mask ventilation (BMV), endotracheal intubation (ETI), laryngeal mask airway (LMA) insertion, tracheostomy tube change (TTC), and surgical airways, and 2) to investigate predictors of procedural confidence regarding advanced airway management in children. METHODS A web-based survey of senior emergency physicians was distributed through the six research networks associated with Pediatric Emergency Research Network (PERN). Senior physician was defined as anyone working without direct supervision at any point in a 24-h cycle. Physicians were queried regarding their most recent clinical experience performing or supervising airway procedures, as well as with hands on practice time or procedural teaching. Reponses were dichotomized to within the last year, or ≥ 1 year. Confidence was assessed using a Likert scale for each procedure, with results for ETI and LMA stratified by age. Response levels were dichotomized to "not confident" or "confident." Multivariate regression models were used to assess relevant associations. RESULTS 1602 of 2446 (65%) eligible clinicians at 96 PERN sites responded. In the previous year, 1297 (85%) physicians reported having performed bag-mask ventilation, 900 (59%) had performed intubation, 248 (17%) had placed a laryngeal mask airway, 348 (23%) had changed a tracheostomy tube, and 18 (1%) had performed a surgical airway. Of respondents, 13% of physicians reported the opportunity to supervise but not provide ETI, 5% for LMA and 5% for BMV. The percentage of physicians reporting "confidence" in performing each procedure was: BMV (95%) TTC (43%), and surgical airway (16%). Clinician confidence in ETT and LMA varied by patient age. Supervision of an airway procedure was the strongest predictor of procedural confidence across airway procedures. CONCLUSION BMV and ETI were the most commonly performed pediatric airway procedures by emergency medicine physicians, and surgical airways are very infrequent. Supervising airway procedures may serve to maintain procedural confidence for physicians despite infrequent opportunities as the primary proceduralist.
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Affiliation(s)
- Joshua Nagler
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Pediatric Emergency Care Applied Research Network (PECARN), USA.
| | - Marc Auerbach
- Yale University School of Medicine, New Haven, CT, USA; Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC), USA
| | - Michael C Monuteaux
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - John A Cheek
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; University of Melbourne, Melbourne, Australia
| | - Ed Oakley
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; University of Melbourne, Melbourne, Australia
| | - Lucia Nguyen
- Peninsula Health, Frankston, Victoria, Australia
| | - Arjun Rao
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; Sydney Children's Hospital (Randwick), NSW, Australia; University of New South Wales, Australia; Health Education Training Institute (HETI), New South Wales, Australia
| | - Sarah Dalton
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI), UK
| | - Santiago Mintegi
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain; University of the Basque Country, Spain; Research in European Pediatric Emergency Medicine (REPEM), Spain; Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group (RISeuP/SPERG), Spain
| | - Rakesh D Mistry
- Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC), USA; Children's Hospital Colorado, Aurora, CO, USA
| | - Andrew Dixon
- University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada; Women's and Children's Health Research Institute, Canada; Pediatric Emergency Research Canada (PERC), Canada
| | - Pedro Rino
- Universidad de Buenos Aires, Argentina; Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina; Red de Investigación y Desarrollo de la Emergencia Pediátrica Latinoamericana (RIDEPLA), Argentina
| | - Guillermo Kohn-Loncarica
- Universidad de Buenos Aires, Argentina; Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina; Red de Investigación y Desarrollo de la Emergencia Pediátrica Latinoamericana (RIDEPLA), Argentina
| | - Stuart R Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; Starship Children's Hospital, Auckland, New Zealand; Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; Paediatric Emergency Department, Monash Medical Centre, Melbourne, Australia; Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Australia
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Impact of Infant Positioning on Cardiopulmonary Resuscitation Performance During Simulated Pediatric Cardiac Arrest: A Randomized Crossover Study. Pediatr Crit Care Med 2020; 21:e1076-e1083. [PMID: 32826836 DOI: 10.1097/pcc.0000000000002521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary objective was to determine the impact of infant positioning on cardiopulmonary resuscitation performance during simulated pediatric cardiac arrest. DESIGN A single-center, prospective, randomized, unblinded manikin study. SETTING Medical university-affiliated simulation facility. SUBJECTS Fifty-two first-line professional rescuers (n = 52). INTERVENTIONS Performance of cardiopulmonary resuscitation was determined using an infant manikin model in three different positions (on a table [T], on the provider's forearm with the manikin's head close to the provider's elbow [P], and on the provider's forearm with the manikin's head close to the provider's palm [D]). For the measurement of important cardiopulmonary resuscitation performance variables, a commercially available infant simulator was modified. In a randomized sequence, healthcare professionals performed single-rescuer cardiopulmonary resuscitation for 3 minutes in each position. Performances of chest compression (primary outcome), ventilation, and hands-off time were analyzed using a multilevel regression model. MEASUREMENTS AND MAIN RESULTS Mean (± SD) compression depth significantly differed between table and the other two manikin positions (31 ± 2 [T], 29 ± 3 [P], and 29 ± 3 mm [D]; overall p < 0.001; repeated measures design adjusted difference: T vs P, -2 mm [95% CI, -2 to -1 mm]; T vs D, -1 mm [95% CI, -2 to -1 mm]). Secondary outcome variables showed no significant differences. CONCLUSIONS Compressions were significantly deeper in the table group compared to positions on the forearm during cardiopulmonary resuscitation, yet the differences were small and perhaps not clinically important.
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Two-Thumb Encircling Technique With a Novel Compression Assist Device Provides Safe and Effective Chest Compressions in Infants. Pediatr Emerg Care 2020; 36:e700-e703. [PMID: 33170576 DOI: 10.1097/pec.0000000000001738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Currently, 2-thumb encircling technique is recommended in 2-rescuer infant cardiopulmonary resuscitation (CPR). However, many complications can occur during CPR. Therefore, we developed a novel compression assist device (Reheart) that can reduce chest compression area and determined whether using our device provides better compression quality. METHODS A novel compression assist device consists of 2 parts. The upper part was designed to put 2 thumbs together in the thumb sleeves, and the lower part was designed based on a circular rubber plate with a 2.0-cm diameter to confine compression area. Infant manikin CPR simulations using the 2-thumb encircling technique with Reheart and without Reheart were sequentially performed by participants in randomized crossover fashion. RESULTS A total of 32 health care providers were included. The average age of the participants was 30.2 ± 3.5 years, and 21 participants (65.6%) were male. The accuracy in the Reheart group was better than that in the conventional group (proportion of compression on target area, 52.5% ± 13.2% vs 35.4% ± 17.6%; P < 0.001). The difference in the rates of chest compressions between the 2 groups was not significant (119.6 ± 14.4 vs 120.7 ± 14.0 compressions/min, P = 0.59). The depth of chest compressions was also not significantly different between the 2 groups (34.5 mm [33.6-34.9 mm] vs 34.2 mm [33.0-34.9 mm], P = 0.32). CONCLUSIONS Our new compression assist device can help provide safe and effective chest compressions during 2-rescuer infant CPR.
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Corazza F, Snijders D, Arpone M, Stritoni V, Martinolli F, Daverio M, Losi MG, Soldi L, Tesauri F, Da Dalt L, Bressan S. Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study. JMIR Mhealth Uhealth 2020; 8:e19070. [PMID: 32788142 PMCID: PMC7563631 DOI: 10.2196/19070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 01/22/2023] Open
Abstract
Background Pediatric cardiac arrest (PCA), although rare, is associated with high mortality. Deviations from international management guidelines are frequent and associated with poorer outcomes. Different strategies/devices have been developed to improve the management of cardiac arrest, including cognitive aids. However, there is very limited experience on the usefulness of interactive cognitive aids in the format of an app in PCA. No app has so far been tested for its usability and effectiveness in guiding the management of PCA. Objective To develop a new audiovisual interactive app for tablets, named PediAppRREST, to support the management of PCA and to test its usability in a high-fidelity simulation-based setting. Methods A research team at the University of Padova (Italy) and human–machine interface designers, as well as app developers, from an Italian company (RE:Lab S.r.l.) developed the app between March and October 2019, by applying an iterative design approach (ie, design–prototyping–evaluation iterative loops). In October–November 2019, a single-center nonrandomized controlled simulation–based pilot study was conducted including 48 pediatric residents divided into teams of 3. The same nonshockable PCA scenario was managed by 11 teams with and 5 without the app. The app user’s experience and interaction patterns were documented through video recording of scenarios, debriefing sessions, and questionnaires. App usability was evaluated with the User Experience Questionnaire (UEQ) (scores range from –3 to +3 for each scale) and open-ended questions, whereas participants’ workload was measured using the NASA Raw-Task Load Index (NASA RTLX). Results Users’ difficulties in interacting with the app during the simulations were identified using a structured framework. The app usability, in terms of mean UEQ scores, was as follows: attractiveness 1.71 (SD 1.43), perspicuity 1.75 (SD 0.88), efficiency 1.93 (SD 0.93), dependability 1.57 (SD 1.10), stimulation 1.60 (SD 1.33), and novelty 2.21 (SD 0.74). Team leaders’ perceived workload was comparable (P=.57) between the 2 groups; median NASA RTLX score was 67.5 (interquartile range [IQR] 65.0-81.7) for the control group and 66.7 (IQR 54.2-76.7) for the intervention group. A preliminary evaluation of the effectiveness of the app in reducing deviations from guidelines showed that median time to epinephrine administration was significantly longer in the group that used the app compared with the control group (254 seconds versus 165 seconds; P=.015). Conclusions The PediAppRREST app received a good usability evaluation and did not appear to increase team leaders’ workload. Based on the feedback collected from the participants and the preliminary results of the evaluation of its effects on the management of the simulated scenario, the app has been further refined. The effectiveness of the new version of the app in reducing deviations from guidelines recommendations in the management of PCA and its impact on time to critical actions will be evaluated in an upcoming multicenter simulation-based randomized controlled trial.
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Affiliation(s)
- Francesco Corazza
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Deborah Snijders
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marta Arpone
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Valentina Stritoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Francesco Martinolli
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | | | | | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
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Lin Y, Hecker K, Cheng A, Grant VJ, Currie G. Cost-effectiveness analysis of workplace-based distributed cardiopulmonary resuscitation training versus conventional annual basic life support training. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:297-303. [DOI: 10.1136/bmjstel-2020-000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/18/2020] [Accepted: 09/12/2020] [Indexed: 11/04/2022]
Abstract
ContextAlthough distributed cardiopulmonary resuscitation (CPR) practice has been shown to improve learning outcomes, little is known about the cost-effectiveness of this training strategy. This study assesses the cost-effectiveness of workplace-based distributed CPR practice with real-time feedback when compared with conventional annual CPR training.MethodsWe measured educational resource use, costs, and outcomes of both conventional training and distributed training groups in a prospective-randomised trial conducted with paediatric acute care providers over 12 months. Costs were calculated and reported from the perspective of the health institution. Incremental costs and effectiveness of distributed CPR training relative to conventional training were presented. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER) if appropriate. One-way sensitivity analyses and probabilistic sensitivity analysis were conducted.ResultsA total of 87 of 101 enrolled participants completed the training (46/53 in intervention and 41/48 in the control). Compared with conventional training, the distributed CPR training group had a higher proportion of participants achieving CPR excellence, defined as over 90% guideline compliant for chest compression depth, rate and recoil (control: 0.146 (6/41) vs intervention 0.543 (25/46), incremental effectiveness: +0.397) with decreased costs (control: $C266.50 vs intervention $C224.88 per trainee, incremental costs: −$C41.62). The sensitivity analysis showed that when the institution does not pay for the training time, distributed CPR training results in an ICER of $C147.05 per extra excellent CPR provider.ConclusionWorkplace-based distributed CPR training with real-time feedback resulted in improved CPR quality by paediatric healthcare providers and decreased training costs, when training time is paid by the institution. If the institution does not pay for training time, implementing distributed training resulted in better CPR quality and increased costs, compared with conventional training. These findings contribute further evidence to the decision-making processes as to whether institutions/programmes should financially adopt these training programmes.
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Pediatric Cardiopulmonary Resuscitation Tasks and Hands-Off Time: A Descriptive Analysis Using Video Review. Pediatr Crit Care Med 2020; 21:e804-e809. [PMID: 32590835 DOI: 10.1097/pcc.0000000000002486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize tasks performed during cardiopulmonary resuscitation in association with hands-off time, using video recordings of resuscitation events. DESIGN Single-center, prospective, observational trial. SETTING Twenty-six bed cardiac ICU in a quaternary care free standing pediatric academic hospital. PATIENTS Patients admitted to the cardiac ICU with cardiopulmonary resuscitation events lasting greater than 2 minutes captured on video. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Videos of 17 cardiopulmonary resuscitation episodes comprising 264.5 minutes of cardiopulmonary resuscitation were reviewed: 11 classic cardiopulmonary resuscitation (87.5 min) and six extracorporeal cardiopulmonary resuscitations (177 min). A total of 209 tasks occurred in 178 discrete time periods including compressor change (36%), rhythm/pulse check (18%), surgical pause (18%), extracorporeal membrane oxygenation preparation/draping (9%), repositioning (7.5%), defibrillation (6%), backboard placement (3%), bagging (<1%), pacing (<1%), intubation (<1%). In 31 time periods, 62 tasks were clustered with 18 (58%) as compressor changes and pulse/rhythm check. In the 178 discrete time periods, 135 occurred with a pause in compressions for greater than or equal to 1 second; 43 tasks occurred without pause. After accounting for repeated measures from individual patients, providers were less likely to perform rhythm or pulse checks (p < 0.0001) or change compressors regularly (p = 0.02) during extracorporeal cardiopulmonary resuscitation as compared to classic cardiopulmonary resuscitation. The frequency of tasks occurring during cardiopulmonary resuscitation interruptions in the classic cardiopulmonary resuscitation group was constant over the resuscitation but variable in extracorporeal cardiopulmonary resuscitation, peaking during activities required for cannulation. CONCLUSIONS On video review of cardiopulmonary resuscitation, we found that resuscitation guidelines were not strictly followed in either cardiopulmonary resuscitation or extracorporeal cardiopulmonary resuscitation patients, but adherence was worse in extracorporeal cardiopulmonary resuscitation. Clustering of resuscitation tasks occurred 23% of the time during chest compression pauses suggesting attempts at minimizing cardiopulmonary resuscitation interruptions. The frequency of cardiopulmonary resuscitation interruptions task events was relatively constant during classic cardiopulmonary resuscitation but variable in extracorporeal cardiopulmonary resuscitation. Characterization of resuscitation tasks by video review may inform better cardiopulmonary resuscitation orchestration and efficiency.
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Effective Method Using a Stool in Cardiopulmonary Resuscitation (CPR) on Dialysis Chair. Emerg Med Int 2020; 2020:5691607. [PMID: 32802512 PMCID: PMC7403903 DOI: 10.1155/2020/5691607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022] Open
Abstract
Background Heart failure is the leading cause of death in dialysis patients. Cardiac arrest due to hypotension may also occur during dialysis therapy. If cardiac arrest is elicited, manual chest compressions (MCCs) should be started as soon as possible. However, all types of dialysis chairs are not stable for MCC, because there is no steady support between the backboard of the dialysis chair and the floor. These conditions may alter the effectiveness of MCC. Methods We investigated whether a round chair is effective in supporting the dialysis chair for MCC. Four adult males performed MCC on a mannequin placed on three dialysis chairs. MCC was performed in sets of 2 (each set was 100 times per minute) per person, with and without a round chair. A total of 4,800 compressions were performed by four executors. Results When the chair was not used as a stabilizer, the mean values of the fluctuation range were 20.8 ± 8.1 mm, 18.7 ± 5.5 mm, and 12.8 ± 1.8 mm, respectively. When the chair was used, the mean values of the fluctuation range were 6.1 ± 1.1 mm, 7.5 ± 2.1 mm, and 1.0 ± 0 mm, decreasing by 70%, 59%, and 92%. Conclusion MCC performed with the stool under the backrest as a stabilizer was effective in supporting the dialysis chair.
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Two-Thumb or Two-Finger Technique in Infant Cardiopulmonary Resuscitation by a Single Rescuer? A Meta-Analysis with GOSH Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145214. [PMID: 32707697 PMCID: PMC7400494 DOI: 10.3390/ijerph17145214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 01/08/2023]
Abstract
Out-of-hospital infant cardiopulmonary arrest is a fatal and uncommon event. High mortality rates and poor neurological outcomes may be improved by early cardiopulmonary resuscitation (CPR). The ongoing debate over two different infant CPR techniques, the two-thumb (TT) and the two-finger (TF) technique, has remained, especially in terms of the adequate compression depth, compression rate, and hands-off time. In this article, we searched three major databases, PubMed, EMBASE (Excerpta Medica database), and CENTRAL (Cochrane Central Register of Controlled Trials), for randomized control trials which compared the outcomes of interest between the TT and TF techniques in infant CPR. The results showed that the TT technique was associated with higher proportion of adequate compression depth (Mean difference (MD): 19.99%; 95%, Confidence interval (CI): 9.77 to 30.22; p < 0.01) than the TF technique. There was no significant difference in compression rate and hands-off time. In our conclusion, the TT technique is better in terms of adequate compression depth than the TF technique, without significant differences in compression rate and hands-off time.
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Jeon S, Lee HJ, Jung YH, Do W, Cho AR, Baik J, Lee DW, Kim EJ, Kim E, Hong JM. Concealed congenital long QT syndrome during velopharyngeal dysfunction correction: a case report. J Dent Anesth Pain Med 2020; 20:165-171. [PMID: 32617412 PMCID: PMC7321742 DOI: 10.17245/jdapm.2020.20.3.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/02/2022] Open
Abstract
The congenital long QT syndrome (LQTS) is an inherited cardiac disorder characterized by increased QT intervals and a tendency to experience ventricular tachycardia, which can cause fainting, heart failure, or sudden death. A 4-year-old female patient undergoing velopharyngeal correction surgery under general anesthesia suddenly developed Torsades de pointes. Although the patient spontaneously resolved to sinus rhythm without treatment, subsequent QT prolongation persisted. Here, we report a case of concealed LQTS with a literature review.
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Affiliation(s)
- Soeun Jeon
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea.,Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyeon-Jeong Lee
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea.,Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Young-Hoon Jung
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Wangseok Do
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Ah-Reum Cho
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Jiseok Baik
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Do-Won Lee
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Eun-Jung Kim
- Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University, Dental Research Institute, Yangsan, Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Jeong-Min Hong
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
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How Much Cardiopulmonary Resuscitation Does a Pediatric Emergency Provider Perform in 1 Year? A Video-Based Analysis. Pediatr Emerg Care 2020; 36:327-331. [PMID: 30247459 DOI: 10.1097/pec.0000000000001625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We aimed to quantify time performing chest compressions (CCs) per year of individual providers in a pediatric ED and to project a rate of opportunity for CC based on median clinical hours per provider category. METHODS This was an observational study of video-recorded resuscitations in a pediatric ED over 1 year. Events where CCs were performed for more than 2 minutes were included. Identification of providers and duration of CCs per provider were determined by video review. Time of CCs was totaled per provider over the study period. Data were expressed as median and interquartile range (IQR). Rate of opportunity for providing CC to a child was calculated by dividing the median clinical hours per year per provider type by the number of CC events per year. RESULTS Twenty-three CC events totaling 340 minutes of CCs were analyzed. Chest compressions were performed by 6 (13%) of 45 attending physicians, 3 (25%) of 12 fellows, 32 (22%) of 143 nurses, and 19 (59%) of 32 technicians. The median amount of time performing CC was 182 seconds (IQR, 91-396 seconds); by provider category, median amount of time was as follows: attending physicians, 83 seconds (IQR, 64-103 seconds); fellows, 45 seconds (IQR, 6-83 seconds); nurses, 128 seconds (IQR, 93-271 seconds); and technicians, 534 seconds (IQR, 217-793 seconds). The projected hours needed for an opportunity to perform CCs was 730 hours (91 shifts) for attending physicians, 243 hours (30 shifts) for fellows, and 1460 hours (121 shifts) for nurses and technicians. CONCLUSIONS Performing CCs on children in the ED is a rare event, with a median of 3 minutes per provider per year. Future studies should determine training methods to optimize readiness for these rare occurrences.
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Pei-Chuan Huang E, Fu CM, Chang WT, Huang CH, Tsai MS, Chou E, Wolfshohl J, Wang CH, Wu YW, Chen WJ. Associations of thoracic cage size and configuration with outcomes of adult in-hospital cardiac arrest: A retrospective cohort study. J Formos Med Assoc 2020; 120:371-379. [PMID: 32536380 DOI: 10.1016/j.jfma.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND To analyse the association of thoracic cage size and configuration with outcomes following in-hospital cardiac arrest (IHCA). METHODS A single-centred retrospective study was conducted. Adult patients experiencing IHCA during 2006-2015 were screened. By analysing computed tomography images, we measured thoracic anterior-posterior and transverse diameters, circumference, and both anterior and posterior subcutaneous adipose tissue (SAT) depths at the level of the internipple line (INL). We also recorded the anatomical structure located immediately posterior to the sternum at the INL. RESULTS A total of 649 patients were included. The median thoracic circumference was 88.6 cm. The median anterior and posterior thoracic SAT depths were 0.9 and 1.5 cm, respectively. The ascending aorta was found to be the most common retrosternal structure (57.6%) at the INL. Multivariate logistic regression analyses indicated that anterior thoracic SAT depth of 0.8-1.6 cm (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.40-6.35; p-value = 0.005) and thoracic circumference of 83.9-95.0 cm (OR: 2.48, 95% CI: 1.16-5.29; p-value = 0.02) were positively associated with a favourable neurological outcome while left ventricular outflow track or aortic root beneath sternum at the level of INL was inversely associated with a favourable neurological outcome (OR: 0.37, 95% CI: 0.15-0.91; p-value = 0.03). CONCLUSION Thoracic circumference and anatomic configuration might be associated with IHCA outcomes. This proof-of-concept study suggested that a one-size-fits-all resuscitation technique might not be suitable. Further investigation is needed to investigate the method of providing personalized resuscitation tailored to patient needs.
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Affiliation(s)
- Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Chia-Ming Fu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Eric Chou
- Department of Emergency Medicine, Baylor Scott&White All Saints Medical Center, Fort Worth, Texas, USA
| | - Jon Wolfshohl
- Department of Emergency Medicine, Baylor Scott&White All Saints Medical Center, Fort Worth, Texas, USA; Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, Texas, USA
| | - Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Yen-Wen Wu
- Department of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Torney H, McAlister O, Harvey A, Kernaghan A, Funston R, McCartney B, Davis L, Bond R, McEneaney D, Adgey J. Real-world insight into public access defibrillator use over five years. Open Heart 2020; 7:openhrt-2020-001251. [PMID: 32513668 PMCID: PMC7282393 DOI: 10.1136/openhrt-2020-001251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Public access defibrillators (PADs) represent unique life-saving medical devices as they may be used by untrained lay rescuers. Collecting representative clinical data on these devices can be challenging. Here, we present results from a retrospective observational cohort study, describing real-world PAD utilisation over a 5-year period. METHODS Data were collected between October 2012 and October 2017. Responders voluntarily submitted electronic data downloaded from HeartSine PADs, and patient demographics and other details using a case report form in exchange for a replacement battery and electrode pack. RESULTS Data were collected for 977 patients (692 males, 70.8%; 255 females, 26.1%; 30 unknown, 3.1%). The mean age (SD) was 59 (18) years (range <1 year to 101 years). PAD usage occurred most commonly in homes (n=328, 33.6%), followed by public places (n=307, 31.4%) and medical facilities (n=128, 13.1%). Location was unknown in 40 (4.09%) events. Shocks were delivered to 354 patients. First shock success was 312 of 350 patients where it could be determined (89.1%, 95% CI 85.4% to 92.2%). Patients with reported response times ≤5 min were more likely to survive to hospital admission (89/296 (30.1%) vs 40/250 (16.0%), p<0.001). Response time was unknown for 431 events. CONCLUSION This is the first study to report global PAD usage in voluntarily submitted, unselected real-world cases and demonstrates the real-world effectiveness of PADs, as confirmed by first shock success.
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Affiliation(s)
- Hannah Torney
- Ulster University, Newtownabbey, Northern Ireland, UK .,HeartSine Technologies Ltd, Belfast, UK
| | - Olibhéar McAlister
- Ulster University, Newtownabbey, Northern Ireland, UK.,HeartSine Technologies Ltd, Belfast, UK
| | | | - Amy Kernaghan
- Ulster University, Newtownabbey, Northern Ireland, UK.,HeartSine Technologies Ltd, Belfast, UK
| | | | | | | | - Raymond Bond
- Ulster University, Newtownabbey, Northern Ireland, UK
| | - David McEneaney
- Cardiovascular Research Unit, Craigavon Area Hospital, Southern Health and Social Care Trust, Portadown, UK
| | - Jennifer Adgey
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, UK
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Analysis of Chest-Compression Depth and Full Recoil in Two Infant Chest-Compression Techniques Performed by a Single Rescuer: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114018. [PMID: 32516929 PMCID: PMC7312068 DOI: 10.3390/ijerph17114018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 12/27/2022]
Abstract
Pediatric cardiac arrest is associated with high mortality and permanent neurological injury. We aimed to compare the effects of the two-thumb (TT) and two-finger (TF) techniques in infant cardiopulmonary resuscitation (CPR) performed by a single rescuer. We searched PubMed, EMBASE, and CENTRAL for randomized control trials published before December 2019. Studies comparing the TT and TF techniques in infant CPR were included for meta-analysis. Relevant information was extracted for methodological assessment. Twelve studies were included. The TT technique was associated with deeper chest-compression depth (mean difference: 4.71 mm; 95% confidence interval: 3.61 to 5.81; p < 0.001) compared with the TF technique. The TF technique was better in terms of the proportion of complete chest recoil (mean difference: -11.73%; 95% confidence interval: -20.29 to -3.17; p = 0.007). CPR was performed on a manikin model, and the application of the results to real human beings may be limited. The TT technique was superior to the TF technique in terms of chest-compression depth, but with inferior chest full recoil. Future investigations should focus on modifying the conventional TT technique to generate greater compression depth and achieve complete chest recoil.
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47
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Analysis of CPR quality by individual providers in the pediatric emergency department. Resuscitation 2020; 153:37-44. [PMID: 32505613 DOI: 10.1016/j.resuscitation.2020.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/23/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To describe chest compression (CC) quality by individual providers in two pediatric emergency departments (EDs) using video review and compression monitor output during pediatric cardiac arrests. METHODS Prospective observational study. Patients <18 yo receiving CC for >1 min were eligible. Data was collected from video review and CC monitor device in a synchronized fashion and reported in 'segments' by individual providers. Univariate comparison by age (<1 yo, 1-8 yo, >8 yo) was performed by chi-square testing for dichotomous variables ('high-quality' CPR) and nonparametric testing for continuous variables (CC rate and depth). Univariate comparison of ventilation rate (V) was made between segments with an advanced airway versus without. RESULTS 524 segments had data available; 42/524 (8%) met criteria for 'high-quality CC'. Patients >8 yo had more segments meeting criteria (18% vs. 2% and 0.5%; p < 0.001). Segments compliant for rate were less frequent in <1 yo (17% vs. 24% vs. 27%; p = 0.03). Segments compliant for depth were less frequent in <1 year olds and 1-8 year olds (5% and 9% vs. 20%, p < 0.001.) Mean V for segments with an advanced airway was higher than with a natural airway (24 ± 18 vs. 14 ± 10 bpm, p < 0.001). Hyperventilation was more prevalent in CPR segments with an advanced airway (66% vs. 32%, p < 0.001). CONCLUSIONS CC depth is rarely guideline compliant in infants. Hyperventilation is more prevalent during CPR periods with an advanced airway in place. Measuring individual provider CPR quality is feasible, allowing future studies to evaluate the impact of CPR training.
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48
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Jang YE, Park JB, Kang CH, Park S, Kim EH, Lee JH, Kim HS, Kim JT. Cardiopulmonary resuscitation in pediatric pectus excavatum patients-Where is the heart? Paediatr Anaesth 2020; 30:698-707. [PMID: 32298510 DOI: 10.1111/pan.13878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In children with pectus excavatum, the posteriorly depressed sternum compresses and displaces the heart. However, the currently recommended compression site and depth for cardiopulmonary resuscitation have not been studied in this population. AIM This retrospective study investigated the location of the center of ventricles with the largest cross-sectional area to determine the optimal site and depth for chest compressions in pediatric pectus excavatum patients. METHODS Chest computed tomography images of 94 pediatric pectus excavatum patients before and after correction surgery were compared with normal patients. The caudal displacement of the ventricles was calculated by dividing the length of sternum by the length from the suprasternal notch to the transverse level of the largest cross-sectional area of the ventricles. The proportional leftward deviation of the center of the ventricles from the midline versus transverse diameter of the thorax was calculated. The remaining internal thickness was calculated at the midline assuming the recommended compression depth of one-third of the anterior to posterior diameter. RESULTS Compared with the normal population (mean = 81% [SD = 10.3%]), pediatric pectus excavatum patients showed caudal displacement of ventricles before (98.2% [15.1%], 95% CI of mean difference; 13.7%-20.5%, P < .001) and after correction (100.4% [13.5%], 95% CI of mean difference; 16.2%-22.5%, P < .001). Compared with the normal population (6.9% [2.7%]), pediatric pectus excavatum patients showed leftward deviation of ventricles before (16.2% [5.5%], 95% CI of mean difference; 8.2%-10.4%, P < .001) and after correction (13.3% [4.8%], 95% CI of mean difference; 5.3%-7.3%, P < .001). The remaining internal thickness assuming the recommended chest compression was <10 mm in 54/94(57.4%) and 18/94 (19.1%) of pediatric pectus excavatum patients before and after correction, respectively. CONCLUSIONS Pediatric pectus excavatum patients showed significant caudal displacement and leftward deviation of the ventricles compared with the normal population despite correction surgery and the currently recommended compression site and depth might injure intrathoracic structures without effective cardiac compression during cardiopulmonary resuscitation.
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Affiliation(s)
- Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Korea
| | - Jung-Bin Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Korea
| | - Chang-Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Korea
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Donoghue AJ, Kou M, Good GL, Eiger C, Nash M, Henretig FM, Stacks H, Kochman A, Debski J, Chen JY, Sharma G, Hornik CP, Gosnell L, Siegel D, Krug S, Adler MD. Impact of Personal Protective Equipment on Pediatric Cardiopulmonary Resuscitation Performance: A Controlled Trial. Pediatr Emerg Care 2020; 36:267-273. [PMID: 32483079 PMCID: PMC7274141 DOI: 10.1097/pec.0000000000002109] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to determine whether personal protective equipment (PPE) results in deterioration in chest compression (CC) quality and greater fatigue for administering health care providers (HCPs). METHODS In this multicenter study, HCPs completed 2 sessions. In session 1 (baseline), HCPs wore normal attire; in session 2, HCPs donned full PPE. During each session, they performed 5 minutes of uninterrupted CCs on a child manikin. Chest compression rate, depth, and release velocity were reported in ten 30-second epochs. Change in CC parameters and self-reported fatigue were measured between the start and 2- and 5-minute epochs. RESULTS We enrolled 108 HCPs (prehospital and in-hospital providers). The median CC rate did not change significantly between epochs 1 and 10 during baseline sessions. Median CC depth and release velocity decreased for 5 minutes with PPE. There were no significant differences in CC parameters between baseline and PPE sessions in any provider group. Median fatigue scores during baseline sessions were 2 (at start), 4 (at 2 minutes), and 6 (at 5 minutes). There was a significantly higher median fatigue score between 0 and 5 minutes in both study sessions and in all groups. Fatigue scores were significantly higher for providers wearing PPE compared with baseline specifically among prehospital providers. CONCLUSIONS During a clinically appropriate 2-minute period, neither CC quality nor self-reported fatigue worsened to a significant degree in providers wearing PPE. Our data suggest that Pediatric Basic Life Support recommendations for CC providers to switch every 2 minutes need not be altered with PPE use.
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Affiliation(s)
- Aaron J Donoghue
- From the Departments of Anesthesia and Critical Care Medicine
- Pediatrics, Perelman School of Medicine at the University of Pennsylvania
- Center for Simulation, Advanced Education, and Innovation, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Maybelle Kou
- Department of Emergency Medicine
- Inova Center for Advanced Medical Simulation, Inova Fairfax Medical Campus, Falls Church, VA
| | | | - Carmel Eiger
- Clinical and Organizational Development, Lurie Children's Hospital of Chicago, Chicago, IL
| | - Mark Nash
- Fairfax County Fire and Rescue Department, Hazardous Materials Response Team, Fairfax, VA
| | - Fred M Henretig
- Pediatrics, Perelman School of Medicine at the University of Pennsylvania
| | - Helen Stacks
- Inova Center for Advanced Medical Simulation, Inova Fairfax Medical Campus, Falls Church, VA
| | | | | | | | | | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Leigh Gosnell
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - David Siegel
- Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Steven Krug
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mark D Adler
- Feinberg School of Medicine, Northwestern University, Chicago, IL
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50
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Loaec M, Himebauch AS, Kilbaugh TJ, Berg RA, Graham K, Hanna R, Wolfe HA, Sutton RM, Morgan RW. Pediatric cardiopulmonary resuscitation quality during intra-hospital transport. Resuscitation 2020; 152:123-130. [PMID: 32422246 DOI: 10.1016/j.resuscitation.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 02/06/2023]
Abstract
AIM To evaluate pediatric cardiopulmonary resuscitation (CPR) quality during intra-hospital transport to facilitate extracorporeal membrane oxygenation (ECMO)-CPR (ECPR). We compared chest compression (CC) rate, depth, and fraction (CCF) between the pre-transport and intra-transport periods. METHODS Observational study of children <18 years with either in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) who underwent transport between two care locations within the hospital for ECPR and who had CPR mechanics data available. Descriptive patient and arrest characteristics were summarized. The primary analysis compared pre- to intra-transport CC rate, depth, and fraction. A secondary analysis compared the proportion of pre- versus intra-transport 60-s epochs meeting guideline recommendations for rate (100-120/min), depth (≥4 cm for infants; ≥5 cm for children ≥1 year), and CCF (≥0.80). RESULTS Seven patients (four IHCA; three witnessed OHCA) met eligibility criteria. Six (86%) patients survived the event and two (28%) survived to hospital discharge. Median transport CPR duration was 7 [IQR 5.5, 8.5] minutes. There were no differences in pre- vs. intra-transport CC rate (115 [113, 118] vs. 118 [114, 127] CCs/minute; p = 0.18), depth (3.2 [2.7, 4.4] vs. 3.6 [2.5, 4.6] cm; p = 0.50), or CCF (0.89 [0.82, 0.90] vs. 0.92 [0.79, 0.97]; p = 0.31). Equivalent proportions of 60-s CPR epochs met guideline recommendations between pre- and intra-transport (rate: 66% vs. 57% [p = 0.22]; depth: 14% vs. 19% [p = 0.39]; CCF: 80% vs. 75% [p = 0.43]). CONCLUSIONS Pediatric CPR quality was maintained during intra-hospital patient transport, suggesting that it is reasonable for ECPR systems to incorporate patient transport to facilitate ECMO cannulation.
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Affiliation(s)
- Morgann Loaec
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Kathryn Graham
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Richard Hanna
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Heather A Wolfe
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
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