Does the use of a chest compression system in children improve the effectiveness of chest compressions? A randomised crossover simulation pilot study

Szarpak, Łukasz; Truszewski, Zenon; Smereka, Jacek; Czyżewski, Łukasz

doi:10.5603/kp.a2016.0107

Cited by 26 publications

(13 citation statements)

References 15 publications

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“…High-quality CPR in infants, [15,16] as well as in adults, [17,18] can be a challenge even for certified CPR providers. A constant quality assurance system, including repetitive practical training, is necessary, and the quality of chest compressions is influenced by motor skills and the working environment.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a newly developed infant chest compression technique

Smereka

Bielski²,

Ładny

et al. 2017

Medicine

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Background:Providing adequate chest compression is essential during infant cardio-pulmonary-resuscitation (CPR) but was reported to be performed poor. The “new 2-thumb technique” (nTTT), which consists in using 2 thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist, was recently introduced. Therefore, the aim of this study was to compare 3 chest compression techniques, namely, the 2-finger-technique (TFT), the 2-thumb-technique (TTHT), and the nTTT in an randomized infant-CPR manikin setting.Methods:A total of 73 paramedics with at least 1 year of clinical experience performed 3 CPR settings with a chest compression:ventilation ratio of 15:2, according to current guidelines. Chest compression was performed with 1 out of the 3 chest compression techniques in a randomized sequence. Chest compression rate and depth, chest decompression, and adequate ventilation after chest compression served as outcome parameters.Results:The chest compression depth was 29 (IQR, 28–29) mm in the TFT group, 42 (40–43) mm in the TTHT group, and 40 (39–40) mm in the nTTT group (TFT vs TTHT, P < 0.001; TFT vs nTTT, P < 0.001; TTHT vs nTTT, P < 0.01). The median compression rate with TFT, TTHT, and nTTT varied and amounted to 136 (IQR, 133–144) min–1 versus 117 (115–121) min–1 versus 111 (109–113) min–1. There was a statistically significant difference in the compression rate between TFT and TTHT (P < 0.001), TFT and nTTT (P < 0.001), as well as TTHT and nTTT (P < 0.001). Incorrect decompressions after CC were significantly increased in the TTHT group compared with the TFT (P < 0.001) and the nTTT (P < 0.001) group.Conclusions:The nTTT provides adequate chest compression depth and rate and was associated with adequate chest decompression and possibility to adequately ventilate the infant manikin. Further clinical studies are necessary to confirm these initial findings.

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Section: Discussionmentioning

confidence: 99%

Evaluation of a newly developed infant chest compression technique

Smereka

Bielski²,

Ładny

et al. 2017

Medicine

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“…Subjects performed intraosseous access during simulated ongoing CPR. To standardize the difficulties resulting from the chest compressions, the mechanical chest compression device Lucas 3 (Physio-Control, Redmond, WA, USA) was used [23]. For each intraosseous attempt, the manikin was placed on the floor in a bright room.…”

Section: Methodsmentioning

confidence: 99%

Comparison of four different intraosseous access devices during simulated pediatric resuscitation. A randomized crossover manikin trial

Bielski¹,

Szarpak

Smereka

et al. 2017

Eur J Pediatr

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The aim of the study was to compare the success rate, procedure time, and user satisfaction of pediatric NIO™ compared to Pediatric BIG®, EZ-IO®, and Jamshidi intraosseous access devices. This was a randomized, crossover manikin trial with 87 paramedics. The correct location of intraosseous access when using NIO, BIG, EZ-IO, and Jamshidi was varied and was respectively 100, 90, 90, and 90%. The time required to obtain intravascular access (time T1) in the case of NIO, BIG, EZ-IO, and Jamshidi was varied and amounted to 9 s [IQR, 8–12] for NIO, 12 s [IQR, 9–16] for BIG, 13.5 s [IQR, 11–17] for the EZ-IO, and 15 s [IQR, 13–19] for Jamshidi. The paramedics evaluated each device on the subjective ease with which they performed the procedures. The intraosseous device, which proved the easiest to use was NIO, which in the case of CPR received a median rating of 1.5 (IQR, 0.5–1.5) points. Conclusion: Our study found that NIO® is superior to BIG®, EZ-IO®, and Jamshidi. NIO® achieved the highest first attempt success rate. NIO® also required the least time to insert and easiest to operate even by novice users. Further study is needed to test our findings in cadavers or human subjects. Based on our findings, NIO® is a promising intraosseous device for use in pediatric resuscitation. What is Known: • Venous access in acutely ill pediatric patients, such as those undergoing cardiopulmonary resuscitation, is needed for prompt administration of drugs and fluids.• Intraosseous access is recommended by American Heart Association and European Resuscitation council if vascular access is not readily obtainable to prevent delay in treatment. What is New: • This simulated pediatric resuscitation compared performance of four commercially available pediatric intraosseous devices in a manikin model.• NIO® outperformed BIG®, EZ-IO®, and Jamshidi in first attempt success rates and time of procedure among novice users.

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“…The quality of chest compressions (CC) performed by laypersons and staff with duty to assist is a decisive factor in the success of CPR [3]. However, some studies demonstrate that the quality of CPR performance during SCA is poor, even when CPR is conducted by medical staff [4][5][6][7]. Due to the fact that CC must be performed as continuously as possible and maintained over time, fatigue may be also a critical quality factor in CC [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation

et al. 2017

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A b s t r a c tBackground: Providing high-quality chest compressions and rescue breaths are key elements in the effectiveness of cardiopulmonary resuscitation. Aim:To investigate the effects of a strength training programme on the quality of prolonged basic cardiopulmonary resuscitation on a manikin. Methods:This was a quasi-experimental trial. Thirty-nine participants with prior basic life support knowledge were randomised to an experimental or control group. They then performed a test of 10 min of chest compressions and mouth-to-mouth ventilation on manikins equipped with a skill reporter tool (baseline or test 1). The experimental group participated in a four-week strength training programme focused on the muscles involved in chest compressions. Both groups were subsequently tested again (test 2).Results: After training, the experimental group significantly increased the mean depth of compression (53.7 ± 2.3 mm vs. 49.9 ± 5.9 mm; p = 0.003) and the correct compression fraction (68.2 ± 21.0% vs. 46.4 ± 29.1%; p = 0.004). Trained subjects maintained chest compression quality over time better than the control group. The mean tidal volume delivered was higher in the experimental than in the control group (701.5 ± 187.0 mL vs. 584.8 ± 113.6 mL; p = 0.040) and above the current resuscitation guidelines. In test 2, the percentage of rescue breaths with excessive volume was higher in the experimental group than in the controls (31.5 ± 19.6% vs. 15.6 ± 13.0%; p = 0.007). Conclusions:A simple strength training programme has a significant impact on the quality of chest compressions and its maintenance over time. Additional training is needed to avoid over-ventilation of potential patients.

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Does the use of a chest compression system in children improve the effectiveness of chest compressions? A randomised crossover simulation pilot study

Cited by 26 publications

References 15 publications

Evaluation of a newly developed infant chest compression technique

Evaluation of a newly developed infant chest compression technique

Comparison of four different intraosseous access devices during simulated pediatric resuscitation. A randomized crossover manikin trial

The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation

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