Methods for Determining Pediatric Thoracic Force-Deflection Characteristics From Cardiopulmonary Resuscitation

Maltese, Matthew R.; Castner, Thomas; Niles, Dana; Nishisaki, Akira; Balasubramanian, Sriram; Nysæther, Jon; Sutton, Robert M.; Arbogast, Kristy B.

doi:10.4271/2008-22-0004

Cited by 24 publications

(33 citation statements)

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“…15 Although we could not find data describing chest compression force in younger children, our results show that the force applied to patients in the pre-teen and adolescent groups (>8 years old) (∼6.0 kg) in our study was considerably lower than the force used in studies of children of a similar age (mean >30 kg). 16,17 Our results are comparable with those of a previous study which used a porcine model to examine effectiveness of chest compressions for ventilation under conditions of continuous positive airway pressure (CPAP). 5 In their study, Hevesi et al demonstrated that, with CPAP set to 75% of the animals' baseline ventilation, chest compressions allowed substantial CO 2 exchange and significantly higher SaO 2 levels compared to non-CPAP conditions.…”

Section: Discussionsupporting

confidence: 92%

Generation of tidal volume via gentle chest pressure in children over one year old

et al. 2015

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Section: Discussionsupporting

confidence: 92%

Generation of tidal volume via gentle chest pressure in children over one year old

et al. 2015

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“…We attribute the small variation in CC rates to an ongoing and successful CPR quality improvement program at our institution, which consists of a daily CPR retraining program 18-20 , feedback-enabled defibrillators, and post-cardiac arrest debriefings. 21 As an alternative explanation, the higher compliance of pediatric chest walls 27 may have also made it easier for providers to achieve sufficient CC depths even when pushing fast. Irrespective of reason, this data supports that providing high quality CPR with excellent chest compression depths AND rates – PUSHING HARD AND FAST – is possible.…”

Section: Discussionmentioning

confidence: 99%

2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival

et al. 2014

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Aim Gaps exist in pediatric resuscitation knowledge due to limited data collected during cardiac arrest in real children. The objective of this study was to evaluate the relationship between the 2010 American Heart Association (AHA) recommended chest compression (CC) depth (≥ 51mm) and survival following pediatric resuscitation attempts. Methods Single-center prospectively collected and retrospectively analyzed observational study of children (> 1 year) who received CCs between October 2006 and September 2013 in the intensive care unit (ICU) or emergency department (ED) at a tertiary care children's hospital. Multivariate logistic regression models controlling for calendar year and known potential confounders were used to estimate the association between 2010 AHA depth compliance and survival outcomes. The primary outcome was 24-hour survival. The primary predictor variable was event AHA depth compliance, prospectively defined as an event with ≥ 60 percent of 30-second epochs achieving an average CC depth ≥ 51mm during the first 5 minutes of the resuscitation. Results There were 89 CC events, 87 with quantitative CPR data collected (23 AHA Depth Compliant). AHA depth compliant events were associated with improved 24-hour survival on both univariate analysis (70% vs. 16%, p<0.001) and after controlling for potential confounders (calendar year of arrest, gender, first documented rhythm; aOR 10.3; CI95: 2.75 – 38.8; p<0.001). Conclusions 2010 AHA compliant chest compression depths (≥ 51mm) are associated with higher 24-hour survival compared to shallower chest compression depths, even after accounting for potentially confounding patient and event factors.

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“…In accordance with previous animal and adult investigations, we prospectively designated an increase in peak ETP of ≥2 cmH 2 O as a minimal clinically important difference. 10,12–15 Moreover, using the findings of Tomlinson et al, 16 and Maltese et al, 17 that demonstrated average chest compression forces of approximately 25–30 kg during adolescent and adult resuscitation, and Zuercher et al, 13 who found in a piglet model of cardiac arrest that clinically important hemodynamic effects were seen with leaning ≥10% of the overall compression force, significant sternal force was defined as ≥2.5 kg (i.e., 10% of 25 kg). Also based upon the findings of this pediatric model of cardiac arrest, in an attempt to investigate a cutoff standardized to bodyweight for pediatric subjects, we defined a leaning force of ≥20% of the subject’s body weight as significant as well.…”

Section: Discussionmentioning

confidence: 96%

Effect of residual leaning force on intrathoracic pressure during mechanical ventilation in children

et al. 2010

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Aim Determine the effect of residual leaning force on intrathoracic pressure (ITP) in healthy children receiving mechanical ventilation. We hypothesized that application of significant residual leaning force (2.5 kg or 20% of subject body weight) would be associated with a clinically important change in ITP. Methods IRB-approved pilot study of healthy, anesthetized, paralyzed mechanically ventilated children (6 months to 7 years). Peak endotracheal pressure (ETP), a surrogate of ITP, was continuously measured before and during serial incremental increases in sternal force from 10% to 25% of the subject’s body weight. A delta ETP of ≥2.0 cmH2O was considered clinically significant. Results 13 healthy, anesthetized, paralyzed mechanically ventilated children (age: 26 ± 24 m, range: 6.5–87 m; weight: 13 ± 5 kg, range: 7.4–24.8 kg) were enrolled. Peak ETP increased from baseline for all force applications (10% body weight: mean difference of 0.8 cmH2O, p < 0.01; 15% body weight: mean difference of 1.1 cmH2O, p < 0.01; 20% body weight: mean difference of 1.5 cmH2O, p < 0.01; 25% body weight: mean difference of 1.89 cmH2O, p < 0.01). Residual leaning force of ≥2.5 kg was associated with a 2.0 cmH2O change in peak ETP (odds ratio 7.5; CI95 1.5–37.7; p = 0.014) while sternal force ≥20% body weight was not (odds ratio 2.4; CI95 0.6–9.2; p = 0.2). Conclusion In healthy anesthetized children, changes in ETP were detectable at residual leaning forces as low as 10% of subject body weight. Residual leaning force of 2.5 kg was associated with increases in ETP ≥2.0 cmH2O.

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Methods for Determining Pediatric Thoracic Force-Deflection Characteristics From Cardiopulmonary Resuscitation

Cited by 24 publications

References 0 publications

Generation of tidal volume via gentle chest pressure in children over one year old

Generation of tidal volume via gentle chest pressure in children over one year old

2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival

Effect of residual leaning force on intrathoracic pressure during mechanical ventilation in children

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