Rescuer fatigue during simulated neonatal cardiopulmonary resuscitation

Es, Li; Cheung, Po-Yin; O’Reilly, Megan; Aziz, Khalid; Schmölzer, GM

doi:10.1038/jp.2014.165

Cited by 39 publications

(51 citation statements)

References 30 publications

(45 reference statements)

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“…A recent randomized animal trial comparing CC+SI using CC rates of 90/min versus 120/min reported a similar time to ROSC and survival rate, and similar hemodynamic and respiratory parameters during CPR [17], suggesting that higher CC rates are not necessarily an advantage. In addition, recent simulation studies assessing fatigue reported that operators using CC rates of 120/min compared to 90/min showed signs of fatigue within 2 min of initiating CC [18,19]. …”

Section: Discussionmentioning

confidence: 99%

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Görens²,

Cheung³

et al. 2017

Neonatology

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Background: Recently, sustained inflations (SI) during chest compression (CC) (CC+SI) have been suggested as an alternative to the current approach during neonatal resuscitation. No previous study compared CC+SI using CC rates of 90/min to the current 3:1 compression:ventilation ratio (C:V). Objective: To determine whether CC+SI versus a 3:1 C:V reduces the time to the return of spontaneous circulation (ROSC) and improves hemodynamic recovery in newborn piglets with asphyxia-induced bradycardia. Intervention and Measurements: Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-min normocapnic hypoxia followed by asphyxia. Cardiopulmonary resuscitation (CPR) was initiated when the heart rate decreased to 25% of baseline. Piglets were randomized into 3 groups: CC during SI at a rate of 90 CC/min (SI+CC 90, n = 8), a 3:1 C:V using 90 CC and 30 inflations (3:1, n = 8), or a sham group (n = 6). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Results: CC+SI significantly reduced the median (IQR) time of ROSC, i.e., 34 s (28-156 s) versus 210 s (72-300 s) in the 3:1 group (p = 0.048). CC+SI also significantly reduced the requirement for 100% oxygen, improved respiratory parameters, and resulted in a similar hemodynamic recovery. Conclusions: CC+SI during CPR significantly improved ROSC in a porcine model of neonatal resuscitation. This is of considerable clinical relevance because improved respiratory and hemodynamic parameters potentially minimize morbidity and mortality in newborn infants.

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Section: Discussionmentioning

confidence: 99%

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Görens²,

Cheung³

et al. 2017

Neonatology

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“…Leaning decreased with time during continuous CC, suggesting that either leaning is not caused by rescuer fatigue, or that it may be mitigated by automated feedback during CPR. Our own observations from manikin studies also suggest leaning during neonatal CPR,34 however this has not been systematically analysed.…”

Section: Resultsmentioning

confidence: 95%

A review of approaches to optimise chest compressions in the resuscitation of asphyxiated newborns

Solevåg

Cheung

O’Reilly

et al. 2015

Arch Dis Child Fetal Neonatal Ed

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“…Moreover, the optimal frequency of CCs in both children and adults is not specified [21][22][23]. Li et al [24] showed that even though it was possible for neonatal staff to perform continuous CCs at rates of 90 and 120 × min -1 , a significant decay in CC pressure occurred after 96 s and 72 s, respectively. Moreover, when CPR was performed with the standard 3:1 compression:ventilation (C:V) ratio, a significant decay occurred only after 156 s. According to Li et al [24], good quality CCs might be maintained for more than twice as long in 3:1 C:V CPR compared with uninterrupted CCs at the rate of 120 × min -1 (CCaV-120).…”

Section: Discussionmentioning

confidence: 99%

“…Li et al [24] showed that even though it was possible for neonatal staff to perform continuous CCs at rates of 90 and 120 × min -1 , a significant decay in CC pressure occurred after 96 s and 72 s, respectively. Moreover, when CPR was performed with the standard 3:1 compression:ventilation (C:V) ratio, a significant decay occurred only after 156 s. According to Li et al [24], good quality CCs might be maintained for more than twice as long in 3:1 C:V CPR compared with uninterrupted CCs at the rate of 120 × min -1 (CCaV-120). In addition, the three-minute CC depth decline was 50% if CCs were performed at the rate of 120 × min -1 vs. 30% if they were performed at the rate of 90 × min -1 .…”

Section: Discussionmentioning

confidence: 99%

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

et al. 2018

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A b s t r a c tBackground: Early bystander cardiopulmonary resuscitation (CPR) for cardiac arrest is crucial in the chain of survival. Cardiac arrest in infants is rare, but CPR is also performed in severe bradycardia. European Resuscitation Council and American Heart Association guidelines recommend continuing CPR until the heart muscle is sufficiently oxygenated and regains sufficient contractility and function. The most common and recommended CPR techniques that can be applied in newborns are the two-finger technique and two-thumb technique. Aim:We sought to assess the quality of CPR performed in newborns with the two-finger technique depending on the position of the rescuer during resuscitation. Methods:This was a prospective, randomised, crossover, simulated study. It involved 93 nurses who were required to perform a two-minute CPR using the two-finger technique in three scenarios: (A) with the newborn lying on the floor; (B) on a table; and (C) with the newborn on the rescuer's forearm. The Newborn Tory ® S2210 manikin was used to simulate a neonatal patient in cardiac arrest. The following parameters were measured: chest compression (CC) depth, CC rate, no-flow time, percentage of full release, ventilation rate, and ventilation volume, as well as the number of effective compressions and effective ventilations.Results: Statistical analysis showed significant differences in CC rates between scenarios A and B (p < 0.001) and between scenarios B and C (p = 0.002). Significant differences were also observed between the median CC depth. The median percentage of no-flow-fraction was the highest for scenario A (55%), followed by scenario B (48%), and scenario C (46%). There were significant differences between the values of no-flow-fraction between scenarios A and B (p < 0.001), and between scenarios A and C (p < 0.001). The percentage of chest full releases for scenarios A, B, and C amounted to 94%, 1%, and 92%, respectively. Significant differences in the number of effective CCs between scenarios A and B (p < 0.001) as well as B and C (p < 0.001) were revealed. The median ventilation rate was highest for scenario B (13 × min ). The highest tidal volume was obtained in scenario A (27 mL), and the lowest in scenario C (26 mL). The most effective CPR was performed when resuscitation was carried out on the rescuer's forearm. Conclusions:The quality of CCs in newborns depends on the location of the patient and the rescuer. The optimal form of resuscitation of newborns is resuscitation on the rescuer's forearm.

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Rescuer fatigue during simulated neonatal cardiopulmonary resuscitation

Abstract: Similarly, 3:1 C:V and CCaV CPR were also fatiguing. We recommend that rescuers should switch after every second cycle of heart rate assessment during neonatal CPR.

Cited by 39 publications

References 30 publications

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

A review of approaches to optimise chest compressions in the resuscitation of asphyxiated newborns

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

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