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

Abstract

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.

Comparison of two infant chest compression techniques during simulated newborn cardiopulmonary resuscitation performed by a single rescuer: A randomized, crossover multicenter trial

“…Another study of 2-min cardiopulmonary resuscitation using a Newborn Tory ® S2210 manikin (Gaumard ® Scientific, Miami, FL, USA) to compare TFT chest compressions in different resuscitation positions of the rescuer revealed that in no tested manikin position were TFT nurses able to reach the recommended CC depth (14-25 mm, the best result for the rescuers; forearm position) [35]. When resuscitation was performed on a table with the top adjusted to the height of 2/3 of the rescuer's thigh, the median CC depth for TFT achieved 14 mm only [22].…”

“…Previous studies have proven advantages of NTTT in infant, neonatal, and newborn resuscitation in various simulation settings, including 2-min vs. 10-min CCs, different manikin models, and diverse study methodology [20][21][22][23][24]. In contrast to previous research in newborn simulation settings [21,35], in this study the standard CC was used: the 3:1 ventilation ratio for newborn resuscitation [4], allowing to achieve approximately 90 CCs per minute. In pediatric patients, the standard recommended CC rate equals 100-120 per minute [3].…”

An optimal chest compression technique using personal protective equipment during resuscitation in the COVID-19 pandemic: a randomized crossover simulation study

“…Another important factor influencing the quality of chest compressions is the compression rate [22,23]. In our study, the participants performed compressions with the correct rate; however, the parameter differed between the methods studied.…”

Reanimação Neonatal

“…Além disso, foi constatada a insuficiência de conhecimentos sobre protocolos atuais. Smereka et al 22 Avaliar a qualidade da RCP realizada em recém-nascidos com a técnica dos dois dedos, dependendo da posição do socorrista durante a reanimação. / Estudo prospectivo, randomizado, cruzado e simulado.…”