Fatigue during Chest Compression Using a Neonatal Patient Simulator

Abstract

CC performance quality decreased and fatigue was frequent before 10 minutes had elapsed on a neonatal simulator. Provider fatigue was associated with both lack of aerobic activity and BMI ≥ 25. Our findings support the need for guidelines requiring frequent rotation of CC providers during prolonged neonatal resuscitation.

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

“…The fatigue during newborn resuscitation with different CC to ventilation ratio methods is a wellknown problem [36][37][38], resulting in a decreasing quality of CCs over time. It can even appear during a relatively short-lasting neonatal resuscitation (below 10 min) and is associated with lack of aerobic activity and body mass index ≥ 25 [39,40]. In the standard CC techniques (TFT, TTHT), finger and thumb pain is common [23].…”

Effect of rotating providers on chest compression performance during simulated neonatal cardiopulmonary resuscitation

“…In a previous study by our group, we similarly reported a decline in performance quality as early as 3.5 minutes from the start of CCs [ 10 ]. The same manikin and skills reporting device were used in both the studies.…”

“…Providers were paired and asked to perform the following three simulations: A) three rounds of CCs rotating every 3 minutes for a total of 18 minutes; B) two rounds of CCs rotating every 5 minutes for a total of 20 minutes and C) one full round of CCs rotating every 10 minutes or until the provider was too fatigued to perform for maximum total of 20 minutes. Our rationale for choosing a 3-minute rotation schedule was based on the results of the two studies demonstrating a reduction in CCs efficiency after 3 minutes of CCs [ 9 , 10 ]. The 10-minute rotation schedule was based on the resuscitation guidelines at the time of study design, advising that it is reasonable to consider stopping resuscitation if heart rate remains undetectable for 10 minutes [ 7 , 8 ].…”

“…In addition, data on the role of human factors and team science in neonatal resuscitation are scarce. A few recent simulator-based neonatal resuscitation studies on term manikins demonstrate fatigue development and CC quality deterioration over time during prolonged resuscitations [ 9 , 10 ]. These studies demonstrate significant CCs quality reduction as early as 3 minutes of provider performance.…”

Is Chest Compression Superimposed with Sustained Inflation during Cardiopulmonary Resuscitation an Alternative to 3:1 Compression to Ventilation Ratio in Newborn Infants?

“…In infants and newborns, there are fundamental physical and mathematical reasons including (i) effects of the mass of venous blood columns entering the chest pump, (ii) length, and (iii) area scale with body size [33]. However, these higher CC rates might be impossible during manual CPR as healthcare professionals will get fatigued more quickly, which conversely affects CC quality [34][35][36]. Using an automated CC machine might be the solution to achieving these high CC rates.…”