Impact of Two Resuscitation Sequences on Alveolar Ventilation during the First Minute of Simulated Pediatric Cardiac Arrest: Randomized Cross-Over Trial

Abstract

The International Liaison Committee on Resuscitation regularly publishes a Consensus on Science with Treatment Recommendations, but guidelines can nevertheless differ when knowledge gaps persist. In case of pediatric cardiac arrest, the American Heart Association recommends following the adult resuscitation sequence, i.e., starting with chest compressions. Conversely, the European Resuscitation Council advocates the delivery of five initial rescue breaths before starting chest compressions. This was a superiority, randomized cross-over trial designed to determine the impact of these two resuscitation sequences on alveolar ventilation in a pediatric model of cardiac arrest. The primary outcome was alveolar ventilation during the first minute of resuscitation maneuvers according to the guidelines used. A total of 56 resuscitation sequences were recorded (four sequences per team of two participants). The ERC approach enabled higher alveolar ventilation volumes (370 mL [203–472] versus 276 mL [140–360], p < 0.001) at the cost of lower chest compression fractions (57% [54;64] vs. 66% [59;68], p < 0.001). Although statistically significant, the differences found in this simulation study may not be clinically relevant. Therefore, and because of the importance of overcoming barriers to resuscitation, advocating a pediatric-specific resuscitation algorithm may not be an appropriate strategy.

Correction: Suppan et al. Impact of Two Resuscitation Sequences on Alveolar Ventilation during the First Minute of Simulated Pediatric Cardiac Arrest: Randomized Cross-Over Trial. Healthcare 2022, 10, 2451

“…There was an error in the original publication [ 1 ]. We used a “manufacturer’s recommendation” regarding the compressions’ depth of ≥3 cm, which was actually erroneous since the manufacturer states that the compression depth should have been between 4 and 5 cm, instead of 3 to 5 cm (written ≥3 cm in the whole manuscript because there were no compressions above 5 cm).…”

“…In the original publication [ 1 ], there were two mistakes in Table 2. First, it appears that the value under the “Difference” column was wrongly pasted.…”

Effect of Intermediate Airway Management on Ventilation Parameters in Simulated Pediatric Out-of-Hospital Cardiac Arrest: Protocol for a Multicenter, Randomized, Crossover Trial

“…The AHA guidelines will be considered as standard approach [49]. These guidelines recommend alternating 15 compressions and 2 ventilations, starting with compressions [9].…”

“…The sample size is based on an estimate using data from two previous simulation studies [35,49]. Ventilation is expected to be provided for 8 min only (given the time necessary to prepare ventilation devices).…”

“…The expected difference in alveolar minute ventilation between basic airway management and IAM devices is 185 mL (125 mL versus 310 mL). The standard deviation is estimated to be 140 mL [49]. To be conservative, the correlation used to compute the calculation is 0.…”