Quality of chest compressions during pediatric resuscitation with 15:2 and 30:2 compressions-to-ventilation ratio in a simulated scenario

Abstract

The main objetive was to compare 30:2 and 15:2 compression-to-ventilation ratio in two simulated pediatric cardiopulmonary resuscitation (cpR) models with single rescuer. the secondary aim was to analyze the errors or omissions made during resuscitation. A prospective randomized parallel controlled study comparing 15:2 and 30:2 ratio in two manikins (child and infant) was developed. The CPR was performed by volunteers who completed an basic CPR course. Each subject did 4 CPR sessions of 3 minutes each one. Depth and rate of chest compressions (CC) during resuscitation were measured using a Zoll Z series defibrillator. Visual assessment of resuscitation was performed by an external researcher. A total of 26 volunteers performed 104 CPR sessions. Between 54-62% and 44-53% of CC were performed with an optimal rate and depth, respectively, with no significant differences. No differences were found in depth or rate of CC between 15:2 and 30:2 compression-to-ventilation ratio with both manikins. In the assessment of compliance with the ERC CPR algorithm, 69.2-80.8% of the subjects made some errors or omissions during resuscitation, the most frequent was not asking for help and not giving rescue breaths. the conclusions were that a high percentage of cc were not performed with optimal depth and rate. errors or omissions were frequently made by rescuers during resuscitation.Pediatric cardiac arrest (CA) is an important health problem since it has high mortality (52-80%) and a large proportion of survivors suffer from permanent and severe neurologic disability (poor outcome in 20-50%) 1-4 . Previous studies have shown that optimizing maneuvers of cardiopulmonary resuscitation (CPR) in children could improve survival and prognosis 4,5 . Nevertheless, many studies documented that CPR is often not optimally performed 6,7 .The 2015 European Resuscitation Council (ERC) guidelines recommend a synchronized 15:2 compression-to-ventilation ratio during basic pediatric CPR 1,8,9 . However, there is not a strong evidence to indicate the best compression-to-ventilation ratio in pediatric CPR 10,11 . Firstly, maintaining an adequate ventilation is crucial during CPR in children because pediatric CA is primarily caused by respiratory failure 2 . The 15:2 ratio delivers more ventilations whereas the 30:2 ratio delivers more chest compressions (CC). In the other hand, different recommendations for the compression-to-ventilation ratio between children (15:2 ratio) and adults (30:2 ratio) could increase the errors or omissions and impair learning. In adult simulation models 12-14 , there are different studies that compare the quality of CC in both compression-to-ventilation ratio. However, only one study conducted in pediatric models, but it was developed by volunteers with pediatric advanced life support (PALS) accreditation 15 . In our knowledge, there are no previous studies comparing the quality of CC between 15:2 and 30:2 compression-to-ventilation ratio during pediatric CPR conducted by volunteers training in basic life support.with ...

A novel retraining strategy of chest compression skills for infant CPR results in high skill retention for longer

“…The baseline results at time point 0 indicate a similarity to previous pediatric CPR research [ 5 , 6 , 11 – 16 , 27 , 28 ], in that, although our participants took part in a two-hour pediatric BLS training, only 27% performed adequately (as defined in our study) immediately after training. This suggests the current input training model struggles to adequately prepare individuals to be competent and brings into question the efficacy of this model of training.…”

“…The minimum requirements to obtain certification are normally visually assessed by the instructor or via a self-assessment tool [ 9 , 10 ]. Although some participants may achieve the minimum requirements, previous researchers have established that performance immediately after training is consistently poor [ 5 – 8 , 11 – 16 , 27 ] and the skills may deteriorate within as little as one month after training [ 15 ]. It might be postulated that this traditional strategy of pediatric CPR training should, therefore, be reviewed for effectiveness.…”

“…High-quality infant cardiopulmonary resuscitation (iCPR) is considered critical to a positive outcome after cardiac arrest [ 3 , 4 ]. However, it is often poorly performed [ 5 , 6 ], predominantly because of ineffective learning, poor retention, and decay of skills over time [ 7 , 8 ].…”

Volumetric capnography and return of spontaneous circulation in an experimental model of pediatric asphyxial cardiac arrest

“…A sample size calculation was performed accepting an alpha risk of 0.05 and a beta risk of 0.2. ROSC was considered the main effect, with an estimated incidence of 30% based on previous experiences 10 – 12 with the same animal model. An effect size of 25% on the usual incidence of ROSC was considered significant.…”

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

“…Das PLS-COSTR #1605 von 2020 zur Thoraxkompressionstiefe ergab keine ausreichende Evidenz, um bestehende Empfehlungen zu ändern. Zusätzlich zu einer Übersichtsarbeit [ 579 ] beziehen wir uns auf 6 RCT [ 580 – 585 ] und 15 Beobachtungsstudien (Anhang RR 21.1; [ 586 – 600 ]).…”