Infant Cardiopulmonary Resuscitation Research Articles

Development of examination objectives for the Korean paramedic and emergency medical technician examination: a survey study.

The duties of paramedics and emergency medical technicians (P&EMTs) are continuously changing due to developments in medical systems. This study presents evaluation goals for P&EMTs by analyzing their work, especially the tasks that new P&EMTs (with less than 3 years’ experience) find difficult, to foster the training of P&EMTs who could adapt to emergency situations after graduation. A questionnaire was created based on prior job analyses of P&EMTs. The survey questions were reviewed through focus group interviews, from which 253 task elements were derived. A survey was conducted from July 10, 2023 to October 13, 2023 on the frequency, importance, and difficulty of the 6 occupations in which P&EMTs were employed. The P&EMTs’ most common tasks involved obtaining patients’ medical histories and measuring vital signs, whereas the most important task was cardiopulmonary resuscitation (CPR). The task elements that the P&EMTs found most difficult were newborn delivery and infant CPR. New paramedics reported that treating patients with fractures, poisoning, and childhood fever was difficult, while new EMTs reported that they had difficulty keeping diaries, managing ambulances, and controlling infection. Communication was the most important item for P&EMTs, whereas CPR was the most important skill. It is important for P&EMTs to have knowledge of all tasks; however, they also need to master frequently performed tasks and those that pose difficulties in the field. By deriving goals for evaluating P&EMTs, changes could be made to their education, thereby making it possible to train more capable P&EMTs.

Koolangka Infant Life Saving: Culturally responsive infant CPR education for Aboriginal Australian parents

Objectives: Among Aboriginal children, the year between birth and 1 year of age has the highest mortality rate compared with any other age. Prompt administration of cardiopulmonary resuscitation (CPR) leads to better outcomes and a lower likelihood of ongoing sequalae. Current education on infant CPR is not provided to parents except in certain circumstances in a neonatal intensive care unit. Currently, there are no identified CPR education courses specifically available for Aboriginal or Torres Strait Islander people, meaning that current infant CPR education courses are not culturally responsive. Design: Partnering with an Aboriginal community from the Bindjareb region of the Western Australian Noongar nation, the researchers used a co-design approach and an Aboriginal Participatory Action Research (APAR) design to explore how to deliver culturally safe and responsive infant CPR community education. This resulted in the development of the Koolangka Infant Life Saving Education Framework (KILSEF), which can be used to guide future planning and delivery of culturally safe and responsive community level infant CPR education. Results: The study findings identified that members of the Aboriginal community were very interested in receiving infant CPR education, but the barriers identified from mainstream CPR course delivery need to be removed for the community to benefit from culturally responsive ways of learning. Culturally responsive community CPR education should be provided in culturally safe places and the focus of learning should be on the practical applications of CPR and less on the academic pre-reading and written requirements. Explanations should be provided in lay terms and patience is required to communicate ideas in ways that facilitate understanding, and the course may need to be delivered over several days to accommodate community participant availability. Conclusion: Addressing Aboriginal community concerns and barriers allowed for the implementation of culturally responsive infant resuscitation education which was highly valued by community members and led to increased community confidence and participation in CPR education.

Effectiveness of a dispatcher-assisted CPR using an animated image: Simulation study

IntroductionConsidering the few studies evaluating bystander cardiopulmonary resuscitation (CPR) performance, we sought to analyze differences in bystander CPR performance with and without the use of our self-developed animated GIFs based on dispatcher-assisted CPR simulation. MethodsA total of 80 adults who had not received CPR training over the past two years participated in the study. Among them, 40 people were classified into the auditory group (receiving CPR instructions only over the phone), and the other 40 people were classified into the audiovisual group (receiving CPR instructions over the phone after receiving images on a smartphone). All participants were asked to perform adult and infant CPR for 2 min. CPR performance was recorded using two video cameras (front and side) and analyzed by two emergency physicians, whereas CPR quality was measured using Resusci Anne & Baby QCPR Mk II (Laerdal). ResultsIn the adult CPR study, the audiovisual group had higher performance scores for adequacy of “knee position,” “hand posture,” “elbow extension,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). No significant difference in CPR quality was observed between the two groups. In the infant CPR study, audiovisual group had higher performance scores in adequacy of “compression site,” “finger posture,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). Regarding CPR quality, the audiovisual group had higher scores for “adequate compression rate ratio” (p = 0.047). ConclusionAudiovisual guidance using animated GIFs more effectively improved CPR Standard Posture Completeness and Instruction Performance than did traditional auditory guidance.

Bag-mask ventilation by low- or untrained rescuers during adult and pediatric resuscitation: a randomized cross-over manikin study

AimBag-mask ventilation (BMV) is often applied during advanced cardiopulmonary resuscitation (CPR). Lay rescuers usually apply mouth-to-mouth ventilation, which is contraindicated in case of potential disease transmission (e.g., during the COVID-19 pandemic). This study evaluates the influence of rescuers' before BMV training in following the correct BMV procedures during adult and infant CPR.MethodsMedical students (n = 112) were enrolled in a randomized cross-over manikin study: 60 first-year students (53.6%) (untrained, without any prior knowledge of CPR) and 52 fourth-year students (46.4%) (BLS-trained, with three consecutive years of basic CPR training), excluding Basic Life Support (BLS) certificate holders or lifeguards. Student-formed duos (i.e., two students from the same year working together) received a 15-min just-in-time onsite training in full CPR cycle using BMV and were tested during five cycles of 2-person CPR following the European Resuscitation Council (ERC) guidelines with the inclusion of BMV. Tidal volumes of 300–600 ml (adults) and 20–60 ml (infants) were considered as correct ventilations.ResultsFrom the initial 56 duos, 17 (30.4%) were excluded after applying incorrect numbers of ventilation or uninterpretable values. In adult CPR, comparing BLS-trained rescuers to untrained ones in correctly administrating ventilations using BMV after a 15-min just-in-time onsite training revealed no statistically significant difference [first years: 63.0% (n = 136 out of 216 ventilations); fourth years: 59.5% (n = 119 out of 200 ventilations); with a proportional difference of −3.5% (−12.8; 5.9)]. In infant CPR, a significant difference was observed in effective ventilations [first years: 55.5% (n = 120 out of 216 ventilations); fourth years: 72.3% (n = 133 out of 184 ventilations); with a proportional difference of 16.8 (7.25; 26.21)].ConclusionTwo-person BMV is a complex skill to perform both in adults and children, requiring sufficient and regular training. Lay rescuers receiving a 15-min just-in-time onsite BMV training could perform decent BMV in an adult CPR setting. BMV during infant CPR requires more extensive prior training and should not be entrusted to lay rescuers, even after a 15-min just-in-time onsite training.

One hand open palm technique for infant CPR

BackgroundThe guideline recommended chest compression depth, rate, and recoil are essential factors for the return of spontaneous circulation (ROSC) in cardiopulmonary resuscitation (CPR). A pediatric resuscitation collaboration recently demonstrated that healthcare providers fail to meet the American Heart Association (AHA) guidelines, with the greatest difficulty being in achieving chest compression depth targets in infants. We hypothesized that the use of the heel of one hand [open palm technique (OPT)] will increase chest compression depth in infants compared to standard CPR techniques [two-finger technique (TFT), two thumb-encircling hand technique (TTT)].MethodsA prospective, randomized, single-center study was completed using an infant manikin. Thirty pediatric critical care providers performed 2 min of CPR for each technique followed by 5 min of rest. Each participant completed a survey at the end that assessed the difficulty level in order to assess the feasibility of this new technique.ResultsThe mean chest compression depth for the OPT was significantly deeper compared to TFT (2.61± 0.63 cm vs. 2.25 ± 0.54 cm, p = 0.0004) but not significantly deeper compared to TTT (2.43 ± 0.46 cm, p = 0.0820). OPT was graded as the easiest technique, followed by TTT (2.20 ± 0.76 vs. 3.17 ± 0.95, p &amp;lt; 0.0001) and then TFT (3.38 ± 0.83, p &amp;lt; 0.0001).ConclusionThe use of OPT for infant CPR resulted in improved chest compression depth. OPT was considered the easiest technique compared to standard infant CPR techniques, thus making it feasible to perform. Importantly, all providers failed to meet the AHA infant chest compression depth goal of 4 cm, regardless of the technique. Future research is needed to optimize CPR technique and performance to achieve targeted chest compression depth in infants.

Extracorporeal Cardiopulmonary Resuscitation in Infants: Outcomes and Predictors of Mortality

Extracorporeal cardiopulmonary resuscitation (E-CPR) plays an indispensable role when resuscitation fails; however, extracorporeal life support (ECLS) in infants is different from that in adults. The objective of this study was to evaluate the outcomes of E-CPR in infants. A single-center retrospective study was conducted, analyzing 51 consecutive patients (age <1 year) who received E-CPR for in-hospital cardiac arrest between 2010 and 2021. The median age and body weight was 51 days (interquartile range [IQR], 17-111 days) and 3.4 kg (IQR, 2.9-5.1 kg), respectively. The cause of arrest was cardiogenic in 45 patients (88.2%), and 48 patients (94.1%) had congenital cardiac anomalies. The median conventional cardiopulmonary resuscitation (C-CPR) time before the initiation of ECLS was 77 minutes (IQR, 61-103 minutes) and duration of ECLS was 7 days (IQR, 3-12 days). There were 36 in-hospital deaths (70.6%), and another patient survived after heart transplantation. In the multivariate analysis, single-ventricular physiology (odds ratio [OR], 5.05; p=0.048), open sternum status (OR, 8.69; p=0.013), and C-CPR time (OR, 1.47 per 10 minutes; p=0.021) were significant predictors of in-hospital mortality. In a receiver operating characteristic curve, the optimal cut-off of C-CPR time was 70.5 minutes. The subgroup with early E-CPR (C-CPR time <70.5 minutes) showed a tendency for lower in-hospital mortality tendency (54.5% vs. 82.8%, p=0.060), albeit not statistically significant. If resuscitation fails in an infant, E-CPR could be a life-saving option. It is crucial to improve C-CPR quality and shorten the time before ECLS initiation.

The knowledge of infant CPR among parents visiting Maternity and Children Hospital (MCH) in Al –Ahsa, Saudi Arabia

Background: CPR (cardiopulmonary resuscitation) is a medical procedure that anyone can learn which can help to save a life in the event of a medical emergency. Resuscitation Council UK report that for every minute that a person in cardiac arrest does not receive CPR its survival chance drops by up to 10%. However, an inadequate public awareness and knowledge of infant and pediatric CPR have been documented. Therefore, parents and caregiver should be educated about infant CPR which can help in correctly implementing it and save the life of infant. This study was conducted on the mothers attending the MCH for the baby care is to assess their knowledge on infant CPR skill. Material and methods: This was a Cross sectional study conducted at Maternity and Children Hospital (MCH) in AL- Ahsa. All the parents visiting MCH with their children for the treatment were the study population. The website Raosoft was used to calculate the sample size (n=284). Convenient sampling technique was used to collect the sample. Pretested and predesigned self-reported questionnaire from the previous regional study was distributed to the selected sample participants. The data were entered and analyzed by using the SPSS; version 21. Descriptive statistics were presented using counts, proportions (%), mean ± standard deviation whenever appropriate. Descriptive statistics (e.g. number, percentage) and analytic statistics using Chi Square tests (χ2) to test for the association and/or the difference between two categorical variables were applied. A p-value equal to or less than 0.05 was considered statistically significant. Results: A total of 254 out of 284 subjects responded the questionnaires. The mean age of the participants was 38.65 years ± Std. Dev. 9.90 years .The majority of the participants (61.0%) were graduate Almost sixteen percent (15.7%) of the participants had family history of heart disease. Fifty percent of the participants had attended the CPR course. An overwhelming majority of the participants (87.0%) were willing to take a short course of infant CPR if it is available in MCH. The mean knowledge sore in infant CPR of the participants was 2.42 ± Std.Dev.1.33 (Range 00-6). More than forty one percent of the participants had poor knowledge regarding Infant CPR while 58.7% had good knowledge. As educational qualification increased the percent of good knowledge significantly also increased .The participants who did not have the family history of cardiac disease were having significantly good knowledge about infant(P=0.01).Those participants who had attended infant CPR course had significantly higher knowledge score than those who did not attend the infant CPR course (76.37% vs.40.94%, P=0.000) Those participants who were not willing to take a short course of infant CPR had significantly better knowledge score on infant CPR as compared to those participants who were willing to join the course on infant CPR (69.69% vs.57.01%,P=0.021). Conclusion: The present study has shown a better knowledge among the females regarding infant CPR as compared to other studies conducted in Saudi Arabia. The participants in this study were found very motivated to learn the skills of infant CPR. However there is a need to develop programmers for teaching the infant CPR to the mothers at all level of health care facility attending the MCH, Al Ahsa.

The availability and delivery of culturally responsive Australian Aboriginal infant resuscitation education programmes: a structured literature review.

To critically appraise the literature to determine availability and identify the cultural responsiveness of infant resuscitation education for Aboriginal and Torres Strait Islander populations. Despite overall reductions in infant mortality in the last two decades, Aboriginal people have some of the highest rates of infant mortality of any developed nation. One of the key factors that has attributed to improvements in infant mortality rates is parent and carer education around risk factors and actions of first responders. Identifying gaps in the current basic first-aid initiatives available to Aboriginal communities may contribute to developing resources to contribute to reductions in Aboriginal neonatal mortality rates. The review used key terms and Boolean operators across an 11-month time frame searching for research articles utilising the databases of CINAHL, Scopus, Ovid Emcare, Informit, Pubmed and Proquest. After review, 39 articles met the inclusion criteria, 25 articles were discarded due to irrelevant material and 14 articles were included in the structured literature review. The search process was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Articles were assessed for validity and inclusion using the Critical Appraisal Skills Program checklist. Research literature relating to First Nation community-based CPR and first-aid education programmes in Canada, USA, India, UK and Europe, Asia and Africa were identified; however, none pertaining specifically to CPR and first-aid education in Australian Aboriginal communities were found. Despite the lack of research evidence relating to infant cardiopulmonary resuscitation (CPR) education for Australian Aboriginal populations, the reviewed studies noted the importance of culturally responsive education designed in collaboration with First Nation peoples, using novel ways of teaching CPR, that align with the language, culture and needs of the communities it is intended for. Further research is required to create a framework for the delivery of culturally responsive infant resuscitation education for Australian Aboriginal parents and communities.

A Randomized, Controlled Animal Study: 21% or 100% Oxygen during Cardiopulmonary Resuscitation in Asphyxiated Infant Piglets.

During pediatric cardiopulmonary resuscitation (CPR), resuscitation guidelines recommend 100% oxygen (O2); however, the most effective O2 concentration for infants unknown. We aimed to determine if 21% O2 during CPR with either chest compression (CC) during sustained inflation (SI) (CC + SI) or continuous chest compression with asynchronized ventilation (CCaV) will reduce time to return of spontaneous circulation (ROSC) compared to 100% O2 in infant piglets with asphyxia-induced cardiac arrest. Piglets (20-23 days of age, weighing 6.2-10.2 kg) were anesthetized, intubated, instrumented, and exposed to asphyxia. Cardiac arrest was defined as mean arterial blood pressure &lt; 25 mmHg with bradycardia. After cardiac arrest, piglets were randomized to CC + SI or CCaV with either 21% or 100% O2 or the sham. Heart rate, arterial blood pressure, carotid blood flow, and respiratory parameters were continuously recorded. Baseline parameters, duration, and degree of asphyxiation were not different. Median (interquartile range) time to ROSC was 107 (90-440) and 140 (105-200) s with CC + SI 21% and 100% O2, and 600 (50-600) and 600 (95-600) s with CCaV 21% and 100% O2 (p = 0.27). Overall, six (86%) and six (86%) piglets with CC + SI 21% and 100% O2, and three (43%) and three (43%) piglets achieved ROSC with CCaV 21% and 100% O2 (p = 0.13). In infant piglets resuscitated with CC + SI, time to ROSC reduced and survival improved compared to CCaV. The use of 21% O2 had similar time to ROSC, short-term survival, and hemodynamic recovery compared to 100% oxygen. Clinical studies comparing 21% with 100% O2 during infant CPR are warranted.

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

Infant cardiopulmonary resuscitation (iCPR) is often poorly performed, predominantly because of ineffective learning, poor retention and decay of skills over time. The aim of this study was to investigate whether an individualized, competence-based approach to simulated iCPR retraining could result in high skill retention of infant chest compressions (iCC) at follow-up. An observational study with 118 healthcare students was conducted over 12 months from November 2019. Participants completed pediatric resuscitation training and a 2-min assessment on an infant mannequin. Participants returned for monthly assessment until iCC competence was achieved. Competence was determined by passing assessments in two consecutive months. After achieving competence, participants returned just at follow-up. For each ‘FAIL’ during assessment, up to six minutes of practice using real-time feedback was completed and the participant returned the following month. This continued until two consecutive monthly ‘PASSES’ were achieved, following which, the participant was deemed competent and returned just at follow-up. Primary outcome was retention of competence at follow-up. Descriptive statistics were used to analyze demographic data. Independent t-test or Mann–Whitney U test were used to analyze the baseline characteristics of those who dropped out compared to those remaining in the study. Differences between groups retaining competence at follow-up were determined using the Fisher exact test. On completion of training, 32 of 118 participants passed the assessment. Of those achieving iCC competence at month 1, 96% retained competence at 9–10 months; of those achieving competence at month 2, 86% demonstrated competence at 8–9 months; of those participants achieving competence at month 3, 67% retained competence at 7–8 months; for those achieving competence at month 4, 80% demonstrated retention at 6–7 months. Conclusion: Becoming iCC competent after initial training results in high levels of skill retention at follow-up, regardless of how long it takes to achieve competence.What is Known:• Infant cardiopulmonary resuscitation (iCPR) is often poorly performed and skills decay within months after training.• Regular iCPR skills updates are important, but the optimal retraining interval considering individual training needs has yet to be established.What is New:• Infant chest compression (iCC) competence can be achieved within one to four months after training and once achieved, it can be retained for many months.• With skill reinforcement of up to 28 minutes after initial training, 90% of individuals were able to achieve competence in iCC and 86% retained this competence at follow-up.

Comparison of two infant cardiopulmonary resuscitation techniques explained by phone in a non-health professionals' population: Two-thumbs encircling hand technique vs. two-fingers technique, a randomised crossover study in a simulation environment

BackgroundPaediatric out-of-hospital cardiac arrest (OHCA) is the reason for an emergency call in approximately 8/100,000 person-years. Improvement of OHCA resuscitation needs a quality chain of survival and a rapid start of resuscitation.The aim of this study was to compare the efficacy of two resuscitation techniques provided on a mannequin, the two-fingers technique (TFT) and the two-thumbs encircling hand technique (TTHT), explained by a trained emergency call responder on the phone in a population of non-health professionals. MethodsWe conducted a randomised crossover study in the simulation lab of a University Hospital. The participants included in the study were non-health professional volunteers of legal age. The participants were assigned (1:1 ratio) to two groups: group A: TFT then TTHT, group B: TTHT then TFT. Scenario and techniques were discovered during the evaluation. ResultsThirty-five volunteers were randomised before the sessions and 33 ultimately came to the simulation lab. We found a better median QCPR global score during TTHT sessions than during TFT sessions (74 vs. 59, P = 0.046). Linear mixed models showed that the TTHT method was the only variable associated with a better QCPR global score [model 1: β = 14.3; 95% confidence interval (CI), 2.4–26.2; model 2: β = 14.5; 95% CI, 2.5–26.6]. ConclusionOur study showed the superiority of TTHT for infant CPR performed by non-health professionals when an emergency call responder advised them over the phone. It seemed to be the best technique for a solo rescuer regardless of previous training.

New chest compression method in infant resuscitation: Cross thumb technique

BackgroundThe two-thumb encircling technique (2TT) is superior to the two-finger technique (2FT) in infant cardiopulmonary resuscitation (CPR), but there are difficulties in providing ventilation as soon as possible. We modified the 2TT to the cross-thumb technique (CTT) to maintain good CPR performance at the same position as 2FT. We aimed to compare the quality of chest compression and brief hands-off times in 2FT, 2TT, and CTT by a single rescuer using an infant CPR manikin model.MethodsThis study was designed as a prospective randomized controlled simulation-based study. We used the Resusci® Baby QCPR (Laerdal Medical, Stavanger, Norway) as a simulated 3-month-old infant. Ventilation was performed by the mouth-to-mouth technique using a chest compression-to-ventilation ratio of 30:2 as a single rescuer. Data on CPR quality, such as locations, rates, depth and release of chest compressions, hands-off times, and proper ventilation, were recorded using the Resusci® Baby QCPR and SkillReporter. Also, the chest compression fraction (CCF) was automatically calculated.ResultsThe depth of chest compression in 2FT, 2TT, and CTT were 40.0 mm (interquartile range [IQR] 39.0, 41.0), 42.0 mm (IQR 41.0, 43.0), and 42.0 mm (IQR 41.0, 43.0), respectively. The depth of chest compression in 2FT was shallower than that in the other two techniques (P<0.05). CCF in 2FT, 2TT, and CTT were 73.9% (IQR 72.2, 75.6), 71.2% (IQR 67.2, 72.2) and 71.3% (IQR 67.7, 74.1), respectively. CCF was higher in 2FT than in the other two techniques (P<0.05). Correct location in 2FT, 2TT, and CTT were 99.0% (IQR 86.0, 100.0), 100.0% (IQR 97.0, 100.0) and 100.0% (IQR 99.0, 100.0), respectively. Correct location in CTT and 2TT was higher than that in 2FT. Performing CTT, the subjective pain and fatigue score were lower than other two technique.ConclusionA new chest compression technique, CTT was better in chest compression depth compared with 2FT and may be helpful in maintaining correct chest compression location with less pain and fatigue in infant CPR.

Effect of real-time feedback device compared to use or non-use of a checklist performance aid on post-training performance and retention of infant cardiopulmonary resuscitation: A randomized simulation-based trial

IntroductionThis study aims to determine the best method for achieving optimal performance of pediatric cardiopulmonary resuscitation (CPR) during simulation-based training, whether with or without a performance aid. MethodsIn this randomized controlled study, 46 participants performed simulated CPR in pairs on a Resusci Baby QCPR™ mannequin, repeated after four weeks. All participants performed the first simulation without performance aids. For the second simulation, they were randomly assigned to one of three groups with stratification based on status: throughout CPR, Group A (n = 16) was the control group and did not use a performance aid; Group B (n = 16) used the CPR checklist; Group C (n = 14) used real-time visualization of their CPR activity on a feedback device. Overall performance was assessed using the QCPR™. ResultsAll groups demonstrated improved performance on the second simulation (p < 0.01). Use of the feedback device resulted in better CPR performance than use of the CPR checklist (p = 0.02) or no performance aid (p = 0.04). Additionally, participants thought that the QCPR™ could effectively improve their technical competences. ConclusionsPerformance aid based on continuous feedback is helpful in the learning process. The use of the QCPR™, a real-time feedback device, improved the quality of resuscitation during infant CPR simulation-based training.

A Comparison between Three Different Techniques Considering Quality Skills, Fatigue and Hand Pain during a Prolonged Infant Resuscitation: A Cross-Over Study with Lifeguards.

The aim of the study was to compare the quality of CPR (Q-CPR), as well as the perceived fatigue and hand pain in a prolonged infant cardiopulmonary resuscitation (CPR) performed by lifeguards using three different techniques. A randomized crossover simulation study was used to compare three infant CPR techniques: the two-finger technique (TF); the two-thumb encircling technique (TTE) and the two-thumb-fist technique (TTF). 58 professional lifeguards performed three tests in pairs during a 20-min period of CPR. The rescuers performed compressions and ventilations in 15:2 cycles and changed their roles every 2 min. The variables of analysis were CPR quality components, rate of perceived exertion (RPE) and hand pain with numeric rating scale (NRS). All three techniques showed high Q-CPR results (TF: 86 ± 9%/TTE: 88 ± 9%/TTF: 86 ± 16%), and the TTE showed higher values than the TF (p = 0.03). In the RPE analysis, fatigue was not excessive with any of the three techniques (values 20 min between 3.2 for TF, 2.4 in TTE and 2.5 in TTF on a 10-point scale). TF reached a higher value in RPE than TTF in all the intervals analyzed (p < 0.05). In relation to NRS, TF showed significantly higher values than TTE and TTF (NRS minute 20 = TF 4.7 vs. TTE 2.5 & TTF 2.2; p < 0.001). In conclusion, all techniques have been shown to be effective in high-quality infant CPR in a prolonged resuscitation carried out by lifeguards. However, the two-finger technique is less efficient in relation to fatigue and hand pain compared with two-thumb technique (TF vs. TTF, p = 0.01).

Unexpected high prevalence of infant resuscitation related rib fractures identified radiologically in postmortem population

Rib fractures from chest compression during cardiopulmonary resuscitation in infants are suggested to be uncommon compared to adults. However, the actual prevalence is not well documented and there are only limited studies, particularly after the changes to recommended resuscitation methods in infants. Furthermore, it is unclear whether there is a difference in prevalence between younger and older infants. This 6-year retrospective study reviewed 94 infants (between 4 weeks and 1 year old) who had received resuscitation chest compressions around the time of death and showed 20% (19 out of 94) had radiological evidence of rib fractures.

Analysis of the adequacy of infant cardiopulmonary resuscitation according to chest compression technique based on the 2020 AHA guidelines

The quantitative and qualitative differences between the two-finger (TF) and two-thumb-encircling hands (TT) techniques were not sufficiently investigated to determine which is more effective for single-rescuer infant cardiopulmonary resuscitation (CPR). As the type of chest compression (CC) technique can impact survival rates and prognoses of patients, this study aimed to compare the adequacy of single-rescuer infant CPR CC techniques and explore participants’ CPR experiences using an exploratory sequential mixed methods design. To assess the adequacy of CC and ventilation according to technique, 70 students who completed basic life support provider certification among students from emergency medical services and nursing departments of a single college performed CC using the TF and TT techniques (4 sets of 5 cycles with a ratio of 30:2) in simulation. Meanwhile, a numeric rating scale was used to measure fatigue. SPSS (v. 25.0, IBM Corp, Armonk, NY, USA) was used to analyze the collected data by frequency analysis, descriptive statistics, paired t-test, and repeated measures analysis of variance (ANOVA). We conducted focus group interviews and analyzed CPR experiences. There were statistically significant differences between the TF and TT techniques in fatigue score (6.09 vs. 4.23 points, p &lt; 0.001), average hands-off time (6.77 vs. 7.43 s, p =0.001), mean ventilation volume (41.40 vs. 35.51 ml, p = 0.002), CC accuracy rate (65.89% vs. 77.11%, p = 0.011), mean CC rate (104.37 vs. 107.11 beats/min, p = 0.020), overall CPR score (78.26 vs. 84.37 points, p = 0.005), and overall compression score (82.60 vs. 92.54 points, p &lt; 0.001). Furthermore, we found significant differences over time in mean CC count (p = 0.030), mean ventilation volume (p = 0.042), and mean hands-off time (p = 0.029). Two categories (ambivalent attitudes and perception of pain) and five sub-categories were derived based on the results. In conclusion, as stated in the 2020 American Heart Association (AHA) guidelines, both TF and TT techniques are useful for single-rescuer infant CPR. Overall, TT technique provides higher quality of compressions at the cost of fewer ventilations. We recommend future studies of more diverse groups and techniques.

Characterization of Infant Cardiopulmonary Resuscitation Delivery with Range Sensor Feedback on Performance

Cardiac arrest (CA) in infants is an issue worldwide, which causes significant morbidity and mortality rates. Cardiopulmonary resuscitation (CPR) is a technique performed in case of CA to save victims’ lives. However, CPR is often not performed effectively, even when delivered by qualified rescuers. Therefore, international guidelines have proposed applying a CPR feedback device to achieve high-quality application of CPR to enhance survival rates. Currently, no feedback device is available to guide learners through infant CPR performance in contrast to a number of adult CPR feedback devices. This study presents a real-time feedback system to improve infant CPR performance by medical staff and laypersons using a commercial CPR infant manikin. The proposed system uses an IR sensor to compare CPR performance obtained with no feedback and with a real-time feedback system. Performance was validated by analysis of the CPR parameters actually delivered against the recommended target parameters. Results show that the real-time feedback system significantly improves the quality of chest compression parameters. The two-thumb compression technique is the achievable and appropriate mechanism applied to infant subjects for delivering high-quality CPR. Under the social distancing constraints imposed by the SARS-CoV-2 pandemic, the results from the training device were sent to a CPR training center and provided each participant with CPR proficiency.

Two-Thumb Technique Is Superior to Two-Finger Technique in Cardiopulmonary Resuscitation of Simulated Out-of-Hospital Cardiac Arrest in Infants.

BackgroundTo compare the 2‐finger and 2‐thumb chest compression techniques on infant manikins in an out‐of‐hospital setting regarding efficiency of compressions, ventilation, and rescuer pain and fatigue.Methods and ResultsIn a randomized crossover design, 78 medical students performed 2 minutes of cardiopulmonary resuscitation with mouth‐to‐nose ventilation at a 30:2 rate on a Resusci Baby QCPR infant manikin (Laerdal, Stavanger, Norway), using a barrier device and the 2‐finger and 2‐thumb compression techniques. Frequency and depth of chest compressions, proper hand position, complete chest recoil at each compression, hands‐off time, tidal volume, and number of ventilations were evaluated through manikin‐embedded SkillReporting software. After the interventions, standard Likert questionnaires and analog scales for pain and fatigue were applied. The variables were compared by a paired t‐test or Wilcoxon test as suitable. Seventy‐eight students participated in the study and performed 156 complete interventions. The 2‐thumb technique resulted in a greater depth of chest compressions (42 versus 39.7 mm; P<0.01), and a higher percentage of chest compressions with adequate depth (89.5% versus 77%; P<0.01). There were no differences in ventilatory parameters or hands‐off time between techniques. Pain and fatigue scores were higher for the 2‐finger technique (5.2 versus 1.8 and 3.8 versus 2.6, respectively; P<0.01).ConclusionsIn a simulation of out‐of‐hospital, single‐rescuer infant cardiopulmonary resuscitation, the 2‐thumb technique achieves better quality of chest compressions without interfering with ventilation and causes less rescuer pain and fatigue.

Healthcare Provider Characteristics and Cardiopulmonary Resuscitation Quality During Infant Resuscitation: A Simulation Study.

Healthcare providers' anthropometric characteristics can adversely affect adult cardiopulmonary resuscitation (CPR) performance quality. However, their effects on infant CPR are unknown. We aimed to determine any relationships between healthcare provider characteristics (anthropomorphic, demographics, training, occupational data) and simulated infant CPR performance at multiple international sites. Our secondary aim was to examine provider's CPR performance degradation. Providers from 4 international hospitals performed 2 minutes of single-rescuer simulated infant CPR using 2015 American Heart Association Basic Life Support criteria with guidance from a real-time visual performance feedback device. Providers' characteristics were collected, and the simulator collected compression and ventilation data. Multivariate analyses examined the entire 2 minutes and performance degradation. Data from 127 participants were analyzed. Although median values for all compression variables (depth, rate, lean) and ventilation volume were within guideline target ranges, when looking at individuals, only 52% chest compressions and 20% ventilations adhered to the American Heart Association guidelines. Age was found to be independently associated with ventilation volume (direct-relationship), and height was associated with chest compression lean (shorter participant-deeper lean). No significant differences were noted based on sex or body mass index. Neonatal intensive care unit participants were noted to perform shallower chest compressions (P < 0.001). Overall, there was minimal evidence of performance degradation over 2 minutes. Isolated provider characteristics were noted among a diverse cohort of healthcare providers that may affect the CPR quality on a simulated infant. Understanding the relationships between provider characteristics and CPR quality could inform future infant CPR guidelines customized for the provider and not just the patient.

Infant Cardiopulmonary Resuscitation Quality While Walking Fast: A Simulation Study.

This study focuses on the characteristics (feasibility, resuscitation quality, and physical demands) of infant cardiopulmonary resuscitation (CPR) on the forearm during fast walking, performed by a trained lay rescuer. Twenty-one university students from the infant education degree participated in a randomized crossover simulation study to compare a standard pediatric CPR versus a walking pediatric CPR with a manikin on the rescue forearm. Each rescuer performed 2 resuscitation tests of 2 minutes on the infant manikin. Cardiopulmonary resuscitation, physiological, and perceived effort variables were measured. The quality of chest compressions was higher in standard pediatric CPR than in walking pediatric CPR (72% vs 51%; P < 0.001) and overall CPR quality (59% vs 49%; P = 0.02). There were no differences between ventilation quality (47% vs 46%). Walking pediatric CPR presented a higher percentage of maximum heart rate (52% vs 69%; P < 0.001) and perceived exertion rate (2 vs 5; P < 0.001). Participants walked an average of 197 m during the test. In conclusion, pediatric walking CPR is feasible although it represents a slight quality decrease in a simulation infant CPR setting. The option "CPR while walking fast to a safe place" seems to be suitable in terms of safety both for the victim and the rescuer, as well as CPR quality in special circumstances.