Infant Cardiopulmonary Resuscitation Research Articles

Gum-Elastic Bougie Efficacy for Tracheal Intubation During Continuous Chest Compression in Infants—A Crossover Simulation Trial

BackgroundRecent guidelines for infant cardiopulmonary resuscitation emphasize that all rescuers should minimize interruption of chest compression, even for endotracheal intubation. ObjectiveWe compared the utility of application of a gum-elastic bougie (GEB) plus Miller laryngoscope (Mil) with the Mil alone during chest compression on an infant mannequin. MethodsSixteen anesthesiologists with more than 2 years of experience performed tracheal intubation on an infant mannequin using the Mil or Mil plus 6Fr GEB, with or without chest compression. Intubation success rate, intubation time, and subjective difficulty scores of laryngoscopy and tube passage through the glottis were measured. ResultsIn Mil trials, none of the participants failed without compression, whereas four failed with compression (p = 0.03). In Mil-plus-GEB trials, all participants succeeded regardless of chest compression. Intubation time was significantly longer with chest compression in both Mil and Mil-plus-GEB trials (p < 0.001). The intubation time during chest compression was significantly longer in Mil than in Mil-plus-GEB trials (p < 0.001). Difficulty of operation on a visual analog scale (VAS) for laryngoscopy did not significantly differ between Mil and Mil-plus-GEB trials during chest compression, whereas the VAS for tube passage through the glottis was significantly higher in Mil than in Mil-plus-GEB trials. ConclusionsGEB use shortened the intubation time and improved the success rate of infant tracheal intubation during chest compression by anesthesiologists in simulations.

Resuscitators who compared four simulated infant cardiopulmonary resuscitation methods favoured the three‐to‐one compression‐to‐ventilation ratio

Suboptimal cardiopulmonary resuscitation (CPR) is associated with a poor outcome, and international guidelines state that resuscitators should optimise compression and ventilation techniques with as few interruptions as possible. We investigated compression and ventilation quality during simulated CPR with four compression-to-ventilation (C:V) methods. In this crossover manikin study, 42 pairs of doctors, nurses, midwives and sixth-year medical students from two Norwegian hospitals provided two-minute resuscitation using the 3:1, 9:3 and 15:2 C:V methods and continuous chest compressions at 120 per minute with asynchronous ventilations (CCaV-120). We measured chest compression, ventilation mechanics and the resuscitators' preferences. C:V methods 3:1 and 9:3 provided comparable chest compressions and ventilation mechanics, whereas 15:2 produced fewer ventilations and lower minute volumes. The CCaV-120 method was significantly less effective than the 3:1 C:V ratio method: the chest compression depth was 1.9 mm lower, there were 25 fewer chest compressions and 21 fewer ventilations per minute, and the minute volume was 69 mL lower. The 3:1 C:V method also provided better coordination between resuscitators. Our comparison of four simulated infant cardiopulmonary resuscitation methods favoured the 3:1 C:V method, and the multidisciplinary group of participants felt it offered the best level of coordination between resuscitators.

Rescuers’ physical fatigue with different chest compression to ventilation methods during simulated infant cardiopulmonary resuscitation

Objective: To assess development of objective, subjective and indirect measures of fatigue during simulated infant cardiopulmonary resuscitation (CPR) with two different methods.Methods: Using a neonatal manikin, 17 subject-pairs were randomized in a crossover design to provide 5-min CPR with a 3:1 chest compression (CC) to ventilation (C:V) ratio and continuous CCs at a rate of 120 min−1 with asynchronous ventilations (CCaV-120). We measured participants’ changes in heart rate (HR) and mean arterial pressure (MAP); perceived level of fatigue on a validated Likert scale; and manikin CC measures.Results: CCaV-120 compared with a 3:1 C:V ratio resulted in a change during 5-min of CPR in HR 49 versus 40 bpm (p = 0.01), and MAP 1.7 versus −2.8 mmHg (p = 0.03); fatigue rated on a Likert scale 12.9 versus 11.4 (p = 0.2); and a significant decay in CC depth after 90 s (p = 0.03).Conclusions: The results indicate a trend toward more fatigue during simulated CPR in CCaV-120 compared to the recommended 3:1 C:V CPR. These results support current guidelines.

보육교사를 대상으로 한 영아 심폐소생술 현장교정교육의 지속효과

보육교사를 대상으로 한 영아 심폐소생술 현장교정교육의 지속효과

Postpartum Unit Modifies Delivery of Care to Enhance Readiness

Poster Presentation Purpose for the Program New mothers and their families have multiple learning needs, starting in the prenatal period and progressing through labor into the postpartum phase. Nurses are accountable for facilitating the necessary learning by identifying and addressing the specific needs of the family unit. Before discharge it is the responsibility of the nurse and health care team to ensure that the patient and family receive consistent and reliable information. Recognizing an opportunity to improve patient perception of readiness for discharge, our mother/infant unit decided to revise our care delivery model. Proposed Change Modifications to practice included development of a blue discharge folder to be originated upon admission and serve as a living document to record education and follow the woman throughout her stay. This folder served as a reference for the interprofessional team as well as a continuous resource for home. Additionally by incorporating a designated discharge nurse, providing an in‐patient daily Baby Care Class, developing and utilizing a Postpartum Resource Reference Guide , and incorporating specific medication use/side effect information cards, efforts were established to reinforce patient education throughout the hospital stay. Additional resources were implemented for women after discharge, including 24‐hour help‐lines, follow‐up phone calls, home health visits, breastfeeding support groups, and infant cardiopulmonary resuscitation (CPR) education. Implementation, Outcomes, and Evaluation For a 12‐month period we have tracked patient responses to the following specific Press Ganey Patient Satisfaction Survey questions. These data were used to measure the effectiveness of the modifications implemented. Specific questions and corresponding results included Staff described possible side effects of their medicine (preintervention 55, postintervention 73.7); Nurses and physicians explained things in a way patients could understand (preintervention 84.2 postintervention 91.50); Patients received information in writing about symptoms or health problems to look out for after leaving the hospital (preintervention 87.3, postintervention 98.3); and Extent to which you felt ready for discharge (preintervention 85.9, postintervention 92.7). The patient response has been overwhelmingly positive to these changes as evidenced by patient comments. Implications for Nursing Practice By providing consistent and individualized education to all patients, our unit was able to provide thorough and accurate discharge education and to increase patient readiness for discharge.

영아 심폐소생술시 지지대를 사용한 두 손가락 가슴 압박의 효과

영아 심폐소생술 1인 수행시 효과적인 가슴 압박 방법을 모색하기 위해 시뮬레이션을 활용하여 두 손가락에 지지대를 사용하기 전 후의 가슴 압박 효과를 측정하였다. 여자 대학생 50명을 대상으로 실험을 실시하고 paired t-test, 카이제곱 검정 및 Fisher's exact test를 이용하여 결과를 분석하였다. 가슴 압박의 깊이는 두 손가락에 지지대를 사용하기 전 <TEX>$2.50{\pm}0.59cm$</TEX>에 비해 사용 후 <TEX>$3.73{\pm}0.33cm$</TEX>로 유의하게 개선되었다(p < 0.001). 두 손가락 지지대 사용은 대상자의 가슴 압박에 대한 자신감과 효과를 유의하게 증가시켰다(p < 0.001). 결론적으로 영아 심폐소생술 1인 수행시 두 손가락 지지대 사용은 가슴 압박의 깊이와 자신감 그리고 효과를 유의하게 증가시켰다. 따라서 지지대를 이용한 두 손가락 압박법은 영아 심폐소생술 1인 수행시 유용할 것으로 판단된다. This paper aims to compare the effectiveness of the chest compression when a person pushes on the infant's chest by using two fingers with the support during infant cardiopulmonary resuscitation, with the effectiveness of it without the support, and to find which one is better. For the study, 50 college woman students were tested during the simulation and the result of the test has been analyzed by chi-square test, Fisher's exact test. In case of the chest compression by using the support, the depth of the chest compression comes to <TEX>$3.73{\pm}0.33cm$</TEX>. On the other hand, in case of the chest compression without the support, <TEX>$2.50{\pm}0.59cm$</TEX>. It is founded that the method of pushing on the chest by using the support is more effective than that without the support (p < 0.001). It is concluded that the way that a person pushes on the infant's chest by using two fingers with the support during infant cardiopulmonary resuscitation has turned out to be more effective and useful. It is thought that in the future, the further study for it should be conducted.

Comparison of infant intubation through the TruView EVO2, TruView PCD, and Miller laryngoscope by paramedics during simulated infant cardiopulmonary resuscitation: A randomized crossover manikin study

IntroductionThe aim of the study was to compare the efficacy of the TruView EVO2, TruView PCD, and Miller laryngoscopes for tracheal intubation during cardiopulmonary resuscitation with and without chest compressions (CCs) by paramedics in an infant manikin model. MethodsThis was an open, prospective, randomized, simulated trial. After a brief didactic session, 78 volunteer paramedics attempted to intubate a manikin using TruView EVO2, TruView PCD, and Miller laryngoscopes during resuscitation with and without CC scenarios. Primary end point was intubation success rate and secondary was time to intubation with each device. Glottic view using a Cormack-Lehane grade in using each device was also assessed. ResultsIn scenario with uninterrupted CCs, the median time to intubation using the TruView EVO2, TruView PCD, and Miller varied with the times being 25.3 seconds (interquartile range [IQR], 23-30.5 seconds) vs 20.2 seconds (IQR, 18-23 seconds) vs 24.4 seconds (IQR, 21-28 seconds), respectively. The overall success rate of intubation during CC for the devices were 94.9% vs 100% vs 92.1%. During intubation without CC, median time to intubation varied and amounted to 24.9 seconds (IQR, 21-29.6 seconds) for TruView EVO2, 18.3 seconds (IQR, 16-21.3 seconds) for TruView PCD, and 19.4 seconds (IQR, 17-23.3 seconds) for Miller laryngoscope. The overall success rate of intubation without CC for all devices was 100%. ConclusionsFor infant tracheal intubation with TruView PCD, when used by paramedics, the malleable TruView PCD showed shorter intubation time and higher overall success rate in a simulated CC scenario than TruView EVO2 or Miller laryngoscopes. Further clinical studies are necessary to confirm these initial positive findings.

A vertical two-thumb technique is superior to the two-thumb encircling technique for infant cardiopulmonary resuscitation.

The two-thumb encircling (TTE) technique often results in suboptimal cardiac compression and does not meet the requirements of current resuscitation guidelines. We compared this technique with the vertical two-thumb (VTT) technique, our novel modification of the TTE technique. This was a prospective randomised crossover simulation study of out-of-hospital infant cardiopulmonary resuscitation (CPR). Participants who had completed a basic life support course performed 10 cycles of cardiac compressions on a manikin for each technique. We enrolled 36 medical doctors who had applied for a hospital internship in this study. The VTT generated significantly higher pressure than the TTE and the pressure difference ranged from 26.8 to 62.9mmHg for each cycle, with a mean difference of 43.5mmHg (95% CI, 37.8-49.2). The difference in pressure showed a tendency to increase with increasing cycles of cardiac compressions. The participants' heart and respiratory rate was higher with the VTT, but they said that it was easier to perform cardiac compressions with this technique. The VTT technique generated more pressure than the TTE technique in a simulated model of infant out-of-hospital CPR. It can provide an alternative compression technique for effective infant CPR, especially for the rescuers with small hands or a weak grip.

Over-the-head two-thumb encircling technique as an alternative to the two-finger technique in the in-hospital infant cardiac arrest setting: a randomised crossover simulation study

ObjectiveTo determine if the over-the-head two-thumb encircling technique (OTTT) provides better quality cardiopulmonary resuscitation (CPR) than the conventional two-finger technique (TFT) when performed by a lone rescuer in an in-hospital...

보육교사 대상의 영아 심폐소생술 현장교정교육의 효과

Purpose: The purpose of this study was to evaluate the effectiveness of infant CPR (Cardiopulmonary Resuscitation) immediate remediation[LAB2]. Methods: This is a quasi-experimental study with a non-equivalent comparison group pre-post test design. Participants were 73 child care teachers in J district in Seoul. The experimental group (35) received immediate remediation with video learning [LAB3]for infant CPR education and the control group (38) received video learning only. We investigated confidence of infant CPR and tested single-rescuer infant CPR performance depending on a checklist (8 items). Data were collected before and right after to evaluate the confidence of infant CPR and before, right after and 2 weeks after the education to evaluate the skill performance and final acceptance. Results: There was a significant increase in confidence of infant CPR in the experimental group and control group. There was a statistically significant difference in the degree of skill performance between groups according to the amount time (F

Manikin-Integrated Digital Measuring System for Assessment of Infant Cardiopulmonary Resuscitation Techniques

The process of cardiopulmonary resuscitation (CPR) involves various components that must be followed to deliver high quality of CPR. While the components commonly apply to CPR for all ages from infant to adult, there are several different suggestions for infant CPR such as two-thumb CPR and two-finger CPR. However, the comprehensive evaluation based on all these components has been difficult in the absence of proper evaluation tool. Here, we developed a new manikin-integrated, digital measuring system that objectively estimates overall performance of infant CPR by evaluating individual CPR components one by one including different hand placements. The system collects and analyzes data to present estimations in digital scores according to a new evaluation index constructed based on the previously verified one. The feasibility of the system was validated through simulations with beginners and experts in first aid, resulting in statistically significant differences between the two groups with the indication of specific weaknesses for each group which may provide a basis for creating customized CPR training strategy in compliance with the personal level. We believe that the system would become a valuable assessment tool not only for infant CPR but also for the CPR technique, in general, by reflecting every component in the evaluation.

Compression rate of infant CPR in three positions

Purpose: The recently published guidelines by the European Resuscitation Council (ERC) still focus on high-quality chest compressions to minimise no-flow periods in paediatric life support. In infants compression depth should achieve at least 1/3 of the anterior–posterior chest diameter with a compression rate of at least 100 but no greater than 120min. Published figures of infant resuscitation assume the supine position to be the recommended one. Besides this, other positions were published1 or mentioned by paediatricians, but have not yet been evaluated in respect to quality of cardiopulmonary resuscitation (CPR).

Training Mothers in Infant Cardiopulmonary Resuscitation With an Instructional DVD and Manikin

Classes in infant cardiopulmonary resuscitation (CPR) can be time consuming and costly. To determine whether mothers in an obstetric unit could learn infant CPR by using a 22-minute instructional kit and to assess the value and confidence they gained by learning CPR. Quasi-experimental study with enrollment between January and December 2008. Obstetric unit in Lehigh Valley Hospital, a suburban teaching hospital in Allentown, Pennsylvania. Mothers at least 18 years old who had given birth within the previous 24 hours. The experimental group included mothers without prior CPR training who watched a 22-minute instructional DVD and practiced on a manikin. The control group included mothers with prior conventional CPR training. In both groups, knowledge and proficiency were assessed with written and practical examinations developed by certified CPR instructors. Participant surveys were conducted at 3 times: immediately before dissemination of course materials, within 24 hours after the mother agreed to participate in the study, and 6 months after initial evaluation. A total of 126 mothers were enrolled in the study: 79 in the experimental group, 25 in the control group, and 22 who withdrew from the study. Written and practical examinations were used to determine proficiency, and composite scores were generated, with a maximum composite score of 12. The composite scores were statistically significantly higher in the experimental group than in the control group, with median scores of 10 and 7, respectively (P<.001). Twenty-two mothers (21%) had been previously offered CPR training. In the experimental group, 76 mothers (96%) felt more confident as caregivers after learning CPR. Before training in both groups, 84 mothers (81%) stated that learning CPR was extremely important, compared with 100 mothers (96%) after training (P=.001). Use of an instructional kit is an effective method of teaching CPR to new mothers. Mothers reported that learning CPR is extremely important and that it increases their confidence as caregivers.

P11 Can Real-Time Performance Feedback Improve Chest Compression Quality During Simulated Infant CPR? A Randomised Controlled Trial

AimsCurrent International Liaison Committee on Resuscitation (ILCOR) guidelines emphasise the provision of high quality chest compressions during infant cardiopulmonary resuscitation (CPR). Recent research, however, reports that <1% of all chest...

Comparison of Pentax-AWS Airwayscope, Airtraq and Miller laryngoscope for tracheal intubation by novice doctors during infant cardiopulmonary resuscitation simulation: a randomized crossover trial

Recent guidelines for infant cardiopulmonary resuscitation emphasize that all rescuers should minimize interruption of chest compressions, even for endotracheal intubation. We compared the utility of the Pentax-AWS Airway Scope (AWS) with an infant-sized Intlock (AWS-I), Airtraq laryngoscope (ATQ) and Miller laryngoscope during chest compressions on an infant manikin. Twenty-three novice doctors performed tracheal intubation on an infant manikin using the AWS-I, ATQ and Miller laryngoscope, with or without chest compressions. In Miller laryngoscope trials, one participant failed to secure the airway without chest compressions, while nine failed with compressions (P < 0.05). In ATQ trials, none of the participants failed without compressions, while six failed with compressions (P < 0.05). In AWS-I trials, all participants succeeded regardless of chest compressions. Intubation time was significantly longer with chest compressions with the Miller laryngoscope and ATQ, but not with the AWS-I. The AWS-I is an effective device for endotracheal intubation during chest compressions in infant simulations managed by novice doctors.

Do chest compressions during simulated infant CPR comply with international recommendations?

BackgroundMorbidity and mortality remain high following infant cardiac arrest. Optimal cardiopulmonary resuscitation (CPR) is therefore imperative.ObjectiveComparison of two-thumb (TT) and two-finger (TF) infant chest compression technique compliance with international recommendations.DesignRandomised...

Evaluation of the 2010 American Heart Association Guidelines for infant CPR finger/thumb positions for chest compression: A study using computed tomography

IntroductionWe sought to verify, using computed tomography (CT) examinations of infants, which the left ventricle (LV) is compressed and abdominal compression avoided by using the chest compression landmarks recommended by the 2010 American Heart Association (AHA) Guidelines for infant cardiopulmonary resuscitation (CPR). MethodsUsing CT examinations of 63 infants performed between March 2002 and July 2011, we retrospectively measured the distance between the INL and the xiphoid process, and the distance of the lower third (LT) of the sternum. The distances between LV maximal diameter (LVMD) and xiphoid processes were also measured to determine whether LVs would be compressed by chest compressions. These distances were compared with the finger placements by 20 adults, when placed on infant mannequins for simulated two-finger or two-thumb infant CPR. ResultsThe mean distances of the INL and the LT of the sternum were 32±8mm and 12±2mm from the xiphoid, respectively. The LVMD was placed 15±6mm from the xiphoid process. When we overlaid the width of adult finger placement (a mean of 28mm for two-finger technique, and 23mm for two-thumb technique), the LV was compressed in 57 patients (90.5%) and 59 patients (93.7%), respectively. The upper abdomen was compressed in 22 patients (34.9%) by the two-finger technique and in 16 patients (25.3%) by the two-thumb technique with the range of 0.3–10.8mm. ConclusionWhen applying the 2010 AHA Guidelines for infant CPR, recommended finger placement allows for adequate compression of the LV in more than 90% of patients. In 23–35% of infants, the upper abdomen is compressed from 0.3mm to 10.7mm.

The Two-Thumb Technique Using an Elevated Surface is Preferable for Teaching Infant Cardiopulmonary Resuscitation

To determine whether the two-thumb technique is superior to the two-finger technique for administering chest compressions using the floor surface and the preferred location for performing infant cardiopulmonary resuscitation (CPR) (ie, floor, table, or radiant warmer). Twenty Neonatal Resuscitation Program trained medical personnel performed CPR on a neonatal manikin utilizing the two-thumb vs two-finger technique, a compression to ventilation ratio of 30:2 for 2 minutes in random order on the floor, table, and radiant warmer. Compression depth favored the two-thumb over two-finger technique on the floor (27 ± 8 mm vs 23 ± 7), table (26 ± 7 mm vs 22 ± 7), and radiant warmer (29 ± 4 mm vs 23 ± 4) (all P < .05). Per individual subject, the compression depth varied widely using both techniques and at all surfaces. More variability between compressions was observed with the two-finger vs two-thumb technique on all surfaces (P < .05). Decay in compression over time occurred and was greater with the two-finger vs two-thumb technique on the floor (-5 ± 7 vs -1 ± 6 mm; P < .05) and radiant warmer (-3 ± 6 vs -0.3 ± 2 mm; P < .05), compared with the table (-3 ± 9 vs -4 ± 5 mm). Providers favored the table over radiant warmer, with the floor least preferred and most tiring. The two-thumb technique is superior to the two-finger technique, achieving greater depth, less variability, and less decay over time. The table was considered most comfortable and less tiring. The two-thumb technique should be the preferred method for teaching lay persons infant CPR preferably using an elevated firm surface.

Comparison of overlapping (OP) and adjacent thumb positions (AP) for cardiac compressions using the encircling method in infants

ObjectivesThe aim of this manikin study was to compare the efficiency between overlapping (OP) and adjacent thumb positions (AP) for cardiac compressions using the encircling method in infants.MethodsThe study conducted...

Comparison of air-Q® and Soft Seal® laryngeal mask for airway management by novice doctors during infant chest compression: A manikin study

BackgroundRecent resuscitation guidelines for infant cardiopulmonary resuscitation (CPR) emphasise that rescuers should minimise the interruption of chest compressions. To that end, supraglottic devices such as laryngeal mask airways (LMAs) are suggested as a backup for airway management during infant CPR. We therefore compared the utility of the air-Q® LMA (air-Q) with that of the Soft Seal® LMA (Soft Seal) for infant CPR in an infant manikin. MethodsTwenty-four novice doctors in the anaesthesia department performed insertion and ventilation with air-Q and Soft Seal on an infant manikin with or without chest compression. ResultsTwo doctors failed to insert the Soft Seal without chest compression, while nine failed during chest compression (P<0.05). However, only one doctor failed to insert the air-Q without chest compression, and two doctors failed during chest compression. Insertion time was not significantly increased with chest compression using either device. Insertion time during chest compression was significantly shorter for the air-Q than for the Soft Seal (P<0.05). The visual analogue scale (VAS) was used to evaluate difficulty of use (0mm (extremely easy) to 100mm (extremely difficult)). VAS scores did not change significantly by the addition of chest compression with either device; however, VAS scores during chest compression were significantly higher with Soft Seal than with the air-Q device. ConclusionWe conclude that novice doctors find the air-Q easier to use than Soft Seal for emergency airway management during chest compression in infants, in an infant manikin.