Child Manikin Research Articles

Development of an augmented reality system for tracheal intubation guidance of airway management.

Tracheal intubation is a crucial procedure performed in airway management to sustain life during various procedures. However, difficult airways can make intubation challenging, which is associated with increased mortality and morbidity. This is particularly important for children who undergo intubation where the situation is difficult. Improved airway management will decrease incidences of repeated attempts, decrease hypoxic injuries in patients, and decrease hospital stays, resulting in better clinical outcomes and reduced costs. Currently, 3D printed models based on CT scans and ultrasound-guided intubation are being used or tested for device fitting and procedure guidance to increase the success rate of intubation, but both have limitations. Maintaining a 3D printing facility can be logistically inconvenient, and it can be time consuming and expensive. Ultrasound-guided intubation can be hindered by operator dependence, limited two-dimensional visualization, and potential artifacts. In this study, we developed an augmented reality (AR) system that allows the overlay of intubation tools and internal airways, providing real-time guidance during the procedure. A child manikin was used to develop and test the AR system. Three-dimensional CT images were acquired from the manikin. Different tissues were segmented to generate the 3D models that were imported into Unity to build the holograms. Phantom experiments demonstrated the AR-guided system for potential applications in tracheal intubation guidance.

Measurement of heat transfer characteristics by a child manikin with embedded cyclic temperature control

Thermal manikin is an effective tool to study the heat transfer between the human body and the surrounding environment. Combining the heat transfer characteristics with a human-body thermal model enables the detailed analysis of the interaction of the human body and the surrounding thermal environment. Most thermal manikins adopt steady surface temperature control. However, this control method can evaluate the heat transfer coefficient only in a uniform thermal environment while daily thermal environments are non-uniform. In the present study, a theory for cyclic control method is proposed to determine the heat transfer characteristics in a non-uniform environment. A new child-shaped thermal manikin with embedded the cyclic control method is developed. The theory to determine heat transfer characteristics is verified in both uniform and non-uniform thermal environments by using the developed thermal manikin.

Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool.

Pediatric out-of-hospital cardiac arrests (P-OHCA) are infrequent, have low survival rates, and often have poor neurologic outcomes. Recent evidence indicates that high-performance emergency medical service (EMS) care can improve outcomes. To evaluate Pediatric Advanced Life Support (PALS) guideline performance in the out of hospital setting and introduce an easy-to-use tool that scores guideline compliance and patient safety. We observed EMS teams responding to standardized pediatric resuscitation simulations. Teams were dispatched to a mock assisted living home for a choking 6-year-old with a complex medical history. The child manikin was presented as unconscious and apneic, with bradycardic pulse. Teams were expected to monitor vitals; initiate airway management and cardiopulmonary resuscitation (CPR); and establish vascular access and administer epinephrine based on PALS guidelines. We developed a tool to score the quality of care for critical tasks and had a clinical expert evaluate technical performance using blinded video review. We observed 34 EMS teams providing care in P-OHCA simulations. Teams were proficient at assessing vitals, using correct-sized equipment, intubation, and confirmation of tube placement. Teams were delayed in initiating positive pressure ventilation (PPV) and chest compressions. Many teams (53%) deviated from guidelines in chest compressions with 17 (50%) performing continuous compressions before establishing an advanced airway and one (3%) not performing compressions. Similarly, 20 (59%) teams deviated from medication guidelines with 12 (35%) failing to administer epinephrine, six (18%) underdosing, and two (6%) overdosing by more than 20%. EMS teams were successful in selecting the appropriate equipment but delayed initiating ventilations in a child with severe bradycardia. We also noted frequent use of continuous chest CC rather than the AHA recommended 15:2 ratio. We developed a scoring tool with time-based criteria that can be used to assess guideline compliance, individual performance, and/or educational effectiveness.

Establishment of 3D-printed Child Manikins Using Anthropometric Data of 6- and 10-year-old ASEAN Children


 
 
 The New Car Assessment Programme for Southeast Asian Countries (ASEAN NCAP) has been working hard to increase vehicle safety levels in the ASEAN region. To ensure a significant impact on the ASEAN community, few enhancements need to be made to their test methodology and facilities. As an example, ASEAN NCAP is using child manikins with generic build in their vehicle safety assessment. Meanwhile, vehicle manufacturers and product developers are also using these generic references in their product designs such as the seat restraint system, child seat design, etc. For the improvement of vehicle safety especially for the ASEAN region, dedicated manikins with ASEAN anthropometric measurements are necessary. This paper aims to describe the development of 3D-printed manikins based on anthropometric data of ASEAN children aged 6 and 10 years old. The completed prototypes will be tested using a selected vehicle safety assessment (i.e., Child Restraint System installation) and intended to be applied for design refinement of vehicle safety systems.
 
 

Comparison of direct and video laryngoscope endotracheal intubations by pediatric residents: A study of a child model with normal airway.

This study aimed to compare the efficacy of direct and videolaryngoscopy procedures performed by pediatric residents who had limited experience of direct endotracheal intubation and had not previously used video laryngoscopes in a normal airway child manikin. The endotracheal intubations performed by pediatric residents with a direct laryngoscope and Storz C-MAC videolaryngoscope on a pediatric manikin with a normal airway were compared. Theoretical and practical training was given before the study. In the first attempt, the success of the intubation procedure, glottis visual duration, and endotracheal tube insertion time were determined. Practitioners grouped the glottis image between 1-4 according to the Cormack-Lehane Staging (Stage 1 ideal image). After the intervention, the participants scored one to ten points on direct and videolaryngoscopy (1 not useful, 10 very useful). The success of direct and videolaryngoscopy of 51 pediatric residents on the same manikin was 48 out of 51 (94%) for each method (P> 0.05). Glottis visual duration was similar in both methods (P>0.05); tube insertion and total intubation time were shorter in the video laryngoscope group (P<0.05); glottis image was better in the video laryngoscope group according to Cormack-Lehane Classification (P<0.05). Participants' rating was higher on videolaryngoscope (P<0.05). Users with limited endotracheal intubation experience use Video laryncoscope more effectively than direct laryngoscope in children with normal airway model after training.

Which Device Is Favorable for Intubation Attempts of Pediatric Residents on Four Different Pediatric Airway Simulations?

Endotracheal intubation is an essential skill for the pediatric airway management. Although direct laryngoscopy (DL) is the standard method, several videolaryngoscopes (VLs) have been recently enhanced as an alternative especially for difficult intubations. We aimed to compare McGrath MAC (McG) and Storz C-MAC PM (ST) VLs with DL in terms of intubation success rate, time to intubation (TTI), and duration of obtaining glottis view of intubation attempts performed by pediatric residents on different pediatric airway manikins. The pediatric residents with no experience in videolaryngoscopy were included. After a brief demonstration, intubation attempts with 3 randomly handled different devices with 6 different blades were performed on a child manikin, an infant manikin, a Pierre-Robin sequence infant manikin, and a child manikin with cervical immobilization sequentially. Fifty pediatric residents were enrolled. The attempts of DL on child manikin and attempts of all devices on child with cervical immobilization simulation were completely successful. For the attempts on both infant manikin and Pierre-Robin sequence infant manikin, the success rate of McG was significantly lower than ST and DL (P = 0.011 and P = 0.001). In the child manikin, McG and ST had prolonged TTI compared with DL (P = 0.016 and P = 0.001). For the child with cervical immobilization simulation, TTI of DL was significantly shorter than McG and ST (P = 0.011 and P = 0.001). Time to intubation of McG was significantly longer than DL and ST for the attempts on both 2 infant manikins. The rate of Cormack-Lehane grade I glottis view was similar for the attempts on both 2 child airway simulations. For infant manikin and Pierre-Robin sequence infant simulation, the rate of Cormack-Lehane grade I of ST was higher than attempts of DL and McG. The attempts of pediatric residents on infant normal airway and Pierre-Robin sequence infant airway simulations resulted with enhanced glottis view by the utilization of Storz C-MAC PM, but both 2 VLs did not provide the improvement of intubation success rate and TTI compared with DL on these 4 different pediatric manikins. Further clinical studies of different VLs in different clinical courses are required for a reliable utilization in children.

In situ deteriorating patient simulation in general practice.

GP practices have limited access to medical emergency training and basic life support is often taught out of context as a skills-based event. To develop and evaluate a whole team integrated simulation-based education, to enhance learning, change behaviours and provide safer care. Phase 1: 10 practices piloted a 3-hour programme delivering 40 minutes BLS and AED skills and 2-hour deteriorating patient simulation. Three scenarios where developed: adult chest pain, child anaphylaxis and baby bronchiolitis. An adult simulation patient and relative were used and a child and baby manikin. Two facilitators trained in coaching and debriefing used the 3D debriefing model. Phase 2: 12 new practices undertook identical training derived from Phase 1, with pre- and post-course questionnaires. Teams were scored on: team working, communication, early recognition and systematic approach. The team developed action plans derived from their learning to inform future response. Ten of the 12 practices from Phase 2 received an emergency drill within 6 months of the original session. Three to four members of the whole team integrated training, attended the drill, but were unaware of the nature of the scenario before. Scoring was repeated and action plans were revisited to determine behaviour changes. Every emergency drill demonstrated improved scoring in skills and behaviour. A combination of: in situ GP simulation, appropriately qualified facilitators in simulation and debriefing, and action plans developed by the whole team suggests safer care for patients experiencing a medical emergency.

Comparison of endotracheal intubations performed by pediatric residents with direct and video laryngoscope: a child manikin study with normal airway

Comparison of endotracheal intubations performed by pediatric residents with direct and video laryngoscope: a child manikin study with normal airway

Endotracheal intubation skills of pediatricians versus anesthetists in neonates and children

This study compares the performance of pediatricians and anesthetists in neonatal and pediatric endotracheal intubations (ETI) during simulated settings. Participants completed a questionnaire and performed an ETI scenario on a neonatal and a child manikin. The procedures were recorded with head cameras and cameras attached to standard laryngoscope blades. The outcomes were successful intubation, time to successful intubation, number of attempts, complications, total performance score, end-assessment rating, and an assessment whether the participant was sufficiently able to perform an ETI. Fifty-two pediatricians and 52 anesthetists were included. For the neonatal ETI, the rate of successful intubation was in favor of anesthetists although not significant. Anesthetists performed significantly better in all other outcomes. Of the pediatricians, 65% was rated sufficiently adept to perform a neonatal ETI vs 100% of the anesthetists. Pediatricians (29%) overestimated while anesthetists (33%) underestimated their performance in neonatal ETI. For the pediatric ETI, all outcomes were significantly better for anesthetists. Only 15% of all pediatricians were considered sufficiently able to perform pediatric ETI vs 94% of the anesthetists.Conclusion: Anesthetists are far more adept in performing ETI in neonates and children compared with pediatricians in a simulated setting. Complications are expected to occur less frequently and less seriously when anesthetists perform ETI.What is Known:• Endotracheal intubation (ETI) performed by inexperienced care providers can lead to unsuccessful and/or prolonged intubation attempts. This can cause complications such as hypoxemia, trauma to the oropharynx and larynx, and prolonged interruption of resuscitation, which results in a high morbidity/mortality.• Fifty to 60 real-life ETI procedures are needed before ETI can be performed with a 90% success rate. Despite this, 18% of providers still require some assistance even after performing 80 intubations. Skill fade will occur if there is too little exposure.What is New:• This study shows that, on both neonatal and child manikins, anesthetists perform better in ETI compared with pediatricians. Besides this, complications are expected to occur less frequently and less seriously when anesthetists are performing the ETIs on neonates and children.• In those countries where there are no clear interprofessional agreements made in general hospitals on who will perform ETI on neonates and children in acute care settings, these agreements are urgently necessary.

Comparison between modified and conventional one-handed chest compression techniques for child cardiopulmonary resuscitation: A randomised, non-blind, cross-over simulation trial.

Chest compression depth (CCD) decreases significantly when performing one-handed chest compression (OHCC). We modified OHCC posture to increase CCD as follows: first, the axis of the compression hand was adjusted to the compression area; second, the opposite hand was wrapped around the elbow of the compression arm. This study compared modified OHCC with conventional OHCC for child cardiopulmonary resuscitation. A total of 46 health-care providers performed 2 min of continuous chest compression using conventional OHCC (trial 1) and modified OHCC (trial 2) in a random order on a 5-year-old-sized child manikin lying on a bed. Chest compression parameters were assessed with an accelerometer and analysed by comparing the mean values of 30-s segments. The average CCD decreased significantly in all segments in both trials (trial 1 (segments 1-4): 40.9 ± 5.6 mm, 39.4 ± 6.6 mm, 38.0 ± 6.9 mm, 36.7 ± 7.3 mm, P < 0.001; trial 2 (segments 1-4): 42.3 ± 5.4 mm, 41.2 ± 6.2 mm, 40.1 ± 6.8 mm, 39.0 ± 6.9 mm, P < 0.001). However, the average CCD in trial 2 was significantly greater in all segments than that in trial 1 (segments 1-4: P = 0.016; P = 0.009; P = 0.004; P = 0.001). The average chest compression rates were comparable in all segments in both trials. By modifying OHCC posture, a deeper mean CCD could be maintained for 2 min than by using conventional OHCC.

Evaluation of knowledge of students in paediatric dentistry concerning cardiopulmonary resuscitation skills in children.

The study evaluated the theoretical knowledge and practical ability of students in paediatric dentistry concerning basic life support (BLS) and cardiopulmonary resuscitation (CPR) in children and babies. Seventy paediatric dentistry students answered a questionnaire and also performed a simulation of the manoeuvres of BLS and CPR on baby and child manikins. The results showed that 41 (58%) students had never received BLS training. When questioned about the correct ratio of compression and ventilation during CPR, most students answered incorrectly. For the CPR of babies in the presence of a first responder only 19 (27.1%) answered correctly (30 × 2), and for babies with two rescuers, 23 (32.8%) answered correctly (15 × 2); in relation to the correct rhythm of chest compressions, 38 (54.4%) answered incorrectly; when asked if they felt prepared to deal with a medical emergency in their dental surgeries, only 12 (17.1%) stated "yes". In the practice evaluation, 51 (73%) students who had been assessed in CPR manoeuvres for children and 55 (78%) in the manoeuvres for babies scored inadequately. The evaluated students did not have adequate knowledge about CPR in children and babies.

Semiprone position is superior to supine position for paediatric endotracheal intubation during massive regurgitation, a randomized crossover simulation trial

BackgroundEndotracheal intubation of patients with massive regurgitation represents a challenge in emergency airway management. Gastric contents tend to block suction catheters, and few treatment alternatives exist. Based on a technique that was successfully applied in our district, we wanted to examine if endotracheal intubation would be easier and quicker to perform when the patient is turned over to a semiprone position, as compared to the supine position.MethodsIn a randomized crossover simulation trial, a child manikin with on-going regurgitation was intubated both in the supine and semiprone positions. Endpoints were experienced difficulty with the procedure and time to intubation, as well as visually confirmed intubation and first-pass success rate.ResultsIntubation in the semiprone position was significantly easier and faster compared to the supine position; the median experienced difficulty on a visual analogue scale was 27 and 65, respectively (p = 0.004), and the median time to intubation was 26 and 45 s, respectively (p = 0.001). There were no significant differences in frequency of visually confirmed intubation (16 and 18, p = 0.490) of first-pass success rate (17 and 18, p = 1.000).ConclusionIn this experiment, endotracheal intubation during massive regurgitation with the patient in the semiprone position was significantly easier and quicker to perform than in the supine position. Endotracheal intubation in the semiprone position can provide a quick rescue method in situations where airway management is hindered by massive regurgitation, and it represents a possible supplement to current airway management training.

Perceived affordances and postures for lifting in child care

ABSTRACTChildcare work appears to be full of the physical and mental risk factors frequently associated with chronic exertion leading to injury of the musculoskeletal system. The purpose of this study was to examine the affordances and mechanics for lifting a child, and to associate those mechanics with physical demands reports provided by experienced childcare workers. Participants perceived a smaller safe reaching distance to a child compared to a conventional handling target, despite the identical load and similar load distribution. This difference may reflect the influence of coupling (suitcase had ‘good’ coupling, child manikin had ‘poor’ coupling), or an increased concern for the safety of the child over the suitcase. While lifting at a smaller affordant distance could contribute to decreasing spinal loading from reactive moments, the greater trunk and knee flexions observed in child lifting may be contributing to childcare workers’ musculoskeletal discomfort and injury in those regions.

A randomized comparison of the Laryngoscope with Fiber Optic Reusable Flexible Tip English Macintosh blade to the conventional Macintosh laryngoscope for intubation in simulated easy and difficult child airway with chest compression scenarios

IntroductionWe hypothesized that the Laryngoscope with Fiber Optic Reusable Flexible Tip English Macintosh blade (TMAC) is beneficial for the intubation of child manikins while performing cardiopulmonary resuscitation (CPR). In the present study, we evaluated the effectiveness of the conventional Macintosh laryngoscope (MAC) and TMAC in 3 simulated CPR scenarios. MethodsA randomized crossover simulation trial was designed. One hundred seven paramedics intubated the trachea of a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, FL) using the MAC and TMAC in a normal airway scenario (scenario A), normal airway with chest compression scenario (scenario B), and difficult airway with chest compression scenario (scenario C). The participants were directed to make a maximum of 3 attempts in each scenario. The success rate, time required for intubation, Cormack-Lehane grade, dental compression, and the ease of intubation were measured. ResultsThe median time of intubation with MAC and TMAC in scenario A was 19.6 (interquartile range [IQR], 18-23) vs 19 (IQR, 16.2-21.8); in scenario B, 29.5 (IQR, 25-31) vs 26 (IQR, 23.5-29) seconds; and in scenario C, 38 (IQR, 32.5-45) vs 29 (IQR, 25-31) seconds, respectively. The overall efficacy for each of the scenarios was as follows: in scenario A, it was 100% vs 100%; in scenario B, it was 79.4% vs 100% (P = .007); and in scenario C, it was 68.2% vs 90.7% (P < .001), respectively. ConclusionsThe TMAC seems to be a superior intubating device compared with the conventional MAC when used in simulated normal and difficult child airway with chest compression scenarios. Future studies should explore the efficacy of TMAC in pediatric clinical emergency settings.

Should we change chest compression providers every 2 min when performing one-handed chest compressions?

Because the one-handed chest compression (OHCC) technique uses one hand, unlike the two-handed chest compression (THCC) technique, compression depth might be reduced more rapidly in OHCC than THCC. The present study was conducted to determine whether compression depth was affected within 2 min after the start of OHCC in a simulated in-hospital paediatric arrest model. Forty medical doctors performed continuous OHCC on a child manikin lying on a hard floor using a CPRmeter for 2 min. The hand used to perform the OHCC technique was randomised to the right or left hand. The mean compression depth (MCD) and the mean compression rate (MCR) were calculated at 30 s intervals using the Q-CPR review software. MCD values decreased significantly with time (0-30 s: 44.3 ± 4.1 mm, 30-60 s: 42.4 ± 4.9 mm, 60-90 s: 40.5 ± 5.8 mm, and 90-120 s: 38.7 ± 5.7 mm; P < 0.001). The MCR also tended to decrease with time (0-30 s: 119.3 ± 12.5/min, 30-60 s: 119.0 ± 13.1/min, 60-90 s: 117.9 ± 14.5/min, 90-120 s: 117.8 ± 14.9/min), and the differences were statistically significant between 30-60 s and 60-90 s (P = 0.037) and between 30-60 s and 90-120 s (P = 0.043). Compression depth was decreased significantly from 30 s onwards after starting the OHCC technique using a simulated paediatric arrest model. The results of the present study suggest that future strategies should be established to prevent a decrease in compression depth within 1 min during OHCC.

Tracheal intubation of pediatric manikins during ongoing chest compressions. Does Glidescope® videolaryngoscope improve pediatric residents' performance?

Our objective was to test the ability of pediatric residents to intubate the trachea of infant and child manikins during continuous chest compressions (CC) by means of indirect videolaryngoscopy with Glidescope® versus standard direct laryngoscopy. A randomized crossover simulation trial was designed. Twenty-three residents trained to intubate child and infant manikins were eligible for the study. They were asked to perform tracheal intubation in manikins assisted by both standard laryngoscopy and Glidescope® while a colleague delivered uninterrupted chest compressions. In the infant cardiac arrest scenario, the median (IQR) total time for intubation was significantly shorter with the Miller laryngoscope [28.2 s (20.4-34.4)] than with Glidescope® [38.0 s (25.3-50.5)] (p = 0.021). The number of participants who needed more than 30 s to intubate the manikin was also significantly higher with Glidescope® (n = 13) than with the Miller laryngoscope (n = 7, p = 0.01). In the child scenario, the total time for intubation and number of intubation failures were similar with Macintosh and Glidescope® laryngoscopes. The participants' subjective difficulty of the procedure was similar for direct and videolaryngoscopy. In simulated infant and child cardiac arrest scenarios, pediatric residents are able to intubate the trachea during CC. The videolaryngoscope Glidescope® does not improve performance in this setting.

Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Comparison of the GlideScope Videolaryngoscope to the Standard Macintosh for Intubation by Pediatric Residents in Simulated Child Airway Scenarios

Videolaryngoscopy may facilitate tracheal intubation in difficult airway scenarios. Our objective was to compare the ability of residents to intubate a child manikin using the standard Macintosh laryngoscope and the novel GlideScope. Pediatric residents who passed an advanced pediatric life support course were eligible. Four scenarios were proposed: Macintosh (M) and GlideScope (G) "easy" intubation and M and G "difficult"; intubation (cervical immobilization with rigid collar). No participant had previous experience with videolaryngoscope. Each participant performed the 4 scenarios in a random sequence. Time from initiation of intubation procedure to inflation of manikin's chest was recorded, as well as the number of intubation attempts, number of additional maneuvers, dental injury index, and participant's subjective impression. Eighteen subjects were included. Median (range) time for easy airway intubation was 18 seconds (8-120 seconds) with M versus 37 seconds (18-96 seconds) with G (P = 0.029). Time for intubation with cervical immobilization was 19 seconds (9-120 seconds) with M versus 49 seconds (22-120 seconds) with G (P = 0.006). The G intubation in case of cervical immobilization needed significantly more maneuvers than with the M intubation (P = 0.014). There were no significant differences when number of attempts, dental injury index, and participant's subjective difficulty rate were compared. Without specific training, videolaryngoscope-guided intubation did not improve intubation performance by pediatric residents in this manikin model of normal and simulated difficult intubation caused by a cervical collar in place. To achieve skills with videolaryngoscope intubation in children, a specific training program is needed.

My Car Is Sinking: Automobile Submersion, Lessons in Vehicle Escape

In North America approximately 400 individuals per year die in submersed vehicles, accounting for 5-11% of all drownings. About half of people surveyed would let the vehicle fill with water before attempting exit. We used a crane and two passenger vehicles of the same make, model, and year-one with passenger compartment intact (I) and one with holes (H) in the floor (area approximately 2200 cm2)--to conduct occupied and unoccupied submersions. Three phases of submersion were identified: 1) FLOATING, vehicles floated for 15 s (H) to 63 s (I) before the water reached the bottom of the side windows; 2) SINKING, the subsequent period until the vehicle is completely under water, but before it fills completely; and 3) SUBMERGED, the vehicle was full of water and several feet below the surface. Total time to submersion was 150 s for I but only 37 s for H. Opening the door to exit Vehicle I decreased submersion time from 150 to 30 s. Even the most difficult exit strategy attempted (three men and a child manikin through one window) was quickly performed from Vehicle I (only 51 s). During one exit attempt, initiated during the sinking phase, it was impossible to open the doors or windows until the vehicle was completely full of water. A vehicle is most easily exited during the initial Floating Phase. We suggest the following escape procedure: SEATBELT(s) unfastened; WINDOWS open; CHILDREN released from restraints and brought close to an adult; and OUT, children should exit first.

Expert clinical assessment of thorax stiffness of infants and children during chest compressions

Background High-fidelity manikins have been shown to be useful in teaching appropriate cardiopulmonary resuscitation (CPR) techniques. Similarity of manikin chest compression characteristics to real children is desirable. Little data exists on thorax stiffness in infants and children to guide manikin construction. Objective To determine a ‘consensus clinical-expert assessment’ of the pediatric chest stiffness for two specific age groups—infants and 5-year-olds. Methods Four manikins in each of two sizes (5-year child, 6-month infant) were identically constructed, except for thorax downstroke spring stiffness. Health care providers with pediatric CPR experience provided chest compressions to each manikin in random order, masked to thoracic stiffness. Each health care provider was instructed to identify the manikin with downstroke thoracic stiffness most similar to children on whom they have performed chest compressions. Duplicate assessment of a randomly selected, previously assessed manikin was performed to assess health care provider consistency using the kappa statistic. Subject inter-rater agreement on which manikin best approximated a child of that age was assessed by calculating the percentage of subjects who identified that manikin as the best approximation of an actual child. Results A convenience sample of 63 international experts was obtained: 52 from Critical Care, 3 from Emergency Medicine, 4 from Pediatrics, and 4 from other specialties. There were 6 and 8 experts whose assessments were inconsistent for the infant manikins and child manikins, respectively. Approximately half of the subjects agreed on a single manikin as the best approximation of the human for both the infant (46%) and child manikins (43%). Excluding assessments of stiffness “out of range”, the percentage of experts who agreed on a single manikin as the best approximation for the human increased to approximately 90% for each manikin size. Conclusion Experienced health care providers consistently identified and agreed on the manikin thorax stiffness which they felt best approximated downstroke chest compression stiffness of children and infants. Expert opinion can be used to create manikins with realistic spring stiffness for CPR training. Further study is needed to evaluate whether enhanced manikin biofidelity will improve CPR performance.