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Trends in chest compression performance over time. Circles and bars represent means and standard deviations, respectively. Residual leaning rate is the ratio of the number of compressions with residual leaning to the total number of compressions; residual leaning is defined as ≥2.5 kg residual force on the chest at the end of the release phase of each compression.
Source publication
The aim of this study was to assess the quality of chest compressions performed by inexperienced rescuers using three different techniques: two-hand, right one-hand, and left one-hand.
We performed a prospective, randomised, crossover study in a simulated 6-year-old paediatric manikin model. Each participant performed 2-minute continuous chest comp...
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Aim
Automated real-time feedback devices have been considered a potential tool to improve the quality of cardiopulmonary resuscitation (CPR). Despite previous studies supporting the usefulness of such devices during training, others have conflicting conclusions regarding its efficacy during real-life CPR. This systematic review aimed to assess the...
This study aimed to assess the effectiveness of a novel chest compression (CC) smart-ring-based feedback system in a manikin simulation. In this randomized, crossover, controlled study, we evaluated the effect of smart-ring CC feedback on cardiopulmonary resuscitation (CPR). The learnability and usability of the tool were evaluated with the System...
Citations
... That the even force distribution resulted in less fatigue might explain why the majority of participants preferred the TH compression technique [6,19]. Several researchers have reported that TH ECC was considered to have incomplete chest recoil when compared to OH ECC [1,21]. In our study, although the difference was not statistically significant, there was a trend that TH has greater residual force than OH. ...
Background
Even force distribution would generate efficient external chest compression (ECC). Little research has been done to compare force distribution between one-hand (OH) and two-handed (TH) during child ECC. Therefore, this study was to investigate force distribution, rescuer perceived fatigue and discomfort/pain when applying OH and TH ECC in children.
Methods
Crossover manikin study. Thirty-five emergency department registered nurses performed lone rescuer ECC using TH and OH techniques, each for 2 min at a rate of at least 100 compressions/min. A Resusci Junior Basic manikin equipped with a MatScan pressure measurement system was used to collect data. The perceived exertion scale (modified Borg scale) and numerical rating scale (NRS) was applied to evaluate the fatigue and physical pain of delivering chest compressions.
Results
The maximum compression force (kg) delivered was 56.58 ± 13.67 for TH and 45.12 ± 7.90 for OH ECC (p < 0.001). The maximum-minimum force difference force delivered by TH and OH ECC was 52.24 ± 13.43 and 41.36 ± 7.57, respectively (p < 0.001). The mean caudal force delivered by TH and OH ECC was 29.45 ± 16.70 and 34.03 ± 12.01, respectively (p = 0.198). The mean cranial force delivered by TH and OH ECC was 27.13 ± 11.30 and 11.09 ± 9.72, respectively (p < 0.001). The caudal–cranial pressure difference delivered by TH and OH ECC was 19.14 ± 15.96 and 26.94 ± 14.48, respectively (p = 0.016). The perceived exertion and NRS for OH ECC was higher than that of the TH method (p < 0.001, p = 0.004, respectively).
Conclusions
The TH method produced greater compression force, had more efficient compression, and delivered a more even force distribution, and produced less fatigue and physical pain in the rescuer than the OH method.
Trial registration
The Cheng Kung University Institutional Review Board A-ER-103-387. http://nckuhirb.med.ncku.edu.tw/sitemap.php
... Additionally, irrespective of the provision of audio feedback, the CCD achieved during CPR performed using the THCC technique was found to be greater than that achieved during CPR performed using the OHCC technique (p < 0.001). It is well known that increased CCD is achieved with THCC [26]; compared to CPR with OHCC, CPR with THCC produces significantly higher pressure, which causes increased CCD [27]. ...
Although the use of audio feedback with devices such as metronomes during cardiopulmonary resuscitation (CPR) is a simple method for improving CPR quality, its effect on the quality of pediatric CPR has not been adequately evaluated. In this study, 64 healthcare providers performed CPR (with one- and two-handed chest compression (OHCC and THCC, respectively)) on a pediatric resuscitation manikin (Resusci Junior QCPR), with and without audio feedback using a metronome (110 beats/min). CPR was performed on the floor, with a compression-to-ventilation ratio of 30:2. For both OHCC and THCC, the rate of achievement of an adequate compression rate during CPR was significantly higher when performed with metronome feedback than that without metronome feedback (CPR with vs. without feedback: 100.0% (99.0, 100.0) vs. 94.0% (69.0, 99.0), p < 0.001, for OHCC, and 100.0% (98.5, 100.0) vs. 91.0% (34.5, 98.5), p < 0.001, for THCC). However, the rate of achievement of adequate compression depth during the CPR performed was significantly higher without metronome feedback than that with metronome feedback (CPR with vs. without feedback: 95.0% (23.5, 99.5) vs. 98.5% (77.5, 100.0), p = 0.004, for OHCC, and 99.0% (95.5, 100.0) vs. 100.0% (99.0, 100.0), p = 0.003, for THCC). Although metronome feedback during pediatric CPR could increase the rate of achievement of adequate compression rates, it could cause decreased compression depth.
... Excessive rates are not uncommon in children and might impact outcome. 602,603 Very low certainty evidence suggests slightly slower rates (80À100) are associated with a higher rate of survival to hospital discharge and survival with favourable neurological outcome. 588 The current guideline is unchanged. ...
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
... There are no pediatric-specific clinical data to determine if the 1-hand or 2-hand technique produces better outcomes for children receiving CPR. In manikin studies, the 2-hand technique has been associated with improved compression depth, 47 compression force, 48 and less rescuer fatigue. 49 4. ...
... There are no pediatric-specific clinical data to determine if the 1-hand or 2-hand technique produces better outcomes for children receiving CPR. In manikin studies, the 2-hand technique has been associated with improved compression depth, 47 compression force, 48 and less rescuer fatigue. 49 Text in cascading boxes describes the actions that a single rescuer should perform in sequence during a pediatric cardiac arrest. ...
... Previous studies have investigated the quality of chest compressions based on hand dominance during CPR in the adult 13À18 or older child populations. 19 Others have explored the difference between the TTT and TFT for infant chest compressions, 20À25 or the use of different fingers with the TFT. 12 However, to date, no research has specifically compared DH and NH for iCPR performance using TFT. Therefore, in an attempt to fill a gap in the knowledge and to reproduce a single rescuer performing iCPR in an OHCA episode, evaluation of hand dominance using TFT is warranted. ...
... Some studies have investigated optimal depth of CC but there is a lack of evidence in infants and children CC [25][26][27] . Although deeper CC have shown higher arterial blood pressure 28 , excessive CC depth may cause serious mechanical complications 25 . ...
... This might have been because each CPR session lasted only 3 minutes. Nevertheless, other published studies with simulated CPR sessions and shorter periods found a decrease in depth over time 26 . Vaillancourt et al. 13 measured objective fatigue by changes in heart rate, mean arterial pressure and venous lactate, and perceived level of exhaustion using the validated Borg Rating of Perceived Exertion scale. ...
The main objetive was to compare 30:2 and 15:2 compression-to-ventilation ratio in two simulated pediatric cardiopulmonary resuscitation (CPR) models with single rescuer. The secondary aim was to analyze the errors or omissions made during resuscitation. A prospective randomized parallel controlled study comparing 15:2 and 30:2 ratio in two manikins (child and infant) was developed. The CPR was performed by volunteers who completed an basic CPR course. Each subject did 4 CPR sessions of 3 minutes each one. Depth and rate of chest compressions (CC) during resuscitation were measured using a Zoll Z series defibrillator. Visual assessment of resuscitation was performed by an external researcher. A total of 26 volunteers performed 104 CPR sessions. Between 54–62% and 44–53% of CC were performed with an optimal rate and depth, respectively, with no significant differences. No differences were found in depth or rate of CC between 15:2 and 30:2 compression-to-ventilation ratio with both manikins. In the assessment of compliance with the ERC CPR algorithm, 69.2–80.8% of the subjects made some errors or omissions during resuscitation, the most frequent was not asking for help and not giving rescue breaths. The conclusions were that a high percentage of CC were not performed with optimal depth and rate. Errors or omissions were frequently made by rescuers during resuscitation.
... On the other hand, according to clinical studies in adult cardiac arrest, large proportions of inadequate chest compression depth than guidelines were reported [14,15]. Mannequin 2 Emergency Medicine International studies for infant and pediatric CPR also reported shallower mean chest compression depth than guidelines [16,17]. As a result, various attempts have been made to obtain the guidelines recommended compression depth. ...
Aim:
To determine whether the chest compression depth of at least 1/3 of the Anteroposterior (AP) diameter of the chest and about 5 cm is appropriate for children of all age groups via chest computed tomography.
Methods:
The AP diameter of the chest, anterior chest wall diameter, and compressible diameter (Cd) were measured at the lower half of the sternum for patients aged 1-18 years using chest computed tomography. The mean ratio of 5 cm compression to the Cd of adult patients was used as the lower limit, and the mean ratio of 6 cm compression to the Cd of adult patients was used as the upper limit. Also, the depth of chest compression resulting in a residual depth <1 cm was considered to cause internal injury potentially. With the upper and lower limits, the compression ratios to the Cd were compared when compressions were performed at a depth of 1/3 the AP diameter of the chest and 5 cm for patients aged 1-18 years.
Results:
Among children aged 1-7 years, compressing 5 cm was deeper than 1/3 the AP diameter. Also, among children aged 1-5 years, 5 cm did not leave a residual depth of 1 cm, potentially causing intrathoracic injury.
Conclusion:
Current pediatric resuscitation guidelines of chest compression depth for children were too deep for younger children aged 1-7 years.
... 1,2 The one-handed chest compression technique (OHCC) can be used when the child is small because the chest compression pressure and depth of OHCC are lower than those in the two-handed chest compression technique (THCC). 3,4 However, OHCCs have several advantages. First, a single rescuer can maintain airway stability and minimise hand-off time by easy transition from chest compression to ventilation using OHCCs. ...
... Although no difference was reported in chest compression quality between OHCC performed with the dominant and non-dominant hand, chest compression was randomly assigned to the right or left hand before the experiment using a randomisation list. 3,13 The participants only performed OHCC with the assigned hand in both trials. In addition, the positions of the participants and manikin were standardised. ...
... These results showed the same findings as those of previous studies. 3,13 Our study had several limitations. First, although we recruited trained medical doctors, the average CCD did not reach the depth recommended by the resuscitation guidelines. ...
Aim
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.
Methods
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.
Results
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.
Conclusion
By modifying OHCC posture, a deeper mean CCD could be maintained for 2 min than by using conventional OHCC.
... One of the most important problems with manual chest compressions is that rescuers may not have the strength to perform sufficient compression depth and, consequently, mean arterial pressure (MAP), diastolic arterial pressure (DAP) and coronary perfusion pressure (COPP) are low. Moreover, quality of chest compressions deteriorates with time during CPR, probably due to rescuer fatigue [6,7]. ...
Aims
Chest compressions (CC) during cardiopulmonary resuscitation are not sufficiently effective in many circumstances. Mechanical CC could be more effective than manual CC, but there are no studies comparing both techniques in children. The objective of this study was to compare the effectiveness of manual and mechanical chest compressions with Thumper device in a pediatric cardiac arrest animal model.
Material and methods
An experimental model of asphyxial cardiac arrest (CA) in 50 piglets (mean weight 9.6 kg) was used. Animals were randomized to receive either manual CC or mechanical CC using a pediatric piston chest compressions device (Life-Stat®, Michigan Instruments). Mean arterial pressure (MAP), arterial blood gases and end-tidal CO2 (etCO2) values were measured at 3, 9, 18 and 24 minutes after the beginning of resuscitation.
Results
There were no significant differences in MAP, DAP, arterial blood gases and etCO2 between chest compression techniques during CPR. Survival rate was higher in the manual CC (15 of 30 = 50%) than in the mechanical CC group (3 of 20 = 15%) p = 0.016. In the mechanical CC group there was a non significant higher incidence of haemorrhage through the endotracheal tube (45% vs 20%, p = 0.114).
Conclusions
In a pediatric animal model of cardiac arrest, mechanical piston chest compressions produced lower survival rates than manual chest compressions, without any differences in hemodynamic and respiratory parameters.
