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European Resuscitation Council Guidelines 2000 for Basic Paediatric Life Support
... Importantly, the authors advocate starting the sequence with five initial rescue breaths [IRB]. In early guidelines this used to be just two breaths (as in the further sequence) (9). Later paediatric cardiopulmonary resuscitation [CPR] guidelines recommend five attempts to at least deliver two effective ventilations. ...
... Later paediatric cardiopulmonary resuscitation [CPR] guidelines recommend five attempts to at least deliver two effective ventilations. The fact the authors changed this in 2015 to five initial breaths regardless was driven by the yet unproven hypothesis that one initially needs more attempts to be effective (9). ...
Background and objectives
Children are more likely to suffer a hypoxic-ischaemic cause for cardiac arrest. Early ventilation may provide an advantage in outcome during paediatric cardiopulmonary resuscitation [CPR]. European Resuscitation Council guidelines recommend five initial rescue breaths [IRB] in infants, stemming from the hypothesis that rescuers might need 5 attempts in order to deliver 2 effective ventilations. This study aimed to verify this hypothesis.
Methods
Participants ( n = 112, convenience sample) were medical students from the Faculty of Medicine and Health Sciences Ghent University, Belgium. Students were divided into duos and received a 15 min just-in-time training regarding the full CPR-cycle using BMV. Participants then performed five cycles of 2-person CPR. The IRB were given by 1-person BMV, as opposed to a 2-persons technique during the further CPR-cycle. Correct ventilations for the infant were defined as tidal volumes measured (Laerdal® Q-CPR) between 20 and 60 ml, with n = 94 participants included in the analysis. The primary outcome consisted of the difference in the % of medical student duos providing at least 2 effective IRB between 2 and 5 attempts.
Results
Off all duos, 55,3% provided correct volumes during their first 2 initial ventilations. An increase up to 72,4% was noticed when allowing 5 ventilations. The proportional difference between 2 and 5 IRB allowed was thus significant [17,0%, 95% confidence interval (5.4; 28.0)].
Conclusion
In this manikin study, 5 IRB attempts during infant CPR with BMV increased the success rate in delivering 2 effective ventilations. Besides, students received training emphasizing the need for 5 initial rescue breaths. This study provides evidence supporting European Resuscitation Council guidelines.
... nos indivíduos de até quarenta anos de idade, a primeira causa de mortalidade refere-se às emergências decorrentes do trauma, e naqueles acima dos quarenta anos, pelas emergências decorrentes de doen ças cardiovasculares. o atendimento de emergên-cia sistematizado, apoiado em protocolos pré-estabelecidos, contribui para a diminuição nesses índices (aha, 2000a;Phillips et al., 2001;aha, 2000b). ...
... Ementa da unidade curricular: conceitos sobre suporte básico de vida e identificação das situações de risco; prevenção de acidentes nas diversas faixas etárias; causas de morbidade e mortalidade no Brasil e no Estado de São Paulo; diagnóstico e tratamento do choque e da insuficiência respiratória aguda; reanimação cardiopulmonar no lactente até um ano, na criança de um a oito anos e nos maiores de oito anos e nos adultos (aha, 2000a;Phillips et al., 2001;aha, 2000b;Ministério, 2007;Secretaria, 2007;World, 2002). objetivos Capacitações esperadas: diagnóstico do choque e da insuficiência respiratória no lactente, na criança de um a oito anos, nos maiores de oito anos e nos adultos baseado na obtenção dos dados durante a anamnese e exame físico, priorização de atendimento e plano terapêutico (Mangia, 2006 o conteúdo da unidade curricular foi estruturado assumindo seu caráter dinâmico, para que possa ser revisto, criticado, atualizado e modificado ao longo dos anos, de acordo com o Plano Político Pedagógico do curso de Medicina da universidade, necessidades dos alunos e da nossa sociedade. ...
... nos indivíduos de até quarenta anos de idade, a primeira causa de mortalidade refere-se às emergências decorrentes do trauma, e naqueles acima dos quarenta anos, pelas emergências decorrentes de doen ças cardiovasculares. o atendimento de emergên-cia sistematizado, apoiado em protocolos pré-estabelecidos, contribui para a diminuição nesses índices (aha, 2000a;Phillips et al., 2001;aha, 2000b). ...
... Ementa da unidade curricular: conceitos sobre suporte básico de vida e identificação das situações de risco; prevenção de acidentes nas diversas faixas etárias; causas de morbidade e mortalidade no Brasil e no Estado de São Paulo; diagnóstico e tratamento do choque e da insuficiência respiratória aguda; reanimação cardiopulmonar no lactente até um ano, na criança de um a oito anos e nos maiores de oito anos e nos adultos (aha, 2000a;Phillips et al., 2001;aha, 2000b;Ministério, 2007;Secretaria, 2007;World, 2002). objetivos Capacitações esperadas: diagnóstico do choque e da insuficiência respiratória no lactente, na criança de um a oito anos, nos maiores de oito anos e nos adultos baseado na obtenção dos dados durante a anamnese e exame físico, priorização de atendimento e plano terapêutico (Mangia, 2006 o conteúdo da unidade curricular foi estruturado assumindo seu caráter dinâmico, para que possa ser revisto, criticado, atualizado e modificado ao longo dos anos, de acordo com o Plano Político Pedagógico do curso de Medicina da universidade, necessidades dos alunos e da nossa sociedade. ...
... 1 The European Resuscitation Council (ERC) based its own resuscitation guidelines on this document, and these were published as a series of papers in 2001. [2][3][4][5][6][7] Resuscitation science continues to advance, and clinical guidelines must be updated regularly to reflect these developments and advise healthcare providers on best practice. In between major guideline updates (about every five years), interim advisory statements can inform the healthcare provider about new therapies that might influence outcome significantly; 8 we anticipate that further advisory statements will be published in response to important research findings. ...
It is intended that these new guidelines will improve the practice of resuscitation and, ultimately, the outcome from cardiac arrest. The universal ratio of 30 compressions to two ventilations should decrease the number of interruptions in compression, reduce the likelihood of hyperventilation, simplify instruction for teaching and improve skill retention. The single-shock strategy should minimise 'no-flow' time. Resuscitation course materials are being updated to reflect these new guidelines. © 2005 European Resuscitation Council. All Rights Reserved. Published by Elsevier Ireland Ltd.
... When all combined, the term cardiopulmonary resuscitation (CPR) is used (Handley et al., 2001). According to European Resuscitation Council Guidelines almost 60 different skills are required to perform BLS (Handley et al., 2001;Philips et al., 2001). Although effective BLS decreases morbidity and mortality, and is a core skill for all healthcare professionals, it has been documented by several authors worldwide that training programs in this area are poor (Kaye & Mancini, 1998;Garcia-Barbero & Caturla-Such, 1999;Perkins et al., 1999;Jordan & Bradley, 2000;Phillips & Nolan, 2001). ...
Although the Basic Life Support (BLS) ability of a medical student is a crucial competence, poor BLS training programs have been documented worldwide. Better training designs are needed. This study aims to share detailed descriptions and the test results of two cognitive-constructivist training models for the BLS skills in the first year of medical curriculum.
A BLS skills training module was implemented in the first year curriculum in the course of 6 years (1997-2003). The content was derived from the European Resuscitation Council Guidelines. Initially, a competence-based model was used and was upgraded to a cognitive apprenticeship model in 2000. The main performance-content type that was expected at the end of the course was: competent application of BLS procedures on manikins and peers at an OSCE as well as 60% achievement in a test consisting of 25 MCQ items. A retrospective cohort survey design using exam results and a self-completed anonymous student ratings' questionnaire were used in order to test models.
Training time for individual students varied from 21 to 29 hours. One thousand seven hundred and sixty students were trained. Fail rates were very low (1.0-2.2%). The students were highly satisfied with the module during the 6 years.
In the first year of the medical curriculum, a competence-based or cognitive apprenticeship model using cognitive-constructivist designs of skills training with 9 hours theoretical and 12-20 hours long practical sessions took place in groups of 12-17 students; medical students reached a degree of competence to sufficiently perform BLS skills on the manikins and their peers. The cognitive-constructivist designs for skills training are associated with high student satisfaction. However, the lack of controls limits the extrapolation of this conclusion.
Objective: 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.
Methods: Twenty-one university students from the infant education degree participated in a randomized crossover simulation study to compare a standard pediatric CPR versus awalking 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.
Results: 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.
Conclusions: 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.
Background:
Use of automated external defibrillators (AEDs) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA). However, there are no conclusive studies that elucidated the effectiveness of public-access defibrillation (PAD) in children.
Methods:
This was a nationwide, population-based, propensity score-matched study of pediatric OHCA in Japan from 2011 to 2012, based on data from the All-Japan Utstein Registry. We included pediatric OHCA patients (aged 1-17 years) who received bystander cardiopulmonary resuscitation. The primary outcome was a favorable neurological state 1 month after OHCA defined as a Glasgow-Pittsburgh cerebral performance category (CPC) score of 1-2 (corresponding to a Pediatric CPC score of 1-3).
Results:
A total of 1193 patients were included in the final cohort; 57 received PAD and 1136 did not. Among 1193 patients, 188 (15.8%) survived with a favorable neurological status 1 month after OHCA. The odds of neurologically favorable survival were significantly higher for patients receiving PAD after adjusting for potential confounders: propensity score matching, OR 3.17 (95% CI 1.40-7.17), and multivariable logistic regression modeling, ORadjusted 5.10 (95% CI 2.01-13.70). Similar findings were observed for the secondary outcomes (i.e., neurologically favorable survival with a CPC score of 1, one-month survival, and prehospital return of spontaneous circulation). In subgroup analyses, there were no significant differences in neurologically favorable survival between the PAD group and non-PAD group in the unwitnessed cohort (ORadjusted 7.76 [0.75-81.90]) or the non-cardiac etiology cohort (ORadjusted 6.65 [0.64-66.24]).
Conclusions:
PAD was associated with an increased chance of neurologically favorable survival in pediatric OHCA (aged 1-17 years) who received bystander CPR, except for in cases of unwitnessed or non-cardiac etiology.
OBJETIVO: Devido ao impacto determinado pelo trauma na população infanto-juvenil no que diz respeito à mortalidade, morbidade e conseqüências sociais geradas, nossos objetivos concentram-se nas peculiaridades da avaliação pré-hospitalar, em ambiente hospitalar e ainda durante o transporte do paciente traumatizado pediátrico. FONTES DE DADOS: Pesquisa eletrônica realizada nas bases Cochrane para revisões sistemáticas e estudos controlados, MEDLINE e LILACS nos últimos 5 anos e revisão de referências anteriores em publicações significativas, utilizando as seguintes palavras-chave: trauma, trauma pediátrico, exame primário, exame secundário, atendimento hospitalar, transporte pré-hospitalar e inter-hospitalar. SÍNTESE DOS DADOS: Diferentes estratégias compõem a sistematização do atendimento de crianças e adolescentes traumatizados. Entretanto, quase todas comportam a necessidade de conhecer as particularidades da população a ser tratada, no que diz respeito à idade, ao processo de crescimento e desenvolvimento e, finalmente, compondo o atendimento com os recursos minimamente aceitáveis e disponíveis. CONCLUSÕES: O princípio de maior importância diz respeito a não determinar lesão adicional. Mantendo a visão sistemática das diferentes peculiaridades quanto à abordagem das vias aéreas, ventilação, circulação com controle de hemorragias, exame minineurológico e exposição, além do exame secundário, com o preparo do transporte pré-hospitalar e inter-hospitalar quando necessário, serão esperados melhores resultados.OBJECTIVES: Since trauma has a great impact on mortality and preventable morbidity among children and adolescents, in addition to its social consequences, the aim of this study is to evaluate peculiarities regarding prehospital, in-hospital, and interhospital assessment of injured pediatric patients. SOURCES OF DATA: The Cochrane database was searched for systematic reviews and controlled trials, the MEDLINE and LILACS databases were used for the last 5 years, and review of older reference sections in significant publications using trauma, pediatric trauma, primary survey, secondary survey, in-hospital assessment, prehospital and transportation as keywords. SUMMARY OF THE FINDINGS: There are different strategies that constitute the systematic assessment of the injured pediatric patient. Nevertheless, almost all strategies involve knowing the peculiarities about the pediatric population, with regard to age, to the growth and development process, and finally, to the minimally acceptable and available resources. CONCLUSIONS: The most important principle is to do no further harm. If the peculiarities about airway maintenance, ventilation, circulation with hemorrhage control, disability, exposure up to secondary survey and preparation of prehospital and interhospital transportation are properly taken care of, better results will certainly be obtained.
The guidelines for paediatric resuscitation have been made by international consensus, following a review of the available research data, but evidence is limited. In children, respiratory arrest usually precedes cardiac arrest, so there is an emphasis on respiratory support in this age group. In older children and adults, the underlying pathology may be different, and emergency medical service activation should immediately be sought. Pulse checks for lay rescuers have been omitted because of inherent difficulty for the inexperienced. The preferred method of cardiac compression in infants is with two apposed thumbs and hands encircling the chest. Two-finger compressions continue to be recommended for lay rescuers. Automated external defibrillators are not currently suitable for use in infants and young children, although manufacturers are developing such instruments. High-dose epinephrine is no longer routinely recommended in cardiac arrest as there are significant adverse effects. Amiodarone is used for the treatment of ventricular tachyarrhythmias in place of lignocaine.
The American Heart Association, together with representatives from the International Liaison Committee on Resuscitation (ILCOR), which is made up of leading resuscitation organizations from the Americas, Europe, Southern Africa, Australia, and New Zealand, undertook a series of evidence-based evaluations of the science of resuscitation which culminated in the publication of ’Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care’ in August 2000 tL2). Experts from non-ILCOR organizations from Asia and elsewhere also participated in drawing up the guidelines.
Wrestling with pathology as our only activity will lead to rapid burn-out. Enhancing one's practice with client education and care, sharing with colleagues, making consultation room time easier, having equipment available that increases professional service and the enjoyment of the profession, and serving our patients and clients well improve our practices and ourselves.
In adults, first responders to a cardiopulmonary arrest provide better ventilation using a laryngeal mask airway than a facemask. It is unclear if the same is true in children. We investigated this by comparing the ability of 36 paediatric ward nurses to ventilate the lungs of 99 anaesthetised children (a model for cardiopulmonary arrest) using a laryngeal mask airway and using a facemask with an oropharyngeal airway. Anteroposterior chest wall displacement was measured using an ultrasonic detector. Nurses achieved successful ventilation in 74 (75%) of cases with the laryngeal mask airway and 76 (77%) with facemask and oropharyngeal airway (p = 0.89). Median (IQR [range]) time to first breath was longer for the laryngeal mask airway (48 (39-65 [8-149])) s than the facemask/airway (35 (25-53 [14-120]) s; p < 0.0001). In 10 cases (10%) the lungs were ventilated using the laryngeal mask airway but not using the facemask/oropharyngeal airway. We conclude that ventilation is achieved rapidly using a facemask and oropharyngeal airway, and that the laryngeal mask airway may represent a useful second line option for first responders.
La reanimación cardiopulmonar (RCP)básica en la edad pediátrica desarrolla un conjunto de pautas estandarizadas para el tratamiento de la parada cardiorrespiratoria en los lactantes y niños.Estas pautas son diferentes en diversos aspectos a las establecidas en los adultos.Las técnicas de RCP deben ser realizadas de forma correcta y rápida,además de ser extendidas mediante la enseñanza. En este trabajo se analizan: 1) las causas en el lactante y en el niño que conllevan a una parada cardiorrespiratoria, 2) se elaboran una serie de objetivos a llevar a cabo, 3) una valoración en cada uno de los casos, y una revisión bibliográfica, 4) describiendo una serie de pautas estandarizadas para la reanimación cardiopulmonar pediátrica.
Current guidelines for chest compressions in CPR advocate a one handed technique in children (1-8 years old) and a two handed technique in adults (>8 years old). No previous study has examined whether these two techniques generate different compression pressures. This study assesses the relative difference in intrathoracic compression pressures generated by one- and two handed chest compression techniques in a paediatric manikin.
Randomised crossover design. Subjects performed both types of chest compressions on an adapted paediatric resuscitation manikin connected to a pressure transducer and personal computer. Ethical approval was granted.
A 30 volunteer subjects (9 male, 21 female) participated in the study. Their mean age was 30.8 years (S.D. 8.6), and mean weight was 70.5 kg (S.D. 12.8). The mean compression pressure was 86.6 mmHg (S.D. 13.68) for two handed and 75.1 mmHg (S.D. 12.02) for one handed (P < 0.001, paired t-test). The average peak compression pressure was 133.5 mmHg (S.D. 26.36) for two handed and 116.8 mmHg (S.D. 21.48) for one handed (P = 0.001, paired t-test); 29 found the two handed technique easier to perform.
Two handed chest compression CPR seems to be easier to perform on a paediatric resuscitation manikin and produces significantly higher mean and peak pressures. Further work is needed to determine the comparative effects on children and which technique produces better clinical outcomes.
We conclude that jaw thrust is the most effective maneuver to open an obstructed airway and improve ventilation in anesthetized and unconscious spontaneously breathing pediatric patients. Whereas chin lift is effective in healthy children without tonsillar hypertrophy, it has the potential to obstruct the airway in children with hypertrophic tonsils and adenoids when the mouth is closed. Given the high incidence of large tonsils and adenoids especially in toddlers and preschool children, chin lift is a less reliable measure to improve upper airway patency in this age group. CPAP with or without jaw thrust and chin lift can further improve upper airway patency in sedated or anesthetized children, but may decrease ventilation in some patients.
Since trauma has a great impact on mortality and preventable morbidity among children and adolescents, in addition to its social consequences, the aim of this study is to evaluate peculiarities regarding prehospital, in-hospital, and interhospital assessment of injured pediatric patients.
The Cochrane database was searched for systematic reviews and controlled trials, the MEDLINE and LILACS databases were used for the last 5 years, and review of older reference sections in significant publications using trauma, pediatric trauma, primary survey, secondary survey, in-hospital assessment, prehospital and transportation as keywords.
There are different strategies that constitute the systematic assessment of the injured pediatric patient. Nevertheless, almost all strategies involve knowing the peculiarities about the pediatric population, with regard to age, to the growth and development process, and finally, to the minimally acceptable and available resources.
The most important principle is to do no further harm. If the peculiarities about airway maintenance, ventilation, circulation with hemorrhage control, disability, exposure up to secondary survey and preparation of prehospital and interhospital transportation are properly taken care of, better results will certainly be obtained.
Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training.
For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites. We performed hand searches and contacted 6 content experts. We reviewed without restriction all communications pertaining to who should learn CPR, what should be taught, when to repeat training, where to give CPR instructions and why people lack the motivation to learn and perform CPR. We used standardized forms to review papers for inclusion, quality and data extraction. We grouped publications by category and classified recommendations using a standardized classification system that was based on level of evidence.
We reviewed 2409 articles and selected 411 for complete evaluation. We included 252 of the 411 papers in this systematic review. Differences in their study design precluded a meta-analysis. We classified 22 recommendations; those with the highest scores were 1) 9-1-1 dispatch- assisted CPR instructions, 2) teaching CPR to family members of cardiac patients, 3) Braslow's self-training video, 4) maximizing time spent using manikins and 5) teaching the concepts of ambiguity and diffusion of responsibility. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by laymen and CPR using chest compressions alone.
We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates.
In 554 anaesthetised patients, the times taken to separately palpate and identify each of the carotid, radial, brachial and femoral pulses were recorded. The patients were divided into three groups based on the form of airway management chosen (tracheal tube, facemask or laryngeal mask airway). Our results demonstrate that in the operating theatre environment the identification of the radial pulse is the most rapid and reliable; by 5s, 98% and by 10s, more than 99% of radial pulses were identified. The carotid pulse was not so easily identified, requiring 10s to enable an identification rate of greater than 95%. The presence of a laryngeal mask airway or a tracheal tube did not hinder the identification of carotid pulse.
To assess the type, rate, and severity of unanticipated complications of CPR (external cardiac compressions and ventilation) in a pediatric population.
A retrospective review was undertaken of the records from all deceased children ( < 12 years old) who had been given CPR during an 8-year period (1988 through 1995). Patients with historical or physical evidence of preceding trauma were excluded. Clinical and autopsy records were abstracted for patient demographics, clinical findings, duration of CPR, persons administering CPR, and medical examiner summaries.
Two hundred eleven children (mean age, 19.0 months) met the inclusion criteria and were entered into the study. The most common cause of cardiac arrest was sudden infant death syndrome (56%), followed by drowning (8%), congenital heart disease (7%), and pneumonia (4%). Mean duration of CPR was 45 minutes (range, 3 to 180 minutes). Fifteen children (7%) had at least one injury as a result of CPR; 7 (3%) had injuries that were considered medically significant. These included retroperitoneal hemorrhage (n = 2), pneumothorax (n = 1), pulmonary hemorrhage (n = 1), epicardial hematoma (n = 1), and gastric perforation (n = 1); in spite of prolonged resuscitation performed with variable degrees of skill, only one patient was noted to have rib fractures.
Significant iatrogenic injuries are rare in children who receive CPR; they occur in approximately 3% of cases. Recognizing the possibility of a complication may help in the management of children who survive cardiac arrest. Regardless of resuscitation history, abuse should be considered whenever traumatic injuries are encountered.
International guidelines for cardiopulmonary resuscitation (CPR) in adults advocate that cardiac arrest be recognized, within 5–10 s, by the absence of a pulse in the carotid arteries. However, validation of first responders' assessment of the carotid pulse has begun only recently. We aimed (1) to develop a methodology to study diagnostic accuracy in detecting the presence or absence of the carotid pulse in unresponsive patients, and (2) to evaluate diagnostic accuracy and time required by first responders to assess the carotid pulse.
This document reflects the deliberations of ILCOR. The epidemiology and outcome of paediatric cardiopulmonary arrest and the priorities, techniques and sequence of paediatric resuscitation assessments and interventions differ from those of adults. The working group identified areas of conflict and controversy in current paediatric basic and advanced life support guidelines, outlined solutions considered and made recommendations by consensus. The working group was surprised by the degree of conformity already existing in current guidelines advocated by the American Heart Association (AHA), the Heart and Stroke Foundation of Canada (HSFC), the European Resuscitation Council (ERC), the Australian Resuscitation Council (ARC), and the Resuscitation Council of Southern Africa (RCSA). Differences are currently based upon local and regional preferences, training networks and customs, rather than scientific controversy. Unresolved issues with potential for future universal application are highlighted. This document does not include a complete list of guidelines for which there is no perceived controversy and the algorithm/decision tree figures presented attempt to follow a common flow of assessments and interventions, in coordination with their adult counterparts. Survival following paediatric prehospital cardiopulmonary arrest occurs in only approximately 3-17% and survivors are often neurologically devastated. Most paediatric resuscitation reports have been retrospective in design and plagued with inconsistent resuscitation definitions and patient inclusion criteria. Careful and thoughtful application of uniform guidelines for reporting outcomes of advanced life support interventions using large, randomized, multicenter and multinational clinical trials are clearly needed. Paediatric advisory statements from ILCOR will, by necessity, be vibrant and evolving guidelines fostered by national and international organizations intent on improving the outcome of resuscitation for infants and children worldwide.
American Heart Association as well as European Resuscitation Council require the carotid pulse check to determine pulselessness in an unconscious victim and to decide whether or not cardiopulmonary resuscitation (CPR) should be initiated. Recent studies on the ability of health professionals to check the carotid pulse have called this diagnostic tool in question and led to discussions. To contribute to this discussion we performed a study to evaluate skills of lay people in checking the carotid pulse. A group of 449 volunteers (most had participated in a first aid course) were asked to check the carotid pulse in a young healthy, non-obese person by counting aloud the detected pulse rate. Time intervals until correct detection of the carotid pulse were registered. Overall the volunteers needed an average of 9.46 s, ranging from 1 to 70 s. Only 47.4% of the volunteers were able to detect a pulse within 5 s, and 73.7% within 10 s. A level of 95% volunteers detecting the pulse correctly was reached only after 35 s. Based on these findings we conclude that the intervals established for carotid pulse check may be too short and that perhaps the value of pulse check within in the scope of CPR needs to be reconsidered.
To evaluate the accuracy and efficacy of automated external defibrillators (AEDs) in patients <16 years old.
AEDs are standard therapy in out-of-hospital resuscitation of adults and have led to higher success rates. Their use in children and adolescents has never been evaluated, despite recommendations from the American Heart Association that they be used in children >8 years of age.
This was a retrospective cohort study of children <16 years old who underwent out-of-hospital cardiac resuscitation and on whom an AED was used during the resuscitation. The setting was rural and urban prehospital emergency medical systems. Patients were identified by review of a database of cardiac arrests maintained by a large surveillance program of these services.
AEDs were used to assess cardiac rhythm in 18 patients with a mean age of 12.1 +/- 3.7 years. The cardiac rhythms were analyzed 67 times and included ventricular fibrillation (25), asystole/pulseless electrical activity (32), sinus bradycardia (6), and sinus tachycardia (4). The AEDs recognized all nonshockable rhythms accurately and advised no shock. Ventricular fibrillation was recognized accurately in 22 (88%) of 25 episodes and advised or administered a shock 22 times. Sensitivity and specificity for accurate rhythm analysis were 88% and 100%, respectively. One patient with a nonshockable rhythm survived, whereas 3 of 9 patients with ventricular fibrillation survived.
These data furnish evidence that AEDs provide accurate rhythm detection and shock delivery to children and young adolescents. AED use is potentially as effective for children as it is for adults.
The American Heart Association (AHA) currently recommends two-finger (TF) chest compression for infants. A previous study demonstrated that two-thumb (TT) with lateral chest wall compression provided significantly higher arterial pressures than did the TF method. Limitations of that study included the lack of an asphyxial model and non-standardized compression forces.
To test the hypothesis that TT chest compression generates higher arterial pressures than does the TF method, using an asphyxial model. Also, by standardizing sternal compression force (SCF), the authors sought to show that the increased pressures are the result of thoracic compression.
The study was a randomized, crossover trial in immature swine weighing 10 kg. Each swine was sedated, anesthetized, paralyzed, intubated, and mechanically ventilated on room air. A femoral arterial catheter was placed. Cardiac arrest was induced by asphyxiation and verified by ECG and pressure tracings. Eleven AHA-certified basic rescuers each randomly performed four 1-minute trials of external chest compressions. Each of the two CPR techniques was performed, with and without feedback of SCF. Compression forces were measured using the Uniforce Sensor System (Force Imaging Technology, Inc., Chicago, IL). During the feedback mode, the rescuers were instructed to maintain sternal pressures at 20-25 psi. During the nonfeedback mode, the rescuers were blinded to the force transducer. All compressions were analyzed for systolic blood pressure (SBP), diastolic blood pressure (DBP), and SCF. Data were analyzed using repeated-measures analysis of variance (RMANOVA) and Tukey multiple comparisons (alpha = 0.05).
A total of 2,297 compressions were analyzed. The TT method produced significantly higher SBPs both with (25% increase) and without (57% increase) feedback when compared with the TF. The DBPs were not significantly different. The SCFs were also significantly higher in the two groups with feedback. The SCFs in the TF groups did not reach the standardized value of 20 psi, whereas in the TT groups, both were in the range of 20-25 psi.
The TT method produced significantly higher SBPs. The authors were unable to demonstrate that the increased SBPs were secondary to the thoracic compression component because the rescuers did not reach the predetermined SCF in the TF groups. In this swine model of infant CPR, TT chest compression is an easier and more effective method.
Our objective was to establish the proportion of Emergency Room and Intensive Care doctors and nurses able to locate the carotid pulse in less than 5 s, and identify the variables that influence this ability. The method followed was locating the carotid pulse in a healthy male adult volunteer with normal blood pressure in two situations (stretcher or floor) and with the neck in either a neutral or in an extended position. We recorded the gender, age, and previous training in cardiopulmonary resuscitation (CPR) of each participant and the time spent in detecting the pulse in each of the four possible positions. A model of logistic regression was constructed to determine if the patient's position had any influence on the proportion of health workers capable of finding the pulse within 5 s. The average age of the 72 subjects studied was 33.4 years (SD = 6.6); 80% of the participants had CPR training. Thirty-one participants (43.1%; CI 95%, 31.4-55.3%) required more than 5 s to detect the pulse, although only three (4.2%; CI 95%, 0.9-11.7%) required more than 10 s. The variable 'no CPR training' was associated with the inability to detect the pulse within 5 s. The detection of the pulse was easier with an extended neck. A significant proportion of nurses and doctors were slow to locate the carotid pulse on a healthy, young volunteer with normal blood pressure. No relation was found between gender or age of the participants. More attention should be given to carotid pulse detection in CPR training.
Reluctance of the lay public to perform bystander CPR is becoming an increasingly worrisome problem in the USA. Most bystanders who admit such reluctance concede that fear of contagious disease from mouth-to-mouth contact is what keeps them from performing basic life support. Animal models of prehospital cardiac arrest indicates that 24-h survival is essentially as good with chest compression-only CPR as with chest compressions and assisted ventilation. This simpler technique is an attractive alternative strategy for encouraging more bystander participation. Such experimental studies have been criticized as irrelevant however secondary to differences between human and porcine airway mechanics. This study examined the effect of chest compression-only CPR under the worst possible circumstances where the airway was totally occluded. After 6 min of either standard CPR including ventilation with a patent airway or chest compressions-only with a totally occluded airway, no difference in 24 h survival was found (10/10 vs. 9/10). As anticipated arterial blood gases were not as good, but hemodynamics produced were better with chest compression-only CPR (P < 0.05). Chest compression-only CPR, even with a totally occluded airway, is as good as standard CPR for successful outcome following 6.5 min of cardiac arrest. Such a strategy for the first minutes of cardiac arrest, particularly before professional help arrives, has several advantages including increased acceptability to the lay public.
Paediatric Life Support Working Group of the European Resuscitation Council. The 1998 European Resuscitation Council guidelines for paediatric life support
Specificity of automatic external defibrillator rhythm analysis in pediatric tachyarrhythmias
- Hazinsky