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Chest compression quality over time in pediatric resuscitations
Oluwakemi Badaki-Makun1, Frances Nadel, Aaron Donoghue
1Emergency Medicine and Trauma Center, Children's National Medical Center, Washington, DC 20010, USA. obadaki@cnmc.org
Insights
Chest compression quality declines similarly in child and adult manikin models, with providers needing to switch every 2 minutes. This study highlights the importance of adhering to guidelines for effective cardiopulmonary resuscitation.
Area of Science:
- Emergency Medicine
- Pediatric Resuscitation
- Cardiopulmonary Physiology
Background:
- Chest compression (CC) quality in adults degrades over time, potentially due to rescuer fatigue.
- Limited data exist on pediatric chest compression quality and the work involved.
- This study investigated differences in compression quality, work, and fatigue between child and adult manikin models.
Purpose of the Study:
- To compare chest compression quality, work, and rescuer fatigue in child versus adult manikin models.
- To evaluate the impact of time on compression effectiveness in pediatric and adult resuscitation scenarios.
- To provide data supporting current guidelines for rescuer rotation during cardiopulmonary resuscitation.
Main Methods:
- Prospective randomized crossover study involving 45 in-hospital rescuers.
- 10-minute single-rescuer continuous chest compressions performed on child and adult manikins.
- Compression quality, work, power, and fatigue measured using accelerometers, force data, and visual analogue scales.
Main Results:
- Chest compression quality declined significantly over 10 minutes in both child (85.1% to 24.6%) and adult (86.3% to 35.3%) models.
- Adequate compressions fell below 70% within 2 minutes for both manikin types.
- Peak power output was significantly higher in the adult model (166.5 W) compared to the child model (144.1 W).
Conclusions:
- Chest compression quality deteriorates similarly in child and adult manikin models.
- Peak work per compression is comparable between child and adult models.
- Peak power output during chest compressions is comparable to intense exercise; rescuer rotation every 2 minutes is crucial.
Background:
Chest compression (CC) quality deteriorates with time in adults, possibly because of rescuer fatigue. Little data exist on compression quality in children or on work done to perform compressions in general. We hypothesized that compression quality, work, and rescuer fatigue would differ in child versus adult manikin models.
Methods:
This was a prospective randomized crossover study of 45 in-hospital rescuers performing 10 minutes of single-rescuer continuous compressions on each manikin. An accelerometer recorded compression quality measures over 30-second epochs. Work and power were calculated from recorded force data. A modified visual analogue scale measured fatigue. Data were analyzed by using linear mixed-effects models and Cox regression analysis.
Results:
A total of 88 484 compression cycles were analyzed. Percent adequate CCs/epoch (rate ≥ 100/minute, depth ≥ 38 mm) fell over 10 minutes (child: from 85.1% to 24.6%, adult: from 86.3% to 35.3%; P = .15) and were <70% in both by 2 minutes. Peak work per compression cycle was 13.1 J in the child and 14.3 J in the adult (P = .06; difference, 1.2 J; 95% confidence interval, -0.05 to 2.5). Peak power output was 144.1 W in the child and 166.5 W in the adult (P < .001; difference, 22.4 W, 95% confidence interval, 9.8-35.0).
Conclusions:
CC quality deteriorates similarly in child and adult manikin models. Peak work per compression cycle is comparable in both. Peak power output is analogous to that generated during intense exercise such as running. CC providers should switch every 2 minutes as recommended by current guidelines.
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