Rescuer fatigue during simulated neonatal cardiopulmonary resuscitation

Area of Science:

• Medical Research
• Pediatric Medicine
• Emergency Medicine

Background:

• Chest compressions (CCs) are critical during neonatal cardiopulmonary resuscitation (CPR).
• Rescuer fatigue can compromise CC quality and patient outcomes.
• Assessing fatigue development during different CPR techniques is essential for optimizing resuscitation protocols.

Purpose of the Study:

• To evaluate the onset and progression of fatigue in healthcare professionals performing chest compressions during simulated neonatal CPR.
• To compare fatigue levels between a 3:1 compression:ventilation (C:V) ratio and two continuous chest compressions with asynchronous ventilation (CCaV) rates (90 and 120 CCs/min).

Main Methods:

• A prospective, randomized manikin crossover study was conducted with 30 neonatal healthcare professionals.
• Participants performed 10-minute CPR trials using 3:1 C:V, CCaV at 90 CCs/min, and CCaV at 120 CCs/min.
• Peak compression pressure (as a surrogate for fatigue) and CC rate were continuously monitored, alongside subjective comfort and fatigue ratings.

Main Results:

• Significant decreases in peak compression pressure, indicating fatigue, occurred earlier with CCaV at 120 CCs/min (72s), followed by CCaV at 90 CCs/min (96s), and 3:1 C:V (156s).
• Compression depth reduction reached 50% within 3 minutes for CCaV-120, 30% for CCaV-90, and 20% for 3:1 C:V.
• Healthcare professionals reported similar preferences for both 3:1 C:V and CCaV techniques.

Conclusions:

• Both 3:1 C:V and CCaV methods of neonatal CPR are fatiguing for rescuers.
• To maintain effective resuscitation, it is recommended that rescuers switch roles every second cycle of heart rate assessment during neonatal CPR.