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Five vs. two initial rescue breaths during infant basic life support: A manikin study using bag-mask-ventilation
Anke Geerts1, Sandrine Herbelet1, Gautier Borremans1
1Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium.
Insights
Five initial rescue breaths [IRB] in infant cardiopulmonary resuscitation [CPR] significantly increase the success rate of delivering effective ventilations. This finding supports current European Resuscitation Council guidelines for pediatric resuscitation.
Area of Science:
- Pediatric Emergency Medicine
- Cardiopulmonary Resuscitation (CPR)
- Medical Education
Background:
- Hypoxic-ischemic events are a common cause of cardiac arrest in children.
- Early ventilation is crucial for improving outcomes in pediatric CPR.
- European Resuscitation Council guidelines recommend five initial rescue breaths (IRB) for infants, based on the hypothesis that five attempts may be needed for two effective ventilations.
Purpose of the Study:
- To verify the hypothesis that five initial rescue breaths are necessary for effective infant ventilation during CPR.
- To assess the success rate of delivering effective ventilations with varying numbers of IRB attempts.
Main Methods:
- A manikin study involving 112 medical students trained in basic mask ventilation (BMV) for infant CPR.
- Participants performed 2-person CPR, with 1-person BMV for IRB.
- Effective ventilation was defined as a tidal volume between 20 and 60 ml, measured using a Laerdal® Q-CPR device.
Main Results:
- 55.3% of duos achieved effective ventilation within the first two IRB attempts.
- Allowing up to five IRB attempts increased the success rate to 72.4%.
- This represents a significant proportional difference of 17.0% (95% CI: 5.4; 28.0).
Conclusions:
- Five initial rescue breaths in infant CPR using BMV improve the success rate of delivering two effective ventilations.
- The study findings provide evidence supporting the European Resuscitation Council's recommendation for five IRB.
- This research reinforces the importance of adequate initial ventilation in pediatric resuscitation protocols.
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.
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