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Ventilation efficacy during paediatric cardiopulmonary resuscitation (PEDIVENT): simulation-based comparative study
Tamara Skrisovska1,2, Jana Djakow1,2,3, Petr Jabandziev2,4
1Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia.
Insights
Structured training significantly improved ventilation effectiveness in paediatric cardiopulmonary resuscitation (CPR) for both healthcare professionals (HCPs) and lay rescuers (LRs). This study highlights the importance of initial breaths in paediatric CPR, especially when delivered by trained individuals.
Area of Science:
- Resuscitation science
- Pediatric emergency medicine
- Cardiopulmonary resuscitation techniques
Background:
- Effective ventilation is crucial in pediatric cardiopulmonary resuscitation (CPR), as most cardiac arrests stem from hypoxia.
- Current European Resuscitation Council (ERC) guidelines recommend initial breaths before chest compressions, but this is based on expert consensus without robust evidence.
- A knowledge gap exists regarding the efficacy of ventilation during pediatric CPR by both healthcare professionals (HCPs) and lay rescuers (LRs).
Purpose of the Study:
- To evaluate and compare the efficacy of ventilation during pediatric CPR provided by HCPs and LRs.
- To assess the number of effective breaths delivered during the initial sequence of CPR in a simulation setting.
- To determine the impact of structured CPR training on ventilation effectiveness in both HCPs and LRs.
Main Methods:
- A simulation-based study involving 90-second CPR sequences on 5-kg Baby and 20-kg Junior mannequins.
- Participants included HCPs using bag-mask ventilation and LRs performing dispatcher-assisted CPR with mouth-to-mouth ventilation.
- Ventilation efficacy was assessed before and after structured CPR training for both groups.
Main Results:
- Significant improvements in reaching the primary outcome (effective ventilation) were observed post-training for both HCPs and LRs on the Baby mannequin (p < 0.001).
- For the Junior mannequin, LRs showed a significant improvement in effective ventilation post-training (p = 0.005), while HCPs showed a non-significant improvement (p = 0.77).
- Trained HCPs and LRs demonstrated the ability to deliver effective ventilation to pediatric mannequins.
Conclusions:
- This study provides the first evidence on ventilation efficacy in pediatric CPR by HCPs and LRs using simulation.
- The findings support the ERC guideline concept of initiating pediatric CPR with breaths, particularly when delivered by trained individuals.
- Structured training enhances ventilation effectiveness, suggesting its importance for improving pediatric resuscitation outcomes.
Introduction:
This simulation-based study aimed to evaluate the efficacy of ventilation during paediatric cardiopulmonary resuscitation (CPR) provided by healthcare professionals (HCPs) and lay rescuers (LRs). The objective was to assess the number of effective breaths delivered during the initial sequence of CPR. Effective ventilation plays a critical role during paediatric CPR as most cardiac arrests are secondary to hypoxia in origin. The recommendations on initial resuscitation in unresponsive, non-breathing children differ worldwide. The European Resuscitation Council (ERC) guidelines recommend five breaths before starting the chest compressions. Yet, this recommendation was based on the expert consensus historically and has not changed since 2000 because of the lack of evidence. This research addresses the identified knowledge gap, with potential implications for improving resuscitation practices and ultimately enhancing patient outcomes.
Methods:
HCPs and LRs performed 90 s of CPR involving two mannequins: 5-kg Baby and 20-kg Junior. Both groups (HCPs and LRs) performed the task before and after structured CPR training, and the efficacy of ventilation before and after the training was compared. The HCPs provided bag-mask ventilation; LR performed dispatcher-assisted CPR with mouth-to-mouth ventilation.
Results:
The number of participants that reached the primary outcome before and after the training in Baby was 26 (65%) vs. 40 (100%) in HCPs and 28 (60.9%) vs. 45 (97.8%) in LRs (improvement in both p < 0.001), respectively. The number of participants that reached the primary outcome before and after the training in the Junior mannequin was 31 (77.5%) vs. 32 (82.1%) in HCPs (p = 0.77) and 32 (82.1%) vs. 37 (94.9%) in LRs (p = 0.005), respectively.
Discussion:
This simulation-based study is the first to investigate ventilation efficacy during paediatric CPR provided by HCPs and LRs. Ventilation represents an important aspect of good-quality CPR in children. The concept of initiating paediatric CPR with initial breaths, as stated in ERC guidelines 2021, is justifiable. Trained HCPs and LRs providing dispatcher-assisted CPR could deliver effective ventilation to paediatric mannequins. These findings can contribute to future research in this area and address identified knowledge gaps concerning resuscitation guidelines, given the unique practical application of simulation as a research tool.
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