Related Experiment Video
Updated: May 28, 2025
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Improving the Quality of Pediatric Basic Life Support Cardiopulmonary Resuscitation With a Novel Method: The Maryland
Jennifer F Anders1, Camille Anderson2, Cynthia Wright-Johnson3
1Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
Insights
The Maryland Hiccup (MH) method improves pediatric CPR quality by enabling near-continuous compressions. This novel approach enhances compression fraction and reduces interruptions compared to standard guidelines for out-of-hospital cardiac arrest in children.
Area of Science:
- Emergency medicine
- Pediatric resuscitation
- Cardiopulmonary resuscitation quality
Background:
- High-performance cardiopulmonary resuscitation (CPR) significantly improves survival in adult out-of-hospital cardiac arrest (OHCA).
- Pediatric survival rates after OHCA remain a concern, prompting the development of pediatric-specific CPR protocols.
- Current pediatric CPR guidelines without an advanced airway adhere to a 15:2 compression-to-ventilation ratio with pauses, unlike adult protocols favoring continuous compressions.
Purpose of the Study:
- To introduce and evaluate the Maryland Hiccup (MH) method, a novel pediatric CPR approach.
- To compare CPR quality metrics between the MH method and the standard American Heart Association (AHA)/International Liaison Committee on Resuscitation (ILCOR) 15:2 CPR style.
- To assess the MH method's effectiveness in improving near-continuous compressions for pediatric basic life support.
Main Methods:
- A simulation study involving 38 Maryland Emergency Medical Services (EMS) clinicians in two-person teams.
- Teams performed simulated pediatric CPR on a manikin using both the standard AHA/ILCOR 15:2 style and the novel MH style.
- CPR data, including compression fraction and rate, were recorded over 76 two-minute cycles.
Main Results:
- The MH method significantly improved compression fraction (98% vs. 80%, p<0.001) compared to the standard AHA/ILCOR style.
- Epochs outside the target compression rate (100-120 CPM) were significantly lower with the MH method (32% vs. 80%).
- No significant differences were observed in ventilation volume or compression depth between the two methods.
Conclusions:
- The MH method is a novel approach for two-provider pediatric basic life support CPR.
- The MH method enhances CPR quality metrics, including compression fraction and rate, for EMS clinicians.
- This simulation-based study suggests the MH method allows for near-continuous compressions in pediatric CPR without an advanced airway, warranting further clinical research.
Abstract:
Prehospital high-performance cardiopulmonary resuscitation (CPR) has demonstrated remarkable improvements in the survival of adult patients after out-of-hospital cardiac arrest (OHCA). With a goal to improve pediatric survival rates, Maryland Emergency Medical Services (EMS) for Children created a pediatric-specific high-performance CPR protocol to align with the existing state protocol for adult CPR. While prehospital CPR for adults has moved toward continuous compressions, prehospital CPR for children without an advanced airway continues to adhere to American Heart Association (AHA)/International Liaison Committee on Resuscitation (ILCOR) guidance for two ventilations for every 15 compressions. The Maryland Hiccup (MH) is a novel approach to pediatric CPR. The method combines the goal of continuous compressions with AHA/ILCOR guidance for a 15:2 compression-to-ventilation ratio. In contrast to the two- to four-second pause after compression 15 of the AHA/ILCOR style, the "hiccup" of the MH method describes two brief pauses for ventilation during the upstrokes of compressions 14 and 15. We compare basic CPR quality metrics for two-rescuer high-performance CPR using the standard AHA/ILCOR 15:2 style compared to the MH style. We enrolled 38 Maryland EMS clinicians in two-person teams to perform simulated CPR on a pediatric manikin. We recorded compression and ventilation data for 76 two-minute cycles of high-performance CPR. Compression fraction was significantly improved using the MH when compared to the standard AHA style for high-performance CPR (median 98% vs 80%, p<0.001). When compressions per minute (CPM) were compared by 30-second epochs, 80% of epochs were out of range (<100 CPM or >120 CPM) using the AHA/ILCOR style, while only 32% of epochs were out of range for MH style. No significant differences were found between the two CPR styles in ventilation volume or compression depth. The MH is a novel method for pediatric basic life support two-provider CPR which improves CPR quality metrics among EMS clinicians regardless of their prior experience. The use of this method in simulation allows near-continuous compressions without the placement of an advanced airway. Future research is needed to explore whether the CPR quality improvements translate to improved patient outcomes in real-world use.
Related Concept Videos
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
01:30Administering Oxygen by Mask
Administering oxygen by mask is a common nursing intervention that provides supplemental oxygen to patients with respiratory distress or chronic lung conditions. This procedure involves delivering oxygen at a specified rate through a face mask connected to an oxygen source.
Equipment
The equipment necessary for this procedure includes:
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...