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Two new chest compression methods might challenge the standard in a simulated infant model

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Abstract

Paediatric cardiorespiratory arrest is a rare event that requires a fast, quality intervention. High-quality chest compressions are an essential prognostic factor. The aim of this prospective, randomized and crossover study in infant manikin 2-min cardiorespiratory resuscitation scenario is to quantitatively compare the quality of the currently recommended method in infants (two-thumb-encircling hand techniques) with two new methods (the new two-thumb and the knocking-fingers techniques) using a 15:2 compression-to-ventilation ratio. Ten qualified health professionals were recruited. Variables analysed were mean rate and the ratio of compressions in the recommended rate range, mean depth and the ratio of compressions within the depth range recommendations, ratio of compressions with adequate chest release and ratio of compressions performed with the fingers in the correct position. Ratios of correct compressions for depth, rate, chest release and hand position were always above 70% regardless of the technique used. Reached mean depth and mean rate were similar to the 3 techniques. No statistically significant differences were found in any of the variables analysed.

Conclusion: In an infant manikin, professionals are able to perform chest compressions with the new techniques with similar quality to that obtained with the standard method.

What is Known:

• Quality chest compressions are an essential prognostic factor in paediatric cardiorespiratory arrest.

• It has been reported poor results when studied cardiorespiratory resuscitation quality in infants applying the recommended methods.

What is New:

• In a simulated scenario, quality of chest compressions performed with two new techniques (nTTT and KF) is similar to that obtained with the currently recommended method (TTHT).

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Abbreviations

CPR:

Cardiopulmonary resuscitation

IQR:

Interquartile ranges

KF:

Knocking-fingers technique

nTTT:

New two-thumb technique

SD:

Standard deviations

TFT:

Two-finger technique

TTHT:

Two-thumb-encircling hand techniques

References

  1. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of paediatric and neonatal patients: paediatric basic life support. Pediatrics;117(5):e989–1004. https://doi.org/10.1542/peds.2006-0219, 2006

  2. Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW, Berg RA, Sutton RM, Hazinski MF (2010) American Heart Association. Pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 126(5):e1345–e1360. https://doi.org/10.1542/peds.2010-2972C

  3. Cheng A, Brown LL, Duff JP, Davidson J, Overly F, Tofil NM, Peterson DT, White ML, Bhanji F, Bank I et al (2015) International Network for Simulation-Based Pediatric Innovation, Research, & Education (INSPIRE) CPR Investigators. Improving cardiopulmonary resuscitation with a CPR feedbackdevice and refresher simulations (CPR CARES Study): a randomized clinical trial. JAMA Pediatr 169(2):137–144. https://doi.org/10.1001/jamapediatrics.2014.2616

    Article  PubMed  Google Scholar 

  4. Cheskes S, Schmicker RH, Christenson J, Salcido DD, Rea T, Powell J, Edelson DP, Sell R, May S, Menegazzi JJ, van Ottingham L, Olsufka M, Pennington S, Simonini J, Berg RA, Stiell I, Idris A, Bigham B, Morrison L (2011) Perishock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest. Circulation 124(1):58–66. https://doi.org/10.1161/CIRCULATIONAHA.110.010736

    Article  PubMed  PubMed Central  Google Scholar 

  5. Christenson J, Andrusiek D, Everson-Stewart S, Kudenchuk P, Hostler D, Powell J, Callaway CW, Bishop D, Vaillancourt C, Davis D, Aufderheide TP, Idris A, Stouffer JA, Stiell I, Berg R, the Resuscitation Outcomes Consortium Investigators (2009) Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation 120(13):1241–1247. https://doi.org/10.1161/CIRCULATIONAHA.109.852202

    Article  PubMed  PubMed Central  Google Scholar 

  6. Christman C, Hemway RJ, Wyckoff MH, Perlman JM (2011) The two-thumb is superior to the two-finger method for administering chest compressions in a manikin model of neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed 96(2):F99–F101. https://doi.org/10.1136/adc.2009.180406

  7. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 11: neonatal resuscitation. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Circulation;102(8 Suppl):I343–57

  8. Houri PK, Frank LR, Menegazzi JJ, Taylor R (1997) A randomized, controlled trial of two-thumb vs two-finger chest compression in a swine infant model of cardiac arrest [see comment]. Prehosp Emerg Care 1(2):65–67

    Article  CAS  PubMed  Google Scholar 

  9. Idris AH, Guffey D, Aufderheide TP, Brown S, Morrison LJ, Nichols P, Powell J, Daya M, Bigham BL, Atkins DL, Berg R, Davis D, Stiell I, Sopko G, Nichol G (2012) Relationship between chest compression rates and outcomes from cardiac arrest. Circulation 125(24):3004–3012. https://doi.org/10.1161/CIRCULATIONAHA.111.059535

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jung WJ, Hwang SO, Kim HI, Cha YS, Kim OH, Kim H, Lee KH, Cha KC (2018) ‘Knocking-fingers’ chest compression technique in infant cardiac arrest: single-rescuer manikin study. Eur J Emerg Med 30:261–265. https://doi.org/10.1097/MEJ.0000000000000539

    Article  Google Scholar 

  11. Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D (2015) Paediatric life support section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support. Resuscitation 95:223–248. https://doi.org/10.1016/j.resuscitation.2015.07.028

  12. Menegazzi JJ, Auble TE, Nicklas KA, Hosack GM, Rack L, Goode JS (1993) Two-thumb versus two-finger chest compression during CRP in a swine infant model of cardiac arrest. Ann Emerg Med 22(2):240–243

    Article  CAS  PubMed  Google Scholar 

  13. Nichol G, Leroux B, Wang H, Callaway CW, Sopko G, Weisfeldt M, Stiell I, Morrison LJ, Aufderheide TP, Cheskes S, Christenson J, Kudenchuk P, Vaillancourt C, Rea TD, Idris AH, Colella R, Isaacs M, Straight R, Stephens S, Richardson J, Condle J, Schmicker RH, Egan D, May S, Ornato JP (2015) Trial of continuous or interrupted chest compressions during CPR. N Engl J Med 373(23):2203–2214. https://doi.org/10.1056/NEJMoa1509139

    Article  CAS  PubMed  Google Scholar 

  14. Niles D, Sutton RM, Donoghue A, Kalsi MS, Roberts K, Boyle L, Nishisaki A, Arbogast KB, Helfaer M, Nadkarni V (2009) “Rolling refreshers”: a novel approach to maintain CPR psychomotor skill competence. Resuscitation 80(8):909–912. https://doi.org/10.1016/j.resuscitation.2009.04.021

    Article  PubMed  Google Scholar 

  15. Rodriguez-Ruiz E, Guerra Martín V, Abelairas-Gómez C, Sampedro Vidal F, Gómez González C, Barcala-Furelos R, Rodríguez-Nuñez A (2018) A new chest compression technique in infants. Med Int S0210-5691(18)30154-2. https://doi.org/10.1016/j.medin.2018.04.010

  16. Ruetzler K, Smereka J, Szarpak L, Czekajlo M (2018) Novel method of infant chest compression. Does the arrangement of the thumbs matter? Am J Emerg Med 8:769–770. https://doi.org/10.1016/j.ajem.2018.08.030

    Article  Google Scholar 

  17. Smereka J, Szarpak L, Smereka A, Leung S, Ruetzler K (2017) Evaluation of new two-thumb chest compression technique for infant cardiopulmonary resuscitation performed by novice physicians. A randomized crossover, manikin trial. Am J Emerg Med 35(4):604–609. https://doi.org/10.1016/j.ajem.2016.12.045

    Article  PubMed  Google Scholar 

  18. Smereka J, Szarpak L, Rodríguez-Núñez A, Ladny JR, Leung S, Ruetzler K (2017) A randomized comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: a randomized manikin study. Am J Emerg Med 35(10):1420–1425. https://doi.org/10.1016/j.ajem.2017.04.024

    Article  PubMed  Google Scholar 

  19. Smereka J, Bielski K, Ladny JR, Ruetzler K, Szarpak L (2017) Evaluation of a newly developed infant chest compression technique: a randomized crossover manikin trial. Medicine (Baltimore) 96(14):e5915. https://doi.org/10.1097/MD.0000000000005915

    Article  Google Scholar 

  20. Smereka J, Szarpak L, Ladny JR, Rodriguez-Nunez A, Ruetzler K (2018) A novel method of newborn chest compression: a randomized crossover simulation study. Front Pediatr 29(6):159. https://doi.org/10.3389/fped.2018.00159

    Article  Google Scholar 

  21. Stiell IG, Brown SP, Christenson J, Cheskes S, Nichol G, Powell J, Bigham B, Morrison LJ, Larsen J, Hess E, Vaillancourt C, Davis DP, Callaway CW (2012) What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 40(4):1192–1198. https://doi.org/10.1097/CCM.0b013e31823bc8bb

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sutton RM, Niles D, Meaney PA, Aplenc R, French B, Abella BS, Lengetti EL, Berg RA, Helfaer MA, Nadkarni V (2011) “Booster” training: evaluation of instructor-led bedside cardiopulmonary resuscitation skill training and automated corrective feedback to improve cardiopulmonary resuscitation compliance of paediatric basic life support providers during simulated cardiac arrest. Pediatr Crit Care Med 12(3):e116–e121. https://doi.org/10.1097/PCC.0b013e3181e91271

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sutton RM, Niles D, Meaney PA, Aplenc R, French B, Abella BS, Lengetti EL, Berg RA, Helfaer MA, Nadkarni V (2011) Low-dose, high-frequency CPR training improves skill retention of in-hospital paediatric providers. Pediatrics 128(1):e145–e151. https://doi.org/10.1542/peds.2010-2105

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sutton RM, Wolfe H, Nishisaki A, Leffelman J, Niles D, Meaney PA, Donoghue A, Maltese MR, Berg RA, Nadkarni VM (2013) Pushing harder, pushing faster, minimizing interruptions... but falling short of 2010 cardiopulmonary resuscitation targets during in-hospital paediatric and adolescent resuscitation. Resuscitation 84(12):1680–1684. https://doi.org/10.1016/j.resuscitation.2013.07.029

    Article  PubMed  Google Scholar 

  25. Szarpak L, Smereka J, Ladnyc JR, Ruetzlerd R (2018) The thumbs angle used in the novel infant chest compression technique (new two-thumb technique, nTTT) can influence the quality parameters of resuscitation. Med Intensiva 43. https://doi.org/10.1016/j.medin.2018.09.008

  26. Whitelaw CC, Slywka B, Goldsmith LJ (2000) Comparison of a two-finger versus two- thumb method for chest compressions by healthcare providers in an infant mechanical model. Resuscitation 43(3):213–216

    Article  CAS  PubMed  Google Scholar 

  27. Zebuhr C, Sutton RM, Morrison W, Niles D, Boyle L, Nishisaki A, Meaney P, Leffelman J, Berg RA, Nadkarnia VM (2012) Evaluation of quantitative debriefing after paediatric cardiac arrest. Resuscitation 83(9):1124–1128. https://doi.org/10.1016/j.resuscitation.2012.01.021

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Critical Care and Intensive Care Medicine Department,, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, University of Santiago de Compostela, C/Choupana s/n, 15706, Santiago de Compostela, A Coruña, Spain

    Emilio Rodriguez-Ruiz

  2. CLINURSID research group of the University of Santiago de Compostela and Life Support and Simulation research group of the Health Research Institute of Santiago (FIDIS), Santiago de Compostela, Spain

    Emilio Rodriguez-Ruiz, Aida Carballo-Fazanes, Cristian Abelairas-Gómez & Antonio Rodríguez-Nuñez

  3. School of Nursery, University of Santiago de Compostela, 15705, Santiago de Compostela, A Coruña, Spain

    Ainhoa Martínez-Puga

  4. School of Education Sciences, University of Santiago de Compostela, 15705, Santiago de Compostela, A Coruña, Spain

    Cristian Abelairas-Gómez

  5. Paediatric Intensive Care Unit, University Clinical Hospital of Santiago de Compostela, SERGAS, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain

    Antonio Rodríguez-Nuñez

  6. Maternal and Child Health and Development Research Network SAMID-III, Institute of Health Carlos III, Madrid, Spain

    Antonio Rodríguez-Nuñez

Authors
  1. Emilio Rodriguez-Ruiz
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  2. Ainhoa Martínez-Puga
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  3. Aida Carballo-Fazanes
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  4. Cristian Abelairas-Gómez
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  5. Antonio Rodríguez-Nuñez
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Contributions

ER-R participated in the design of the study, reviewed the data and drafted the final manuscript. AM-P and AC-F carried out the fieldwork and the control of the quality of the data. CA-G participated in the design of the study and performed the statistical analysis and figures. AR-N participated in the design of the study, supervised the fieldwork and the elaboration of the results and reviewed the final manuscript.

Corresponding author

Correspondence to Emilio Rodriguez-Ruiz.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Communicated by Piet Leroy

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Rodriguez-Ruiz, E., Martínez-Puga, A., Carballo-Fazanes, A. et al. Two new chest compression methods might challenge the standard in a simulated infant model. Eur J Pediatr 178, 1529–1535 (2019). https://doi.org/10.1007/s00431-019-03452-2

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  • DOI: https://doi.org/10.1007/s00431-019-03452-2

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