Simulation and educationReal-time feedback can improve infant manikin cardiopulmonary resuscitation by up to 79%—A randomised controlled trial☆
Introduction
Survival rates following paediatric cardiac arrest are extremely low.1, 2, 3, 4 A return of spontaneous circulation (ROSC) is achieved in approximately 60% of paediatric patients following in-hospital cardiac arrest, with newborns and infants (i.e. <1 year olds) having the greatest likelihood of neurologically-intact survival (∼20%).1, 2 By direct comparison, only 2–9% of such patients will achieve neurological survival if they suffer an out-of-hospital cardiac arrest.3, 4, 5, 6, 7, 8, 9
The importance of high quality chest compressions during infant cardiopulmonary resuscitation (CPR) is recognised by both the European and UK Resuscitation Councils.10, 11 Recent publications, however, describe the poor chest compression performance of Advanced Paediatric Life Saver (APLS)-certified instructors during simulated infant CPR, typified by inconsistent chest compression depths, excessive compression rates and prolonged compression duty cycles.12, 13, 14, 15 Even when utilising a manikin with enhanced “physiological” characteristics, APLS-certified instructors could still only achieve an overall chest compression quality <1% when compared to the targets of the four internationally recommended parameters (chest compression depth, chest compression rate, duty cycle, release force; summarised in Online Table 1 and schematically in Fig. 1).15
Whilst the effect of instantaneous performance feedback during adult CPR has previously been reported, this study is the first to investigate the hypothesis that instantaneous feedback will improve the performance of chest compression quality during simulated, infant CPR.
Section snippets
Methods
Sixty-nine European Paediatric Life Support (EPLS) and/or APLS certified CPR providers were recruited from seven EPLS/APLS training courses, and were evaluated when performing two-thumb (TT) and two-finger (TF) technique chest compressions during simulated, chest compression-only, infant CPR. The flow of participants through the study is described in Fig. 2. Providers were excluded if there was >4 years since certification.
This study utilised a commercially available CPR manikin (Laerdal® ALS
Results
The demographics of the 69 APLS and/or EPLS certified CPR providers that participated in this study are available in Online Table 2.
Discussion
This study is unique in demonstrating how ‘real-time’ feedback during simulated infant CPR leads to a dramatic improvement in quality, with 75% (TF) and 80% (TT) of chest compressions simultaneously achieving the four, internationally recommended targets. This compares to an overall quality <1% when performing chest compressions without feedback.
Providers achieved relatively high CD quality (∼20%) versus other data when performing chest compressions without feedback (Online Table 4),14 although
Conclusion
The study demonstrated that the provision of real-time feedback during simulated infant CPR coincided with a dramatic improvement in overall infant chest compression quality (from 1% to 75–80%). Should these result transfer to clinical practice, then this technology will enable CPR providers to perform the vast majority of chest compressions to within the targets of internationally recommended parameters, thereby having great potential to influence survival following infant cardiac arrest.
Conflict of interest statement
Dr. Ian Maconochie is Co-chair of the Paediatric Task Force for ILCOR 2015, and a member of the European and the UK Resuscitation Councils. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Acknowledgements
The authors would like to thank the EPLS training course organisers and NHS Trusts for hosting and helping organise this research, and the CPR providers that consented to participate in this study.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.03.029.