Elsevier

Resuscitation

Volume 85, Issue 6, June 2014, Pages 814-819
Resuscitation

Simulation and education
Schoolchildren as life savers: At what age do they become strong enough??

https://doi.org/10.1016/j.resuscitation.2014.03.001Get rights and content

Abstract

Objective

It is not clear when schoolchildren become enough strong to perform good quality chest compressions (CC). Our purpose was to assess CC quality in schoolchildren.

Methods

721 children, 10–15 years old (YO) participated in 1 h hands-on training session. Subjects were tested during performing 2 min of continuous CC by means of Laerdal Resusci Anne® with Skillreporter®, without feedback.

Results

Mean compression depth (MCD) increased with age, from 30.7 mm in 10YO to 42.9 mm in 15YO (p < 0.05) and was related to height, weight, and BMI. Boys delivered significantly deeper CC than girls in the 10, 13, 14 and 15YO groups (p < 0.001). The percentage of children who achieved the MCD goal (50–60 mm), increased with age, from 0.0% at 10 years to 26.5% at 15 years (p < 0.001). Mean compression rate (MCR) ranged from 121 min–1 in 15YO to 134 min–1 in 12YO. The percentage of children who achieved a CC rate inside the goal (100–120 min–1), ranged from 20.3% in 11YO to 31.0% in 15YO. Correct CC fraction was low and ranged from 2% in the 10YO to 22% in the 15YO (p < 0.05). Children older than 13YO obtained better results than younger ones for all analyzed variables (p < 0.001). Performance decreased with time: 12% of children achieved >50% of correct CC fraction in first minute, while only 5% did it in second minute (p < 0.001).

Conclusions

In schoolchildren, age, sex and anthropometry are significant CPR quality factors. Although quality increases with age, their global performance is poor. Thirteen years is the minimum age to be able to achieve a minimum CPR quality similar to the one adult possess. CPR performance in schoolchildren significantly deteriorates within 60 s.

Introduction

Since at least two decades ago, teaching and training CPR at schools have been proposed as a way to disseminate skills and increase the rate of bystander resuscitation.1, 2 As a consequence, a variety of programs to teach CPR in school has been developed in European countries.3, 4, 5, 6, 7, 8, 9 Also, in 2011 the American Heart Association (AHA) recommended that CPR training for schoolchildren (including high-quality chest compressions (CC) with minimum interruptions) should be mandatory.10

While there is general agreement on the usefulness of training interventions in order to increase knowledge and skills of school children,3, 10, 11 a debate remains about the methods, the optimal age to start and the age at what they become enough strong to perform high-quality CPR.12, 13

Two studies that evaluated children's performance based on 2005 international guidelines, indicated that schoolchildren aged less than 13 years old (YO)12, 13 did not achieve the standards for compression depth.

ERC and AHA 2010 guidelines have increased the recommended CC depth from 39–51 mm to 50–60 mm, and the CC rate from 90–100 per min, to 100–120 per min.14, 15, 16 As we are not aware of studies that tested children's ability to fill current CPR guidelines, our purpose was to investigate this point and to correlate CC quality with children's age, sex and anthropometry.

Section snippets

Participants

Children 10–15 years old from 7 public schools in Pontevedra, A Coruña and Madrid (Spain) were candidates to participate in the study. Children with physical handicaps or underlying diseases that significantly limit physical performance, and those whose parents did not consented were excluded. A total of 721 children (361 boys/360 girls) were finally included.

Ethics

The study protocol was approved by the ethics committee of the Faculty of Education and Sport Science of the University of Vigo (Spain).

Study design and implementation

Results

All participants (n = 721) were able to perform the CPR quality test and all data were available for analysis.

Anthropometry (Table 1 and tables in supplementary files).

Height, weight and BMI of the whole sample are shown in Table 1. Ten YO children's mean weight was significantly lower than the weight of the other groups (p < 0.05), as well as 11–12 YO children when compared with older ones (p < 0.05). No statistically significant differences were observed in weight of children who were 13–15 YO. The

Discussion

Schoolchildren constitute a clear target population to train CPR.3, 10, 11 At least from 9 YO they are able to understand the importance of bystander CPR, they can learn how to perform basic life support and they retain this knowledge.5, 8, 9 But good quality CPR, namely effective CC, requires a minimum physical strength and endurance that may be out of the range of a normal school child. Some studies have addressed this point, trying to detect the cut-off age beyond which CC quality is

Conflict of interest statement

The authors have no financial or personal conflicts of interest regarding the study.

Cited by (72)

View all citing articles on Scopus
?

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.2014.03.001.

View full text