open access

Vol 76, No 6 (2018)
Original articles
Published online: 2018-01-19
Submitted: 2017-11-30
Accepted: 2017-12-27
Get Citation

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

Jacek Smereka, Halla Kaminska, Wojciech Wieczorek, Marek Dąbrowski, Jerzy Robert Ładny, Kurt Ruetzler, Łukasz Szarpak, Oliver Robak, Michael Frass
DOI: 10.5603/KP.a2018.0030
·
Kardiol Pol 2018;76(6):980-986.

open access

Vol 76, No 6 (2018)
Original articles
Published online: 2018-01-19
Submitted: 2017-11-30
Accepted: 2017-12-27

Abstract

Background: Early bystander cardiopulmonary resuscitation (CPR) for cardiac arrest is crucial in the chain of survival. Cardiac arrest in infants is rare, but CPR is also performed in severe bradycardia. European Resuscitation Council and American Heart Association guidelines recommend continuing CPR until the heart muscle is sufficiently oxygenated and regains sufficient contractility and function. The most common and recommended CPR techniques that can be applied in newborns are the two-finger technique and two-thumb technique.

Aim: We sought to assess the quality of CPR performed in newborns with the two-finger technique depending on the posi­tion of the rescuer during resuscitation.

Methods: This was a prospective, randomised, crossover, simulated study. It involved 93 nurses who were required to perform a two-minute CPR using the two-finger technique in three scenarios: (A) with the newborn lying on the floor; (B) on a table; and (C) with the newborn on the rescuer’s forearm. The Newborn Tory® S2210 manikin was used to simulate a neonatal patient in cardiac arrest. The following parameters were measured: chest compression (CC) depth, CC rate, no-flow time, percentage of full release, ventilation rate, and ventilation volume, as well as the number of effective compressions and effective ventilations.

Results: Statistical analysis showed significant differences in CC rates between scenarios A and B (p < 0.001) and between scenarios B and C (p = 0.002). Significant differences were also observed between the median CC depth. The median per­centage of no-flow-fraction was the highest for scenario A (55%), followed by scenario B (48%), and scenario C (46%). There were significant differences between the values of no-flow-fraction between scenarios A and B (p < 0.001), and between scenarios A and C (p < 0.001). The percentage of chest full releases for scenarios A, B, and C amounted to 94%, 1%, and 92%, respectively. Significant differences in the number of effective CCs between scenarios A and B (p < 0.001) as well as B and C (p < 0.001) were revealed. The median ventilation rate was highest for scenario B (13 × min–1), and lowest for scenario A (9 × min–1). The highest tidal volume was obtained in scenario A (27 mL), and the lowest in scenario C (26 mL). The most effective CPR was performed when resuscitation was carried out on the rescuer’s forearm.

Conclusions: The quality of CCs in newborns depends on the location of the patient and the rescuer. The optimal form of resuscitation of newborns is resuscitation on the rescuer’s forearm.

Abstract

Background: Early bystander cardiopulmonary resuscitation (CPR) for cardiac arrest is crucial in the chain of survival. Cardiac arrest in infants is rare, but CPR is also performed in severe bradycardia. European Resuscitation Council and American Heart Association guidelines recommend continuing CPR until the heart muscle is sufficiently oxygenated and regains sufficient contractility and function. The most common and recommended CPR techniques that can be applied in newborns are the two-finger technique and two-thumb technique.

Aim: We sought to assess the quality of CPR performed in newborns with the two-finger technique depending on the posi­tion of the rescuer during resuscitation.

Methods: This was a prospective, randomised, crossover, simulated study. It involved 93 nurses who were required to perform a two-minute CPR using the two-finger technique in three scenarios: (A) with the newborn lying on the floor; (B) on a table; and (C) with the newborn on the rescuer’s forearm. The Newborn Tory® S2210 manikin was used to simulate a neonatal patient in cardiac arrest. The following parameters were measured: chest compression (CC) depth, CC rate, no-flow time, percentage of full release, ventilation rate, and ventilation volume, as well as the number of effective compressions and effective ventilations.

Results: Statistical analysis showed significant differences in CC rates between scenarios A and B (p < 0.001) and between scenarios B and C (p = 0.002). Significant differences were also observed between the median CC depth. The median per­centage of no-flow-fraction was the highest for scenario A (55%), followed by scenario B (48%), and scenario C (46%). There were significant differences between the values of no-flow-fraction between scenarios A and B (p < 0.001), and between scenarios A and C (p < 0.001). The percentage of chest full releases for scenarios A, B, and C amounted to 94%, 1%, and 92%, respectively. Significant differences in the number of effective CCs between scenarios A and B (p < 0.001) as well as B and C (p < 0.001) were revealed. The median ventilation rate was highest for scenario B (13 × min–1), and lowest for scenario A (9 × min–1). The highest tidal volume was obtained in scenario A (27 mL), and the lowest in scenario C (26 mL). The most effective CPR was performed when resuscitation was carried out on the rescuer’s forearm.

Conclusions: The quality of CCs in newborns depends on the location of the patient and the rescuer. The optimal form of resuscitation of newborns is resuscitation on the rescuer’s forearm.

Get Citation

Keywords

cardiopulmonary resuscitation, chest compression, quality, newborn, nursing personnel

About this article
Title

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 6 (2018)

Pages

980-986

Published online

2018-01-19

DOI

10.5603/KP.a2018.0030

Bibliographic record

Kardiol Pol 2018;76(6):980-986.

Keywords

cardiopulmonary resuscitation
chest compression
quality
newborn
nursing personnel

Authors

Jacek Smereka
Halla Kaminska
Wojciech Wieczorek
Marek Dąbrowski
Jerzy Robert Ładny
Kurt Ruetzler
Łukasz Szarpak
Oliver Robak
Michael Frass

References (30)
  1. Atkins DL, de Caen AR, Berger S, et al. 2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018; 137(1): e1–e6.
  2. Aro AL, Chugh SS. Prevention of Sudden Cardiac Death in Children and Young Adults. Prog Pediatr Cardiol. 2017; 45: 37–42.
  3. Sutton RM, Morgan RW, Kilbaugh TJ, et al. Cardiopulmonary Resuscitation in Pediatric and Cardiac Intensive Care Units. Pediatr Clin North Am. 2017; 64(5): 961–972.
  4. Schleien C, Craven M. Acute Respiratory Compromise Leading to Cardiac Arrest. Pediatr Crit Care Med. 2017; 18(9): 894–895.
  5. Forrest A, Butt WW, Namachivayam SP. Outcomes of children admitted to intensive care after out-of-hospital cardiac arrest in Victoria, Australia. Crit Care Resusc. 2017; 19(2): 150–158.
  6. Meert KL, Telford R, Holubkov R, et al. Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators. Pediatric Out-of-Hospital Cardiac Arrest Characteristics and Their Association With Survival and Neurobehavioral Outcome. Pediatr Crit Care Med. 2016; 17(12): e543–e550.
  7. Maconochie IK, Bingham R, Eich C, et al. Paediatric life support section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support. Resuscitation. 2015; 95: 223–248.
  8. Wyllie J, Bruinenberg J, Roehr CC, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth. Resuscitation. 2015; 95: 249–263.
  9. Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2): S543–S560.
  10. Saini SS, Gupta N, Kumar P, et al. A comparison of two-fingers technique and two-thumbs encircling hands technique of chest compression in neonates. J Perinatol. 2012; 32(9): 690–694.
  11. Jiang J, Zou Y, Shi W, et al. Two-thumb-encircling hands technique is more advisable than 2-finger technique when lone rescuer performs cardiopulmonary resuscitation on infant manikin. Am J Emerg Med. 2015; 33(4): 531–534.
  12. You Y. Optimum location for chest compressions during two-rescuer infant cardiopulmonary resuscitation. Resuscitation. 2009; 80(12): 1378–1381.
  13. Smereka J, Szarpak L, Rodríguez-Núñez A, et al. A randomized comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: A randomized manikin study. Am J Emerg Med. 2017; 35(10): 1420–1425.
  14. Smereka J, Bielski K, Ladny JR, et al. Evaluation of a newly developed infant chest compression technique: A randomized crossover manikin trial. Medicine (Baltimore). 2017; 96(14): e5915.
  15. Smereka J, Kasiński M, Smereka A, et al. The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial. Kardiol Pol. 2017; 75(6): 589–595.
  16. Smereka J, Szarpak L, Smereka A, et al. Evaluation of new two-thumb chest compression technique for infant CPR performed by novice physicians. A randomized, crossover, manikin trial. Am J Emerg Med. 2017; 35(4): 604–609.
  17. Oh JeH. Letter to the Editor: Chest Compression Rate, Rescuer's Fatigue and Patient's Survival. J Korean Med Sci. 2016; 31(10): 1668–1669.
  18. Szarpak L, Filipiak KJ, Ładny JR, et al. Should nurses use mechanical chest compression devices during CPR? Am J Emerg Med. 2016; 34(10): 2044–2045.
  19. Szarpak Ł, Truszewski Z, Smereka J, et al. Does the use of a chest compression system in children improve the effectiveness of chest compressions? A randomised crossover simulation pilot study. Kardiol Pol. 2016; 74(12): 1499–1504.
  20. Kurowski A, Czyżewski L, Bogdański L, et al. Quality of chest compression with CardioPump CPR compared to single rescuer standard BLS. Am J Emerg Med. 2015; 33(1): 114–115.
  21. Solevåg AL, Schmölzer GM. Optimal Chest Compression Rate and Compression to Ventilation Ratio in Delivery Room Resuscitation: Evidence from Newborn Piglets and Neonatal Manikins. Front Pediatr. 2017; 5: 3.
  22. Solevåg AL, Cheung PY, O'Reilly M, et al. A review of approaches to optimise chest compressions in the resuscitation of asphyxiated newborns. Arch Dis Child Fetal Neonatal Ed. 2016; 101(3): F272–F276.
  23. Ashoor HM, Lillie E, Zarin W, et al. ILCOR Basic Life Support Task Force. Effectiveness of different compression-to-ventilation methods for cardiopulmonary resuscitation: A systematic review. Resuscitation. 2017; 118: 112–125.
  24. Li ES, Cheung PY, O'Reilly M, et al. Rescuer fatigue during simulated neonatal cardiopulmonary resuscitation. J Perinatol. 2015; 35(2): 142–145.
  25. Schmölzer GM, O'Reilly M, Labossiere J, et al. 3:1 compression to ventilation ratio versus continuous chest compression with asynchronous ventilation in a porcine model of neonatal resuscitation. Resuscitation. 2014; 85(2): 270–275.
  26. Zhan L, Yang LiJ, Huang Yu, et al. Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest. Cochrane Database Syst Rev. 2017; 3: CD010134.
  27. Travers AH, Perkins GD, Berg RA, et al. Basic Life Support Chapter Collaborators. Part 3: Adult Basic Life Support and Automated External Defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2015; 132(16 Suppl 1): S51–S83.
  28. Aufderheide TP, Pirrallo RG, Yannopoulos D, et al. Incomplete chest wall decompression: a clinical evaluation of CPR performance by EMS personnel and assessment of alternative manual chest compression-decompression techniques. Resuscitation. 2005; 64(3): 353–362.
  29. Vliegenthart RJ, Onland W, van Kaam AH. Ventilation in Preterm Infants and Lung Function at 8 Years. N Engl J Med. 2017; 377(16): 1600–1601.
  30. Narayanan I, Mendhi M, Bansil P, et al. Evaluation of Simulated Ventilation Techniques With the Upright and Conventional Self-Inflating Neonatal Resuscitators. Respir Care. 2017; 62(11): 1428–1436.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl