open access

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

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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

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