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Analysis of Chest-Compression Depth and Full Recoil in Two Infant Chest-Compression Techniques Performed by a Single Rescuer: Systematic Review and Meta-Analysis.

ABSTRACT: Pediatric cardiac arrest is associated with high mortality and permanent neurological injury. We aimed to compare the effects of the two-thumb (TT) and two-finger (TF) techniques in infant cardiopulmonary resuscitation (CPR) performed by a single rescuer. We searched PubMed, EMBASE, and CENTRAL for randomized control trials published before December 2019. Studies comparing the TT and TF techniques in infant CPR were included for meta-analysis. Relevant information was extracted for methodological assessment. Twelve studies were included. The TT technique was associated with deeper chest-compression depth (mean difference: 4.71 mm; 95% confidence interval: 3.61 to 5.81; p < 0.001) compared with the TF technique. The TF technique was better in terms of the proportion of complete chest recoil (mean difference: -11.73%; 95% confidence interval: -20.29 to -3.17; p = 0.007). CPR was performed on a manikin model, and the application of the results to real human beings may be limited. The TT technique was superior to the TF technique in terms of chest-compression depth, but with inferior chest full recoil. Future investigations should focus on modifying the conventional TT technique to generate greater compression depth and achieve complete chest recoil.

SUBMITTER: Chang CY

PROVIDER: S-EPMC7312068 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Analysis of Chest-Compression Depth and Full Recoil in Two Infant Chest-Compression Techniques Performed by a Single Rescuer: Systematic Review and Meta-Analysis.

Chang Chun-Yu CY Lin Po-Chen PC Chien Yung-Jiun YJ Chen Chien-Sheng CS Wu Meng-Yu MY

International journal of environmental research and public health 20200605 11

Pediatric cardiac arrest is associated with high mortality and permanent neurological injury. We aimed to compare the effects of the two-thumb (TT) and two-finger (TF) techniques in infant cardiopulmonary resuscitation (CPR) performed by a single rescuer. We searched PubMed, EMBASE, and CENTRAL for randomized control trials published before December 2019. Studies comparing the TT and TF techniques in infant CPR were included for meta-analysis. Relevant information was extracted for methodologica ...[more]

PMID: 32516929

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Project description:BackgroundCardiopulmonary resuscitation (CPR) is a lifesaving skill performed during the cardiac arrest. Various factors of rescuer affect CPR quality, and rescuers physical fitness is one among the important factors needs to be explored for improved CPR quality. This study aimed to assess the physical activity (PA) levels of the health care providers (HCPs) who were trained in basic life support (BLS) and its relationship on chest compression duration, hemodynamic parameters, and fatigue levels of the rescuers.Materials and methodsA single-center, cross-sectional study was conducted on 48 HCPs who were trained in BLS within one year. Eligible participants were contacted by email, and the responders' level of PA was determined using the global physical activity questionnaire (GPAQ). The participants were recruited for chest compression-only cardiac arrest scenarios. Each subject performed continuous chest compression on the manikin until they perceived maximum fatigue. Heart rate (HR), blood pressure (BP), oxygen saturation (SpO2), and fatigue level were assessed at baseline, immediately after and following two minutes of cessation of chest compressions. The total duration of chest compression was also documented.ResultsMost participants (24, 50%) reported high levels of PA while 22 (45.83%) and 2 (4.17%) reported moderate and low intensity of PA, respectively. The mean age of the 35 participants was 26.08 ± 4.60 years. The mean duration of chest compressions was 193.25 seconds with higher times reported for those with high PA when compared to those with moderate PA (p = 0.017). Similar findings were also observed for fatigue.ConclusionRescuers who reported high PA had lower levels of fatigue and could perform longer duration of chest compressions.How to cite this articleNayak VR, Babu A, Unnikrishnan R, Babu AS, Krishna HM. Influence of Physical Activity of the Rescuer on Chest Compression Duration and its Effects on Hemodynamics and Fatigue Levels of the Rescuer: a Simulation-based Study. Indian J Crit Care Med 2020;24(6):409-413.

Project description:BackgroundThe two-thumb encircling technique (2TT) is superior to the two-finger technique (2FT) in infant cardiopulmonary resuscitation (CPR), but there are difficulties in providing ventilation as soon as possible. We modified the 2TT to the cross-thumb technique (CTT) to maintain good CPR performance at the same position as 2FT. We aimed to compare the quality of chest compression and brief hands-off times in 2FT, 2TT, and CTT by a single rescuer using an infant CPR manikin model.MethodsThis study was designed as a prospective randomized controlled simulation-based study. We used the Resusci® Baby QCPR (Laerdal Medical, Stavanger, Norway) as a simulated 3-month-old infant. Ventilation was performed by the mouth-to-mouth technique using a chest compression-to-ventilation ratio of 30:2 as a single rescuer. Data on CPR quality, such as locations, rates, depth and release of chest compressions, hands-off times, and proper ventilation, were recorded using the Resusci® Baby QCPR and SkillReporter. Also, the chest compression fraction (CCF) was automatically calculated.ResultsThe depth of chest compression in 2FT, 2TT, and CTT were 40.0 mm (interquartile range [IQR] 39.0, 41.0), 42.0 mm (IQR 41.0, 43.0), and 42.0 mm (IQR 41.0, 43.0), respectively. The depth of chest compression in 2FT was shallower than that in the other two techniques (P<0.05). CCF in 2FT, 2TT, and CTT were 73.9% (IQR 72.2, 75.6), 71.2% (IQR 67.2, 72.2) and 71.3% (IQR 67.7, 74.1), respectively. CCF was higher in 2FT than in the other two techniques (P<0.05). Correct location in 2FT, 2TT, and CTT were 99.0% (IQR 86.0, 100.0), 100.0% (IQR 97.0, 100.0) and 100.0% (IQR 99.0, 100.0), respectively. Correct location in CTT and 2TT was higher than that in 2FT. Performing CTT, the subjective pain and fatigue score were lower than other two technique.ConclusionA new chest compression technique, CTT was better in chest compression depth compared with 2FT and may be helpful in maintaining correct chest compression location with less pain and fatigue in infant CPR.

Project description:Introduction This study was designed to compare the outcomes of standard cardiopulmonary resuscitation (STD-CPR) and combined chest compression and abdominal compression–decompression cardiopulmonary resuscitation (CO-CPR) with a new device following out-of-hospital cardiac arrest (OHCA). Moreover, we investigated whether patient prognosis improved with this combination treatment. Methods This trial was a single-centre, prospective, randomized trial, and a blinded assessment of the outcomes was performed. A total of 297 consecutive patients with OHCA were initially screened, and 278 were randomized to the STD-CPR group (n = 135) or the CO-CPR group (n = 143). We compared the proportions of patients who achieved a return of spontaneous circulation (ROSC), survived to hospital admission and survived to hospital discharge. In addition, we also performed the Kaplan–Meier analysis with a log-rank test at the end of the follow-up period to compare the survival curves of the two groups. Results The differences were not statistically significant in the proportion of patients who achieved ROSC [31/135 (23.0%) versus 35/143 (24.5%)] and survived to hospital admission [28/135 (20.7%) versus 33/143 (23.1%)] between the CO-CPR group and STD-CPR group. However, there was a significant difference in the proportion of patients who survived to hospital discharge [16/135 (11.9%) versus 7/143 (4.9%)] between the two groups. Nine patients (6.7%) in the CO-CPR group and 2 patients (1.4%) in the STD group showed good neurological outcomes according to the cerebral performance category (CPC) scale score, and the difference was statistically significant (P = 0.003). The Kaplan–Meier curves showed that the patients in the CO-CPR group achieved better survival benefits than those in the STD-CPR group at the end of the follow-up period (log-rank P = 0.007). Conclusion CO-CPR was more beneficial than STD-CPR in terms of survival benefits in patients who have suffered out-of-hospital cardiac arrest. Trial registration Chinese Clinical Trial Registry, registered number: ChiCTR2100049581. Registered 30 July 2021- Retrospectively registered. http://www.medresman.org.cn/uc/index.aspx. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-022-01036-y.

Project description:BackgroundCurrent guidelines recommend a 50 mm or greater compression depth for manual chest compression in adults. However, whether this uniform compression depth is a suitable requirement for mechanical CPR remains to be determined. We hypothesized that a relatively shallow compression depth (30 mm) would have similar hemodynamic efficacy but fewer complications versus the standard compression depth (50 mm) during mechanical cardiopulmonary resuscitation (CPR) with the miniaturized chest compressor (MCC) in a porcine model.MethodsIn the current study, we used a total of 16 domestic male pigs (38±2 kg). All pigs were exposed to 7 min of ventricular fibrillation (VF) followed by 5 min of CPR. Then the animals were randomly assigned to the shallow (30 mm) group and the standard (50 mm) group. At the second min of CPR, every pig was given epinephrine (20 µg/kg) through the femoral vein and repeated every 3 min. First defibrillation was delivered with a single 120 J shock at 5 min of CPR. Hemodynamics, carotid blood flow (CBF), end-tidal carbon dioxide (ETCO2), coronary perfusion pressure (CPP), intrathoracic pressure (ITP) and arterial blood gas were measured. Rib fractures and lung injuries, as indicated by ground-glass opacification (GGO), as well as intense parenchymal opacification (IPO), were assessed and calculated by quantitative computed tomography (QCT) scan.ResultsWe found no significant differences in CPP, CBF, or ETCO2 between the both groups throughout the CPR period. After administration of epinephrine, the CPP of all animals increased while ETCO2 and CBF decreased during CPR. A significantly lower intrathoracic positive pressure (ITPP) and systolic artery pressure (SAP) were measured in the shallow group at the first min of CPR. However, we didn't find remarkable differences in these values between the both groups for the next 4 min of CPR. All animals were successfully resuscitated. The shallow group had significantly lower IPO QCT scores compared with the standard group. We found no significant differences in GGO QCT scores after resuscitation between both groups.ConclusionsRelatively shallow compression depth has similar hemodynamic efficacy but fewer complications versus the standard compression depth.

Dataset Information

Analysis of Chest-Compression Depth and Full Recoil in Two Infant Chest-Compression Techniques Performed by a Single Rescuer: Systematic Review and Meta-Analysis.

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Analysis of Chest-Compression Depth and Full Recoil in Two Infant Chest-Compression Techniques Performed by a Single Rescuer: Systematic Review and Meta-Analysis.

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