Article Text
Abstract
Background Effective cardiac compressions (CC) with a full relaxation phase ensure adequate coronary artery blood flow by increasing coronary perfusion pressure (CPP). CC during neonatal resuscitations are rare thus requiring them to be practiced in simulation training. No studies have explored the efficacy of CC during preterm simulations.
Aims 1) Develop a preterm manikin simulation system for CC training
2) Define key measures of effective CC in this preterm simulation
Methods We used the Laerdel term and LifeForm preterm (~25 week gestation, 0.8kg) manikins with an in-house developed calibrated CC measurement system (accuracy ±3%). NLS trained neonatal staff randomly performed 2 finger or 2 thumb (circling) CC resuscitation simulations. Compression rate, depth (>1/3 AP diameter of chest) and release (>75% release of compression distance) were measured.
Results 30 participants each performed 8 simulations (total 23,340 CC). Median CC rate was 93/min(IQR 84–111). For both term and preterm simulations, the 2 thumb technique achieved more adequate depth CC than the 2 finger technique (P < 0.0001). Incomplete release was significantly worse in the 2 thumb group especially in the preterm simulations. With increasing CC rate, incomplete release increased significantly from 8% in the 60–84 CC/min rising to 52% in the 112–140 CC/min (P < 0.0001, see Figure).
Conclusion We have developed a useful CC preterm training simulator with important feedback measures. These simulations demonstrate the quality of CC decreases with increasing rate above NLS recommended guidelines. In clinical practice, this would reduce CPP and delay the restoration of an adequate cardiac output.
Percentage of compressions with inadequate release during the simulated cardiac compressions