Skrisovska Tamara, Djakow Jana, Jabandziev Petr, Kramplova Tereza, Klucka Jozef, Kosinova Martina, Stourac Petr
Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia.
Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia.
Front Med (Lausanne). 2024 May 13;11:1400948. doi: 10.3389/fmed.2024.1400948. eCollection 2024.
This simulation-based study aimed to evaluate the efficacy of ventilation during paediatric cardiopulmonary resuscitation (CPR) provided by healthcare professionals (HCPs) and lay rescuers (LRs). The objective was to assess the number of effective breaths delivered during the initial sequence of CPR. Effective ventilation plays a critical role during paediatric CPR as most cardiac arrests are secondary to hypoxia in origin. The recommendations on initial resuscitation in unresponsive, non-breathing children differ worldwide. The European Resuscitation Council (ERC) guidelines recommend five breaths before starting the chest compressions. Yet, this recommendation was based on the expert consensus historically and has not changed since 2000 because of the lack of evidence. This research addresses the identified knowledge gap, with potential implications for improving resuscitation practices and ultimately enhancing patient outcomes.
HCPs and LRs performed 90 s of CPR involving two mannequins: 5-kg Baby and 20-kg Junior. Both groups (HCPs and LRs) performed the task before and after structured CPR training, and the efficacy of ventilation before and after the training was compared. The HCPs provided bag-mask ventilation; LR performed dispatcher-assisted CPR with mouth-to-mouth ventilation.
The number of participants that reached the primary outcome before and after the training in Baby was 26 (65%) vs. 40 (100%) in HCPs and 28 (60.9%) vs. 45 (97.8%) in LRs (improvement in both < 0.001), respectively. The number of participants that reached the primary outcome before and after the training in the Junior mannequin was 31 (77.5%) vs. 32 (82.1%) in HCPs ( = 0.77) and 32 (82.1%) vs. 37 (94.9%) in LRs ( = 0.005), respectively.
This simulation-based study is the first to investigate ventilation efficacy during paediatric CPR provided by HCPs and LRs. Ventilation represents an important aspect of good-quality CPR in children. The concept of initiating paediatric CPR with initial breaths, as stated in ERC guidelines 2021, is justifiable. Trained HCPs and LRs providing dispatcher-assisted CPR could deliver effective ventilation to paediatric mannequins. These findings can contribute to future research in this area and address identified knowledge gaps concerning resuscitation guidelines, given the unique practical application of simulation as a research tool.
这项基于模拟的研究旨在评估医疗保健专业人员（HCPs）和非专业救援人员（LRs）在小儿心肺复苏（CPR）期间进行通气的效果。目的是评估心肺复苏初始阶段有效呼吸的次数。有效的通气在小儿心肺复苏中起着关键作用，因为大多数心脏骤停起源于缺氧。全球对于无反应、无呼吸儿童的初始复苏建议各不相同。欧洲复苏委员会（ERC）指南建议在开始胸外按压前进行五次呼吸。然而，这一建议历来基于专家共识，自2000年以来由于缺乏证据一直未变。本研究填补了这一已确认的知识空白，可能对改进复苏实践并最终改善患者结局产生影响。
医疗保健专业人员和非专业救援人员对两个模拟人进行了90秒的心肺复苏：5千克的婴儿模拟人和20千克的儿童模拟人。两组人员（医疗保健专业人员和非专业救援人员）在接受结构化心肺复苏培训前后都执行了该任务，并比较了培训前后通气的效果。医疗保健专业人员进行袋面罩通气；非专业救援人员进行调度员辅助的心肺复苏并口对口通气。
在婴儿模拟人上，培训前后达到主要结局的参与者数量分别为26人（65%）和医疗保健专业人员中的40人（100%），以及非专业救援人员中的28人（60.9%）和45人（97.8%）（两者改善均<0.001）。在儿童模拟人上，培训前后达到主要结局的参与者数量分别为医疗保健专业人员中的31人（77.5%）和32人（82.1%）（=0.77），以及非专业救援人员中的32人（82.1%）和37人（94.9%）（=0.005）。
这项基于模拟的研究是首次调查医疗保健专业人员和非专业救援人员在小儿心肺复苏期间的通气效果。通气是儿童高质量心肺复苏的一个重要方面。如2021年ERC指南所述，以初始呼吸开始小儿心肺复苏的概念是合理的。经过培训的医疗保健专业人员和提供调度员辅助心肺复苏的非专业救援人员能够为小儿模拟人提供有效的通气。鉴于模拟作为一种研究工具的独特实际应用，这些发现可为该领域的未来研究做出贡献，并填补已确认的关于复苏指南的知识空白。
