Abstract P161: Fatigue During Infant CPR: Are Guideline Changes Needed?
Introduction: The AHA’s 2005 CPR guidelines emphasized BLS skills by recommending to push hard and fast during chest compressions (CC). This may result in increased rescuer fatigue. Little is known about rescuer fatigue during two-thumb CC on infants. Hypothesis: Rescuer fatigue will develop prior to the recommended two-minute change interval during two-thumb infant CC.
Methods: Fifty BLS/PALS certified health care providers were tested using a metronome set at 100 bpm and the Laerdal HeartCode BLS baby manikin connected to a computer and software. Compression depth (CD), rate, and chest recoil were recorded as measures of objective fatigue (OF). Subjects reported subjective fatigue (SF) as arm/hand discomfort or a desire to change rescuers due to feelings of inadequate performance. After a coaching session, two scenarios were tested: Scenario 1 (S1): five minute cycle of continuous CC, and Scenario 2 (S2): five minutes of CC using a 15:2 compression ventilation ratio. An adequate CC was defined as ≥30 mm depth, reflecting 1/3 of the AP chest diameter, with adequate recoil as >90% (27mm). Subject variables included age, sex, height, weight, and glove size. Statistical analysis was done using ANCOVA and McNemar’s test. A p-value of ≤0.05 was considered significant.
Results: There was no significant decrease in CD, rate or chest recoil occurred during S1 as measures of OF. Mean CD during S1 demonstrated small incremental changes ending only one mm below the recommended depth of 1/3 – 1/2 the AP chest diameter. Conversely, the mean CD during S2 was acceptable throughout. SF developed at two minutes in 48% (24/50) of rescuers during S1 compared to only 22% (11/50) of rescuers during S2 (p value 0.002). At five minutes, 82% described fatigue in S1 vs. 66% in S2 (p value 0.021). Average recoil was <27 mm throughout both scenarios.
Conclusion: Continuous CC results in significantly more rapid development of SF despite no development of OF. Our results suggest that the current interval for rescuer change during two-thumb CC is appropriate despite development of SF. Incomplete chest recoil was present throughout both scenarios suggesting that feedback devices are needed to monitor full chest recoil during infant CPR.