Abstract 14125: Chest Compressions in a Neonatal Manikin Model Vary in Depth and are Modulated by Duration, Height and Gender: Potential Implications for Asphyxial Arrest When Ventilation is Minimized.
Persistent Bradycardia (PB) (Heart rate < 60 BPM) or asystole in the neonate is almost exclusively related to asphyxia. Experimental models indicate that ventilation alone can often restore the circulation with PB. Much debate has focused on timing of chest compressions (CC) to ventilation ranging from 3:1 (NRP), 15:2 (PALS), 30:2 (Infant CPR anytime, BLS). We previously showed that Two Thumb (TT) is superior to Two Finger (TF) irrespective of rate or location i.e. Floor, Radiant Warmer (RW) or Table. Little emphasis has focused on other potential modulators of CC.
Hypothesis. CC are inconsistently administered in neonatal CPR.
Objective Determine factors that may modulate CC when utilizing different ratios and location.
Methods. Review of prior studies comparing TT vs TF utilizing a 30: 2 ratio on the Floor, Table (height 30 inches) or RW (45 inches) and comparing 3:1, 5:1 and 15:2 ratios. Seventy-one studies of neonatal nurses, practitioners, fellows, pediatric residents were reanalyzed to determine consistency of CC depth over time (two minutes), and influence of location and gender on depth. The Laerdal neonatal manikin that continuously records compression depth was used. Data are downloaded for subsequent analysis. All sessions are video-recorded. Data were analyzed with unpaired and paired t tests.
Results Comparing initial and second 60 seconds of CC on the Floor (n=16), 12/16 providers with TF showed decrease in depth (p=0.001), 7/16 with TT showed decrease (NS); on the Table, 2/8 with TF showed decrease (NS), 5/8 with TT showed decrease (NS); the odds ratio of decrease in depth with TF on the Floor vs Table is 9 (CI 1.2, 63). On RW decrease in depth with both TF (5/10) and TT (5/10) (p=0.03) occurred. Males (n=5) vs females (n=27) achieved greater CC depth with TT when comparing ratios 3:1 i.e. 30.6 vs 26 mm(p=0.05) and 15:2 i.e. 33 vs 25mm (p=0.01).
Conclusions. Significant decay in CC depth occurs over time amongst providers influenced by location i.e. greater on Floor and RW vs Table particularly with TF. Gender is an important confounding variable with males achieving greater depth than females. Clinical implications of inconsistent CC are enormous especially with asphyxial cardiac arrest and reduced ventilation (e.g. 30:2 ratio) potentially limiting ROSC.
- © 2011 by American Heart Association, Inc.