Impact of Two Resuscitation Sequences on Alveolar Ventilation during the First Minute of Simulated Pediatric Cardiac Arrest: Randomized Cross-Over Trial

Abstract

The International Liaison Committee on Resuscitation regularly publishes a Consensus on Science with Treatment Recommendations, but guidelines can nevertheless differ when knowledge gaps persist. In case of pediatric cardiac arrest, the American Heart Association recommends following the adult resuscitation sequence, i.e., starting with chest compressions. Conversely, the European Resuscitation Council advocates the delivery of five initial rescue breaths before starting chest compressions. This was a superiority, randomized cross-over trial designed to determine the impact of these two resuscitation sequences on alveolar ventilation in a pediatric model of cardiac arrest. The primary outcome was alveolar ventilation during the first minute of resuscitation maneuvers according to the guidelines used. A total of 56 resuscitation sequences were recorded (four sequences per team of two participants). The ERC approach enabled higher alveolar ventilation volumes (370 mL [203−472] versus 276 mL [140−360], p < 0.001) at the cost of lower chest compression fractions (57% [54;64] vs. 66% [59;68], p < 0.001). Although statistically significant, the differences found in this simulation study may not be clinically relevant. Therefore, and because of the importance of overcoming barriers to resuscitation, advocating a pediatric-specific resuscitation algorithm may not be an appropriate strategy.

Keywords: alveolar ventilation; bag-valve-mask ventilation; cardiopulmonary resuscitation; chest compression fraction; paramedics; pediatric cardiac arrest; randomized trial; simulation study; study protocol.

Figure 1

Study sequence. Teams of two participants will first train on a manikin identical to the one used to collect data. After entering the study room, the first leader will pick an opaque, sealed envelope, and carry out two resuscitation sequences according to the allocation. Team members will then switch roles. The new leader will then pick another envelope and perform the two last resuscitation sequences accordingly.

Figure 2

Alveolar ventilation during the first minute of resuscitation.