Engineering an improvement in chest compression quality during simulated infant cardiopulmonary resuscitation

Cardiac arrests in the infant population result in undesirable rates of both mortality and morbidity. Cardiopulmonary resuscitation (CPR) is a potentially life-saving emergency procedure, performed during cardiac arrest, which aims to promote blood flow to vital organs through the provision of external chest compressions. To improve cardiac arrest outcomes, current international resuscitation guidelines emphasise the provision of high quality chest compressions during infant CPR. The principle goal of this research was to monitor, assess and engineer an improvement in the quality of chest compressions performed during simulated infant CPR. This was investigated in three experimental stages that evaluated: (i) the current quality of chest compressions performed on a commercially available manikin, (ii) the effects of a more ‘physiological’ infant CPR training manikin design on chest compression quality and thoracic over-compression and (iii) the effects of a real-time performance feedback program, developed to aid resuscitators in achieving high quality chest compressions. Performance was benchmarked against infant specific evidence based quality targets, with highly trained resuscitators achieving these targets in <9% of chest compressions during unassisted simulated infant CPR. The potential for thoracic over-compression in clinical practice was also highlighted when investigating the effects of the more ‘physiological’ infant CPR manikin design. The provision of real-time performance feedback considerably improved chest compression quality, with resuscitators achieving quality targets in >70% of all chest compressions. This research indicates that unassisted chest compressions rarely comply with evidence based quality targets during simulated infant CPR. Real-time performance feedback, in combination with a more ‘physiological’ infant CPR manikin, can considerably improve the quality of chest compressions performed by resuscitators. Importantly, these findings provide an excellent foundation for translation into clinical practice, particularly for assisting resuscitators in providing high quality chest compressions during infant CPR, which may contribute to improving the future outcomes of infant cardiac arrest