Jacek Smereka1, Lukasz Szarpak2, Antonio Rodríguez-Núñez3, Jerzy R Ladny4, Steve Leung5, Kurt Ruetzler6. 1. Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland. 2. Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland. Electronic address: lukasz.szarpak@gmail.com. 3. Paediatric Emergency and Critical Care Division, Clinical University Hospital, University of Santiago de Compostela, Santiago de Compostela, Institute of Research of Santiago [IDIS] and SAMID Network, Spain. 4. Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland. 5. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA. 6. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA.
Abstract
INTRODUCTION: Pediatric cardiac arrest is an uncommon but critical life-threatening event requiring effective cardiopulmonary resuscitation. High-quality cardio-pulmonary resuscitation (CPR) is essential, but is poorly performed, even by highly skilled healthcare providers. The recently described two-thumb chest compression technique (nTTT) consists of the two thumbs directed at the angle of 90° to the chest while having the fingers fist-clenched. This technique might facilitate adequate chest-compression depth, chest-compression rate and rate of full chest-pressure relief. METHODS:42 paramedics from the national Emergency Medical Service of Poland performed threesingle-rescuer CPR sessions for 10 minutes each. Each session was randomly assigned to the conventional two-thumb (TTHT), the conventional two-finger (TFT) or the nTTT. The manikin used for this study was connected with an arterial blood pressure measurement device and blood measurements were documented on a 10-seconds cycle. RESULTS: The nTTT provided significant higher systolic (82 vs. 30 vs. 41 mmHg). A statistically significant difference was noticed between nTTT and TFT (p<.001), nTTT and TTHT (p<0.001), TFT and TTHT (p=0.003). The median diastolic preassure using nTTT was 16 mmHg compared with 9 mmHg for TFT (p<0.001), and 9.5 mmHg for TTHT (p<0.001). Mean arterial pressure using distinct methods varied and amounted to 40 vs. 22. vs. 26 mmHg (nTTT vs. TFT vs. TTHT, respectively). A statistically significant difference was noticed between nTTT and TFT (p<0.001), nTTT and TTEHT (p<0.001), and TFT and TTHT (p<0.001). The highest median pulse pressure was obtained by the nTTT 67.5 mmHg. Pulse pressure was 31.5 mmHg in the TTHT and 24 mmHg in the TFT. The difference between TFT and TTHT (p=0.025), TFT and nTTT (p<0.001), as well as between TTHT and nTTT (p<0.001) were statistically significant. CONCLUSIONS: The new nTTT technique generated higher arterial blood pressures compared to established chest compression techniques using an infant manikin model, suggesting a more effective chest compression. Our results have important clinical implications as nTTT was simple to perform and could be widely taught to both healthcare professionals and bystanders. Whether this technique translates to improved outcomes over existing techniques needs further animal studies and subsequent human trials.
RCT Entities:
INTRODUCTION: Pediatric cardiac arrest is an uncommon but critical life-threatening event requiring effective cardiopulmonary resuscitation. High-quality cardio-pulmonary resuscitation (CPR) is essential, but is poorly performed, even by highly skilled healthcare providers. The recently described two-thumb chest compression technique (nTTT) consists of the two thumbs directed at the angle of 90° to the chest while having the fingers fist-clenched. This technique might facilitate adequate chest-compression depth, chest-compression rate and rate of full chest-pressure relief. METHODS: 42 paramedics from the national Emergency Medical Service of Poland performed three single-rescuer CPR sessions for 10 minutes each. Each session was randomly assigned to the conventional two-thumb (TTHT), the conventional two-finger (TFT) or the nTTT. The manikin used for this study was connected with an arterial blood pressure measurement device and blood measurements were documented on a 10-seconds cycle. RESULTS: The nTTT provided significant higher systolic (82 vs. 30 vs. 41 mmHg). A statistically significant difference was noticed between nTTT and TFT (p<.001), nTTT and TTHT (p<0.001), TFT and TTHT (p=0.003). The median diastolic preassure using nTTT was 16 mmHg compared with 9 mmHg for TFT (p<0.001), and 9.5 mmHg for TTHT (p<0.001). Mean arterial pressure using distinct methods varied and amounted to 40 vs. 22. vs. 26 mmHg (nTTT vs. TFT vs. TTHT, respectively). A statistically significant difference was noticed between nTTT and TFT (p<0.001), nTTT and TTEHT (p<0.001), and TFT and TTHT (p<0.001). The highest median pulse pressure was obtained by the nTTT 67.5 mmHg. Pulse pressure was 31.5 mmHg in the TTHT and 24 mmHg in the TFT. The difference between TFT and TTHT (p=0.025), TFT and nTTT (p<0.001), as well as between TTHT and nTTT (p<0.001) were statistically significant. CONCLUSIONS: The new nTTT technique generated higher arterial blood pressures compared to established chest compression techniques using an infant manikin model, suggesting a more effective chest compression. Our results have important clinical implications as nTTT was simple to perform and could be widely taught to both healthcare professionals and bystanders. Whether this technique translates to improved outcomes over existing techniques needs further animal studies and subsequent human trials.
Authors: Jacek Smereka; Łukasz Iskrzycki; Elżbieta Makomaska-Szaroszyk; Karol Bielski; Michael Frass; Oliver Robak; Kurt Ruetzler; Michael Czekajło; Antonio Rodríguez-Núnez; Jesús López-Herce; Łukasz Szarpak Journal: Cardiol J Date: 2018-10-19 Impact factor: 2.737
Authors: Jolanta Majer; Milosz J Jaguszewski; Michael Frass; Marcin Leskiewicz; Jacek Smereka; Jerzy R Ładny; Oliver Robak; Łukasz Szarpak Journal: Cardiol J Date: 2018-08-29 Impact factor: 2.737
Authors: Marek Malysz; Marek Dabrowski; Bernd W Böttiger; Jacek Smereka; Klaudia Kulak; Agnieszka Szarpak; Milosz Jaguszewski; Krzysztof J Filipiak; Jerzy R Ladny; Kurt Ruetzler; Lukasz Szarpak Journal: Cardiol J Date: 2020-05-18 Impact factor: 2.737
Authors: Filip Jaskiewicz; Dawid Kowalewski; Katarzyna Starosta; Marcin Cierniak; Dariusz Timler Journal: Medicine (Baltimore) Date: 2020-11-25 Impact factor: 1.889
Authors: Jacek Smereka; Lukasz Szarpak; Jerzy R Ladny; Antonio Rodriguez-Nunez; Kurt Ruetzler Journal: Front Pediatr Date: 2018-05-29 Impact factor: 3.418
Authors: Jerzy R Ladny; Jacek Smereka; Antonio Rodríguez-Núñez; Steve Leung; Kurt Ruetzler; Lukasz Szarpak Journal: Medicine (Baltimore) Date: 2018-02 Impact factor: 1.889