Ventilation efficacy during Paediatric Cardiopulmonary Resuscitation (PEDIVENT): Simulation-based Comparative Study

Background: To our knowledge, this is the first study concerning the effectiveness of 5 initial breaths and subsequent ventilation during paediatric resuscitation. The recommendations on initial resuscitation in unresponsive non-breathing children differ worldwide. Most cardiac arrests in children are secondary (hypoxic or asphyctic in origin) and ventilation during resuscitation is associated with better neurological outcomes. However, it is not clear whether the particular introduction sequence of paediatric resuscitation has any impact on the outcomes and if the effectiveness of ventilation could be improved by simulation based training. Methods: The aim of this prospective simulation-based comparative study was to evaluate the ventilation efficacy during paediatric cardiopulmonary resuscitation (CPR) provided by health care professionals (HCP) and lay rescuers (LR). The primary outcome was the number of effective breaths during 5 initial CPR breaths. The secondary outcomes were: sub-analysis of 2 first ventilation attempts, time to first effective ventilation, time to 5 and 2 effective breaths, number and percentage of 5 initial breath attempts with ideal, low and high volume, and time to the chest compressions initiation. All parameters were measured before and after structured simulation based training. HCPs and LRs performed 90 seconds of CPR on 2 mannequins: 5 kg Baby and 20 kg Junior. The HCPs provided bag-mask ventilation; LR performed dispatcher-assisted CPR with mouth-to-mouth ventilation. Results: Data were obtained from 40 HCPs and 46 LRs. Significant improvement in the number of effective ventilations before and after the training in Baby was in HCPs 26 (65%) vs. 40 (100%) and in LRs 28 (60.9%) vs. 45(97.8%), (both P˂0.001). In Junior the improvement was significant only in the LR group 32 (82.1%) vs. 37 LR (94.9%), P=0.005), but not in the HCPs group (31 HCPs before (77.5%) and 32 HCPs after structured training (82.1%), (P=0.77). Conclusion: The structured training improved the number of effective ventilation during simulated paediatric CPR performed by health care professionals and lay rescuers. Trial Registration: This study is registered at ClinicalTrials.gov (ID: NCT05345704)