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Resumen: Introducción: El uso de la ecografía ha demostrado mejorar los resultados de la canalización venosa central. Sin embargo, sus beneficios en la canalización arterial en niños no han sido claramente establecidos. El objetivo de este estudio fue evaluar el uso de la ecografía en la canalización arterial en la unidad de cuidados intensivos pediátricos (UCIP). Métodos: Estudio prospectivo multicéntrico en 18 UCIP en España durante un periodo de 6 meses. Se compararon los resultados de la canalización arterial ecoguiada (ECO) con la técnica tradicional basada en referencias anatómicas (REF) en cuanto a la tasa de éxito y las complicaciones inmediatas. Resultados: Se incluyeron 161 procedimientos en 128 pacientes (78 procedimientos en el grupo ECO y 83 en el grupo REF). La mediana (rango intercuartil) de edad y peso de los pacientes fueron 11 meses (2-52) y 10 kg (4-17), respectivamente; el 59,6% eran varones. La ecografía se utilizó preferentemente en las UCIP de mayor tamaño (número de camas 11 [8-16] vs 6 [4-10], p

Introduction: Ultrasound (US) guidance increases the success rate and decreases complications during central venous catheterisation (CVC). The benefits of US guidance in arterial catheterisation are less clear. The aim of this study is to compare the outcomes of US-guided arterial catheterisation with the traditional landmark (LM) technique in critically ill children. Methods: A prospective multicentre study was carried out in 18 Paediatric Intensive Care units in Spain during a 6-months period. Ultrasound guided and landmark techniques were compared in terms of cannulation technical success and immediate mechanical complications. Results: A total of 161 procedures were performed on 128 patients (78 procedures in the US group and 83 in the LM groups).. The median (interquartile range) age and weight of the cohort was 11 months (2–52), and 10 kg (4–17) respectively. More than half (59.6%) were male. US was used mainly in high-volume-high-complexity hospitals (cardiac surgery program 76.9% vs. 25.6%, P

Resumen: Introducción: Los profesores pueden tener un papel esencial en la formación en reanimación cardiopulmonar básica (RCP-B) de los escolares. Sin embargo, se dispone de pocos datos acerca de la capacidad de aprendizaje de la RCP-B por estos profesionales. Objetivo: Evaluar de forma cuantitativa la calidad de la RCP-B realizada por profesores de colegios, tras un programa formativo breve y sencillo. Material y métodos: Se realizó un estudio cuasiexperimental sin grupo control en el que participaron profesores de cuatro centros concertados de educación infantil, primaria y secundaria, en 3 fases: 1.a de evaluación de conocimientos, 2.a de formación en RCP-B y 3.a de evaluación de las competencias. La formación consistió en una sesión teórica de 40 min y otra práctica de 80 min, con ayuda de maniquís con sistema de retroalimentación de la calidad de las compresiones torácicas. Resultados: Se incluyeron 81 profesores (60,5% mujeres). Tras la formación, el porcentaje de sujetos que realizaron bien la secuencia de RCP-B aumentó de 1,2% a 46% (p < 0,001). La calidad de las compresiones torácicas también mejoró significativamente en cuanto a: posición correcta de las manos (97,6 vs. 72,3%; p < 0,001), profundidad media (48,1 vs. 38,8 mm; p < 0,001), porcentaje que alcanzó la profundidad recomendada (46,5 vs. 21,5%; p < 0,001), porcentaje de descompresiones adecuadas (78,7 vs. 61,2%; p < 0,05), y porcentaje de compresiones realizadas al ritmo recomendado (64,2 vs. 26,9%; p < 0,001). Conclusiones: Tras un programa sencillo y breve, los profesores de colegios concertados son capaces de realizar la secuencia de RCP-B y aplicar las compresiones torácicas con una calidad comparable a la de colectivos con el deber de asistir a una víctima de una parada cardíaca. La comprobación de la capacidad de estos profesionales para hacer una RCP-B de calidad es el primer requisito para que puedan implicarse en la enseñanza de la RCP-B a los escolares. Abstract: Introduction: Teachers may have an essential role in basic life support (BLS) training in schoolchildren. However, few data are available about their BLS learning abilities. Aim: To quantitatively assess the quality of BLS when performed by school teachers after a brief and simple training program. Materials and methods: A quasi-experimental study with no control group, and involving primary and secondary education teachers from four privately managed and public funded schools was conducted in 3 stages: 1 st. A knowledge test, 2 nd: BLS training, and 3 rd: Performance test. Training included a 40 minutes lecture and 80 minutes hands-on session with the help feedback on the quality of the chest compressions. Results: A total of 81 teachers were included, of which 60.5% were women. After training, the percentage of subjects able to perform the BLS sequence rose from 1.2% to 46% (P

Introduction: Teachers may have an essential role in basic life support (BLS) training in schoolchildren. However, few data are available about their BLS learning abilities. Aim: To quantitatively assess the quality of BLS when performed by school teachers after a brief and simple training program. Materials and methods: A quasi-experimental study with no control group and involving primary and secondary education teachers from four privately managed and public funded schools was conducted in three stages: (1) a knowledge test, (2) BLS training, and (3) performance test. Training included a 40-min lecture and 80-min hands-on session with the help of feedback on the quality of the chest compressions. Results: A total of 81 teachers were included, of which 60.5% were women. After training, the percentage of subjects able to perform the BLS sequence rose from 1.2 to 46% (p

Aim: Recent emergence of airway clearance devices (ACDs) as a treatment alternative for foreign body airway obstructions (FBAO) lacks substantial evidence on efficacy and safety. This study aimed to assess pediatric residents’ knowledge and skills in managing a simulated pediatric choking scenario, adhering to recommended protocols, and using LifeVac© and DeCHOKER© ACDs. Methods: Randomized controlled simulation trial, in which 60 pediatric residents from 3 different hospitals (median age 27 [25.0–29.9]; 76.7% female) were asked to solve an unannounced pediatric simulated choking scenario using three interventions to manage (randomized order): 1) following the recommended protocol of the European Resuscitation Council (encouraging to cough or combination of back blows and abdominal thrusts); 2) using LifeVac©; and 3) using DeCHOKER©. A Little Anne QCPR™ manikin (Laerdal Medical) was used. The variable compliance rate (%) was calculated according to the correct/incorrect execution of the steps constituting the proper actions for each test. Results: Participants demonstrated a correct compliance rate only ranging between 50–75% in following the recommended protocol for managing partial FBAO progressing to severe. Despite unfamiliarity with the ACDs, pediatric residents achieved rates between 75% and 100%, with no significant difference noted between the two devices (p = 0.173). Both scenarios were successfully resolved in under a minute, with LifeVac© demonstrating a significantly shorter response time compared to DeCHOKER© (39.2 [30.4–49.1] vs. 45.1s [33.7–59.2], p = 0.010). Conclusions: Only a minority of pediatric residents were able to adhere to the recommended FBAO protocol, whereas 70% of them were able to adequately use the ACDs. However, since a significant proportion could not, it seems that ACDs themselves do not address all issues.

(1) Objective: The objective was to evaluate the quality of cardiopulmonary resuscitation (CPR, chest compressions and ventilations) when performed by a lone first responder on an infant victim via the over-the-head technique (OTH) with bag-mask ventilation in comparison with the standard lateral technique (LAT) position. (2) Methods: A randomized simulation crossover study in a baby manikin was conducted. A total of 28 first responders performed each of the techniques in two separate CPR tests (15:2 chest compressions:ventilations ratio), each lasting 5 min with a 15 min resting period. Quality CPR parameters were assessed using an app connected to the manikin. Those variables were related to chest compressions (CC: depth, rate, and correct CC point) and ventilation (number of effective ventilations). Additional variables included perceptions of the ease of execution of CPR. (3) Results: The median global CPR quality (integrated CC + V) was 82% with OTH and 79% with LAT (p = 0.94), whilst the CC quality was 88% with OTH and 80% with LAT (p = 0.67), and ventilation quality was 85% with OTH and 85% with LAT (p = 0.98). Correct chest release was significantly better with OTH (OTH: 92% vs. LAT: 62%, p < 0.001). There were no statistically significant differences in the remaining variables. Ease of execution perceptions favored the use of LAT over OTH. (4) Conclusions: Chest compressions and ventilations can be performed with similar quality in an infant manikin by lifeguards both with the standard recommended position (LAT) and the alternative OTH. This option could give some advantages in terms of optimal chest release between compressions. Our results should encourage the assessment of OTH in some selected cases and situations as when a lone rescuer is present and/or there are physical conditions that could impede the lateral rescue position.

Introduction: Extracorporeal membrane oxygenation (ECMO) improves infant survival outcomes after cardiac arrest. If not feasible at the place of arrest, victims must be transported to a suitable room to perform ECMO while effective, sustained resuscitation maneuvers are performed. The objective of this simulation study was to compare the quality of resuscitation maneuvers on an infant manikin during simulated transfer on a stretcher (stretcher test) within a hospital versus standard stationary resuscitation maneuvers (control test). Methods: A total of 26 nursing students participated in a randomized crossover study. In pairs, the rescuers performed two 2 min tests, consisting of five rescue breaths followed by cycles of 15 compressions and two breaths. The analysis focused on CPR variables (chest compression and ventilation), CPR quality, the rate of perceived exertion and the distance covered. Results: No differences were observed in the chest compression quality variable (82 ± 10% versus 84 ± 11%, p = 0.15). However, significantly worse values were observed in the test for ventilation quality on the stretcher (18 ± 14%) compared to the control test (28 ± 21%), with a value of p = 0.030. Therefore, the overall CPR quality was worse in the stretcher test (50 ± 9%) than in the control test (56 ± 13%) (p = 0.025). Conclusions: Infant CPR performed by nursing students while walking alongside a moving stretcher is possible. However, in this model, the global CPR quality is less due to the low ventilation quality.

Abstract Background The brand-new anti-choking devices (LifeVac® and DeCHOKER®) have been recently developed to treat Foreign Body Airway Obstruction (FBAO). However, the scientific evidence around these devices that are available to the public is limited. Therefore, this study aimed to assess the ability to use the LifeVac® and DeCHOKER® devices in an adult FBAO simulated scenario, by untrained health science students. Methods Forty-three health science students were asked to solve an FBAO event in three simulated scenarios: 1) using the LifeVac®, 2) using the DeCHOKER®, and 3) following the recommendations of the current FBAO protocol. A simulation-based assessment was used to analyze the correct compliance rate in the three scenarios based on the correct execution of the required steps, and the time it took to complete each one. Results Participants achieved correct compliance rates between 80–100%, similar in both devices (p = 0.192). Overall test times were significantly shorter with LifeVac® than DeCHOKER® device (36.6 sec. [31.9–44.4] vs. 50.4 s [36.7–66.9], p

Resumen: Introducción: el ideario popular, la diseminación a través de redes sociales o la «costumbre» han propiciado diversos mitos sobre el ahogamiento y los incidentes acuáticos que no están basados en evidencias y pueden tener efectos colaterales o limitan la comprensión de este fenómeno. El objetivo de este trabajo ha sido analizar el origen de los mitos más frecuentes relacionados con los incidentes acuáticos y ofrecer una perspectiva científica para su refutación. Materiales y métodos: doce expertos de las Ciencias de la Salud mediante un grupo nominal realizaron el cribado de conceptos en 3 fases: 1ª revisión literatura científica en PubMed en la que se abordasen conceptos erróneos u obsoletos relacionados a los incidentes en entornos acuáticos, 2ª el grupo elaboró un listado de 16 ítems susceptibles de analizar y 3ª se seleccionaron por consenso los mitos considerados más relevantes. Resultados: mediante consenso de expertos y las evidencias disponibles, 10 ítems fueron identificados como potenciales generadores de conceptos erróneos o mitos: el «corte de digestión», el uso de flotadores para prevenir el ahogamiento, hiperventilar antes de bucear, las implicaciones de la bandera roja en las playas, el proceso de ahogamiento, la principal función de los socorristas, orinar sobre picaduras de medusa, la terminología sobre ahogamiento y la reanimación de ahogados. Conclusión: en el ámbito del ahogamiento se sigue utilizando terminología obsoleta y existen creencias populares erróneas que deberían ser actualizadas y desmitificadas, ya que esto podría contribuir a disminuir la incidencia del ahogamiento y sus secuelas. Abstract: Introduction: Popular ideology, dissemination by social networks or the “custom” have fostered numerous myths about drowning and aquatic incidents that are not based on evidence and may be harmful or limit the understanding of this phenomenon. The aim of this paper is to analyze the origin of the most frequent myths related to aquatic incidents and to offer a scientific perspective for their refutation. Materials and methods: Twelve experts in the health sciences by means of a nominal group carried out the screening of concepts in three phases: 1st review of scientific literature in PUBMED in which erroneous or obsolete concepts related to incidents in aquatic environments were addressed, 2nd phase the nominal group elaborated an initial list of 16 items to be analyzed, 3rd phase the final list was refined to 1 by universal consensus of the nominal group. Results: Through expert consensus and available evidence, ten items were identified as potential generators of misconceptions or myths: the “digestion cut-off”, the use of floats to prevent drowning, hyperventilating before diving, the implications of the red flag on beaches, the drowning process, the main role of lifeguards, urinating on jellyfish stings, drowning terminology, and resuscitation of drowned persons. Conclusion: In the field of drowning, obsolete terminology continues to be used and there are erroneous popular beliefs that should be updated and demystified, as this could contribute to reduce the incidence of drowning and its sequelae.

Aim: To implement small methodological changes in basic life support (BLS) training to reduce unnecessary pauses during automated external defibrillator (AED) use. Methods: One hundred and two university students with no BLS knowledge were randomly allocated into three groups (control and 2 experimental groups). Both experimental groups received a two-hour BLS training. While the contents were identical in both groups, in one of them the reduction of no-flow time was focused on (focused no-flow group). The control group did not receive any training. Finally, all of them were evaluated in the same out-of-hospital cardiac arrest simulated scenario. The primary endpoint was the compression fraction. Results: Results from 78 participants were analysed (control group: 19; traditional group: 30; focused no-flow group: 29). The focused no-flow group achieved higher percentages of compression fraction (median: 56.0, interquartile rank (IQR): 53.5–58.5) than the traditional group (44.0, IQR: 42.0–47.0) and control group (52.0, IQR: 43.0–58.0) in the complete scenario. Participants from the control group performed compression-only cardiopulmonary resuscitation (CPR), while the other groups performed compression-ventilation CPR. CPR fraction was calculated, showing the fraction of time in which the participants were performing resuscitation manoeuvres. In this case, the focused no-flow group reached higher percentages of CPR fraction (77.6, IQR: 74.4–82.4) than the traditional group (61.9, IQR: 59.3–68.1) and the control group (52.0, IQR: 43.0–58.0). Conclusions: Laypeople having automated external defibrillation training focused on acting in anticipation of the AED prompts contributed to a reduction in chest compression pauses during an OHCA simulated scenario.

Introduction: Laypeople should be trained in basic life support and traditional and innovative methodologies may help to obtain this goal. However, there is a knowledge gap about the ideal basic life support training methods. Smart glasses could have a role facilitating laypeople learning of basic life support. Aim: To analyze the potential impact on basic life support learning of a very brief training supported by smart glasses video communication. Methods: Twelve laypeople were basic life support tele-trained by means of smart glasses by an instructor in this pilot study. During training (assisted trough smart glasses) and after the training (unassisted) participants’ performance and quality of basic life support and automated external defibrillation procedure were assessed on a standardized simulated scenario. Results: After the training all participants were able to deliver good quality basic life support, with results comparable to those obtained when real time remotely guided by the instructor through the smart glasses. Mean chest compression rate was significantly higher when not guided (113 /min vs. 103 /min, p = 0.001). When not assisted, the participants spent less time delivering the sequential basic life support steps than when assisted while training. Conclusions: A very brief remote training supported by instructor and smart glasses seems to be an effective educational method that could facilitate basic life support learning by laypeople. This technology could be considered in cases where instructors are not locally available or in general in remote areas, providing basic internet connection is available. Smart glasses could also be useful for laypeople rolling-refreshers.

Drowning remains a prominent global pediatric health concern, necessitating preventive measures such as educational initiatives for children and caregivers. In this study, we aimed to assess the feasibility and educational effectiveness of an interactive puppet show centered on teaching water safety to children and parents. A 30 min original theater performance, featuring two actors and three puppets (a girl, a crab, and a lifeguard), was conducted. Subsequently, 185 children (aged 4 to 8) and their 160 parents (134 mothers and 26 fathers) participated in this quasi-experimental study. Pre- and post-show tests were administered to evaluate knowledge and behaviors regarding aquatic environments. Prior to the puppet show, 78% of the children exhibited basic aquatic competency. Only 33% considered swimming alone risky. Following the intervention, 81.6% of the children changed their perception of the risks of solo beach activities, showing improved knowledge regarding contacting an emergency number (from 63.2% to 98.9%, p < 0.001). The intervention increased parents’ intention to visit lifeguard-patrolled beaches and improved their CPR knowledge with regard to drowning victims by 58.8%. In conclusion, a drowning prevention puppet show positively impacted children and parents, potentially enhancing safety behaviors during water-related leisure activities, warranting its consideration part of comprehensive drowning prevention strategies.

Resumen: Objetivo: Valorar cuantitativamente la capacidad de aprendizaje en soporte vital básico (teórica y práctica) de escolares de 8-12 años con un programa de formación adaptado a las escuelas. Material y métodos: Estudio cuasiexperimental con una muestra de conveniencia de 567 alumnos de 3° y 5° de Educación Primaria y 1° de Educación Secundaria Obligatoria, de 3 colegios concertados de Galicia, que recibieron 2 h (una teórica y otra práctica) de formación en soporte vital básico por parte de sus profesores de Educación Física integrada en el programa escolar. Los niños fueron evaluados mediante un test teórico y una prueba práctica que midió la calidad de las compresiones torácicas y valoró la secuencia de soporte vital básico. Resultados: El nivel de conocimientos aumentó respecto al basal y fue mayor en los alumnos de cursos superiores (p

Objective: To quantitatively assess the learning capacity of school children aged between 8-12 years in basic life support (theory and practice) after a feasible school training programme. Material and methods: Quasi-experimental study with a convenience sample of 567 pupils in 3rd and 5th year of Primary Education, and first year of Compulsory Secondary Education, from 3 public schools in Galicia. They received 2h (one theoretical and another practical) of basic life support training by their Physical Education teachers, as part of the school program. The children were evaluated by a theoretical test and a practical skill test that measured the quality of chest compressions, and assessed the performance of the basic life support sequence. Results: The level of knowledge increased with respect to the baseline, and was higher in the higher grades (P

The aim of this study was to compare the quality of standard infant CPR with CPR in motion (i.e., walking and running) via performing maneuvers and evacuating the infant from a beach. Thirteen trained lifeguards participated in a randomized crossover study. Each rescuer individually performed three tests of 2 min each. Five rescue breaths and cycles of 30 chest compressions followed by two breaths were performed. Mouth-to-mouth-and-nose ventilation was carried out, and chest compressions were performed using the two-fingers technique. The manikin was carried on the rescuer’s forearm with the head in the distal position. The analysis variables included compression, ventilation, and CPR quality variables, as well as physiological and effort parameters. Significantly lower compression quality values were obtained in running CPR versus standard CPR (53% ± 14% versus 63% ± 15%; p = 0.045). No significant differences were observed in ventilation or CPR quality. In conclusion, lifeguards in good physical condition can perform simulated infant CPR of a similar quality to that of CPR carried out on a victim who is lying down in a fixed position.

Aim: We conducted a systematic review and meta-analysis to answer the question: Does the implementation of Paediatric Early Warning Systems (PEWS) in the hospital setting reduce mortality, cardiopulmonary arrests, unplanned codes and critical deterioration events among children, as compared to usual care without PEWS? Methods: We conducted a comprehensive search using Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and Web of Science. We included studies published between January 2006 and April 2022 on children

Resumen: Objetivo: Validar el contenido y la adecuación del material desplegable «Rescube» con la información adaptada de la «cadena de supervivencia». Material y métodos: La investigación fue realizada en tres etapas: 1) desarrollo del material desplegable por 7 profesionales, utilizando los pasos de un método Delphi; 2) evaluación del material desplegable por 11 expertos mediante una escala Likert y posterior cálculo de índices de validez de contenido, y 3) estudio piloto en dos grupos de niños entre 5 y 8 años: grupo Rescube (GR; n = 60) y grupo Tradicional (GT; n = 60). El GR recibió la formación con el Rescube y un peluche, mientras que en el GT se utilizó un maniquí pediátrico. Los participantes fueron evaluados individualmente antes de la formación, y una semana y un mes después. Resultados: Todos los índices calculados de validez de contenido superan el punto de corte aconsejado para los análisis con más de 9 expertos (≥ 0,80). Los resultados de aprendizaje de los niños fueron positivos, observándose porcentajes iguales o superiores al 80% en todas las variables registradas tras una semana e iguales o superiores al 67% tras un mes. No se observaron diferencias significativas entre los grupos. Conclusión: La herramienta docente basada en imágenes infantiles en un cubo desplegable Rescube es válida y útil para formar a los escolares más jóvenes en la «cadena de supervivencia». Abstract: Purpose: To validate the content and adequacy of the «Rescube» training material that includes adapted information from the chain of survival. Material and methods: The study included three steps: (i) material development by 7 experts, following Delphi method; (ii) assessment of training material by 11 experts by means of a Likert score and calculation of content validity; and (iii) pilot study in two groups of 5 to 8 years-old: Rescube group (GR; n = 60) and Traditional group (GT; n = 60). GR was trained with Rescube and a Teddy bear, while GT was traditionally trained with a pediatric manikin. Participants were individually assessed at baseline, and one week and one month after training. Results: All content validity indexes calculated are above the recommended cut-off for analysis with more than 9 experts (≥ 0,80). Children's learning results were positive, with percentages equal or higher than 80% in all registered variables at the first (one week) evaluation and equal or higher than 67% when evaluated one month after training. No significant differences were detected between groups. Conclusion: The Rescube training tool based on infantile pictures is valid and useful to train young schoolchildren in the chain of survival.

Purpose: To validate the content and adequacy of the «Rescube» training material that includes adapted information from the chain of survival. Material and methods: The study included three steps: (i) material development by 7 experts, following Delphi method; (ii) assessment of training material by 11 experts by means of a Likert score and calculation of content validity; and (iii) pilot study in two groups of 5–8 years-old: Rescube group (GR; n = 60) and Traditional group (GT; n = 60). GR was trained with Rescube and a Teddy bear, while GT was traditionally trained with a pediatric manikin. Participants were individually assessed at baseline, and one week and one month after training. Results: All content validity indexes calculated are above the recommended cut-off for analysis with more than 9 experts (≥0,80). Children’s learning results were positive, with percentages equal or higher than 80% in all registered variables at the first (one week) evaluation and equal or higher than 67% when evaluated one month after training. No significant differences were detected between groups. Conclusion: The Rescube training tool based on infantile pictures is valid and useful to train young schoolchildren in the chain of survival. Resumen: Objetivo: Validar el contenido y la adecuación del material desplegable «Rescube» con la información adaptada de la «cadena de supervivencia». Material y métodos: La investigación fue realizada en tres etapas: 1) Desarrollo del material desplegable por 7 profesionales, utilizando los pasos de un método Delphi; 2) Evaluación del material desplegable por 11 expertos mediante una escala Likert y posterior cálculo de índices de validez de contenido, y 3) estudio piloto en dos grupos de niños entre 5 y 8 años: grupo Rescube (GR; n = 60) y grupo Tradicional (GT; n = 60). El GR recibió la formación con el Rescube y un peluche mientras que en el GT se utilizó un maniquí pediátrico. Los participantes fueron evaluados individualmente antes de la formación, y una semana y un mes después. Resultados: Todos los índices calculados de validez de contenido superan el punto de corte aconsejado para los análisis con más de 9 expertos (≥0,80). Los resultados de aprendizaje de los niños fueron positivos, observándose porcentajes iguales o superiores al 80% en todas las variables registradas tras una semana e iguales o superiores al 67% tras un mes. No se observaron diferencias significativas entre los grupos. Conclusión: La herramienta docente basada en imágenes infantiles en un cubo desplegable Rescube es válida y útil para formar a los escolares más jóvenes en la «cadena de supervivencia».

Resumen: Objetivo: El objetivo de este estudio fue evaluar los conocimientos en primeros auxilios (PP. AA.) de profesorado de educación infantil y primaria y de progenitores de niños en estas etapas educativas. Métodos: Se utilizó un cuestionario ya usado en publicaciones previas compuesto por 4 secciones: 1) información general; 2) valoración de los conocimientos en PP. AA.; 3) preguntas sobre PP. AA., y 4) consideraciones sobre los PP. AA. El cuestionario fue enviado a diferentes centros educativos de la Comunidad Autónoma de Galicia vía correo electrónico en formato Google Formularios. Se les solicitaba a los centros que los enviasen al claustro de profesores y progenitores del alumnado para su cumplimentación. Resultados: El número total de cuestionarios analizados fue 470 (177 docentes; 242 progenitores; 51 docentes con hijos). Doscientos sesenta y ocho (57%) participantes afirmaron poseer conocimientos en PP. AA. En el caso de los docentes, se encontró asociación entre tener formación e impartir estos contenidos en el aula (p = 0,008). Solamente 4 participantes supieron ordenar la secuencia de soporte vital básico y ninguno respondió correctamente a las respuestas sobre reanimación cardiopulmonar. Más del 95% de la muestra consideraba necesario incluir formación en PP. AA. en el currículo escolar y en los planes de estudios de carreras destinadas a formar al profesorado. Conclusiones: La mayoría de los docentes y progenitores tenían formación en PP. AA., aunque no supieron responder correctamente a preguntas relacionadas con el soporte vital básico. Sería recomendable la inclusión de estos contenidos en los currículos escolares, pero para ello sería preciso formar previamente al profesorado. La inclusión de estos contenidos en los planes de estudios universitarios debería ser una medida a tener en cuenta. Abstract: Objective: The aim of this study was to evaluate the knowledge of first aid (FA) of primary and pre-school teachers and the parents of children in these education stages. Methods: A questionnaire already used in previous publications was employed and consisted of 4 sections: 1) general information; 2) assessment of FA knowledge; 3) questions about FA, and 4) attitudes about FA. The questionnaire was sent by e-mail in Google Forms format to different education centres of the Autonomous Community of Galicia. The centres were asked to send them to the school staff and parents of the pupils so that they could be completed. Results: A total of 470 questionnaires were analysed (177 teachers; 242 parents and 51 teachers with children). More than half (268, 57%) of the participants stated to have knowledge of FA. In the case of the teachers, a relationship was found between having this information and teaching these contained in the classroom (P = .008). Only 4 participants managed to arrange the basic life support sequence, and none of them correctly answered the questions on cardiopulmonary resuscitation. More than 95% of the sample considered it necessary to include FA in the school curriculum and in the study plans of degrees destined for teacher training. Conclusions: The majority of teachers and parents had training in FA, although none of them responded correctly to the questions related to basic life support. The inclusion of these contents in school curricula would be recommendable, but it requires training the teaching staff beforehand. The inclusion of these contents in university study plans should be a measure to take into account.

Objective: The aim of this study was to evaluate the knowledge of first aid (FA) of primary and pre-school teachers and the parents of children in these education stages. Methods: A questionnaire already used in previous publications was employed and consisted of 4 sections: (1) general information; (2) assessment of FA knowledge; (3) questions about FA, and (4) attitudes about FA. The questionnaire was sent by e-mail in Google Forms format to different education centres of the Autonomous Community of Galicia. The centres were asked to send them to the school staff and parents of the pupils so that they could be completed. Results: A total of 470 questionnaires were analysed (177 teachers; 242 parents and 51 teachers with children). More than half (268, 57%) of the participants stated to have knowledge of FA. In the case of the school teachers, associations were found between having undertaken some kind of FA training and teaching these contents (P = .008). Only 4 participants were able to put in the correct order the steps of the basic life support sequence, and nobody answered correctly all the questions about cardiopulmonary resuscitation. More than 95% of the sample were in favour to include FA in the school curriculum and in the study plans of university degrees aimed to train school/high school teachers. Conclusions: The majority of teachers and parents had training in FA, although they did not respond correctly to the questions related to basic life support. The inclusion of these contents in school curricula would be recommendable, but it would require training of the teaching staff beforehand. The inclusion of these contents in university study plans should be a measure to take into account. Resumen: Objetivo: El objetivo de este estudio fue evaluar los conocimientos en primeros auxilios (PP. AA.) de profesorado de educación infantil y primaria y de progenitores de niños en estas etapas educativas. Métodos: Se utilizó un cuestionario ya usado en publicaciones previas compuesto por 4 secciones: 1) información general; 2) valoración de los conocimientos en PP. AA.; 3) preguntas sobre PP. AA., y 4) consideraciones sobre los PP. AA. El cuestionario fue enviado a diferentes centros educativos de la Comunidad Autónoma de Galicia vía correo electrónico en formato Google Formularios. Se les solicitaba a los centros que los enviasen al claustro de profesores y progenitores del alumnado para su cumplimentación. Resultados: El número total de cuestionarios analizados fue 470 (177 docentes; 242 progenitores; 51 docentes con hijos). Doscientos sesenta y ocho (57%) participantes afirmaron poseer conocimientos en PP. AA. En el caso de los docentes, se encontró asociación entre tener formación e impartir estos contenidos en el aula (p = 0,008). Solamente 4 participantes supieron ordenar la secuencia de soporte vital básico y ninguno respondió correctamente a a todas las preguntas sobre reanimación cardiopulmonar. Más del 95% de la muestra consideraba necesario incluir formación en PP. AA. En el currículo escolar y en los planes de estudios de carreras destinadas a formar al profesorado. Conclusiones: La mayoría de los docentes y progenitores tenían formación en PP. AA., aunque no supieron responder correctamente a preguntas relacionadas con el soporte vital básico. Sería recomendable la inclusión de estos contenidos en los currículos escolares, pero para ello sería preciso formar previamente al profesorado. La inclusión de estos contenidos en los planes de estudios universitarios debería ser una medida a tener en cuenta.

Abstract Background Post-extubation upper airway obstruction (UAO) is a frequent complication causing stridor and respiratory distress, which occasionally require reintubation, thereby increasing morbidity and mortality rates. Contradictory results have been obtained in studies assessing the effectiveness of steroids in preventing post-extubation UAO, and the available evidence is limited. We designed a multicentric randomized, placebo-controlled study to explore the effectiveness of dexamethasone in preventing post-extubation UAO in children. Methods A multicentric, prospective, double-blind, randomized, placebo-controlled, phase IV clinical trial has been designed. The sample will include pediatric patients who are between 1 month and 16 years of age and who have been intubated for more than 48 h. Patients who have airway disorders or who have received steroids within the previous seven days will be excluded. Patients will be randomly assigned to receive either placebo or a therapy with dexamethasone 0.25 mg/kg every 6 h to be started 6 to 12 h prior to extubation (to a total of four doses). Randomization will be performed at a 1:1 ratio. Follow-up of patients will be carried out for 48 h after extubation. The main objective of this study is to access the reduction in the incidence of moderate to severe UAO symptoms following extubation. Secondary objectives include assessing the decrease in the incidence of reintubation, evaluating the use of additional therapies for UAO, and monitoring potential side effects of dexamethasone. Discussion The results of this study will contribute to the existing evidence on prophylaxis for post-extubation airway obstruction. Trial registration EudraCT identifier: 2009–016596-30 . Registered on May 11, 2010.

Resumen: Introducción: El uso de videos parece ser un buen recurso para la difusión de las técnicas de reanimación cardiopulmonar (RCP) entre jóvenes y adolescentes. Objetivo: Nuestro objetivo ha sido evaluar el efecto de la creación y difusión de un video formativo en técnicas de RCP y uso del desfibrilador semiautomático en un equipo de fútbol-sala de adolescentes. Material y métodos: Se realizó un estudio prospectivo, analítico y observacional con una muestra de 65 jugadores (entre 12 y 33 años). En primer lugar se evaluaron los conocimientos sobre soporte vital básico con un cuestionario. Posteriormente se divulgó un video hecho ad hoc por medio de redes sociales durante una semana. A continuación un total de 52 sujetos se dividieron en grupo experimental, que vieron el video, y grupo control. Ambos fueron evaluados con un test estandarizado. Resultados: El 55% de la muestra inicial refiere no tener conocimientos y el 81% no sabe cómo usar un desfibrilador semiautomático. Tras la difusión del video, encontramos diferencias estadísticamente significativas entre ambos grupos en cuanto a apertura de vía aérea, profundidad y número de compresiones correctas, mejorando por tanto la calidad de RCP. En cuanto al desfibrilador semiautomático, la descarga efectiva se realiza de media en 85 seg desde la entrega del desfibrilador. Conclusiones: Podemos concluir que la visualización de un video breve mejora la capacidad de respuesta ante una parada cardiorrespiratoria y la calidad de la RCP. Abstract: Introduction: Using videos seems to be a good option to share cardiopulmonary resuscitation (CPR) techniques. Aim: Our aim was to evaluate the learning effect of viewing a video about why and how to do CPR in young footballers, as well as on how to use an automatic external defibrillator. Material and methods: A prospective, analytical and observational study was conducted that included 65 young footballers (aged between 12 and 33 years old). First of all, basic life support knowledge was assessed using a questionnaire. After that, a video made ad hoc for this study was shared on the social media for a week. Then, 52 of the participants were split into the experimental group (who watched the video), and a control group. Both groups were evaluated using a standardised test scenario. Results: Fifty five per cent of the sample did not have sufficient knowledge, and 81% said that they did not know how to use an automatic external defibrillator. After the video release, a statistical difference was found between both groups in terms of airway opening, depth and correct compressions, thus improving overall CPR quality. The mean time to deliver an effective shock with the automatic external defibrillator was 85 seconds. Conclusion: In conclusion, watching a brief video improves the responsiveness in a cardiac arrest and the CPR quality. Palabras clave: Video, Adolescentes, Parada cardíaca, Reanimación cardiopulmonar, Cadena de supervivencia, Soporte vital básico, Formación, Keywords: Video, Teenagers, Cardiac arrest, Cardiopulmonary resuscitation, Chain of survival, Basic life support, Training

Background: Analgosedation (AS) assessment using clinical scales is crucial to follow the international recommendations about analgosedation. The Analgosedation workgroup of the Spanish Society of Pediatric Intensive Care (SECIP) carried out two surveys in 2008 and 2015, which verified the gap in analgosedation assessment in Spanish pediatric intensive care unit (PICUs). The objective of the study was to analyze how analgosedation assessment by clinical scales changed after a multicenter intervention program.Methods: This is a multicenter pre–post study comparing the use of sedation, analgesia, withdrawal, and delirium scales before and after the MONISEDA project. Results were also compared with a control group formed by non-participating units. A survey about analgosedation management and monitoring was filled out before (year 2015) and after (year 2020) the implementation of the MONISEDA project in 2016. Results were compared not only between those periods of time but also between participant and non-participant PICUs in the MONISEDA project (M-group and non-M group, respectively). Data related to analgosedation of all patients admitted to a MONISEDA-participant PICU were also collected for 2 months.Results: Fifteen Spanish PICUs were enrolled in the MONISEDA project and another 15 non-participant PICUs formed the control group. In the M-group, the number of PICUs with a written analgosedation protocol increased from 53 to 100% (p = 0.003) and withdrawal protocol from 53 to 100% (p = 0.003), whereas in the non-M group, the written AS protocol increased from 80 to 87% and the withdrawal protocol stayed on 80%. The number of PICUs with an analgosedation team increased from 7 to 47% in the M-group (p = 0.01) and from 13 to 33% in the non-M group (p = 0.25). In the M-group, routine use of analgosedation clinical scales increased from 7 to 100% (p < 0.001), withdrawal scales from 7% to 86% (p = 0.001), and delirium scales from 7 to 33% (p = 0.125). In the non-M group, the number of PICUs using AS scales increased from 13 to 100% (p < 0.001), withdrawal scales from 7 to 27% (p = 0.125), and delirium scales from 0 to 7% (p = 1).Conclusions: The development of a specific training program improves monitoring and management of analgosedation in PICUs.

Objective To compare the effectiveness of 4-month rolling-refreshers and annual retraining in basic life support (BLS) on a sample of schoolchildren.Design Prospective longitudinal trial.Setting and participants Four hundred and seventy-two schoolchildren (8–12 years old).Interventions Schoolchildren were instructed in BLS and then split into the following three groups: control group (CG), standard group (SG) and rolling-refresher group (RRG). Their BLS skills were assessed within 1 week (T1) and 2 years later (T2). Moreover, CG did not receive any additional training; SG received one 50 min retraining session 1 year later; RRG participated in very brief (5 min) rolling-refreshers that were carried out every 4 months.Primary and secondary outcomes Hands-on skills of BLS sequence and cardiopulmonary resuscitation.Results BLS sequence performance was similar in all groups at T1, but SG and RRG followed the steps of the protocol in more proportion than CG at T2. When compared at T2, RRG showed higher proficiency than SG in checking safety, checking response, opening the airway and alerting emergency medical services. In addition, although the mean resuscitation quality was low in all groups, RRG participants reached a higher percentage of global quality cardiopulmonary resuscitation (CG: 16.4±24.1; SG: 25.3±28.8; RRG: 29.9%±29.4%), with a higher percentage of correct chest compressions by depth (CG: 3.9±11.8; SG: 10.8±22.7; RRG: 15.5±26.1 mm).Conclusions In 8-to-12-year-old schoolchildren, although annual 50 min retraining sessions help to maintain BLS performance, 4-month very brief rolling-refreshers were shown to be even more effective. Thus, we recommend implementing baseline BLS training at schools, with subsequently brief rolling-refreshers.

Smart glasses (SG) could be a breakthrough in emergency situations, so the aim of this work was to assess the potential benefits of teleassistance with smart glasses (SG) from a midwife to a lifeguard in a simulated, unplanned, out-of-hospital birth (OHB). Thirty-eight lifeguards were randomized into SG and control (CG) groups. All participants were required to act in a simulated imminent childbirth with a maternal–fetal simulator (PROMPT Flex, Laerdal, Norway). The CG acted autonomously, while the SG group was video-assisted by a midwife through SG (Vuzix Blade, New York, NY, USA). The video assistance was based on the OHB protocol, speaking and receiving images on the SG. The performance time, compliance with the protocol steps, and perceived performance with the SG were evaluated. The midwife’s video assistance with SG allowed 35% of the SG participants to perform the complete OHB protocol. No CG participant was able to perform it (p = 0.005). All OHB protocol variables were significantly better in the SG group than in the CG (p < 0.05). Telemedicine through video assistance with SG is feasible so that a lifeguard with no knowledge of childbirth care can act according to the recommendations in a simulated, unplanned, uncomplicated OHB. Communication with the midwife by speaking and sending images to the SG is perceived as an important benefit to the performance.

Background: There are few studies that analyze ventilation volume and pressure during CPR carried out on infants. The aim of this study was to evaluate the quality of the ventilations administered using a self-inflating bag with an endotracheal tube and a face mask in manikins. Methods: a quasi-experimental simulation study with a randomized case crossover design [endotracheal tube (ET) vs. face mask (FM)] was performed. Sixty participants who were previously trained nursing students participated in the study. The estimated air volumes breathed, and the pressure generated during each ventilation were assessed and the quality of the chest compressions was recorded. Results: the ET test presented a higher percentage of ventilations that reached the lungs (100% vs. 86%; p < 0.001), with adequate volume (60% vs. 28%; p < 0.001) in comparison to FM. Both tests presented peak pressures generated in the airway greater than 30 cm H2O (ET: 22% vs. FM: 31%; p = 0.03). Conclusions: performing quality CPR ventilations on an infant model is not an easy skill for trained nursing students. Both tests presented a significant incidence of excessive peak pressure during ventilations. Specific training, focused on quality of ventilations guided by a manometer attached to the self-inflating bag, must be considered in life support training for pediatric providers.

The aim of the study was to compare the quality of CPR (Q-CPR), as well as the perceived fatigue and hand pain in a prolonged infant cardiopulmonary resuscitation (CPR) performed by lifeguards using three different techniques. A randomized crossover simulation study was used to compare three infant CPR techniques: the two-finger technique (TF); the two-thumb encircling technique (TTE) and the two-thumb-fist technique (TTF). 58 professional lifeguards performed three tests in pairs during a 20-min period of CPR. The rescuers performed compressions and ventilations in 15:2 cycles and changed their roles every 2 min. The variables of analysis were CPR quality components, rate of perceived exertion (RPE) and hand pain with numeric rating scale (NRS). All three techniques showed high Q-CPR results (TF: 86 ± 9%/TTE: 88 ± 9%/TTF: 86 ± 16%), and the TTE showed higher values than the TF (p = 0.03). In the RPE analysis, fatigue was not excessive with any of the three techniques (values 20 min between 3.2 for TF, 2.4 in TTE and 2.5 in TTF on a 10-point scale). TF reached a higher value in RPE than TTF in all the intervals analyzed (p < 0.05). In relation to NRS, TF showed significantly higher values than TTE and TTF (NRS minute 20 = TF 4.7 vs. TTE 2.5 & TTF 2.2; p < 0.001). In conclusion, all techniques have been shown to be effective in high-quality infant CPR in a prolonged resuscitation carried out by lifeguards. However, the two-finger technique is less efficient in relation to fatigue and hand pain compared with two-thumb technique (TF vs. TTF, p = 0.01).

Resumen: Introducción: Se ha observado que los profesionales sanitarios tienen dificultades para realizar maniobras de reanimación cardiopulmonar (RCP) de calidad. Nuestro objetivo ha sido comparar la calidad de las ventilaciones en un modelo de lactante según el método utilizado (boca a boca y nariz o bien bolsa autoinflable y mascarilla facial) por estudiantes de Enfermería. Material y métodos: Estudio cuasiexperimental de corte transversal que incluyó a 46 estudiantes de Enfermería de segundo curso. Se realizaron 2 pruebas cuantitativas de RCP pediátrica de 4 min: a) con ventilación boca a boca y nariz; b) con ventilación con bolsa autoinflable y mascarilla facial. Se utilizó un maniquí Resusci Baby QCPR Wireless SkillReporter® de Laerdal. Se registraron y analizaron los porcentajes de ventilaciones con volumen adecuado, excesivo e insuficiente, además de la calidad global de la RCP (ventilaciones y compresiones torácicas). Resultados: Los estudiantes consiguieron dar más ventilaciones con volumen apropiado con el método boca a boca y nariz (55 ± 22%) que con bolsa y mascarilla (28 ± 16%; p

Introduction: It has been observed that health professionals have difficulty performing quality cardiopulmonary resuscitation (CPR). The aim of this study was to compare the quality of ventilations performed by Nursing students on an infant model using different methods (mouth-to-mouth-and-nose or bag-valve-mask). Material and methods: A quasi-experimental cross-sectional study was performed that included 46 second-year Nursing students. Two quantitative 4-min tests of paediatric CPR were performed: (a) mouth-to-mouth-and-nose ventilations, and (b) ventilations with bag-valve-mask. A Resusci Baby QCPR Wireless SkillReporter® mannequin from Laerdal was used. The proportion of ventilations with adequate, excessive, and insufficient volume was recorded and analysed, as well as the overall quality of the CPR (ventilations and chest compressions). Results: The students were able to give a higher number of ventilations with adequate volume using the mouth-to-mouth-and-nose method (55 ± 22%) than with the bag-valve-mask (28 ± 16%, p

IntroductionDecision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards' capacity to perform the ABCDE (Airway-Breathing-Circulation-Disability-Exposure) approach when facing a simulated critically ill-drowned victim.MethodsA cross-sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status by following the ABCDE primary assessment approach. The two kinds of variables were recorder: those related to the quality of each step of the ABCDE approach and the visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA).ResultsNone of the study participants were able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This was also represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06; p = 0.008).ConclusionProfessional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected the lifeguards' limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards' training programmes.

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous intensive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition. Resumen: La unidad de cuidados intensivos pediátricos (UCIP) es una unidad física asistencial hospitalaria independiente especialmente diseñada para el tratamiento de pacientes pediátricos quienes debido su gravedad o condiciones potencialmente letales requieren observación y asistencia médica intensiva integral y continua por un equipo médico que haya obtenido competencia especial en medicina intensiva pediátrica. La aplicación oportuna de terapia intensiva a los pacientes críticos reduce la mortalidad, el tiempo de estancia y los costes asistenciales. Con los objetivos de respetar el derecho del niño al disfrute del más alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitación de la salud y de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos críticos, la Asociación Española de Pediatría (AEP), la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) han desarrollado y aprobado las guías de ingreso, alta y triage para las UCIP en España. Mediante la aplicación de estas guías se puede optimizar el uso de las UCIP españolas de forma que los pacientes pediátricos reciban el nivel de cuidados médicos más apropiado para su situación clínica.

Resumen: La unidad de cuidados intensivos pediátricos (UCIP) es una unidad física asistencial hospitalaria independiente especialmente diseñada para el tratamiento de pacientes pediátricos quienes debido su gravedad o condiciones potencialmente letales requieren observación y asistencia médica intensiva integral y continua por un equipo médico que haya obtenido competencia especial en medicina intensiva pediátrica. La aplicación oportuna de terapia intensiva a los pacientes críticos reduce la mortalidad, el tiempo de estancia y los costes asistenciales. Con los objetivos de respetar el derecho del niño al disfrute del más alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitación de la salud y de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos críticos, la Asociación Española de Pediatría (AEP), la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) han desarrollado y aprobado las guías de ingreso, alta y triage para las UCIP en España. Mediante la aplicación de estas guías se puede optimizar el uso de las UCIP españolas de forma que los pacientes pediátricos reciban el nivel de cuidados médicos más apropiado para su situación clínica. Abstract: A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition.

Objective: To compare a novel two-thumb chest compression technique with standard techniques during newborn resuscitation performed by novice physicians in terms of median depth of chest compressions, degree of full chest recoil, and effective compression efficacy.Patients and Methods: The total of 74 novice physicians with less than 1-year work experience participated in the study. They performed chest compressions using three techniques: (A) The new two-thumb technique (nTTT). The novel method of chest compressions in an infant consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist. (B) TFT. With this method, the rescuer compresses the sternum with the tips of two fingers. (C) TTHT. Two thumbs are placed over the lower third of the sternum, with the fingers encircling the torso and supporting the back.Results: The median depth of chest compressions for nTTT was 3.8 (IQR, 3.7–3.9) cm, for TFT−2.1 (IQR, 1.7–2.5) cm, while for TTHT−3.6 (IQR, 3.5–3.8) cm. There was a significant difference between nTTT and TFT, and TTHT and TFT (p < 0.001) for each time interval during resuscitation. The degree of full chest recoil was 93% (IQR, 91–97) for nTTT, 99% (IQR, 96–100) for TFT, and 90% (IQR, 74–91) for TTHT. There was a statistically significant difference in the degree of complete chest relaxation between nTTT and TFT (p < 0.001), between nTTT and TTHT (p = 0.016), and between TFT and TTHT (p < 0.001).Conclusion: The median chest compression depth for nTTT and TTHT is significantly higher than that for TFT. The degree of full chest recoil was highest for TFT, then for nTTT and TTHT. The effective compression efficiency with nTTT was higher than for TTHT and TFT. Our novel newborn chest compression method in this manikin study provided adequate chest compression depth and degree of full chest recoil, as well as very good effective compression efficiency. Further clinical studies are necessary to confirm these initial results.

OBJECTIVE:To analyse the acute muscular fatigue (AMF) in triceps brachii and rectus abdominis during compression-only and standard cardiopulmonary resuscitation (CPR) performed by certified basic life support providers. METHODS:Twenty-six subjects were initially recruited and randomly allocated to two study groups according to the muscles analysed; eighteen finally met the inclusion criteria (nine in each group). Both groups carried out two CPR tests (compression-only and standard CPR) of 10 min divided into five 2-min intermittent periods. The ventilation method was freely chosen by each participant (mouth-to-mouth, pocket-mask or bag-valve-mask). CPR feedback was provided all the time. AMF was measured by tensiomyography at baseline and after each 2-min period of the CPR test, in triceps brachii or rectus abdominis according to the study group. RESULTS:Rectus abdominis' contraction time increased significantly during the fifth CPR period (p = 0.020). Triceps brachii's radial muscle belly displacement (p = 0.047) and contraction velocity (p = 0.018) were lower during compression-only CPR than during standard CPR. Participants who had trained previously with feedback devices achieved better CPR quality results in both protocols. Half of participants chose bag-valve-mask to perform ventilations but attained lower significant ventilation quality than the other subjects. CONCLUSIONS:Compression-only CPR induces higher AMF than standard CPR. Significantly higher fatigue levels were found during the fifth CPR test period, regardless of the method. Adequate rescuer's strength seems to be a requisite to take advantage of CPR quality feedback devices. Training should put more emphasis on the quality of ventilation during CPR.