title: Chest compression quality and rescuer fatigue with increased compression to ventilation ratio during single rescuer pediatric CPR.
abstract: OBJECTIVE
  The effects of the recommended 30:2 compression:ventilation (C:V) ratio on chest compression rate (CR), compression depth (CD), compression pressure (CP) and rescuer fatigue is unknown during pediatric CPR. We hypothesized that a 30:2 C:V ratio will decrease compression depth and compression pressure and increase rescuer fatigue compared with a 15:2 ratio.
  
  
  METHODS
  Randomized crossover observational study.
  
  
  METHODS
  Adolescent, child and infant manikins were modified to digitally record compression rate, compression depth, compression pressure and total compression cycles (CC). BLS or PALS certified volunteers were randomized to five CPR groups: adolescent (AD), child 1-hand (OH), child 2-hand (TH), infant two-finger (TF) and infant two-thumb (TT). Each rescuer performed each ratio for 5 min with the order randomized. Rescuer heart rate (HR) and respiratory rate (RR) were recorded continuously during CPR and used to determine the recovery time (RT) for HR/RR to return to baseline. Data (mean+/-S.D.) were contrasted by paired differences for quantitative data and the sign rank test for ordinal data.
  
  
  RESULTS
  Eighty subjects (16 per group) were randomized. The peak compression pressure and compression rate were not different within any group, but total compression cycle were higher in all 30:2 groups. Compression depth (mm) was not significantly different within any group. The rescuer's HR (bpm) increased significantly during 30:2 CPR in AD and OH group with no significant differences in RR and recovery time. Subjects reported that 15:2 CPR was easier to perform (P<0.001).
  
  
  CONCLUSIONS
  During single rescuer pediatric BLS, more compression cycles were achieved with 30:2 C:V ratio without effect on compression depth, pressure and rate. Increased HR with 30:2 C:V ratio was noted during larger manikin CPR without subjective difference of reported fatigue. Most rescuers in AD and TF group did not achieve recommended compression depth regardless of C:V ratio.
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32610-0296, USA. haqueiu@peds.ufl.edu
authors.forename: Ikram U
authors.initials: IU
authors.lastname: Haque
authors.forename: Jai P
authors.initials: JP
authors.lastname: Udassi
authors.forename: Sharda
authors.initials: S
authors.lastname: Udassi
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Theriaque
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Shuster
authors.forename: Arno L
authors.initials: AL
authors.lastname: Zaritsky
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D018592:Cross-Over Studies; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006336:Heart Massage / Q000379:methods*; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D005082:Physical Exertion; D011446:Prospective Studies; D012123:Pulmonary Ventilation; D011787:Quality of Health Care; D015656:Respiratory Mechanics