title: Simplified dispatcher instructions improve bystander chest compression quality during simulated pediatric resuscitation.
abstract: OBJECTIVE
  Cardiopulmonary resuscitation (CPR) quality is associated with survival outcomes after out-of-hospital cardiac arrest. The objective of this study was to evaluate the effectiveness of simplified dispatcher CPR instructions to improve the chest compression (CC) quality during simulated pediatric cardiac arrest in public places.
  
  
  METHODS
  Adult bystanders recruited in public places were randomized to receive one of two scripted dispatcher CPR instructions: (1) "Push as hard as you can" (PUSH HARD) or (2) "Push approximately 2 inches" (TWO INCHES). A pediatric manikin with realistic CC characteristics (similar to a 6-year-old child), and a CPR recording defibrillator was used for quantitative CC data collection during a 2-min simulated pediatric scenario. The primary outcome was average CC depth treated as a continuous variable. Secondary outcomes included compliance with American Heart Association (AHA) CPR targets. Analysis was by two-sided unpaired t-test and Chi-square test, as appropriate.
  
  
  RESULTS
  128 out of 140 providers screened met inclusion/exclusion criteria and all 128 consented. The average CC depth (mean (SEM)) was greater in PUSH HARD compared to TWO INCHES (43 (1) vs. 36 (1) mm, p<0.01) and met AHA targets more often (39% (25/64) vs. 20% (13/64), p=0.02). CC rates trended higher in the PUSH HARD group (93 (4) vs. 82 (4) CC/min, p=0.06). More providers did not achieve full chest recoil with PUSH HARD compared to TWO INCHES (53% (34/64) vs. 75% (48/64), p=0.01).
  
  
  CONCLUSIONS
  Simplified dispatcher assisted pediatric CPR instructions: "Push as hard as you can" was associated with lay bystanders providing deeper and faster CCs on a simulated, 6-year-old pediatric manikin. However, percentage of providers leaning between CC increased. The potential effect of these simplified instructions in younger children remains unanswered.
authors.affiliation: The Children's Hospital of Nevada at UMC, Department of Pediatric Critical Care, 1800 West Charleston Boulevard, Las Vegas, NV 89102, United States. Electronic address: silvana.arciniegas@gmail.com.
authors.forename: Silvana Arciniegas
authors.initials: SA
authors.lastname: Rodriguez
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.affiliation: The University of Arizona, Department of Pediatric Critical Care Medicine, 1500 North Campbell Avenue, Tucson, AZ 85724, United States.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Berg
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Maltese
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Meaney
authors.affiliation: The Children's Hospital of Philadelphia, Center of Simulation, Advanced Education and Innovation, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Dana E
authors.initials: DE
authors.lastname: Niles
authors.affiliation: The Children's Hospital of Philadelphia, Center of Simulation, Advanced Education and Innovation, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Jessica
authors.initials: J
authors.lastname: Leffelman
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D004631:Emergency Medical Service Communication Systems; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies; D055815:Young Adult
keywords: AHA; American Heart Association; CC; CPR; Cardiac arrest; Cardiopulmonary resuscitation; Chest compression; Dispatcher; Quality; cardiopulmonary resuscitation; chest compression
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