title: Provider Adherence to Neonatal Resuscitation Program Recommendations for Coordinated Neonatal Chest Compressions and Ventilations.
abstract: OBJECTIVE
  Medical providers often do not perform chest compressions in accordance with recommended resuscitation guidelines for adults and children. Little is known regarding how well neonatal providers perform coordinated chest compressions and ventilations. The objective of this study was to characterize Neonatal Resuscitation Program (NRP) trained providers' adherence to NRP recommendations for coordinated chest compressions and ventilations in a simulated setting.
  
  
  METHODS
  Fifty NRP providers performed coordinated chest compressions for three minutes on a neonatal manikin. A compression sensor (accelerometer) was used to monitor and record compression data. Data analyzed included ratio of compressions to ventilation pauses, delivered chest compressions per minute (CC/min), and duration of ventilation pauses.
  
  
  RESULTS
  Delivered CC/min ranged from 61 to 136. The mean CC/min (99, SD 16) was significantly higher than the NRP-recommended value of 90 (p=0.002). Delivered CC/min did not differ from the first 30 seconds to the last 30 seconds of compressions (p=0.91). Duration of ventilation pauses was highly correlated with CC/min (Spearman's rho= -0.98, p<0.001), with a median duration of 0.92 seconds (IQ range (0.84, 1.02).
  
  
  CONCLUSIONS
  NRP trained providers often do not adhere to NRP recommendations for delivery of coordinated chest compressions during simulated cardiac depression. The mean CC/min performed is higher than recommended. Duration of ventilation pauses is highly correlated with delivered CC/min. Future studies should focus on methods to improve the timing of delivered chest compressions by NRP providers to conform to NRP recommendations.
authors.affiliation: Division of Neonatology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Foglia
authors.forename: Jay
authors.initials: J
authors.lastname: Patel
authors.forename: Dana
authors.initials: D
authors.lastname: Niles
authors.forename: Per Helge
authors.initials: PH
authors.lastname: Aasland
authors.forename: Vinay
authors.initials: V
authors.lastname: Nadkarni
authors.forename: Anne
authors.initials: A
authors.lastname: Ades
keywords: CPR; Chest compressions; Manikin; Neonatal; Resuscitation