Two-Thumb or Two-Finger Technique in Infant Cardiopulmonary Resuscitation by a Single Rescuer? A Meta-Analysis with GOSH Analysis

Effect of lipopolysaccharides from pathogenic bacteria on broiler chickens' productivity: a meta-analysis

1. This meta-analysis investigated the impact of LPS and covariates (serotype, rearing period and administration route) on the productivity parameters of broiler chickens (average daily feed intake (ADFI), average daily gain (ADG) and feed conversion ratio (FCR)).2. Thirty-two eligible studies were included. Hedges' g effect size was determined using a random-effects model at 95% confidence interval.3. Results showed that LPS significantly decreased average daily feed intake (ADFI; p < 0.0001) and average daily gain (ADG; p < 0.0001) and increased FCR (p < 0.0001). The serotypes Escherichia coli 055: B5 (EC055: B5) and Escherichia coli 0127: B8 (EC 0127: B8) significantly reduced ADFI and ADG, and the serotype EC 055: B5 significantly increased the FCR (p < 0.05).4. The intraperitoneal administration of the LPS significantly reduced the productivity of broiler chickens (p < 0.05), but other administration routes did not show such effects. The reduction in ADFI and ADG was found in all rearing periods (p < 0.05), and the increase in FCR was observed in the starter (p = 0.0302) and grower periods (p = 0.0031).5. Exposure to LPS significantly reduced the productivity of broiler chickens (p < 0.05). However, no relationship was observed between LPS dosage and productivity as indicated by the meta-regression study.6. The findings indicated that LPS has detrimental effects on broiler chickens' ADFI, ADG and FCR across various LPS serotypes and rearing periods. These detrimental impacts of LPS remain consistent regardless of the administered dosage.

A Comparison between Three Different Techniques Considering Quality Skills, Fatigue and Hand Pain during a Prolonged Infant Resuscitation: A Cross-Over Study with Lifeguards

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).

Infant Cardiopulmonary Resuscitation Quality While Walking Fast: A Simulation Study

OBJECTIVE

This study focuses on the characteristics (feasibility, resuscitation quality, and physical demands) of infant cardiopulmonary resuscitation (CPR) on the forearm during fast walking, performed by a trained lay rescuer.

METHODS

Twenty-one university students from the infant education degree participated in a randomized crossover simulation study to compare a standard pediatric CPR versus a walking pediatric CPR with a manikin on the rescue forearm. Each rescuer performed 2 resuscitation tests of 2 minutes on the infant manikin. Cardiopulmonary resuscitation, physiological, and perceived effort variables were measured.

RESULTS

The quality of chest compressions was higher in standard pediatric CPR than in walking pediatric CPR (72% vs 51%; P < 0.001) and overall CPR quality (59% vs 49%; P = 0.02). There were no differences between ventilation quality (47% vs 46%). Walking pediatric CPR presented a higher percentage of maximum heart rate (52% vs 69%; P < 0.001) and perceived exertion rate (2 vs 5; P < 0.001). Participants walked an average of 197 m during the test.

CONCLUSIONS

In conclusion, pediatric walking CPR is feasible although it represents a slight quality decrease in a simulation infant CPR setting. The option "CPR while walking fast to a safe place" seems to be suitable in terms of safety both for the victim and the rescuer, as well as CPR quality in special circumstances.

Chest compression by two-thumb encircling method generates higher carotid artery blood flow in swine infant model of cardiac arrest

Objective

Two-Thumb(TT) technique provides superior quality chest compressions compared with Two-Finger(TF) in an instrumented infant manikin. Whether this translates to differences in blood flow, such as carotid arterial blood flow(CABF), has not been evaluated. We hypothesized that TT-CPR generates higher CABF and Coronary Perfusion Pressure(CPP) compared with TF-CPR in a neonatal swine cardiac arrest model.

Methods

Twelve anesthetized & ventilated piglets were randomized after 3 min of untreated VF to receive either TT-CPR or TF-CPR by PALS certified rescuers delivering a compression rate of 100/min. The primary outcome, CABF, was measured using an ultrasound transonic flow probe placed on the left carotid artery. CPP was calculated and end-tidal CO₂(ETCO₂) was measured during CPR. Data(mean ± SD) were analyzed and p-value ≤0.05 was considered statistically significant.

Results

Carotid artery blood flow (% of baseline) was higher in TT-CPR (66.2 ± 35.4%) than in the TF-CPR (27.5 ± 10.6%) group, p = 0.013. Mean CPP (mm Hg) during three minutes of chest compression for TT-CPR was 12.5 ± 15.8 vs. 6.5 ± 6.7 in TF-CPR, p = 0.41 and ETCO₂ (mm Hg) was 29.0 ± 7.4 in TT-CPR vs. 20.7 ± 5.8 in TF-CPR group, p = 0.055.

Conclusion

TT-CPR achieved more than twice the CABF compared with TF-CPR in a piglet cardiac arrest model. Although CPP and ETCO₂ were higher during TT-CPR, these parameters did not reach statistical significance. This study provides direct evidence of increased blood flow in infant swine using TT-CPR and further supports that TT chest compression is the preferred method for CPR in infants.