Protocol of a Multicenter International Randomized Controlled Manikin Study on Different Protocols of Cardiopulmonary Resuscitation for laypeople (MANI-CPR)

INTRODUCTION

Out-of-hospital cardiac arrest is one of the leading causes of death in industrialised countries. Survival depends on prompt identification of cardiac arrest and on the quality and timing of cardiopulmonary resuscitation (CPR) and defibrillation. For laypeople, there has been a growing interest on hands-only CPR, meaning continuous chest compression without interruption to perform ventilations. It has been demonstrated that intentional interruptions in hands-only CPR can increase its quality. The aim of this randomised trial is to compare three CPR protocols performed with different intentional interruptions with hands-only CPR.

METHODS AND ANALYSIS

This is a prospective randomised trial performed in eight training centres. Laypeople who passed a basic life support course will be randomised to one of the four CPR protocols in an 8 min simulated cardiac arrest scenario on a manikin: (1) 30 compressions and 2 s pause; (2) 50 compressions and 5 s pause; (3) 100 compressions and 10 s pause; (4) hands-only. The calculated sample size is 552 people. The primary outcome is the percentage of chest compression performed with correct depth evaluated by a computerised feedback system (Laerdal QCPR). ETHICS AND DISSEMINATION: . Due to the nature of the study, we obtained a waiver from the Ethics Committee (IRCCS Policlinico San Matteo, Pavia, Italy). All participants will sign an informed consent form before randomisation. The results of this study will be published in peer-reviewed journal. The data collected will also be made available in a public data repository.

TRIAL REGISTRATION NUMBER

NCT02632500.

Cerebral hemodynamics and fetal behavioral states

OBJECTIVE

This study aimed to evaluate the hemodynamic patterns of the proximal (M1) and distal (M2) portions of the middle cerebral artery, during different fetal behavioral states.

DESIGN

The study included 20 normal singleton pregnancies at between 36 and 40 weeks of gestation. After identification of the fetal behavioral state (FBS), flow velocity evaluation was performed on the proximal and distal segments of the middle cerebral artery during 'quiescence' (FBS-1F) and 'activity' (FBS-2F).

RESULTS

A statistically significant decrease of pulsatility index, reflecting a decrease of impedance to flow values, was identified in both segments of the middle cerebral artery (MCA) during 'activity', with a more marked decrease in the MCA-M2 than in MCA-M1 (M1, P = 0.0028; M2, P = 0.00000085). The mean fetal heart rate during 'quiescence' was significantly lower than during 'activity' (P = 0.0047). However, there was no significant correlation between the pulsatility index of both segments of the middle cerebral artery and the fetal heart rate during different fetal behavioral states.

CONCLUSIONS

The results of this study provide evidence of the influence of different fetal behavioral states on fetal cerebral hemodynamic patterns. We believe it is better to sample the proximal segment in clinical practice because it is less influenced by fetal behavioral state. This information should be considered when evaluating fetal cerebral hemodynamics.

Delayed interval delivery of a second twin

We report a case of diamniotic dichorionic pregnancy at 21 weeks and 5 days of gestation with threatened preterm labor with cervical modification and protrusion into vagina of the amniotic sac of twin one. After 4 days there was a rupture of membrane of the protruding sac and delivery of the first twin. We decided to retain the other one to allow improvement in the outcome for the second twin. The patient was treated with tocolytics, antibiotics and continuously monitored. After 18 days there was increasing uterine contractility and we decided to perform the cesarean section and delivered the second twin.