What is the best position to place and re-evaluate an unconscious but normally breathing victim? A randomised controlled human simulation trial on children.

BACKGROUND: Current resuscitation guidelines endorse placing the unconscious and normally breathing victims in the recovery position (RP), but this technique might hinder breathing evaluation. AIM: To compare breathing evaluation and cardiac arrest detection: placing the victim in RP and checking breathing regularly, placing the victim in RP while re-evaluating breathing every minute, and placing the victim on his back, maintaining an open airway with the head-tilt-chin-lift technique and continuously checking breathing. METHODS: Schoolchildren aged 10-12 with no previous cardiopulmonary resuscitation (CPR) training, from three different primary schools were randomly allocated into groups to receive a CPR course involving one of the three strategies. Then a human simulation took place. RESULT: 192 schoolchildren (64 per group) were randomly selected and received one of the courses. 182 participants who correctly assessed the victim were compared: 16 (26.2%) out of the 59 participants using RP and checking breathing regularly detected cardiac arrest before the end of the simulation, compared to 41 (67.20%) out of 61 using RP re-evaluating breathing every minute, and 56 (90.3%) out of 62 using head-tilt-chin-lift. Statistically significant differences were found between the RP groups (p < 0.001; OR = 5.766) as well as between the Head-tilt-chin-lift and both RP groups (p < 0.001; OR = 21.094), (p = 0.002; OR = 4.553). CONCLUSION: The strategy involving head-tilt-chin-lift significantly increased the likelihood of detecting cardiac arrest. Re-evaluating every minute when the RP was used significantly increased the likelihood of detecting cardiac arrest.

[Quasi-experimental study to assess schoolchildren's ability to use a semiautomatic external defibrillator 6 months after training]. / Estudio cuasiexperimental para evaluar la capacidad de los escolares para utilizar un desfibrilador externo semiautomático a los 6 meses tras un proceso formativo.

OBJECTIVES: To evaluate schoolchildren's ability to use a semiautomatic external defibrillator (SAED) in terms of how long they take to deliver a shock 6 months after they received training. MATERIAL AND METHODS: Uncontrolled, quasi-experimental study. Schoolchildren in grades 5 and 6 without prior knowledge of how to use a SAED were included. After the children answered a questionnaire about their knowledge, they were asked to position the SAED to treat a training mannequin. We measured the time it took them to switch on the device, place the electrode pads, and deliver the first shock (T0). The children were then individually given a simple explanation lasting approximately 60 seconds, after which we measured the time they took to place the SAED again and deliver a shock (T1). Each child's time was measured again 6 months later (T2). RESULTS: A total of 253 children aged between 10 and 13 years participated; 128 (50.6%) were girls. All the children were able to use the SAED without prior training, although we did not take into consideration mistakes they made in placing the pads at baseline (T0). The mean times were as follows: T0, 83 (SD 14) seconds; T1, 44 (SD 5) seconds; and T2, 45 (SD 7) seconds. The mean differences between times were as follows: T0-T1, 39 (SD 13) seconds (P < .001); T0-T2, 38 (SD 15) seconds (P < .001); and T1-T2, 1.4 (SD 7.5) seconds (P = .010). CONCLUSION: Pulse CO-oximetry contributed to the prehospital emergency care of these patients by influencing the decision to transfer the patient to a hospital.

OBJETIVO: Evaluar la capacidad por parte de los escolares para utilizar un desfibrilador externo semiautomático (DESA) y el tiempo de administración de una desfibrilación a los 6 meses tras un proceso formativo. METODO: Estudio cuasiexperimental sin grupo control. Se incluyeron niños del tercer ciclo de Educación Primaria sin conocimientos previos en el uso del DESA. Tras aplicar un cuestionario sobre conocimientos previos, se les pidió que usasen el DESA en un maniquí de entrenamiento, midiendo el tiempo que tardaban en encenderlo, colocar los parches y administrar la primera desfibrilación (T0). Se volvió a medir el tiempo tras una sencilla explicación de unos 60 segundos de manera individual (T1) y se repitió la medición de los tiempos pasados seis meses (T2). RESULTADOS: Se incluyeron 253 sujetos, de entre 10 y 13 años, de los cuales 128 (50,6%) fueron niñas. Un 100% de los niños fue capaz de usar el DESA sin formación previa aunque no se tuvieron en cuenta los errores en la colocación de parches en la toma inicial. Los tiempos medios fueron: T0 = 83 (DE 14) s; T1 = 44 (DE 5) s; T2 = 45 (DE 7) s. La diferencia de medias fue: T0-T1 = 39 (DE 13) s (p < 0,001), T0-T2 = 38 (DE 15) s (p < 0,001), T1-T2 = 1,4 (DE 7,5) s (p = 0,010). CONCLUSIONES: Fifth- and sixth-grade primary school students are able to use a SAED without training. After the children received a brief explanation, they were able to deliver an effective shock without committing errors. The time until the first shock scarcely changed after 6 months had passed. We conclude that it would not be necessary to provide training for SAED use as often as is required for manual external chest compressions.