Children and Restraints Study in Emergency Ambulance Transport-Cardiopulmonary Resuscitation (CARSEAT-CPR): An Observational Cohort Study of a Simulated Pediatric Cardiac Arrest.

Objectives: To compare the ability to perform basic life support (BLS) skills on children and infants in a moving ambulance whether or not they are properly secured to the stretcher.

Methods: Emergency Medicine Services provider ability to perform BLS skills was measured in moving ambulances on a closed course using an analog for child and infant cardiac arrest. Data were compared for child and infant manikins secured to the stretcher via different methods in simulated patient resuscitations performed by 24 participants.

Results: We found that there was no significant difference in mean rate (P = 0.104), depth (P = 0.21), or chest compression fraction (P = 0.92) between tests on restrained and unrestrained pediatric manikins. For infants, there was a 4-mm difference in compression depth (P = 0.0018). The clinical significance of this difference is not readily apparent. Infant tests did not show a difference in compression rate (P = 0.35) or compression fraction (P = 0.26). Across all tests, the rate and depth of compressions were adequate, but compression fraction was not adequate in the infant simulations. There were no differences in ventilations between restrained and unrestrained simulations (child P = 0.15; infant P = 0.13) but both were less than the American Heart Association recommendation.

Conclusions: In this simulation study, it was found that there was no significant difference noted in BLS adequacy between unrestrained pediatric patients and those restrained with commercial devices. Overall, the ability to perform appropriate BLS on children was equivocal and our simulations suggested BLS could not be adequately performed on infants regardless of restraint type/status.