Training Neonatal Cardiopulmonary Resuscitation: Can It Be Improved by Playing a Musical Prompt? A Pilot Study

Abstract

Objective Effective neonatal cardiopulmonary resuscitation (CPR) requires 3:1 coordinated manual inflations (MI) and chest compressions (CC). We hypothesized that playing a musical prompt would help coordinate CC and MI during CPR.

Study Design In this pilot trial we studied the effect the “Radetzkymarsch” (110 beats per minute) on neonatal CPR. Thirty-six medical professionals performed CPR on a neonatal manikin. CC and MI were recorded with and without the music played, using a respiratory function monitor and a tally counter. Statistical analysis included Wilcoxon test.

Results Without music, the median (interquartile range) rate of CC was 115 (100 to 129) per minute and the rate of MI was 38 (32 to 42) per minute. When listening to the auditory prompt, the rate of CC decreased significantly to 96 (96 to 100) per minute (p = 0.002) and the rate of MI to 32 (30 to 34) per minute (p = 0.001). The interquartile range of interoperator variability decreased up to 86%.

Conclusion Listening to an auditory prompt improved compliance with the recommended delivery rates of CC and MI during neonatal CPR.

Keywords

neonate - cardiopulmonary resuscitation (CPR) - chest compression - auditory prompt - music - training

• References

• 1 Singhal N, McMillan DD, Yee WH, Akierman AR, Yee YJ. Evaluation of the effectiveness of the standardized neonatal resuscitation program. J Perinatol 2001; 21: 388-392
• 2 Wyckoff MH, Perlman JM. Cardiopulmonary resuscitation in very low birth weight infants. Pediatrics 2000; 106: 618-620
• 3 Wyckoff MH, Berg RA. Optimizing chest compressions during delivery-room resuscitation. Semin Fetal Neonatal Med 2008; 13: 410-415
• 4 Kattwinkel J, Perlman JM, Aziz K , et al. Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122 (18) (Suppl. 03) S909-S919
• 5 Richmond S, Wyllie J. European Resuscitation Council Guidelines for Resuscitation 2010 Section 7. Resuscitation of babies at birth. Resuscitation 2010; 81: 1389-1399
• 6 Halamek LP. The simulated delivery-room environment as the future modality for acquiring and maintaining skills in fetal and neonatal resuscitation. Semin Fetal Neonatal Med 2008; 13: 448-453
• 7 Sawyer T, Sierocka-Castaneda A, Chan D, Berg B, Lustik M, Thompson M. Deliberate practice using simulation improves neonatal resuscitation performance. Simul Healthc 2011; 6: 327-336
• 8 Abella BS, Alvarado JP, Myklebust H , et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 2005; 293: 305-310
• 9 Lemoine JB, Daigle SC. Neonatal resuscitation simulation: improving safety while enhancing confidence and competence. Nurs Womens Health 2010; 14: 143-145
• 10 Nadler I, Sanderson PM, Van Dyken CR, Davis PG, Liley HG. Presenting video recordings of newborn resuscitations in debriefings for teamwork training. BMJ Qual Saf 2011; 20: 163-169
• 11 Brugada M, Schilleman K, Witlox RS, Walther FJ, Vento M, Te Pas AB. Variability in the assessment of “adequate” chest excursion during simulated neonatal resuscitation. Neonatology 2011; 100: 99-104
• 12 Rawlins L, Woollard M, Williams J, Hallam P. Effect of listening to Nellie the Elephant during CPR training on performance of chest compressions by lay people: randomised crossover trial. BMJ 2009; 339: b4707
• 13 Rigo V, Rigo J. Newborns need another tune: “I will survive” sets neonatal resuscitation rhythm. Ann Emerg Med 2009; 53: 837
• 14 Der Beat für Beatmung. Available at: http://derstandard.at/1268700992552/Erste-Hilfe-Der-Beat-fuer-Beatmung . Accessed May 05, 2012
• 15 Matlock D, Hafner JW, Bockewitz EG, Barker LT, Dewar JD. “Stayin' Alive”: a pilot study to test the effectiveness of a novel mental metronome in maintaining appropriate compression rates in simulated cardiac arrest scenarios. Ann Emerg Med 2008; 52: S67-S68
• 16 Hafner JW, Sturgell JL, Matlock DL, Bockewitz EG, Barker LT. “Stayin' Alive”: a novel mental metronome to maintain compression rates in simulated cardiac arrests. J Emerg Med 2012; 43: e373-e377
• 17 Woollard M, Poposki J, McWhinnie B, Rawlins L, Munro G, O'Meara P. Achy breaky makey wakey heart? A randomised crossover trial of musical prompts. Emerg Med J 2012; 29: 290-294
• 18 France J, Wilson S, Whitton N. Auditory and visual prompts during cardiopulmonary resuscitation in the emergency department. Emerg Med J 2006; 23: 160-161
• 19 Oulego-Erroz I, Busto-Cuiñas M, García-Sánchez N, Rodríguez-Blanco S, Rodríguez-Núñez A. A popular song improves CPR compression rate and skill retention by schoolchildren: a manikin trial. Resuscitation 2011; 82: 499-500
• 20 McHale S, Thomas M, Hayden E, Bergin K, McCallion N, Molloy EJ. Variation in inspiratory time and tidal volume with T-piece neonatal resuscitator: association with operator experience and distraction. Resuscitation 2008; 79: 230-233