Title: Analysis of infant rescue breathing performance errors during training that lead to poor quality CPR 

The aim was to examination performance related errors of 70 neonate and PALS specialists performing rescue breaths during training. This focuses on each ventilation and the sub-skills which provided the greatest difficulty. 

An advanced infant simulator providing accurate data on volume of air, rate of air flow and interval between ventilations was used. Results from a pre-test/post-test study were used to analyze sub-skill performance during ventilations. Students had access to a high quality simulator with real time feedback. They had a target score of 60% and the normal class time. 

Pre-test average correct volume was 9.55%; correct rate of squeezing the BVM averaged 20.00%; intervals between breaths averaged of 27.09%,

Post-test volume averaged 93.77%, (range: max 100%, min 61.70%). Rate of inspiration averaged 69.99%, (range: max 100%, min 50%). Interval between vents averaged 81.47%, (range: max 98.30%, min 5%). The change in performance is dramatic. In the pre-test 53 of 70 people produced no correct volumes; in the post-test 93.77% of all ventilations by volume were correct. There is a strong interactive effect between producing the correct volume and the rate of air flow. Both have to be corrected at once. There is a significant difference between the neonate and PALS performance on interval (z is -4.589 p is < .00001). The researchers feel this is potentially a false positive, as instructors often failed to switch the activity to the neonate protocol where the time between breaths is different.

The results of this study point to the importance of the simulator being accurate on ALL parameters. The interaction between parameters is crucial to correct performance. As professionals participants were focused on performing correctly and quickly adjust their performance according to the feedback. This points to the importance of the device and feedback accuracy.

4 - Analysis of infant rescue breathing performance errors during training that lead to poor quality CPR