***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We introduce a new method of external chest compression ( ECC ) , an essential part of cardiopulmonary resuscitation , using a thumb and index finger method ( TIFM ) on infants , and compares , this with two st and ard methods of the two finger method ( TFM ) and the two-thumb encircling h and s method ( TTEM ) .  Sixty trained PALS ( Pediatric Advanced Life Support ) providers were r and omly assigned into three groups and provided one-rescuer ECC for a period of five continuous minutes . Results without coaching or feedback were recorded on a recording CPR simulator ( Laerdal , Inc ) .  ECC  was performed according to the BLS recommendations of the International Liaison Committee on Resuscitation ( ILCOR ) . The quality of ECC  in the TFM group deviated considerably from guideline recommendations . The same parameters in the TTEM and new TIFM groups during this study were in accordance with the parameters recommended by the guidelines . Thus , our new TIFM technique of chest compression , in infants was shown to be better than the currently TFM , especially for achieving adequate compression depth and avoiding fatigue , and is equally as effective as the TTEM . We propose this new method ( TIFM ) should be considered as the method of choice in single rescuer situations CONTEXT The survival benefit of well-performed cardiopulmonary resuscitation ( CPR ) is well-documented , but little objective data exist regarding actual CPR quality during cardiac arrest . Recent studies have challenged the notion that CPR is uniformly performed according to established international guidelines . OBJECTIVES To measure multiple parameters of in-hospital CPR quality and to determine compliance with published American Heart Association and international guidelines . DESIGN AND SETTING A prospect i ve observational study of 67 patients who experienced in-hospital cardiac arrest at the University of Chicago Hospitals , Chicago , Ill , between December 11 , 2002 , and April 5 , 2004 . Using a monitor/defibrillator with novel additional sensing capabilities , the parameters of CPR quality including chest compression rate , compression depth , ventilation rate , and the fraction of arrest time without chest compressions ( no-flow fraction ) were recorded . MAIN OUTCOME MEASURE Adherence to American Heart Association and international CPR guidelines . RESULTS Analysis of the first 5 minutes of each resuscitation by 30-second segments revealed that chest compression rates were less than 90/min in 28.1 % of segments . Compression depth was too shallow ( defined as < 38 mm ) for 37.4 % of compressions . Ventilation rates were high , with 60.9 % of segments containing a rate of more than 20/min . Additionally , the mean ( SD ) no-flow fraction was 0.24 ( 0.18 ) . A 10-second pause each minute of arrest would yield a no-flow fraction of 0.17 . A total of 27 patients ( 40.3 % ) achieved return of spontaneous circulation and 7 ( 10.4 % ) were discharged from the hospital . CONCLUSIONS In this study of in-hospital cardiac arrest , the quality of multiple parameters of CPR was inconsistent and often did not meet published guideline recommendations , even when performed by well-trained hospital staff . The importance of high- quality CPR suggests the need for rescuer feedback and monitoring of CPR quality during resuscitation efforts AIMS To compare quality of CPR during out-of-hospital cardiac arrest with and without automated feedback . MATERIAL S AND METHODS Consecutive adult , out-of-hospital cardiac arrests of all causes were studied . One hundred and seventy-six episodes ( March 2002-October 2003 ) without feedback  were compared to 108 episodes ( October 2003-September 2004 ) where automatic feedback on CPR was given . Automated verbal and visual feedback was based on measured quality with a prototype defibrillator . Quality of CPR was the main outcome measure and survival was reported as specified in the protocol . RESULTS Average compression depth increased from ( mean + /- S.D. ) 34 + /- 9 to 38 + /- 6 mm ( mean difference ( 95 % CI ) 4 ( 2 , 6 ) , P < 0.001 ) , and median percentage of compressions with adequate depth ( 38 - 51 mm ) increased from 24 % to 53 % ( P < 0.001 , Mann-Whitney U-test ) with feedback . Mean compression rate decreased from 121 + /- 18 to 109 + /- 12 min(-1 ) ( difference -12 ( -16 , -9 ) , P = 0.001 ) . There were no changes in the mean number of ventilations per minute ; 11 + /- 5 min(-1 ) versus 11 + /- 4 min(-1 ) ( difference 0 ( -1 , 1 ) , P = 0.8 ) or the fraction of time without chest compressions ; 0.48 + /- 0.18 versus 0.45 + /- 0.17 ( difference -0.03 ( -0.08 , 0.01 ) , P = 0.08 ) . With intention to treat analysis 7/241 control patients were discharged alive ( 2.9 % ) versus 5/117 with feedback ( 4.3 % ) ( OR 1.5 ( 95 % CI ; 0.8 , 3 ) , P = 0.2 ) . In a logistic regression analysis of all cases , witnessed arrest ( OR 4.2 ( 95 % CI ; 1.6 , 11 ) , P = 0.004 ) and average compression depth ( per mm increase ) ( OR 1.05 ( 95 % CI ; 1.01 , 1.09 ) , P = 0.02 ) were associated with rate of hospital admission . CONCLUSIONS Automatic feedback improved CPR quality in this prospect i ve non-r and omised study of out-of-hospital cardiac arrest . Increased compression depth was associated with increased short-term survival . TRIAL REGISTRATION Clinical Trials.gov ( NCT00138996 ) , http://www . clinical Background : The impact of high‐ quality chest compressions during CPR for the patients ' outcome is undisputed , as it is essential for maintaining vital organ perfusion . The aim of our study is to compare the quality of chest compression ( CC ) and ventilation among the two current st and ard techniques with our novel “ nTTT ” technique in infant CPR . Methods : In this r and omized crossover , manikin trial , participants performed CCs using three techniques in a r and omized sequence : st and ard two finger technique ( TFT ) ; st and ard two thumb technique ( TTHT ) , and the ‘ new two‐thumb technique ’ ( nTTT ) . The novel method of CCs in an infant consists in using two thumbs directed at the angle of 90 ° to the chest while closing the fingers of both h and s in a fist . Results : Median depth compression using the distinct chest compression techniques varied and amounted to 26 [ IQR , 25–28 ] mm for TFT , and 39 [ IQR , 39–39 ] mm for TTHT as well as for nTTT . Best percentage of fully released compressions were received using TFT ( 100[100 − 100 ] % ) , then in the case of nTTT ( 99[98–100 ] % ) , and the worst in situation where TTHT ( 18[14–19 ] % ) . was used . The fastest chest compression rate was achieved with TFT ( 134[IQR , 129–135]/min ) and the slowest when using nTTT ( 109 [ IQR , 105–111]/min ) . Conclusions : We found that our new nTTT technique 's performance , in terms of compression depth , h and s‐off time , and ventilation quality , is comparable to the current st and ards . Based on our findings of this initial manikin study , the nTTT technique is superior to TFT in many of parameters that are vital to a quality chest compression during pediatric CPR CONTEXT Out-of-hospital cardiac arrest is a major public health problem . OBJECTIVE To investigate whether the survival of patients with out-of-hospital cardiac arrest  would improve with minimally interrupted cardiac resuscitation ( MICR ) , an alternate emergency medical services ( EMS ) protocol . DESIGN , SETTING , AND PATIENTS A prospect i ve study of survival-to-hospital discharge  between January 1 , 2005 , and November 22 , 2007 . Patients with out-of-hospital cardiac arrests in 2 metropolitan cities in Arizona before and after MICR training of fire department emergency medical personnel were assessed . In a second analysis of protocol compliance , patients from the 2 metropolitan cities and 60 additional fire departments in Arizona who actually received MICR  were compared with patients who did not receive MICR  but received st and ard advanced life support . INTERVENTION Instruction for EMS personnel in MICR , an approach that includes an initial series of 200 uninterrupted chest compressions , rhythm analysis with a single shock , 200 immediate postshock chest compressions before pulse check or rhythm re analysis , early administration of epinephrine , and delayed endotracheal intubation . MAIN OUTCOME MEASURE Survival-to-hospital discharge . RESULTS Among the 886 patients in the 2 metropolitan cities , survival-to-hospital discharge increased from 1.8 % ( 4/218 ) before MICR training to 5.4 % ( 36/668 ) after MICR training ( odds ratio [ OR ] , 3.0 ; 95 % confidence interval [ CI ] , 1.1 - 8.9 ) . In the subgroup of 174 patients with witnessed cardiac arrest and ventricular fibrillation , survival increased from 4.7 % ( 2/43 ) before MICR training to 17.6 % ( 23/131 ) after MICR training ( OR , 8.6 ; 95 % CI , 1.8 - 42.0 ) . In the analysis of MICR protocol compliance involving 2460 patients with cardiac arrest , survival was significantly better among patients who received MICR than those who did not ( 9.1 % [ 60/661 ] vs 3.8 % [ 69/1799 ] ; OR , 2.7 ; 95 % CI , 1.9 - 4.1 ) , as well as patients with witnessed ventricular fibrillation ( 28.4 % [ 40/141 ] vs 11.9 % [ 46/387 ] ; OR , 3.4 ; 95 % CI , 2.0 - 5.8 ) . CONCLUSIONS Survival-to-hospital discharge of patients with out-of-hospital cardiac arrest increased after implementation of MICR as an alternate EMS protocol . These results need to be confirmed in a r and omized trial Background — Population -based data for pediatric cardiac arrest are scant and largely from urban areas . The Resuscitation Outcomes Consortium ( ROC ) Epistry – Cardiac Arrest is a population -based emergency medical services registry of out-of-hospital nontraumatic cardiac arrest ( OHCA ) . This study examined age-stratified incidence and outcomes of pediatric OHCA . We hypothesized that survival to hospital discharge is less frequent from pediatric OHCA than adult OHCA . Methods and Results — This prospect i ve population -based cohort study in 11 US and Canadian ROC sites included persons < 20 years of age who received cardiopulmonary resuscitation or defibrillation by emergency medical service providers and /or received byst and er automatic external defibrillator shock or who were pulseless but received no resuscitation by emergency medical services between December 2005 and March 2007 . Patients were stratified a priori into 3 age groups : < 1 year ( infants ; n=277 ) , 1 to 11 years ( children ; n=154 ) , and 12 to 19 years ( adolescents ; n=193 ) . The incidence of pediatric OHCA was 8.04 per 100 000 person-years ( 72.71 in infants , 3.73 in children , and 6.37 in adolescents ) versus 126.52 per 100 000 person-years for adults . Survival for all pediatric OHCA was 6.4 % ( 3.3 % for infants , 9.1 % for children , and 8.9 % for adolescents ) versus 4.5 % for adults ( P=0.03 ) . Unadjusted odds ratio for pediatric survival to discharge compared with adults was 0.71 ( 95 % confidence interval , 0.37 to 1.39 ) for infants , 2.11 ( 95 % confidence interval , 1.21 to 3.66 ) for children , and 2.04 ( 95 % confidence interval , 1.24 to 3.38 ) for adolescents . Conclusions — This study demonstrates that the incidence of OHCA in infants approaches that observed in adults but is lower among children and adolescents . Survival to discharge was more common among children and adolescents than infants or adults OBJECTIVE Infant CPR guidelines recommend two-finger chest compression with a lone rescuer and two-thumb with two rescuers . Two-thumb provides better chest compression but is perceived to be associated with increased ventilation h and s-off time . We hypothesized that lone rescuer two-thumb CPR is associated with increased ventilation cycle time , decreased ventilation quality and fewer chest compressions compared to two-finger CPR in an infant manikin model . DESIGN Crossover observational study r and om 
    Output:
    
This study indicates that the two-thumb-encircling h and s technique is a more appropriate technique for a single rescuer to perform high- quality chest compression in consideration of chest compression depth than the two-finger technique in infant manikin studies