Browsing by Author "Lloyd, Debbie L."
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- ItemDevelopment and validation of a feedback device suitable for resuscitation of premature neonates.(Stellenbosch : Stellenbosch University, 2016-12) Lloyd, Debbie L.; Van den Heever, David Jacobus; Dellimore, Kiran H.; Stellenbosch University. Faculty of Engineering. Dept. of Mechanical and Mechatronic Engineering.ENGLISH ABSTRACT: Neonatal cardiopulmonary resuscitation (NCPR) is an important life-saving intervention. Clinicians follow the guidelines which recommend using the two-thumb (TT) or two-finger (TF) method to compress the neonates’ chest to one-third of their anterior-posterior diameter (APD) at a 3:1 compression to ventilation ratio. Ineffective compressions can result in an increased mortality and morbidity rate for neonates. Clinicians have difficulty delivering effective and consistent chest compressions (CCs) during NCPR due to the high number of actions (120 events per minute), the lack of practice due to the limited number of occurrences and poor fidelity of infant training manikins in replication of infant thoracic properties. There is therefore a need for a tool to assist the clinician in performing correct and consistent CCs. This report presents the design, fabrication and implementation of a diagnostic tool to guide the clinician on the CC rate using a metronome and on the compression depth using LED feedback. The device is battery powered and records the depth and force during CC for post processing. The need for such a device was investigated during this project by recruiting an experienced neonatal resuscitation programme (NRP) certified clinician to perform tests on five, 6-month old white New Zealand rabbits (weight = 2.74 ± 0.27 kg, APD = 88.4 ± 2.7 mm). The fidelity of the CCs during these tests was assessed according to the target depth (one-third of the APD) and according to the estimated target depth range for ‘wet’ neonates (17.5 to 22.5 mm). The results from the target depth fidelity analysis show that 97%, 2% and <1% of the CCs were too shallow, correct and too deep, respectively for all CCs according to target depth. The results for the target depth range for ‘wet’ neonates’ fidelity analysis showed that 79%, 17% and 4% of all compressions were too shallow, correct and too deep, respectively. The analysis was also performed for individual CC segments which are defined as three consecutive compressions. A segment is deemed to be correct if two out of the three compressions are within the target depth range. The segment fidelity using one-third APD was 89%, 10% and <1% for too shallow, correct and too deep, respectively. These results prove that the clinician is finding it difficult to meet the target depth and that a large percentage of the CCs are too shallow (ineffective CC) according to the APD and ‘wet’ neonate range. The segment analysis also shows that the CCs are inconsistent and very few consecutive CCs are correct and within the target range. The inconsistent and ineffective compressions performed by an experienced and trained clinician validate the need for a NCPR feedback tool for ‘wet’ neonates. A force-depth analysis was completed and the effect of the compression and ventilation method was examined. The mean force results showed no clear difference between compression methods, however, the mean depth for the TT method was higher than that of the TF method. The compression method used also affected the force-deformation curve. The ventilation method, however, had no effect on the measured CC depth and force or shape of the force-deformation curve. A key finding of this study is the ineffective and inconsistent compressions performed by an experienced and trained clinician. The CCs were mostly too shallow regardless of the compression or ventilation method. It is also clear that there is no real, significant, difference between the TT and TF method with regards to fidelity or effectiveness (compression depth and force relationship).