Comparison of times of intervention during pediatric CPR maneuvers using ABC and CAB sequences : a randomized trial

BACKGROUND: The proposed introduction of the CAB (circulation, airway, breathing) sequence for cardiopulmonary resuscitation has raised some perplexity within the pediatric community. We designed a randomized trial intended to verify if and how much timing of intervention in pediatric cardiopulmonary resuscitation is affected by the use of the CAB vs. the ABC (airway, breathing, circulation) sequence. PATIENTS AND METHODS: 340 volunteers, paired into 170 two-person teams, performed 2-rescuer healthcare provider BLS with both a CAB and ABC sequence. Their performances were audio-video recorded and times of intervention in the two scenarios, cardiac and respiratory arrest, were monitored. RESULTS: The CAB sequence compared to ABC prompts quicker recognition of respiratory (CAB vs. ABC=17.48±2.19 vs. 19.17±2.38s; p<0.05) or cardiac arrest (CAB vs. ABC=17.48±2.19 vs. 41.67±4.95; p<0.05) and faster start of ventilatory maneuvers (CAB vs. ABC=19.13±1.47s vs. 22.66±3.07; p<0.05) or chest compressions (CAB vs. ABC=19.27±2.64 vs. 43.40±5.036; p<0.05). CONCLUSIONS: Compared to ABC the CAB sequence prompts shorter time of intervention both in diagnosing respiratory or cardiac arrest and in starting ventilation or chest compression. However, this does not necessarily entail prompter resumption of spontaneous circulation and significant reduction of neurological sequelae, an issue that requires further studies.