Effect of rotating providers on chest compression performance during simulated neonatal cardiopulmonary resuscitation

Tavleen Sandhu; Edgardo G. Szyld; Michael P. Anderson; Birju A. Shah

doi:10.1371/journal.pone.0265072

Peer Review History

Original SubmissionJuly 13, 2021
30 Dec 2021 Decision Letter - Jayasree Nair, Editor PONE-D-21-22882Effect of rotating providers on chest compression performance during simulated neonatal cardiopulmonary resuscitationPLOS ONE Dear Dr. Sandhu, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Cover letter is addressed to Journal of Perinatology and Patrick Gallagher. Would advise authors to carefully read materials submitted to ensure correct information. Please submit your revised manuscript by Feb 13 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. 3. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. If the original language is written in non-Latin characters, for example Amharic, Chinese, or Korean, please use a file format that ensures these characters are visible. 4. Please state whether you validated the questionnaire prior to testing on study participants. Please provide details regarding the validation group within the methods section. Additional Editor Comments: Positives: authors have analyzed physiological data of fatigue Minor revisions: 75 sessions line 106. 76 in table. Please ensure consistency Table 4 headings are missing- table is not explained properly. It seems more CC are “missed” when providers are rotated out- this seems significant? Page 12: “However, in the previous study, CC depth of one-third of chest diameter was defined as adequate quality, and a surrogate marker for provider fatigue was defined as four consecutive CCs below target depth.” This data is available for current study as well. Have the authors looked at these? From fig 2- it looked like CC depth was similar between groups here? How do you explain different findings/interpretation in same mannequin and relatively similar group of participants? If you are showing increased fatigue in 10min- why do you not see effect on quality/depth of CC compared to shorter durations? Page 12 line 238: you report under compression by providers. Was there “over compression” ie compressing excessive depth by some providers- that could impact fatigue. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: In this study, the authors present interesting data on the effect of chest compression (CC) rotation on CC performance and provider fatigue in a simulation manikin study. The authors studied 51 providers paired to deliver CC at 3 min, 5 min and 10 min intervals for a duration of 18 – 20 min. There was no deterioration in CC performance (percent CCs with adequate rate, adequate depth, complete recoil, correct thumb position, and duration of overall pause), but providers reported higher fatigue with longer CC intervals. Provider fatigue was assessed by heart rate and blood pressure measurement, as well as reporting level of fatigue on a scale of 1-10. Five providers consistently had poor CC performance with depth measured at < 10%. Data were re-analysed after removing thirteen simulations in which these five providers participated, and showed no statistically significant difference in the performances under each study arm. This reviewer has the following minor comments/suggestions: 1. p3, line 63: "bpm" should be spelled out the first time the abbreviation is used. 2. p3: ref 7 and 8 should be updated to the more recent 2020 publications. 3. page 3, line 65: "bpm" abbreviation can be used here. 4. p5, line 94: CV should be spelled out as this is the first time the abbreviation has been used. 5. p11, Table 4: Missing a title row for the respective columns (e.g. what do the 19.89 and 37.13 values for the 3 min row indicate?). 6. Methods/Results: The authors mention in the methods section that reporter fatigue was assessed by Likert scale. Can the authors include those results in the manuscript? 7. Discussion, p13: can the authors comment if the five providers who performed chest compressions at <10% depth had a similar performance during their practice time and how they responded to the feedback? One would expect their performance to have improved during the simulation following the practice session. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0265072.r001
Revision 1
14 Jan 2022 Author Response Response to the editors’ comments: • Minor revisions: 75 sessions line 106. 76 in table. Please ensure consistency. o Line 106 mentions what was intended in the protocol, however due to error in pairing of the participants we were left with less than 75 sessions and hence enrolled one additional participant and ended up with a total of 76 sessions (this is explained in the manuscript lines 192-195). Additionally, we have added this information in the text under figure 2 to provide more clarity. • Table 4 headings are missing- table is not explained properly. It seems more CC are “missed” when providers are rotated out- this seems significant? o The table heading has been addressed, sorry for that miss earlier o It is true that the more CC were missed when the providers rotated out more frequently, however the number of CCs missed were not statistically significant when compared to the total number of the CC performed over the 18 and 20 minute runs. We have elaborated on this now in lines 214-217 for additional clarity. • Page 12: “However, in the previous study, CC depth of one-third of chest diameter was defined as adequate quality, and a surrogate marker for provider fatigue was defined as four consecutive CCs below target depth.” This data is available for current study as well. Have the authors looked at these? From fig 2- it looked like CC depth was similar between groups here? How do you explain different findings/interpretation in same mannequin and relatively similar group of participants? If you are showing increased fatigue in 10min- why do you not see effect on quality/depth of CC compared to shorter durations? o The previous study had used the HeartStart Mrx monitor which allowed quantification of the rate, depth, chest deflection and residual leaning force. We solely used the Resusci Anne Skill Reporter device which provided composite data on the entire run, this included the average CC depth and % CC that were deep enough. We have included this piece of information now in line 255-258. • Page 12 line 238: you report under compression by providers. Was there “over compression” ie compressing excessive depth by some providers- that could impact fatigue. o Over compression was not reported by the device. It only reports % compressions that were of adequate depth (>1/3 AP diameter). We have elaborated on this in lines 288-291. Response to reviewers’ comments: 1. p3, line 63: "bpm" should be spelled out the first time the abbreviation is used. - Done 2. p3: ref 7 and 8 should be updated to the more recent 2020 publications. - Done 3. page 3, line 65: "bpm" abbreviation can be used here. - Done 4. p5, line 94: CV should be spelled out as this is the first time the abbreviation has been used. - Thank you, we have now addressed that in line 67. 5. p11, Table 4: Missing a title row for the respective columns (e.g. what do the 19.89 and 37.13 values for the 3 min row indicate?). - Done, apologies for that missing information. 6. Methods/Results: The authors mention in the methods section that reporter fatigue was assessed by Likert scale. Can the authors include those results in the manuscript? - This is shared in the last box plot on the Figure 3 (see below for reference) and mentioned in lines 211-213. Additionally, we have now included this information in the text under the figure. 7. Discussion, p13: can the authors comment if the five providers who performed chest compressions at <10% depth had a similar performance during their practice time and how they responded to the feedback? One would expect their performance to have improved during the simulation following the practice session. -Performances during practice were not recorded. No verbal feedback was shared during practice either, but the participants were able to visually track the compression depth and hand positioning on the SimPad PLUS with Skill reporter device during this practice period. I have included this piece of information in lines 295-298. We are hopeful that the revisions that have been made have successfully addressed the points that were made by the editor and reviewer. However, if any further clarification is needed, we will be happy to address that. We thank the team of PLOS ONE once again for considering this manuscript for publication. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0265072.r002
23 Feb 2022 Decision Letter - Jayasree Nair, Editor Effect of rotating providers on chest compression performance during simulated neonatal cardiopulmonary resuscitation PONE-D-21-22882R1 Dear Dr. Sandhu, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Jayasree Nair, MBBS MD FAAP Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0265072.r003
Formally Accepted
28 Feb 2022 Acceptance Letter - Jayasree Nair, Editor PONE-D-21-22882R1 Effect of rotating providers on chest compression performance during simulated neonatal cardiopulmonary resuscitation Dear Dr. Sandhu: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Jayasree Nair Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0265072.r004

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