An evaluation of front seat distance from rear facing child restraint systems in prevention of injury in frontal crash tests.

Objectives: Elevated head injury incidence in infants compared to toddlers involved as occupants in motor vehicle crashes has been demonstrated in multiple population-representative crash databases. Further, experimental studies have revealed a potential injury mechanism impact between a rear-facing, CRS-restrained child and the back of the vehicle seat or console on the row in front of the CRS. Subsequently, experimental studies have suggested that bracing the CRS against the seat immediately in front of the CRS could mitigate head injury, but also indicated that more research was necessary.

Simulating blood pressure and end tidal CO2 in a CPR training manikin.

Background And Objective: The American Heart Association supports titrating the mechanics of cardiopulmonary resuscitation (CPR) to blood pressure and end tidal carbon dioxide (ETCO2) thresholds during in-hospital cardiac arrest. However, current CPR manikin training systems do not prepare clinicians to use these metrics to gauge their performance, and currently provide only feedback on hand placement, depth, rate, release, and interruptions of chest compressions. We addressed this training hardware deficiency through development of a novel CPR training manikin that displays simulated blood pressure and ETCO2 waveforms in real time on a simulated clinical monitor visible to the learner, reflecting the mechanics of chest compressions provided to the manikin.

Factors contributing to serious and fatal injuries in belted rear seat occupants in frontal crashes.

Earlier research has shown that the rear row is safer for occupants in crashes than the front row, but there is evidence that improvements in front seat occupant protection in more recent vehicle model years have reduced the safety advantage of the rear seat versus the front seat. The study objective was to identify factors that contribute to serious and fatal injuries in belted rear seat occupants in frontal crashes in newer model year vehicles. A case series review of belted rear seat occupants who were seriously injured or killed in frontal crashes was conducted.

Fatal side impact crash scenarios for rear seat and seat belt-restrained occupants from vulnerable populations.

Previous studies have revealed vulnerability of school-age children and older adults in rear seats in motor vehicle crashes. Detailed information about crashes in which these fatalities occur could help improve vehicle and restraint design. Police accident reports were obtained for crashes from the Fatality Analysis Reporting System data set.

Carbon dioxide rebreathing induced by crib bumpers and mesh liners using an infant manikin.

Objectives: Quantify impaired respiration in currently marketed crib bumpers (CBs), mesh liners (MLs) and alternative products (ALTs) used to attenuate the interaction between the baby and the crib sides and elucidate the relationship between impaired respiration and permeability.

Methods: We experimentally quantified carbon dioxide rebreathing (CORB) via an infant manikin and air permeability via previously published test protocols, in commercially available CBs, MLs and ALTs.

Results: Differences in CORB in ML (median [m]=8.

The influence of child restraint lower attachment method on protection offered by forward facing child restraint systems in oblique loading conditions.

Objective: The research objective was to quantify the influence of child restraint lower attachment method on head kinematics, head impact potential, and head, neck, and thorax injury metrics for a child occupant secured in a forward-facing child restraint system (FFCRS) in oblique side impacts.

Methods: Fifteen sled tests were conducted with a Q3s seated in an FFCRS secured to the center position on a production small SUV bench seat. Three lower attachment methods were evaluated: rigid ISOFIX, a flexible single loop lower anchors and tethers for children (LATCH) webbing routed through the vehicle belt path of the FFCRS, and dual flexible LATCH webbing attachments on either side of the FFCRS.

Redesign of an Open-System Oxygen Face Mask With Mainstream Capnometer for Children.

Background: Partial pressure of end-tidal carbon dioxide (P ) monitoring in children is important to detect apnea or hypopnea early to intervene before hypoxemia develops. Monitoring P in children without a tracheal tube is challenging. To improve P measurement accuracy in a commercially available mask with a mainstream CO detector, we implemented design changes with deform-and-hold shaping technology and anterior-posterior adjustment of the expiratory gas flow cup.

Protection of children in forward-facing child restraint systems during oblique side impact sled tests: Intrusion and tether effects.

Objective: Testing was conducted to quantify the kinematics, potential for head impact, and influence on head injury metrics for a center-seated Q3s in a forward-facing child restraint system (FFCRS) in oblique impacts. The influences of a tether and intruded door on these measures were explored.

Methods: Nine lateral oblique sled tests were conducted on a convertible forward-facing child restraint seat (FFCRS).

Biofidelic white matter heterogeneity decreases computational model predictions of white matter strains during rapid head rotations.

The finite element (FE) brain model is used increasingly as a design tool for developing technology to mitigate traumatic brain injury. We developed an ultra high-definition FE brain model (>4 million elements) from CT and MRI scans of a 2-month-old pre-adolescent piglet brain, and simulated rapid head rotations. Strain distributions in the thalamus, coronal radiata, corpus callosum, cerebral cortex gray matter, brainstem and cerebellum were evaluated to determine the influence of employing homogeneous brain moduli, or distinct experimentally derived gray and white matter property representations, where some white matter regions are stiffer and others less stiff than gray matter.

The Influence of Enhanced Side Impact Protection on Kinematics and Injury Measures of Far- or Center-Seated Children in Forward-Facing Child Restraints.

Objective: To evaluate the influence of forward-facing child restraint systems' (FFCRSs) side impact structure, such as side wings, on the head kinematics and response of a restrained, far- or center-seated 3-year-old anthropomorphic test device (ATD) in oblique sled tests.

Methods: Sled tests were conducted utilizing an FFCRS with large side wings and with the side wings removed. The CRS were attached via LATCH on 2 different vehicle seat fixtures-a small SUV rear bench seat and minivan rear bucket seat-secured to the sled carriage at 20° from lateral.

Accounting for sampling variability, injury under-reporting, and sensor error in concussion injury risk curves.

There has been recent dramatic increase in the use of sensors affixed to the heads or helmets of athletes to measure the biomechanics of head impacts that lead to concussion. The relationship between injury and linear or rotational head acceleration measured by such sensors can be quantified with an injury risk curve. The utility of the injury risk curve relies on the accuracy of both the clinical diagnosis and the biomechanical measure.

Blood Pressure Directed Booster Trainings Improve Intensive Care Unit Provider Retention of Excellent Cardiopulmonary Resuscitation Skills.

Objectives: Brief, intermittent cardiopulmonary resuscitation (CPR) training sessions, "Booster Trainings," improve CPR skill acquisition and short-term retention. The objective of this study was to incorporate arterial blood pressure (ABP) tracings into Booster Trainings to improve CPR skill retention. We hypothesized that ABP-directed CPR "Booster Trainings" would improve intensive care unit (ICU) provider 3-month retention of excellent CPR skills without need for interval retraining.

White matter tract-oriented deformation predicts traumatic axonal brain injury and reveals rotational direction-specific vulnerabilities.

A systematic correlation between finite element models (FEMs) and histopathology is needed to define deformation thresholds associated with traumatic brain injury (TBI). In this study, a FEM of a transected piglet brain was used to reverse engineer the range of optimal shear moduli for infant (5 days old, 553-658 Pa) and 4-week-old toddler piglet brain (692-811 Pa) from comparisons with measured in situ tissue strains. The more mature brain modulus was found to have significant strain and strain rate dependencies not observed with the infant brain.

Measurement of Hybrid III Head Impact Kinematics Using an Accelerometer and Gyroscope System in Ice Hockey Helmets.

Helmet-based instrumentation is used to study the biomechanics of concussion. The most extensively used systems estimate rotational acceleration from linear acceleration, but new instrumentation measures rotational velocity using gyroscopes, potentially reducing error. This study compared kinematics from an accelerometer and gyroscope-containing system to reference measures.

Pediatric occupant-vehicle contact maps in rollover motor vehicle crashes.

Objective: Rollover crashes account for more than 33% of all motor vehicle-related fatalities and have the highest fatality risk of all crash types, at 1.37% in the United States. There is increased awareness of the high fatality rate associated with this crash type, but there is very limited pediatric-specific data related to rollover crashes in the United States.

Evaluation of pediatric ATD biofidelity as compared to child volunteers in low-speed far-side oblique and lateral impacts.

Objective: Motor vehicle crashes are a leading cause of injury and mortality for children. Mitigation of these injuries requires biofidelic anthropomorphic test devices (ATDs) to design and evaluate automotive safety systems. Effective countermeasures exist for frontal and near-side impacts but are limited for far-side impacts.

Comparative performance of forward-facing child restraint systems on the C/FMVSS 213 bench and vehicle seats.

Objective: The objective of this study was to evaluate the fidelity of the C/FMVSS 213 test bench, by comparing the dynamic performance of forward-facing child restraint systems (FFCRS) mounted on the C/FMVSS 213 sled bench versus mounted on a selection of production vehicle seats.

Methods: The C/FMVSS 213 bench or one of 3 second-row original equipment manufacturer vehicle seats was mounted to the deck of acceleration crash sled. An FFCRS with a restrained anthropomorphic test device (ATD) was secured by 3-point belt (3-PT) or LATCH lower anchor (LLA) on the C/FMVSS 213 bench or vehicle seat, with or without a tether.

Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation.

Aim: Advances in cardiopulmonary resuscitation (CPR) have focused on the generation and maintenance of adequate myocardial blood flow to optimize the return of spontaneous circulation and survival. Much of the morbidity associated with cardiac arrest survivors can be attributed to global brain hypoxic ischemic injury. The objective of this study was to compare cerebral physiological variables using a hemodynamic directed resuscitation strategy versus an absolute depth-guided approach in a porcine model of ventricular fibrillation (VF) cardiac arrest.

Hemodynamic-directed cardiopulmonary resuscitation during in-hospital cardiac arrest.

Cardiopulmonary resuscitation (CPR) guidelines assume that cardiac arrest victims can be treated with a uniform chest compression (CC) depth and a standardized interval administration of vasopressor drugs. This non-personalized approach does not incorporate a patient's individualized response into ongoing resuscitative efforts. In previously reported porcine models of hypoxic and normoxic ventricular fibrillation (VF), a hemodynamic-directed resuscitation improved short-term survival compared to current practice guidelines.

Comparative Performance of Rear Facing Child Restraint Systems on the CMVSS 213 Bench and Vehicle Seats.

The purpose of this study was to compare the dynamic response of rear-facing child restraint systems (RFCRS) installed on the CMVSS 213 sled bench and a selection of vehicle seats. Thirty-six sled tests were conducted: three models of rear facing CRS with an anthropomorphic test device (ATD) representing a 12 month old child (CRABI) were affixed via lower anchors (LATCH), 3 point belt without CRS base, and 3 point belt with CRS base to one of three vehicle seats or the CMVSS 213 bench seat. All CRS were subjected to an identical sled acceleration pulse.

Simplified dispatcher instructions improve bystander chest compression quality during simulated pediatric resuscitation.

Aim: Cardiopulmonary resuscitation (CPR) quality is associated with survival outcomes after out-of-hospital cardiac arrest. The objective of this study was to evaluate the effectiveness of simplified dispatcher CPR instructions to improve the chest compression (CC) quality during simulated pediatric cardiac arrest in public places.

Methods: Adult bystanders recruited in public places were randomized to receive one of two scripted dispatcher CPR instructions: (1) "Push as hard as you can" (PUSH HARD) or (2) "Push approximately 2 inches" (TWO INCHES).

First quantitative analysis of cardiopulmonary resuscitation quality during in-hospital cardiac arrests of young children.

Aim: The objective of this study is to report, for the first time, quantitative data on CPR quality during the resuscitation of children under 8 years of age. We hypothesized that the CPR performed would often not achieve 2010 Pediatric Basic Life Support (BLS) Guidelines, but would improve with the addition of audiovisual feedback.

Methods: Prospective observational cohort evaluating CPR quality during chest compression (CC) events in children between 1 and 8 years of age.

Pushing harder, pushing faster, minimizing interruptions… but falling short of 2010 cardiopulmonary resuscitation targets during in-hospital pediatric and adolescent resuscitation.

Aim: The objective of this study was to evaluate the effect of instituting the 2010 Basic Life Support Guidelines on in-hospital pediatric and adolescent cardiopulmonary resuscitation (CPR) quality. We hypothesized that quality would improve, but that targets for chest compression (CC) depth would be difficult to achieve.

Methods: Prospective in-hospital observational study comparing CPR quality 24 months before and after release of the 2010 Guidelines.