Impact of 2 Resuscitation Sequences on Alveolar Ventilation During the First Minute of Simulated Pediatric Cardiac Arrest: Randomized Cross-Over Trial
Phase: NA
Conditions: Cardiopulmonary Arrest, Pediatric ALL, Resuscitation
Sponsor: Geneve TEAM Ambulances

Final Study Protocol (retrospective documentation) 
Official title 
Impact of Two Resuscitation Sequences on Alveolar Ventilation 
during the First Minute of Simulated Pediatric Cardiac Arrest: 
Randomized Cross-Over Trial 
NCT Number 
NCT05474170 
Document type 
Final Study Protocol (retrospective documentation) 
Document 
version 
Version 1.0 (Retrospective) 
Document date 
February 15, 2026 
Sponsor 
Genève TEAM Ambulances 
Responsible 
party 
Stuby Loric 
 
Transparency statement 
This document was created retrospectively to describe the study design and statistical 
analysis used in the trial identified as NCT05474170. A single, formally finalized study 
protocol did not exist prior to study initiation. The contents of this document reflect the 
methods actually used and reported in the final published article (Suppan et al., 
Healthcare 2022). 
 
 

Background and RaƟonale 
Pediatric cardiac arrest resuscitation methods vary internationally, with differing 
guideline recommendations on the optimal sequence of initial interventions. The 
impact of these sequences on alveolar ventilation during the first minute of 
resuscitation remains unclear. This study was conducted to compare two commonly 
considered resuscitation sequences in a controlled simulation setting, with the primary 
interest in the ventilation outcome during the earliest phase of resuscitation. 
Study ObjecƟves 
Primary ObjecƟve 
To compare alveolar ventilation achieved during the first minute of simulated pediatric 
cardiac arrest between two resuscitation sequences. 
Secondary ObjecƟves 
Secondary measures include additional ventilation and compression performance 
metrics as detailed in the published article. 
Study Design 
This was a randomized, cross-over simulation trial. Participants conducted 
resuscitation in a manikin simulation under two different resuscitation sequences. Each 
team performed both sequences, with order randomized. 
 
Design Type: Randomized cross-over 
 
Setting: Simulation laboratory 
 
Duration: Single session (of 2 scenarios) per team 
ParƟcipants 
PopulaƟon 
Teams of two individuals trained in pediatric resuscitation methods were enrolled. 
Inclusion and exclusion criteria were specified in the Methods section of the full text. 
 

IntervenƟons 
The order in which teams performed these sequences was randomized. The wwo 
resuscitation sequences compared were: 
- Sequence A: Initial ventilations followed by chest compressions (ERC 
ventilation-first sequence) 
Participants initiated resuscitation with five initial rescue breaths, in accordance with 
European Resuscitation Council recommendations for pediatric cardiac arrest. After 
delivery of the five initial ventilations, participants proceeded with cycles of 15 chest 
compressions followed by 2 ventilations. This 15:2 compression-to-ventilation ratio 
was maintained during the first minute of resuscitation. The objective of this sequence 
was to prioritize early oxygen delivery through ventilation before initiating chest 
compressions. 
- Sequence B: Chest compressions first (AHA compression-first sequence) 
Participants initiated resuscitation immediately with chest compressions, without 
delivering initial rescue breaths, in accordance with American Heart Association 
recommendations for pediatric cardiac arrest.  Compressions were delivered according 
to pediatric resuscitation guidelines, followed by ventilations in 15 compressions to 2 
ventilations (15:2) ratio. No initial series of rescue breaths was provided before the first 
compression cycle. The objective of this sequence was to prioritize immediate 
circulatory support. 
Outcome Measures 
Primary outcome 
Alveolar ventilation during the first minute of simulated pediatric cardiac arrest. 
Secondary outcomes 
Additional measures (e.g., chest compression parameters, ventilation metrics) as 
reported in the article. 
All outcomes are defined and measured as detailed in the article’s Methods section. 

StaƟsƟcal Analysis 
Data from all randomized teams were included in analysis. Statistical methods 
employed reflected the cross-over design of the study. 
 
Data were analyzed using appropriate comparative statistics for cross-over 
studies. 
 
Descriptive and inferential statistics were conducted as reported in the 
published Methods. 
 
No formal separate Statistical Analysis Plan existed; methods were those 
implemented and reported. 
Ethics and approvals 
The Swiss Federal Law on Human Research does not apply to this kind of project as 
no health outcomes are assessed among participants and because the participants do 
not belong to a vulnerable population. A clarification of responsibility (Req #2022-
00810) was nevertheless requested from the regional Ethics Committee (CCER—
Commission Cantonale d’Ethique de la Recherche sur l’être humain, Geneva, 
Switzerland). All included participants provided electronic informed consent. 
Data management 
Data were automatically collected through the manikin’s sensors, thereby preventing 
assessment bias. All the variables of interest listed above were automatically 
generated using a custom-coded hypertext pre-processor (PHP) script. These 
variables were then exported to a comma-separated values (CSV) file and imported 
for statistical analysis in Stata 15.1 (StataCorp, LLC, College Station, TX, USA). All 
authors had access to the database. The curated dataset is publicly available on Yareta 
PublicaƟon 
Suppan L, Jampen L, Siebert JN, Zünd S, Stuby L, Ozainne F. Impact of Two 
Resuscitation Sequences on Alveolar Ventilation during the First Minute of Simulated 
Pediatric Cardiac Arrest: Randomized Cross-Over Trial. Healthcare. 2022; 
10(12):2451. https://doi.org/10.3390/healthcare10122451