{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T13:27:04Z","timestamp":1794317224661,"version":"4.9.0"},"reference-count":47,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Manual ventilation is a lifesaving intervention for children in respiratory arrest, yet the quality of pediatric ventilation delivered by emergency medical services (EMS) clinicians across geographically distinct sites is poorly characterized. We evaluated baseline EMS ventilation performance and whether a ventilation feedback device (VFD) improves adherence to national and international ventilation guidelines for ventilation rate, tidal volume, and mask seal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We conducted a single-anonymized, randomized, crossover study of EMS clinicians from 5 EMS agencies across 3 metropolitan sites in the United States. Using a simulated 3-year-old toddler manikin, participants completed 2 sequential 2-minute respiratory arrest scenarios separated by a 10-minute washout period. Participants performed ventilation with and without real-time VFD feedback in randomized order. The EOLifeX VFD recorded ventilation rate, tidal volume, and mask leak with each breath. Adherence to age-based guidelines was analyzed using generalized linear mixed-effects models with participants nested within sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>We enrolled 123 participants across 5 agencies. With VFD feedback, guideline-recommended tidal volumes were achieved in 87% of breaths compared with 16.2% without feedback. Ventilation rate adherence improved from 65% to 88.6%. Mask leak of less than 30% occurred in 88.4% of ventilations with feedback vs 80% without feedback.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>In our simulation study, EMS clinicians rarely met manual ventilation guidelines for pediatric patients in respiratory arrest. The use of a VFD substantially improved guideline adherence, suggesting broad potential to improve ventilation performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2026-077291","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:02:33Z","timestamp":1792454553000},"source":"Crossref","is-referenced-by-count":0,"title":["Prehospital Pediatric Ventilation Quality Following Use of a Feedback Device: A Randomized Study"],"prefix":"10.1542","volume":"158","author":[{"given":"Joseph D.","family":"Finney","sequence":"first","affiliation":[{"name":"1Department of Pediatrics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri"},{"name":"2Department of Emergency Medicine, Washington University School of Medicine in Saint Louis, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Siegler","sequence":"additional","affiliation":[{"name":"2Department of Emergency Medicine, Washington University School of Medicine in Saint Louis, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinli","family":"Wang","sequence":"additional","affiliation":[{"name":"3Center for Biostatistics and Data Science, Washington University School of Medicine in Saint Louis, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavya","family":"John","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra","family":"Robinson","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Grawey","sequence":"additional","affiliation":[{"name":"4Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad","family":"McClain","sequence":"additional","affiliation":[{"name":"5Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang","family":"Hoon Lee","sequence":"additional","affiliation":[{"name":"5Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren C.","family":"Riney","sequence":"additional","affiliation":[{"name":"5Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Babcock","sequence":"additional","affiliation":[{"name":"5Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorin R.","family":"Browne","sequence":"additional","affiliation":[{"name":"6Department of Pediatrics, Children\u2019s Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin"},{"name":"7Department of Emergency Medicine, Children\u2019s Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahd A.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"issue":"5","key":"2026111008014912300_r1","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1542\/peds.78.5.808","article-title":"Emergency medical services and the pediatric patient: are the needs being met? II. Training and equipping emergency medical services providers for pediatric emergencies","volume":"78","author":"Seidel","year":"1986","journal-title":"Pediatrics."},{"issue":"3","key":"2026111008014912300_r2","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1080\/10903120802100167","article-title":"The epidemiology of emergency medical services use by children: an analysis of the National Hospital Ambulatory Medical Care Survey","volume":"12","author":"Shah","year":"2008","journal-title":"Prehosp Emerg Care."},{"issue":"5","key":"2026111008014912300_r3","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1080\/10903127.2020.1822481","article-title":"Ventilation in simulated out-of-hospital cardiac arrest resuscitation rarely meets guidelines","volume":"25","author":"Neth","year":"2021","journal-title":"Prehosp Emerg Care."},{"issue":"4","key":"2026111008014912300_r4","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1080\/10903127.2022.2066234","article-title":"Emergency medical services responder manual ventilation performance","volume":"27","author":"Ni","year":"2023","journal-title":"Prehosp Emerg Care."},{"issue":"1","key":"2026111008014912300_r5","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1080\/10903127.2016.1227003","article-title":"Can EMS providers provide appropriate tidal volumes in a simulated adult-sized patient with a pediatric-sized bag-valve-mask?","volume":"21","author":"Siegler","year":"2017","journal-title":"Prehosp Emerg Care."},{"key":"2026111008014912300_r6","doi-asserted-by":"crossref","first-page":"109996","DOI":"10.1016\/j.resuscitation.2023.109996","article-title":"Ten steps toward improving in-hospital cardiac arrest quality of care and outcomes","volume":"193","author":"Chan","year":"2023","journal-title":"Resuscitation."},{"issue":"Suppl 1","key":"2026111008014912300_r7","doi-asserted-by":"crossref","first-page":"110767","DOI":"10.1016\/j.resuscitation.2025.110767","article-title":"European Resuscitation Council Guidelines 2025 Paediatric Life Support","volume":"215","author":"Djakow","year":"2025","journal-title":"Resuscitation."},{"issue":"2","key":"2026111008014912300_r8","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/PCC.0000000000003147","article-title":"Executive summary of the second international guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PALICC-2)","volume":"24","author":"Emeriaud","year":"2023","journal-title":"Pediatr Crit Care Med."},{"issue":"16_suppl_2","key":"2026111008014912300_r9","doi-asserted-by":"crossref","first-page":"S479","DOI":"10.1161\/CIR.0000000000001368","article-title":"Part 8: pediatric advanced life support: 2025 American Heart Association and American Academy of Pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"152","author":"Lasa","year":"2025","journal-title":"Circulation."},{"issue":"5","key":"2026111008014912300_r10","doi-asserted-by":"crossref","first-page":"e1195","DOI":"10.1542\/peds.2010-3696","article-title":"Hyperventilation in pediatric resuscitation: performance in simulated pediatric medical emergencies","volume":"128","author":"Niebauer","year":"2011","journal-title":"Pediatrics."},{"key":"2026111008014912300_r11","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.resuscitation.2021.02.015","article-title":"European Resuscitation Council guidelines 2021: paediatric life support","volume":"161","author":"Van de Voorde","year":"2021","journal-title":"Resuscitation."},{"issue":"9","key":"2026111008014912300_r12","doi-asserted-by":"crossref","first-page":"S345","DOI":"10.1097\/01.CCM.0000134335.46859.09","article-title":"Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation","volume":"32","author":"Aufderheide","year":"2004","journal-title":"Crit Care Med."},{"key":"2026111008014912300_r13","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.resuscitation.2015.03.007","article-title":"Videographic assessment of cardiopulmonary resuscitation quality in the pediatric emergency department","volume":"91","author":"Donoghue","year":"2015","journal-title":"Resuscitation."},{"issue":"8","key":"2026111008014912300_r14","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/j.resuscitation.2011.03.020","article-title":"The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents","volume":"82","author":"McInnes","year":"2011","journal-title":"Resuscitation."},{"issue":"11","key":"2026111008014912300_r15","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1097\/CCM.0000000000003898","article-title":"Ventilation rates and pediatric in-hospital cardiac arrest survival outcomes","volume":"47","author":"Sutton","year":"2019","journal-title":"Crit Care Med."},{"key":"2026111008014912300_r16","doi-asserted-by":"crossref","first-page":"109923","DOI":"10.1016\/j.resuscitation.2023.109923","article-title":"Association between the presence of an advanced airway and ventilation rate during pediatric CPR: a report from the Videography in Pediatric Resuscitation (VIPER) collaborative","volume":"191","author":"O\u2019Connell","year":"2023","journal-title":"Resuscitation."},{"issue":"4","key":"2026111008014912300_r17","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1542\/peds.2011-0271","article-title":"Pulse oximetry in pediatric practice","volume":"128","author":"Fouzas","year":"2011","journal-title":"Pediatrics."},{"issue":"2","key":"2026111008014912300_r18","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.resuscitation.2010.10.012","article-title":"Assessment of chest rise during mask ventilation of preterm infants in the delivery room","volume":"82","author":"Poulton","year":"2011","journal-title":"Resuscitation."},{"issue":"2","key":"2026111008014912300_r19","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1080\/10903127.2018.1489020","article-title":"Can altering grip technique and bag size optimize volume delivered with bag-valve-mask by emergency medical service providers?","volume":"23","author":"Kroll","year":"2019","journal-title":"Prehosp Emerg Care."},{"issue":"3","key":"2026111008014912300_r20","doi-asserted-by":"crossref","first-page":"e2021053030","DOI":"10.1542\/peds.2021-053030","article-title":"Improving ventilation rates during pediatric cardiopulmonary resuscitation","volume":"150","author":"Chapman","year":"2022","journal-title":"Pediatrics."},{"issue":"3","key":"2026111008014912300_r21","doi-asserted-by":"crossref","first-page":"722","DOI":"10.5811\/westjem.2020.3.45788","article-title":"It\u2019s in the bag: tidal volumes in adult and pediatric bag valve masks","volume":"21","author":"Dafilou","year":"2020","journal-title":"West J Emerg Med."},{"issue":"2","key":"2026111008014912300_r22","doi-asserted-by":"crossref","first-page":"109","DOI":"10.2174\/1573396311309020003","article-title":"Ventilation during pediatric CPR","volume":"9","author":"Nunez","year":"2013","journal-title":"Curr Pediatr Rev."},{"issue":"6","key":"2026111008014912300_r23","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1080\/10903127.2025.2558861","article-title":"Feasibility and preliminary outcomes of a simulated prehospital pediatric ventilation scenario using a ventilation feedback device","volume":"30","author":"Finney","year":"2026","journal-title":"Prehosp Emerg Care."},{"issue":"sup1","key":"2026111008014912300_r24","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1080\/10903127.2021.1992551","article-title":"Prehospital pediatric respiratory distress and airway management training and education: an NAEMSP position statement and resource document","volume":"26","author":"Lyng","year":"2022","journal-title":"Prehosp Emerg Care."},{"issue":"3","key":"2026111008014912300_r25","doi-asserted-by":"crossref","first-page":"424","DOI":"10.3109\/10903127.2013.869641","article-title":"EMSC program manager survey on education of prehospital providers","volume":"18","author":"Ngo","year":"2014","journal-title":"Prehosp Emerg Care."},{"issue":"1","key":"2026111008014912300_r26","doi-asserted-by":"crossref","first-page":"e20193308","DOI":"10.1542\/peds.2019-3308","article-title":"Pediatric readiness in emergency medical services systems","volume":"145","author":"Owusu-Ansah","year":"2020","journal-title":"Pediatrics."},{"issue":"2","key":"2026111008014912300_r27","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform."},{"issue":"12","key":"2026111008014912300_r28","doi-asserted-by":"crossref","first-page":"e695","DOI":"10.1097\/PEC.0000000000001314","article-title":"Can providers use clinical skills to assess the adequacy of ventilation in children during bag-valve mask ventilation?","volume":"36","author":"Becker","year":"2020","journal-title":"Pediatr Emerg Care."},{"key":"2026111008014912300_r29","doi-asserted-by":"crossref","first-page":"100130","DOI":"10.1016\/j.resplu.2021.100130","article-title":"The impact of introducing real time feedback on ventilation rate and tidal volume by ambulance clinicians in the North East in cardiac arrest simulations","volume":"6","author":"Charlton","year":"2021","journal-title":"Resusc Plus."},{"issue":"4","key":"2026111008014912300_r30","doi-asserted-by":"crossref","first-page":"F254","DOI":"10.1136\/adc.2010.191171","article-title":"Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room","volume":"96","author":"Schm\u00f6lzer","year":"2011","journal-title":"Arch Dis Child Fetal Neonatal Ed."},{"issue":"2","key":"2026111008014912300_r31","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1080\/10903127.2023.2263555","article-title":"Improving pediatric procedural skills for EMS clinicians: a longitudinal simulation-based curriculum with novel, remote, first-person-view video-based outcome measurement","volume":"28","author":"Lee","year":"2024","journal-title":"Prehosp Emerg Care."},{"key":"2026111008014912300_r32","article-title":"EOlife X: the ultimate tool for high performance manual ventilation","author":"Archeon Medical","year":"2024"},{"issue":"10","key":"2026111008014912300_r33","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1016\/j.resuscitation.2010.08.009","article-title":"European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators","volume":"81","author":"Koster","year":"2010","journal-title":"Resuscitation."},{"issue":"6","key":"2026111008014912300_r34","doi-asserted-by":"crossref","first-page":"e194","DOI":"10.1161\/CIR.0000000000000697","article-title":"Pediatric Post-Cardiac Arrest Care: A Scientific Statement From the American Heart Association","volume":"140","author":"Topjian","year":"2019","journal-title":"Circulation."},{"issue":"3","key":"2026111008014912300_r35","doi-asserted-by":"crossref","first-page":"374","DOI":"10.3109\/10903127.2012.664247","article-title":"Accuracy of paramedic Broselow tape use in the prehospital setting","volume":"16","author":"Heyming","year":"2012","journal-title":"Prehosp Emerg Care."},{"issue":"12","key":"2026111008014912300_r36","doi-asserted-by":"crossref","first-page":"1764","DOI":"10.1007\/s00134-017-4920-z","article-title":"Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC)","volume":"43","author":"Kneyber","year":"2017","journal-title":"Intensive Care Med"},{"key":"2026111008014912300_r37","article-title":"Lifecast body simulation: toddler & child","author":"Lifecast"},{"key":"2026111008014912300_r38","author":"iSimulate: Clinical Education Technology","year":"2025"},{"issue":"16_suppl_2","key":"2026111008014912300_r39","doi-asserted-by":"crossref","first-page":"S469","DOI":"10.1161\/CIR.0000000000000901","article-title":"Part 4: pediatric basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"142","author":"Topjian","year":"2020","journal-title":"Circulation."},{"issue":"10","key":"2026111008014912300_r40","doi-asserted-by":"crossref","first-page":"e0186731","DOI":"10.1371\/journal.pone.0186731","article-title":"Effect of a short training on neonatal face-mask ventilation performance in a low resource setting","volume":"12","author":"Mazza","year":"2017","journal-title":"PLoS One."},{"issue":"3","key":"2026111008014912300_r41","doi-asserted-by":"crossref","first-page":"F230","DOI":"10.1136\/adc.2007.117788","article-title":"Improved techniques reduce face mask leak during simulated neonatal resuscitation: study 2","volume":"93","author":"Wood","year":"2008","journal-title":"Arch Dis Child Fetal Neonatal Ed."},{"issue":"1","key":"2026111008014912300_r42","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.annemergmed.2005.02.005","article-title":"Comparison of 1- versus 2-person bag-valve-mask techniques for manikin ventilation of infants and children","volume":"46","author":"Davidovic","year":"2005","journal-title":"Ann Emerg Med."},{"issue":"1","key":"2026111008014912300_r43","doi-asserted-by":"crossref","first-page":"e001768","DOI":"10.1136\/bmjpo-2022-001768","article-title":"One-person versus two-person mask ventilation in preterm infants at birth: a pilot randomised controlled trial","volume":"7","author":"Shah","year":"2023","journal-title":"BMJ Paediatr Open."},{"key":"2026111008014912300_r44","volume-title":"Pediatric prehospital airway resuscitation trial (Pedi-PART)","author":"Ohio State University","year":"2026"},{"issue":"5","key":"2026111008014912300_r45","doi-asserted-by":"crossref","first-page":"e2313969","DOI":"10.1001\/jamanetworkopen.2023.13969","article-title":"Comparison of resuscitation quality in simulated pediatric and adult out-of-hospital cardiac arrest","volume":"6","author":"Hansen","year":"2023","journal-title":"JAMA Netw Open."},{"issue":"6","key":"2026111008014912300_r46","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1007\/s12519-017-0061-2","article-title":"Ventilation during cardiopulmonary resuscitation in children: a survey on clinical practice","volume":"13","author":"Gonz\u00e1lez","year":"2017","journal-title":"World J Pediatr."},{"issue":"2","key":"2026111008014912300_r47","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.ajem.2016.10.085","article-title":"Real-time tidal volume feedback guides optimal ventilation during simulated CPR","volume":"35","author":"You","year":"2017","journal-title":"Am J Emerg Med."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2026-077291\/1978908\/pediatrics.2026077291.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2026-077291\/1978908\/pediatrics.2026077291.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T13:01:59Z","timestamp":1794315719000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/158\/5\/e2026077291\/210992\/Prehospital-Pediatric-Ventilation-Quality"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":47,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,10,20]]},"published-print":{"date-parts":[[2026,11,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2026-077291","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"article-number":"e2026077291"}}