Dear Colleague;
In 2020 the American Heart Association changed the recommended technique for chest compressions during infant cardiopulmonary resuscitation to the two-handed encircling method. Previously either the two finger or the two hand encircling techniques were advocated equally. Because the two-hand encircling technique for chest compressions is theoretically like the proposed mechanism of rib fracture when the chest is squeezed as an infant is shaken in the setting of child abuse, it is possible that the incidence of rib fractures related to cardiopulmonary resuscitation could increase. To evaluate this possibility, we plan to study infants who have had CPR to look for a change in the occurrence of rib fractures with the change in recommended CPR technique. We would like to invite you to become a part of the study consortium.

The study is entitled CArdioPulmonary Resuscitation In Children: Observation of Rib iNjuries, or CAPRICORN for short. Members of the CAPRICORN consortium are being asked to submit to their specific Institutional Review Board for permission to retrospectively query medical records to identify infants less than 1 year of age who have had CPR since January 1, 2021 through December 31, 2023. Two investigators per institution will then review imaging according to the study protocol (attached). A consensus regarding any rib fractures will be submitted in the form of an online survey for each eligible patient from that institution. There will be no sharing of protected, identifiable patient information between institutions. Surveys will be collected through the RedCAP system, and data analyzed for patterns of injury. Comparison with prior reports of CPR related rib injuries will then be made.

Because the inclusion criteria are specific, we anticipate that there will be relatively few cases per institution meeting the inclusion criteria. For that reason, we are hoping to have a large number of institutions participate in this project. A consensus read for the submitted cases by two authors per institution is also required, making the number of contributors for this project potentially very large. When this project is submitted for publication, should the journal to which the manuscript is submitted limit the number of authors, contributors aside from the individuals who planned and created the project will be listed as a collaborator of the CAPRICORN Consortium. This will ensure recognition on PubMed and the publication will count towards each collaborators H-factor. All contributing participants will be referenced by ORCID.

We hope you will be interested in participating in this project to determine any change to patterns of rib injury related to CPR with the advocated change in CPR technique. Please do not hesitate to contact us with any questions or concerns. To join the project please send your response with the two investigator names and one contact email for your institution to . You will then be sent the study protocol and the Nemours IRB letter of approval to use to apply for IRB approval at your institution. Surveys will be sent once IRB approval is received.

Thank you in advance for your time and consideration.

Sharon W Gould, MD
Rick van Rijn, MD, PhD
Prof. Owen Arthurs, RRCPCH, FRCR, SFFMLM
Peter J Strouse, MD
M. Patricia Harty, MD
Prof. Stacey Goergen, MD
Padma Rao, BSc Hons, MBBS, MRCP (UK), FRCR (UK), FRANZCR
Sabah Servaes, MD