First quantitative analysis of cardiopulmonary resuscitation quality during in-hospital cardiac arrests of young children
Robert M Sutton, Dana Niles, Benjamin French, Matthew R Maltese, Jessica Leffelman, Joar Eilevstjønn, Heather Wolfe, Akira Nishisaki, Peter A Meaney, Robert A Berg, Vinay M Nadkarni, Robert M Sutton, Dana Niles, Benjamin French, Matthew R Maltese, Jessica Leffelman, Joar Eilevstjønn, Heather Wolfe, Akira Nishisaki, Peter A Meaney, Robert A Berg, Vinay M Nadkarni
Abstract
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. CPR recording defibrillators collected CPR data (rate (CC/min), depth (mm), CC fraction (CCF), leaning (%>2.5 kg.)). Audiovisual feedback was according to 2010 Guidelines in a subset of patients. The primary outcome, "excellent CPR" was defined as a CC rate ≥ 100 and ≤ 120 CC/min, depth ≥ 50 mm, CCF >0.80, and <20% of CC with leaning.
Results: 8 CC events resulted in 285 thirty-second epochs of CPR (15,960 CCs). Percentage of epochs achieving targets was 54% (153/285) for rate, 19% (54/285) for depth, 88% (250/285) for CCF, 79% (226/285) for leaning, and 8% (24/285) for excellent CPR. The median percentage of epochs per event achieving targets increased with audiovisual feedback for rate [88 (IQR: 79, 94) vs. 39 (IQR 18, 62) %; p=0.043] and excellent CPR [28 (IQR: 7.2, 52) vs. 0 (IQR: 0, 1) %; p=0.018].
Conclusions: In-hospital pediatric CPR often does not meet 2010 Pediatric BLS Guidelines, but compliance is better when audiovisual feedback is provided to rescuers.
Keywords: AHA; American Heart Association; CC; CPR; Cardiopulmonary resuscitation; Pediatric; Quality appraisal; cardiopulmonary resuscitation; chest compression.
Conflict of interest statement
Conflicts of Interest: The authors acknowledge the following potential conflicts of interest. Vinay Nadkarni, Dana Niles, and Matt Maltese receive unrestricted research grant support from the Laerdal Foundation for Acute Care Medicine. Joar Eilevstjønn is an employee of Laerdal Medical. Robert Sutton is supported through a career development award from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (K23HD062629).
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Figures
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Figure 3
Percentage of CPR epochs achieving…
Figure 3
Percentage of CPR epochs achieving targets for depth ≥ 50mm, rate ≥ 100…
- Pushing harder, pushing faster, minimizing interruptions… but falling short of 2010 cardiopulmonary resuscitation targets during in-hospital pediatric and adolescent resuscitation.Sutton RM, Wolfe H, Nishisaki A, Leffelman J, Niles D, Meaney PA, Donoghue A, Maltese MR, Berg RA, Nadkarni VM. Sutton RM, et al. Resuscitation. 2013 Dec;84(12):1680-4. doi: 10.1016/j.resuscitation.2013.07.029. Epub 2013 Aug 15. Resuscitation. 2013. PMID: 23954664 Free PMC article.
- Rescuer fatigue during actual in-hospital cardiopulmonary resuscitation with audiovisual feedback: a prospective multicenter study.Sugerman NT, Edelson DP, Leary M, Weidman EK, Herzberg DL, Vanden Hoek TL, Becker LB, Abella BS. Sugerman NT, et al. Resuscitation. 2009 Sep;80(9):981-4. doi: 10.1016/j.resuscitation.2009.06.002. Epub 2009 Jul 5. Resuscitation. 2009. PMID: 19581036 Free PMC article.
- Quantitative analysis of CPR quality during in-hospital resuscitation of older children and adolescents.Sutton RM, Niles D, Nysaether J, Abella BS, Arbogast KB, Nishisaki A, Maltese MR, Donoghue A, Bishnoi R, Helfaer MA, Myklebust H, Nadkarni V. Sutton RM, et al. Pediatrics. 2009 Aug;124(2):494-9. doi: 10.1542/peds.2008-1930. Epub 2009 Jul 5. Pediatrics. 2009. PMID: 19581266
- Improved Cardiopulmonary Resuscitation Performance With CODE ACES2: A Resuscitation Quality Bundle.Hunt EA, Jeffers J, McNamara L, Newton H, Ford K, Bernier M, Tucker EW, Jones K, O'Brien C, Dodge P, Vanderwagen S, Salamone C, Pegram T, Rosen M, Griffis HM, Duval-Arnould J. Hunt EA, et al. J Am Heart Assoc. 2018 Dec 18;7(24):e009860. doi: 10.1161/JAHA.118.009860. J Am Heart Assoc. 2018. PMID: 30561251 Free PMC article.
- 2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Atkins DL, de Caen AR, Berger S, Samson RA, Schexnayder SM, Joyner BL Jr, Bigham BL, Niles DE, Duff JP, Hunt EA, Meaney PA. Atkins DL, et al. Circulation. 2018 Jan 2;137(1):e1-e6. doi: 10.1161/CIR.0000000000000540. Epub 2017 Nov 6. Circulation. 2018. PMID: 29114009 Review.
- Quality of Ventilations during Infant Resuscitation: A Simulation Study Comparing Endotracheal Tube with Face Mask.Santos-Folgar M, Lafuente-Filgueira P, Otero-Agra M, Fernández-Méndez F, Barcala-Furelos R, Trastoy-Quintela J, Aranda-García S, Fernández-Méndez M, Rodríguez-Núñez A. Santos-Folgar M, et al. Children (Basel). 2022 Nov 16;9(11):1757. doi: 10.3390/children9111757. Children (Basel). 2022. PMID: 36421206 Free PMC article.
- The impact of cognitive aids on resuscitation performance in in-hospital cardiac arrest scenarios: a systematic review and meta-analysis.Corazza F, Fiorese E, Arpone M, Tardini G, Frigo AC, Cheng A, Da Dalt L, Bressan S. Corazza F, et al. Intern Emerg Med. 2022 Oct;17(7):2143-2158. doi: 10.1007/s11739-022-03041-6. Epub 2022 Aug 29. Intern Emerg Med. 2022. PMID: 36031672 Free PMC article. Review.
- Cost-effectiveness analysis of workplace-based distributed cardiopulmonary resuscitation training versus conventional annual basic life support training.Lin Y, Hecker K, Cheng A, Grant VJ, Currie G. Lin Y, et al. BMJ Simul Technol Enhanc Learn. 2020 Sep 29;7(5):297-303. doi: 10.1136/bmjstel-2020-000709. eCollection 2021. BMJ Simul Technol Enhanc Learn. 2020. PMID: 35515736 Free PMC article.
- PediAppRREST: effectiveness of an interactive cognitive support tablet app in reducing deviations from guidelines in the management of paediatric cardiac arrest: protocol for a simulation-based randomised controlled trial.Corazza F, Arpone M, Snijders D, Cheng A, Stritoni V, Ingrassia PL, De Luca M, Tortorolo L, Frigo AC, Da Dalt L, Bressan S. Corazza F, et al. BMJ Open. 2021 Jul 28;11(7):e047208. doi: 10.1136/bmjopen-2020-047208. BMJ Open. 2021. PMID: 34321297 Free PMC article.
- CPR coaching during cardiac arrest improves adherence to PALS guidelines: a prospective, simulation-based trial.Buyck M, Shayan Y, Gravel J, Hunt EA, Cheng A, Levy A. Buyck M, et al. Resusc Plus. 2020 Dec 16;5:100058. doi: 10.1016/j.resplu.2020.100058. eCollection 2021 Mar. Resusc Plus. 2020. PMID: 34223330 Free PMC article.
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- Cardiopulmonary Resuscitation / standards*
- Child, Preschool
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- Female
- Guideline Adherence
- Heart Arrest / therapy*
- Hospitalization
- Humans
- Male
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- Quality of Health Care*
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Source: PubMed