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

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

Figure 1

Study diagram. IDE refers to investigation device exemption.

Figure 2

Percentage of CPR epochs achieving targets for depth ≥ 50mm, rate ≥ 100 and ≤ 120 CC/min, CC fraction > 0.80, and leaning

Figure 3

Percentage of CPR epochs achieving targets for depth ≥ 50mm, rate ≥ 100 and ≤ 120 CC/min, CC fraction > 0.80, and leaning