Elsevier

Resuscitation

Volume 85, Issue 1, January 2014, Pages 70-74
Resuscitation

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

https://doi.org/10.1016/j.resuscitation.2013.08.014Get rights and content

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.

Introduction

In the United States, the number of children who receive in-hospital pediatric cardiopulmonary resuscitation (CPR) each year for cardiac arrest is in the thousands.1, 2 Over the last decade, there have been substantial improvements in survival outcomes after pediatric arrest,3 but there are many children who will still suffer neurological sequelae post-event. As previous investigations have associated CPR quality with cardiac arrest outcome,4, 5, 6, 7, 8, 9 interventions targeted to monitor and improve resuscitation quality are warranted.

Our group has previously established that CPR quality in older children and adolescents frequently does not achieve American Heart Association (AHA) Pediatric Basic Life Support (BLS)10 quality targets.11 However, these “children” are more similar in chest mechanics and compliance to adults than to younger children.12, 13 Therefore, extrapolation of findings in these studies of CPR quality to younger children may not be appropriate. Unfortunately, the technology to quantitatively evaluate CPR quality in younger children is limited, highlighting a knowledge gap in the field of pediatric resuscitation science.

Therefore, the objective of this study was to evaluate quantitatively the quality of CPR performed during the resuscitation of young children between 1 and <8 years of age as compared to the targets established by the 2010 Pediatric BLS Guidelines.10 We hypothesized that the CPR performed in these children would often not achieve Guideline targets, but would improve with the addition of audiovisual feedback.

Section snippets

Design

This investigation is a prospective in-hospital observational study of 30 months duration with the primary objective to evaluate quantitatively the quality of CPR performed during the resuscitation of young children between 1 and <8 years of age. As a secondary objective, the effect of audiovisual feedback to improve CPR quality was evaluated. The study protocol including consent procedures was approved by the Institutional Review Board at The Children's Hospital of Philadelphia. Reporting of

Results

Between November 2011 and May 2013, 15 PICU cardiac arrests in children 1 to <8 years of age occurred at our institution, of which 8 (53%) had CPR recording defibrillators deployed during the resuscitation attempt: 4 events in the No Audiovisual Feedback (NoAVF) group (IDE device) and 4 events in the Audiovisual Feedback (AVF) group (“off-label” use of standard Heartstart MRx with Q-CPR option) (Fig. 1). These events resulted in 285 thirty-second epochs of CPR (152 NAVF; 133 AVF). A total of

Discussion

To the best of our knowledge, this is the first study to report quantitatively the quality of cardiopulmonary resuscitation (CPR) performed during the resuscitation of young children (1 to <8 years of age) during in-hospital resuscitations compared to the targets established by the 2010 American Heart Association (AHA) Pediatric BLS Guidelines.10 We found that often CPR quality does not meet Guideline targets, particularly for depth and rate in these children. Additionally, similar to previous

Conclusions

In this small observational study, CPR quality often did not meet 2010 Guideline targets during pediatric resuscitation attempts, with depth and rate compliance being particularly problematic. Real-time audiovisual feedback resulted in modest improvements in resuscitation quality. Importantly, this study provides some of the first quantitative CPR quality data collected from young children; yet, many gaps still exist in the pediatric resuscitation knowledge base. In the future, larger studies

Conflicts of interest statement

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).

Acknowledgements

This study was supported by a Laerdal Medical Foundation Center of Excellence Grant and the Endowed Chair of Pediatric Critical Care Medicine at the Children's Hospital of Philadelphia. We would like to thank Mette Stavland from Laerdal Medical for her support and guidance during this investigation. We would also like to thank all members of the Pediatric Intensive Care Unit multidisciplinary team for supporting resuscitation research at our institution.

References (38)

  • R.M. Sutton et al.

    The voice advisory manikin (VAM): an innovative approach to pediatric lay provider basic life support skill education

    Resuscitation

    (2007)
  • J. Yeung et al.

    The use of CPR feedback/prompt devices during training and CPR performance: a systematic review

    Resuscitation

    (2009)
  • A.D. McInnes et al.

    The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents

    Resuscitation

    (2011)
  • R.M. Sutton et al.

    Quantitative analysis of chest compression interruptions during in-hospital resuscitation of older children and adolescents

    Resuscitation

    (2009)
  • D.A. Parra et al.

    Outcome of cardiopulmonary resuscitation in a pediatric cardiac intensive care unit

    Crit Care Med

    (2000)
  • A.D. Slonim et al.

    Cardiopulmonary resuscitation in pediatric intensive care units

    Crit Care Med

    (1997)
  • S. Girotra et al.

    Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get with the guidelines-resuscitation

    Circ Cardiovasc Qual Outcomes

    (2013)
  • S. Cheskes et al.

    Perishock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest

    Circulation

    (2011)
  • J. Christenson et al.

    Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation

    Circulation

    (2009)
  • Cited by (0)

    A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.08.014.

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