Clinical paperFirst quantitative analysis of cardiopulmonary resuscitation quality during in-hospital cardiac arrests of young children☆
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.
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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.