title: Leaning is common during in-hospital pediatric CPR, and decreased with automated corrective feedback.
abstract: BACKGROUND
  Cardiopulmonary Resuscitation (CPR) guidelines recommend complete release between chest compressions (CC). No study has evaluated prevalence of leaning and the effect of real-time automated audiovisual feedback during in-hospital pediatric CPR.
  
  
  OBJECTIVE
  We hypothesize that leaning during in-hospital pediatric CPR will be common, and that real-time automated feedback will be associated with reduced leaning prevalence and force.
  
  
  METHODS
  A feedback-capable monitor/defibrillator equipped with force transducer and accelerometer recorded CC leaning force and depth during in-hospital cardiac arrests (>/=8 years) at a children's hospital. Automated feedback was enabled at the resuscitation leader's discretion, and audiovisual prompts were given when leaning force exceeded 2.5 kg. Leaning force and depth CC with No Feedback (NoF) vs. with Feedback (F) were compared.
  
  
  RESULTS
  20 pediatric (mean age 14.7+/-3.8 years) pulse less arrests generated 37,396 evaluable CC. Median leaning force was 1.6 kg [0.9-2.7 kg] and leaning depth 2.9 (1.6-4.7)mm. Leaning force was greater with NoF (2.5 kg, [1.6-3.5 kg]; n=1921) vs. F (1.6 kg [0.9-2.6 kg]; n=35,164, p<0.001). Leaning>2.5 kg (adult feedback threshold) occurred in 50% (n=969) of CC with NoF and 27% (n=9367) CC with F (p<0.001). CC without leaning, defined as a leaning force of<0.5 kg, occurred in 2.2% (n=43) CC with NoF vs. 10.5% (n=3681) CC with F (p<0.001).
  
  
  CONCLUSIONS
  Leaning (residual force>2.5 kg) was common during pediatric CPR. The prevalence and force of leaning were reduced with automated audiovisual feedback. Further study is necessary to determine the effect of the specific leaning threshold on CPR hemodynamics.
authors.affiliation: Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, United States. niles@email.chop.edu
authors.forename: Dana
authors.initials: D
authors.lastname: Niles
authors.forename: Jon
authors.initials: J
authors.lastname: Nysaether
authors.forename: Robert
authors.initials: R
authors.lastname: Sutton
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.forename: Kristy
authors.initials: K
authors.lastname: Arbogast
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Maltese
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Mark
authors.initials: M
authors.lastname: Helfaer
authors.forename: Vinay
authors.initials: V
authors.lastname: Nadkarni
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D019245:Compressive Strength; D047548:Defibrillators; D004867:Equipment Design; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006336:Heart Massage / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D011187:Posture; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013813:Therapy, Computer-Assisted / Q000592:standards; D055815:Young Adult