Quantitative analysis of CPR quality during in-hospital resuscitation of older children and adolescents.
OBJECTIVE
Few data exist on pediatric cardiopulmonary resuscitation (CPR) quality. This study is the first to evaluate actual in-hospital pediatric CPR. We hypothesized that with bedside CPR training and corrective feedback, CPR quality can approach American Heart Association (AHA) targets.


METHODS
Using CPR recording/feedback defibrillators, quality of CPR was assessed for patients >or=8 years of age who suffered a cardiac arrest in the PICU or emergency department (ED). Before and during the study, a bedside CPR training program was initiated.


RESULTS
Between October 2006 and February 2008, twenty events in 18 patients met inclusion criteria and resulted in 36749 evaluable chest compressions (CCs) during 392.3 minutes of arrest. CCs were shallow (<38 mm or <1.5 in) in 27.2% (9998 of 36749), with excessive residual leaning force (>or=2500 g) in 23.4% (8611 of 36749). Segmental analysis of the first 5 minutes of the events demonstrated that shallow CCs and excessive residual leaning force were less prevalent during the first 5 minutes. AHA targets were not achieved for CC rate in 62 (43.1%) of 144 segments, CC depth in 52 (36.1%) of 144 segments, and residual leaning force in 53 (36.8%) of 144 segments.


CONCLUSIONS
This prospective, observational study demonstrates feasibility of monitoring in-hospital pediatric CPR. Even with bedside CPR retraining and corrective audiovisual feedback, CPR quality frequently did not meet AHA targets. Importantly, no flow fraction target of 10% was achieved. Future studies should investigate novel educational methods and targeted feedback technologies.
Sutton
Robert M
RM
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. suttonr@email.chop.edu
Niles
Dana
D
Nysaether
Jon
J
Abella
Benjamin S
BS
Arbogast
Kristy B
KB
Nishisaki
Akira
A
Maltese
Matthew R
MR
Donoghue
Aaron
A
Bishnoi
Ram
R
Helfaer
Mark A
MA
Myklebust
Helge
H
Nadkarni
Vinay
V
D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000295:instrumentation / Q000592:standards*; D002648:Child; D003479:Curriculum; D047548:Defibrillators / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards*; D004867:Equipment Design; D030141:Feedback, Psychological; D019983:Guideline Adherence / Q000592:standards; D006302:Health Services Research / Q000706:statistics & numerical data; D006323:Heart Arrest / Q000628:therapy*; D006776:Hospitals, Pediatric / Q000592:standards; D006801:Humans; D007318:Inservice Training / Q000592:standards; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000592:standards; D012815:Signal Processing, Computer-Assisted; D014481:United States