title: Quantitative analysis of chest compression interruptions during in-hospital resuscitation of older children and adolescents.
abstract: OBJECTIVE
  To quantitatively describe pauses in chest compression (CC) delivery during resuscitation from in-hospital pediatric and adolescent cardiac arrest. We hypothesized that CPR error will be more likely after a chest compression provider change compared to other causes for pauses.
  
  
  METHODS
  CPR recording/feedback defibrillators were used to evaluate CPR quality for victims >/=8 years who received CPR in the PICU/ED. Audiovisual feedback was supplied in accordance with AHA targets. Etiology of CC pauses identified by post-event debriefing/reviews of stored CPR quality data.
  
  
  RESULTS
  Analysis yielded 205 pauses during 304.8 min of CPR from 20 consecutive cardiac arrests. Etiologies were: 57.1% for provider switch; 23.9% for pulse/rhythm analysis; 4.4% for defibrillation; and 14.6% "other." Provider switch accounted for 41.2% of no-flow duration. Compared to other causes, CPR epochs following pauses due to provider switch were more likely to have measurable residual leaning (OR: 5.52; CI(95): 2.94, 10.32; p<0.001) and were shallower (43+/-8 vs. 46+/-7 mm; mean difference: -2.42 mm; CI(95): -4.71, -0.13; p=0.04). Individuals performing continuous CPR>or=120 s as compared to those switching earlier performed deeper chest compressions (42+/-6 vs. 38+/-7 mm; mean difference: 4.44 mm; CI(95): 2.39, 6.49; p<0.001) and were more compliant with guideline depth recommendations (OR: 5.11; CI(95): 1.67, 15.66; p=0.004).
  
  
  CONCLUSIONS
  Provider switches account for a significant portion of no-flow time. Measurable residual leaning is more likely after provider switch. Feedback systems may allow some providers to continue high quality CPR past the recommended switch time of 2 min during in-hospital resuscitation attempts.
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Philadelphia, PA 19104, USA. suttonr@email.chop.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Maltese
authors.forename: Dana
authors.initials: D
authors.lastname: Niles
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.forename: Kristy B
authors.initials: KB
authors.lastname: Arbogast
authors.forename: Aaron
authors.initials: A
authors.lastname: Donoghue
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Mark A
authors.initials: MA
authors.lastname: Helfaer
authors.forename: Vinay
authors.initials: V
authors.lastname: Nadkarni
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000706:statistics & numerical data; D035641:Chest Wall Oscillation / Q000706:statistics & numerical data*; D002648:Child; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007297:Inpatients; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*