title: The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents.
abstract: OBJECTIVE
  During adult cardiac arrest, rescuers frequently provide ventilations at rates exceeding those recommended by the American Heart Association (AHA). Excessive ventilation is associated with worse clinical outcome after adult cardiac arrest. This study is the first to characterize ventilation rate adherence to AHA guidelines during in-hospital pediatric cardiac arrest resuscitation.
  
  
  METHODS
  We prospectively enrolled children and adolescents (≥8 years of age) who suffered a cardiac arrest in a pediatric intensive care unit (PICU) or emergency department (ED) of a tertiary-care pediatric hospital. Ventilation rate (breaths per minute [bpm]) was monitored via changes in chest wall impedance (CWI) recorded by defibrillator electrode pads during cardiopulmonary resuscitation (CPR).
  
  
  RESULTS
  Twenty-four CPR events were enrolled yielding 588 thirty-second CPR epochs. The proportion of CPR epochs with ventilation rates exceeding AHA guidelines (>10 bpm) was 63% (CI(95) 59-67%), significantly higher than our a priori hypothesis of 30% (p<0.01). The proportion of CPR epochs with ventilation rates exceeding 20 bpm was 20% (CI(95) 17-23). After controlling for location of arrest and initial event rhythm, resuscitations that occurred on nights/weekends were 3.6 times (CI(95): 1.6-7.9, p<0.01) more likely to have a ventilation rate exceeding AHA guidelines.
  
  
  CONCLUSIONS
  During in-hospital pediatric cardiac arrest, rescuers frequently provide artificial ventilations at rates in excess of AHA guidelines, with twenty percent of CPR time having ventilation rates double that recommended. Excessive ventilation was particularly common during CPR events that occurred on nights/weekends.
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesia and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States. mcinnesa@email.chop.edu
authors.forename: Andrew D
authors.initials: AD
authors.lastname: McInnes
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.forename: Alberto
authors.initials: A
authors.lastname: Orioles
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.forename: Dana
authors.initials: D
authors.lastname: Niles
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Maltese
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Vinay
authors.initials: V
authors.lastname: Nadkarni
mesh_terms: D000293:Adolescent; D000573:American Hospital Association; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D016009:Chi-Square Distribution; D002648:Child; D004636:Emergency Service, Hospital; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D056152:Respiratory Rate; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014481:United States