title: Comparison of relative and actual chest compression depths during cardiac arrest in children, adolescents, and young adults.
abstract: OBJECTIVE
  Cardiopulmonary resuscitation (CPR) guidelines recommend specific chest compression (CC) target depths for children. We quantitatively describe relative anterior-posterior diameter (APD) depth, actual depth, and force of CCs during real CPR events in children.
  
  
  METHODS
  CC depth and force were recorded during real CPR events in children ≥8 years using FDA-approved CC sensor. Patient chest APD was measured at conclusion of each CPR event. CC data was stratified and analyzed according to age (pre-puberty, 8-14 years; post-puberty, 15+ years). Relative (% APD) and actual CC depth, corrected for mattress deflection, were assessed and compared with American Heart Association (AHA) 2005 and 2010 pediatric CPR guidelines.
  
  
  RESULTS
  35 events in 32 subjects included 16,158 CCs for data analysis: 16 pre-puberty (CCs=7484, age 11.9±2 years, APD 164.6±25.1 mm); 19 post-puberty (CCs=8674, age 18.0±2.7 years, APD 196.5±30.4 mm). After correction for mattress deflection, 92% of CC delivered to pre-puberty were <1/3 relative APD and 60% of CC were <38 mm actual depth. Mean actual CC depth (36.2±9.6 mm vs. 36.8±9.9 mm, p=0.64), mean relative APD (22.5%±7.0% vs. 19.5±6.7%, p=0.13), and mean CC force (30.7±7.6 kg vs. 33.6±9.4 kg, p=0.07) were not significantly less in pre-puberty vs. post-puberty.
  
  
  CONCLUSIONS
  During in-hospital cardiac arrest of children ≥8 years, CCs delivered by resuscitation teams were frequently <1/3 relative APD and <38 mm actual depth after mattress deflection correction, below pediatric and adult target guidelines. Mean CC actual depth and force were not significantly different in pre-puberty and post-puberty. Additional investigation to determine depth of CCs to optimize hemodynamics and outcomes is needed to inform future CPR guidelines.
authors.affiliation: Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, USA. niles@email.chop.edu
authors.forename: Dana E
authors.initials: DE
authors.lastname: Niles
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.forename: Jon
authors.initials: J
authors.lastname: Nysæther
authors.forename: Joar
authors.initials: J
authors.lastname: Eilevstjønn
authors.forename: Jessica
authors.initials: J
authors.lastname: Leffelman
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Maltese
authors.forename: Kristy B
authors.initials: KB
authors.lastname: Arbogast
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.forename: Mark A
authors.initials: MA
authors.lastname: Helfaer
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000379:methods*; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Chest. 2007 Jul;132(1):70-5
references.pmid: 17550931
references.citation: Resuscitation. 2007 Mar;72(3):364-70
references.pmid: 17141936
references.citation: IEEE Trans Biomed Eng. 2002 Mar;49(3):263-8
references.pmid: 11876291
references.citation: Am J Emerg Med. 2009 Sep;27(7):823-9
references.pmid: 19683111
references.citation: Stapp Car Crash J. 2008 Nov;52:83-105
references.pmid: 19085159
references.citation: Crit Care Med. 2010 Apr;38(4):1141-6
references.pmid: 20081529
references.citation: Respir Care. 2010 Aug;55(8):1014-9
references.pmid: 20667148
references.citation: Circulation. 2010 Nov 2;122(18 Suppl 3):S640-56
references.pmid: 20956217
references.citation: Resuscitation. 2010 Oct;81 Suppl 1:e1-25
references.pmid: 20956042
references.citation: Ann Emerg Med. 1989 Jul;18(7):732-7
references.pmid: 2500044
references.citation: Resuscitation. 2009 Aug;80(8):909-12
references.pmid: 19467759
references.citation: Pediatrics. 2009 Aug;124(2):494-9
references.pmid: 19581266
references.citation: Crit Care Med. 1983 Sep;11(9):685-92
references.pmid: 6884048
references.citation: Pediatrics. 2009 Jul;124(1):e69-74
references.pmid: 19564271
references.citation: Resuscitation. 2006 Nov;71(2):137-45
references.pmid: 16982127
references.citation: JAMA. 2005 Jan 19;293(3):305-10
references.pmid: 15657323
references.citation: Child Abuse Negl. 2006 Jul;30(7):739-51
references.pmid: 16857258
references.citation: Circulation. 2005 Dec 13;112(24 Suppl):IV1-203
references.pmid: 16314375
references.citation: J Biomech Eng. 1993 May;115(2):195-201
references.pmid: 8326726
references.citation: Resuscitation. 2009 May;80(5):540-5
references.pmid: 19342150
references.citation: Circulation. 2005 Feb 1;111(4):428-34
references.pmid: 15687130
references.citation: Circulation. 2010 Nov 2;122(18 Suppl 3):S862-75
references.pmid: 20956229
references.citation: JAMA. 2005 Jan 19;293(3):299-304
references.pmid: 15657322
references.citation: Resuscitation. 2006 Dec;71(3):387-90
references.pmid: 16982125
references.citation: Heart Rhythm. 2010 Oct;7(10):1357-62
references.pmid: 20420938
references.citation: Resuscitation. 2006 Dec;71(3):283-92
references.pmid: 17070980