title: Chest compression quality over time in pediatric resuscitations.
abstract: BACKGROUND
  Chest compression (CC) quality deteriorates with time in adults, possibly because of rescuer fatigue. Little data exist on compression quality in children or on work done to perform compressions in general. We hypothesized that compression quality, work, and rescuer fatigue would differ in child versus adult manikin models.
  
  
  METHODS
  This was a prospective randomized crossover study of 45 in-hospital rescuers performing 10 minutes of single-rescuer continuous compressions on each manikin. An accelerometer recorded compression quality measures over 30-second epochs. Work and power were calculated from recorded force data. A modified visual analogue scale measured fatigue. Data were analyzed by using linear mixed-effects models and Cox regression analysis.
  
  
  RESULTS
  A total of 88 484 compression cycles were analyzed. Percent adequate CCs/epoch (rate ≥ 100/minute, depth ≥ 38 mm) fell over 10 minutes (child: from 85.1% to 24.6%, adult: from 86.3% to 35.3%; P = .15) and were <70% in both by 2 minutes. Peak work per compression cycle was 13.1 J in the child and 14.3 J in the adult (P = .06; difference, 1.2 J; 95% confidence interval, -0.05 to 2.5). Peak power output was 144.1 W in the child and 166.5 W in the adult (P < .001; difference, 22.4 W, 95% confidence interval, 9.8-35.0).
  
  
  CONCLUSIONS
  CC quality deteriorates similarly in child and adult manikin models. Peak work per compression cycle is comparable in both. Peak power output is analogous to that generated during intense exercise such as running. CC providers should switch every 2 minutes as recommended by current guidelines.
authors: Emergency Medicine and Trauma Center, Children's National Medical Center, Washington, DC 20010, USA. obadaki@cnmc.org
authors: Oluwakemi
authors: O
authors: Badaki-Makun
authors: Frances
authors: F
authors: Nadel
authors: Aaron
authors: A
authors: Donoghue
authors: Michael
authors: M
authors: McBride
authors: Dana
authors: D
authors: Niles
authors: Thomas
authors: T
authors: Seacrist
authors: Matthew
authors: M
authors: Maltese
authors: Xuemei
authors: X
authors: Zhang
authors: Stephen
authors: S
authors: Paridon
authors: Vinay M
authors: VM
authors: Nadkarni
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D035641:Chest Wall Oscillation / Q000379:methods / Q000592:standards*; D018592:Cross-Over Studies; D005260:Female; D006336:Heart Massage / Q000379:methods / Q000592:standards*; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult