title: Pushing harder, pushing faster, minimizing interruptions… but falling short of 2010 cardiopulmonary resuscitation targets during in-hospital pediatric and adolescent resuscitation.
abstract: OBJECTIVE
  The objective of this study was to evaluate the effect of instituting the 2010 Basic Life Support Guidelines on in-hospital pediatric and adolescent cardiopulmonary resuscitation (CPR) quality. We hypothesized that quality would improve, but that targets for chest compression (CC) depth would be difficult to achieve.
  
  
  METHODS
  Prospective in-hospital observational study comparing CPR quality 24 months before and after release of the 2010 Guidelines. CPR recording/feedback-enabled defibrillators collected CPR data (rate (CC/min), depth (mm), CC fraction (CCF, %), leaning (%>2.5kg)). Audiovisual feedback for depth was: 2005, ≥38mm; 2010, ≥50mm; for rate: 2005, ≥90 and ≤120CC/min; 2010, ≥100 and ≤120CC/min. The primary outcome was average event depth compared with Student's t-test.
  
  
  RESULTS
  45 CPR events (25 before; 20 after) occurred, resulting in 1336 thirty-second epochs (909 before; 427 after). Compared to 2005, average event depth (50±13mm vs. 43±9mm; p=0.047), rate (113±11CC/min vs. 104±8CC/min; p<0.01), and CCF (0.94 [0.93, 0.96] vs. 0.9 [0.85, 0.94]; p=0.013) increased during 2010. CPR epochs during the 2010 period more likely to meet Guidelines for CCF (OR 1.7; CI95: 1.2-2.4; p<0.01), but less likely for rate (OR 0.23; CI95: 0.12-0.44; p<0.01), and depth (OR 0.31; CI95: 0.12-0.86; p=0.024).
  
  
  CONCLUSIONS
  Institution of the 2010 Guidelines was associated with increased CC depth, rate, and CC fraction; yet, achieving 2010 targets for rate and depth was difficult.
authors: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States; The Children's Hospital of Philadelphia, Center for Simulation, Advanced Education, and Innovation, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States. Electronic address: suttonr@email.chop.edu.
authors: Robert M
authors: RM
authors: Sutton
authors: Heather
authors: H
authors: Wolfe
authors: Akira
authors: A
authors: Nishisaki
authors: Jessica
authors: J
authors: Leffelman
authors: Dana
authors: D
authors: Niles
authors: Peter A
authors: PA
authors: Meaney
authors: Aaron
authors: A
authors: Donoghue
authors: Matthew R
authors: MR
authors: Maltese
authors: Robert A
authors: RA
authors: Berg
authors: Vinay M
authors: VM
authors: Nadkarni
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011787:Quality of Health Care
keywords: AHA; American Heart Association; CC35; CPR; Cardiopulmonary resuscitation; Pediatric; Quality appraisal; cardiopulmonary resuscitation; chest compression
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