title: First quantitative analysis of cardiopulmonary resuscitation quality during in-hospital cardiac arrests of young children.
abstract: OBJECTIVE
  The objective of this study is to report, for the first time, quantitative data on CPR quality during the resuscitation of children under 8 years of age. We hypothesized that the CPR performed would often not achieve 2010 Pediatric Basic Life Support (BLS) Guidelines, but would improve with the addition of audiovisual feedback.
  
  
  METHODS
  Prospective observational cohort evaluating CPR quality during chest compression (CC) events in children between 1 and 8 years of age. CPR recording defibrillators collected CPR data (rate (CC/min), depth (mm), CC fraction (CCF), leaning (%>2.5 kg.)). Audiovisual feedback was according to 2010 Guidelines in a subset of patients. The primary outcome, "excellent CPR" was defined as a CC rate ≥ 100 and ≤ 120 CC/min, depth ≥ 50 mm, CCF >0.80, and <20% of CC with leaning.
  
  
  RESULTS
  8 CC events resulted in 285 thirty-second epochs of CPR (15,960 CCs). Percentage of epochs achieving targets was 54% (153/285) for rate, 19% (54/285) for depth, 88% (250/285) for CCF, 79% (226/285) for leaning, and 8% (24/285) for excellent CPR. The median percentage of epochs per event achieving targets increased with audiovisual feedback for rate [88 (IQR: 79, 94) vs. 39 (IQR 18, 62) %; p=0.043] and excellent CPR [28 (IQR: 7.2, 52) vs. 0 (IQR: 0, 1) %; p=0.018].
  
  
  CONCLUSIONS
  In-hospital pediatric CPR often does not meet 2010 Pediatric BLS Guidelines, but compliance is better when audiovisual feedback is provided to rescuers.
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States. Electronic address: suttonr@email.chop.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Dana
authors.initials: D
authors.lastname: Niles
authors.affiliation: University of Pennsylvania School of Medicine, Department of Biostatistics and Epidemiology, 423 Guardian Drive, Philadelphia PA 19104, United States.
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Maltese
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Jessica
authors.initials: J
authors.lastname: Leffelman
authors.affiliation: Laerdal Medical, Stavanger, Norway.
authors.forename: Joar
authors.initials: J
authors.lastname: Eilevstjønn
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Heather
authors.initials: H
authors.lastname: Wolfe
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Meaney
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011787:Quality of Health Care
keywords: AHA; American Heart Association; CC; CPR; Cardiopulmonary resuscitation; Pediatric; Quality appraisal; cardiopulmonary resuscitation; chest compression