Visual assessment of CPR quality during pediatric cardiac arrest: does point of view matter?
OBJECTIVE
In many clinical settings, providers rely on visual assessment when delivering feedback on CPR quality. Little is known about the accuracy of visual assessment of CPR quality. We aimed to determine how accurate pediatric providers are in their visual assessment of CPR quality and to identify the optimal position relative to the patient for accurate CPR assessment.


METHODS
We videotaped high-quality CPR (based on 2010 American Heart Association guidelines) and 3 variations of poor quality CPR in a simulated resuscitation, filmed from the foot, head and the side of the manikin. Participants watched 12 videos and completed a questionnaire to assess CPR quality.


RESULTS
One hundred and twenty-five participants were recruited. The overall accuracy of visual assessment of CPR quality was 65.6%. Accuracy was better from the side (70.8%) and foot (68.8%) of the bed when compared to the head of the bed (57.2%; p<0.001). The side was the best position for assessing depth (p<0.001). Rate assessment was equivalent between positions (p=0.58). The side and foot of the bed were superior to the head when assessing chest recoil (p<0.001). Factors associated with increased accuracy in visual assessment of CPR quality included recent CPR course completion (p=0.034) and involvement in more cardiac arrests as a team member (p=0.003).


CONCLUSIONS
Healthcare providers struggle to accurately assess the quality of CPR using visual assessment. If visual assessment is being used, providers should stand at the side of the bed.
Paediatric Emergency Medicine Subspecialty Resident, University of Calgary, Department of Paediatrics, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta TB 6A8, Canada. Electronic address: angela.jones@albertahealthservices.ca.
Angela
A
Jones
KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada. Electronic address: jeffylin@hotmail.com.
Yiqun
Y
Lin
Department of Paediatrics and Community Health Sciences, Alberta Children's Hospital Research Institute for Child and Maternal Health, University of Calgary, Calgary, Alberta TB 6A8, Canada; Research Methods Team, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada. Electronic address: Alberto.Nettel-Aguirre@albertahealthservices.ca.
Alberto
A
Nettel-Aguirre
Section of Critical Care, Department of Paediatrics, Faculty of Medicine, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada. Electronic address: Elaine.Gilfoyle@albertahealthservices.ca.
Elaine
E
Gilfoyle
KidSim-ASPIRE Research Program, Section of Emergency Medicine, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada. Electronic address: chenger@me.com.
Adam
A
Cheng
D016887:Cardiopulmonary Resuscitation; D002648:Child; D005246:Feedback; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008348:Manikins; D011785:Quality Assurance, Health Care / Q000379:methods*; D016037:Single-Blind Method; D014743:Videotape Recording
Cardiopulmonary resuscitation; Chest compressions; Feedback; Quality; Resuscitation