title: Videographic assessment of cardiopulmonary resuscitation quality in the pediatric emergency department.
abstract: OBJECTIVE
  To describe the adherence to guidelines for CPR in a tertiary pediatric emergency department (ED) where resuscitations are reviewed by videorecording.
  
  
  METHODS
  Resuscitations in a tertiary pediatric ED are videorecorded as part of a quality improvement project. Patients receiving CPR under videorecorded conditions were eligible for inclusion. CPR parameters were quantified by retrospective review. Data were described by 30-s epoch (compression rate, ventilation rate, compression:ventilation ratio), by segment (duration of single providers' compressions) and by overall event (compression fraction). Duration of interruptions in compressions was measured; tasks completed during pauses were tabulated.
  
  
  RESULTS
  33 children received CPR under videorecorded conditions. A total of 650 min of CPR were analyzed. Chest compressions were performed at <100/min in 90/714 (13%) of epochs; 100-120/min in 309/714 (43%); >120/min in 315/714 (44%). Ventilations were 6-12 breaths/min in 201/708 (23%) of epochs and >12/min in 489/708 (70%). During CPR without an artificial airway, compression:ventilation coordination (15:2) was done in 93/234 (40%) of epochs. 178 pauses in CPR occurred; 120 (67%) were <10s in duration. Of 370 segments of compressions by individual providers, 282/370 (76%) were <2 min in duration. Median compression fraction was 91% (range 88-100%).
  
  
  CONCLUSIONS
  CPR in a tertiary pediatric ED frequently met recommended parameters for compression rate, pause duration, and compression fraction. Hyperventilation and failure of C:V coordination were very common. Future studies should focus on the impact of training methods on CPR performance as documented by videorecording.
authors: Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, United States; Division of Critical Care Medicine, Children's Hospital of Philadelphia, PA, United States; Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, PA, United States. Electronic address: donoghue@email.chop.edu.
authors: Aaron
authors: A
authors: Donoghue
authors: Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, PA, United States.
authors: Ting-Chang
authors: TC
authors: Hsieh
authors: Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, United States.
authors: Sage
authors: S
authors: Myers
authors: Tulane University School of Medicine, New Orleans, LA, United States.
authors: Allison
authors: A
authors: Mak
authors: Division of Critical Care Medicine, Children's Hospital of Philadelphia, PA, United States.
authors: Robert
authors: R
authors: Sutton
authors: Division of Critical Care Medicine, Children's Hospital of Philadelphia, PA, United States; Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, PA, United States.
authors: Vinay
authors: V
authors: Nadkarni
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D011787:Quality of Health Care; D012189:Retrospective Studies; D014741:Video Recording
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Pediatric