A quantitative analysis of out-of-hospital pediatric and adolescent resuscitation quality--A report from the ROC epistry-cardiac arrest.
OBJECTIVE
High-quality cardiopulmonary resuscitation (CPR) may improve survival. The quality of CPR performed during pediatric out-of-hospital cardiac arrest (p-OHCA) is largely unknown. The main objective of this study was to describe the quality of CPR performed during p-OHCA resuscitation attempts.


METHODS
Prospective observational multi-center cohort study of p-OHCA patients ≥ 1 and < 19 years of age registered in the Resuscitation Outcomes Consortium (ROC) Epistry database. The primary outcome was an a priori composite variable of compliance with American Heart Association (AHA) guidelines for both chest compression (CC) rate and CC fraction (CCF). Event compliance was defined as a case with 60% or more of its minute epochs compliant with AHA targets (rate 100-120 min(-1); depth ≥ 38 mm; and CCF ≥ 0.80). In a secondary analysis, multivariable logistic regression was used to evaluate the association between guideline compliance and return of spontaneous circulation (ROSC).


RESULTS
Between December 2005 and December 2012, 2564 pediatric events were treated by EMS providers, 390 of which were included in the final cohort. Of these events, 22% achieved AHA compliance for both rate and CCF, 36% for rate alone, 53% for CCF alone, and 58% for depth alone. Over time, there was a significant increase in CCF (p < 0.001) and depth (p = 0.03). After controlling for potential confounders, there was no significant association between AHA guideline compliance and ROSC.


CONCLUSIONS
In this multi-center study, we have established that there are opportunities for professional rescuers to improve prehospital CPR quality. Encouragingly, CCF and depth both increased significantly over time.
The Children's Hospital of Philadelphia, 34th Street, Civic Center Boulevard, Philadelphia, PA 19104, United States. Electronic address: suttonr@chop.edu.
Robert M
RM
Sutton
Resuscitations Outcome Consortium, 1107 NE 45th Street, Suite 505, Seattle, WA 98105-4680, United States. Electronic address: ecase@uw.edu.
Erin
E
Case
Resuscitations Outcome Consortium, 1107 NE 45th Street, Suite 505, Seattle, WA 98105-4680, United States. Electronic address: spes@uw.edu.
Siobhan P
SP
Brown
University of Iowa Carver College of Medicine, Stead Family Department of Pediatrics, Iowa City, IA 52242, United States. Electronic address: dianne-atkins@uiowa.edu.
Dianne L
DL
Atkins
The Children's Hospital of Philadelphia, 34th Street, Civic Center Boulevard, Philadelphia, PA 19104, United States. Electronic address: nadkarni@chop.edu.
Vinay M
VM
Nadkarni
National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Bethesda, MD 20817, United States. Electronic address: kaltmanj@nhlbi.nih.gov.
Jonathan
J
Kaltman
University of Pittsburgh, 400A Iroquois, 3600 Forbes Avenue, Pittsburgh, PA 15260, United States. Electronic address: callawaycw@upmc.edu.
Clifton
C
Callaway
University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8579, United States. Electronic address: ahamed.idris@utsouthwestern.edu.
Ahamed
A
Idris
Resuscitation Outcome Consortium Clinical Trial Center, University of Washington, Seattle, WA 98104, United States. Electronic address: grahamnichol@icloud.com.
Graham
G
Nichol
The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8. Electronic address: jamie.hutchison@sickkids.ca.
Jamie
J
Hutchison
Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, Canada M5B 1W8. Electronic address: DrennanI@smh.ca.
Ian R
IR
Drennan
University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON, Canada K1Y 4E9. Electronic address: tassiemlm@yahoo.com.au.
Michael
M
Austin
Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode CDW-EM, Portland, OR 97239-3098, United States. Electronic address: dayam@ohsu.edu.
Mohamud
M
Daya
Sunnybrook Center for Prehospital Medicine, 77 Browns Line, Toronto, ON, Canada M8W 3S2. Electronic address: Sheldon.Cheskes@sunnybrook.ca.
Sheldon
S
Cheskes
Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States. Electronic address: nuttallj@ohsu.edu.
Jack
J
Nuttall
Resuscitations Outcome Consortium, 1107 NE 45th Street, Suite 505, Seattle, WA 98105-4680, United States. Electronic address: hherren@uw.edu.
Heather
H
Herren
Department of Emergency Medicine, University of British Columbia Faculty of Medicine, Room 3300 3rd Floor, 910 West 10th Avenue, Vancouver, BC, Canada V5Z 1M9. Electronic address: jim.christenson@ubc.ca.
James
J
Christenson
School of Medical Sciences, Faculty of Health, Engineering and Science, Edith Cowan University, Building 19, Room 129d, 270 Joondalup Dr. Joondalup, Western Australia 6023, Australia. Electronic address: dug.andrusiek@alumni.ubc.ca.
Dug
D
Andrusiek
University of Ottawa, The Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, Room F649, 1053 Carling Avenue, Ottawa, ON, Canada K1Y 4E9. Electronic address: cvaillancourt@ohri.ca.
Christian
C
Vaillancourt
University of Pittsburgh, 3600 Forbes Avenue, Pittsburgh, PA 15261, United States. Electronic address: menegazzijj@upmc.edu.
James J
JJ
Menegazzi
University of Washington, 206 3rd Avenue South, Seattle, WA 98104, United States. Electronic address: rea123@u.washington.edu.
Thomas D
TD
Rea
The Children's Hospital of Philadelphia, 34th Street, Civic Center Boulevard, Philadelphia, PA 19104, United States. Electronic address: bergra@chop.edu.
Robert A
RA
Berg
D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods / Q000592:standards; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D013898:Thoracic Injuries / Q000175:diagnosis / Q000209:etiology; D014481:United States / Q000453:epidemiology
Cardiopulmonary resuscitation; Emergency medical services; Pediatric