title: Variability in quality of chest compressions provided during simulated cardiac arrest across nine pediatric institutions.
abstract: The variability in quality of CPR provided during cardiac arrest across pediatric institutions is unknown. We aimed to describe the degree of variability in the quality of CPR across 9 pediatric institutions, and determine if variability across sites would be affected by Just-in-Time CPR training and/or visual feedback during simulated cardiac arrest.
  
  
  
  We conducted secondary analyses of data collected from a prospective, multi-center trial. Participants were equally randomized to either: (1) No intervention; (2) Real-time CPR visual feedback during cardiac arrest or (3) Just-in-Time CPR training. We report the variability in median chest compression depth and rate across institutions, and the variability in the proportion of 30-s epochs of CPR meeting 2010 American Heart Association guidelines for depth and rate.
  
  
  
  We analyzed data from 528 epochs in the no intervention group, 552 epochs in the visual feedback group, and 525 epochs in the JIT training group. In the no intervention group, compression depth (median range 22.2-39.2mm) and rate (median range 116.0-147.6 min(-1)) demonstrated significant variability between study sites (p<0.001). The proportion of compressions with adequate depth (0-11.5%) and rate (0-60.5%) also varied significantly across sites (p<0.001). The variability in compression depth and rate persisted despite use of real-time visual feedback or JIT training (p<0.001).
  
  
  
  The quality of CPR across multiple pediatric institutions is variable. Variability in CPR quality across institutions persists even with the implementation of a Just-in-Time training session and visual feedback for CPR quality during simulated cardiac arrest.
authors.affiliation: University of Calgary, KidSim-ASPIRE Research Program, Division of Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8. Electronic address: chenger@me.com.
authors.forename: Adam
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center, Division of Pediatric Anesthesiology and Critical Care Medicine, 1800 Orleans Street/Room 6321, Baltimore, MD 21287, USA. Electronic address: ehunt@jhmi.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
authors.affiliation: Bristol Royal Hospital for Children, University Hospitals Bristol, Paul O'Gorman Building, Upper Maudin St, Bristol BS2 8BJ, UK. Electronic address: david.grant@nhs.net.
authors.forename: David
authors.initials: D
authors.lastname: Grant
authors.affiliation: KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8. Electronic address: jeffylin@hotmail.com.
authors.forename: Yiqun
authors.initials: Y
authors.lastname: Lin
authors.affiliation: KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8. Electronic address: vinceinfrance@gmail.com.
authors.forename: Vincent
authors.initials: V
authors.lastname: Grant
authors.affiliation: Stollery Children's Hospital, University of Alberta, 8215 112 St NW, Edmonton, AB, Canada T6G 2L9. Electronic address: jon.duff@albertahealthservices.ca.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Duff
authors.affiliation: Pediatric Simulation Center, Children's of Alabama, University of Alabama at Birmingham, 1600 7th Ave, S., Birmingham, AL 35233, USA. Electronic address: mlwhite@peds.uab.edu.
authors.forename: Marjorie Lee
authors.initials: ML
authors.lastname: White
authors.affiliation: Pediatric Simulation Center, Children's of Alabama, University of Alabama at Birmingham, 1600 7th Ave, S., Birmingham, AL 35233, USA. Electronic address: dtpeterson@uab.edu.
authors.forename: Dawn Taylor
authors.initials: DT
authors.lastname: Peterson
authors.affiliation: Children's Medical Center of Dallas, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA. Electronic address: john.zhong@childrens.com.
authors.forename: John
authors.initials: J
authors.lastname: Zhong
authors.affiliation: Montreal Children's Hospital, McGill University, 2300 Tupper St, Montreal, QC, Canada H3H 1P3. Electronic address: ronald.gottesman@mcgill.ca.
authors.forename: Ronald
authors.initials: R
authors.lastname: Gottesman
authors.affiliation: Yale-New Haven Health, Yale Medical School, 730 Howard Ave, New Haven, CT 06519, USA. Electronic address: Stephanie.sudikoff@ynhh.org.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sudikoff
authors.affiliation: British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, BC, Canada V6H 3V4. Electronic address: qdoan@cw.bc.ca.
authors.forename: Quynh
authors.initials: Q
authors.lastname: Doan
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address: nadkarni@email.chop.edu.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Linda
authors.initials: L
authors.lastname: Brown
authors.forename: Frank
authors.initials: F
authors.lastname: Overly
authors.forename: Ilana
authors.initials: I
authors.lastname: Bank
authors.forename: Farhan
authors.initials: F
authors.lastname: Bhanji
authors.forename: David
authors.initials: D
authors.lastname: Kessler
authors.forename: Nancy
authors.initials: N
authors.lastname: Tofil
authors.forename: Jennifer
authors.initials: J
authors.lastname: Davidson
authors.forename: Mark
authors.initials: M
authors.lastname: Adler
authors.forename: Alex
authors.initials: A
authors.lastname: Bragg
authors.forename: Kimberly
authors.initials: K
authors.lastname: Marohn
authors.forename: Nicola
authors.initials: N
authors.lastname: Robertson
authors.forename: Jordan
authors.initials: J
authors.lastname: Duval-Arnould
authors.forename: Hubert
authors.initials: H
authors.lastname: Wong
authors.forename: Aaron
authors.initials: A
authors.lastname: Donoghue
authors.forename: Jenny
authors.initials: J
authors.lastname: Chatfield
authors.forename: Nnenna
authors.initials: N
authors.lastname: Chime
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards*; D002648:Child; D056228:Feedback, Sensory; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D011446:Prospective Studies; D000066908:Simulation Training
keywords: Cardiopulmonary resuscitation; Chest compressions; Pediatric; Quality; Registration ID: NCT02075450; Resuscitation; Variability; www.clinicaltrials.gov