title: The Impact of Monitoring on the Initiation of Cardiopulmonary Resuscitation in Children: Friend or Foe?
abstract: BACKGROUND
  The immediate initiation and high quality of basic life support (BLS) are pivotal to improving patient outcome after cardiac arrest. Although cardiorespiratory monitoring could shorten the time to recognize the onset of cardiac arrest, little is known about how monitoring and the misinterpretation of monitor readings could impair the initiation of BLS. In this study, we assessed the speed of initiation and quality of BLS in simulated monitored and nonmonitored pediatric cardiac arrest.
  
  
  METHODS
  Sixty residents frequently involved in the care of critically ill children were randomly assigned to either the intervention (monitoring) group or the control (nonmonitoring) group. Participants of both groups performed BLS in 1 of 2 clinically identical, unwitnessed simulated cardiac arrest scenarios. Although in 1 scenario cardiorespiratory monitoring (i.e., electrocardiogram) was attached, the other scenario reflected a nonmonitored cardiac arrest. Time to first chest compression was chosen as the primary outcome variable. Adherence to resuscitation guidelines and subjective performance ratings were secondary outcome variables.
  
  
  RESULTS
  Participants in the monitoring group initiated chest compressions significantly later than those in the nonmonitoring group (91 ± 36 vs 71 ± 26 seconds, hazard ratio, 0.26; 95% confidence interval, 0.14-0.49, P < 0.001). Six members of the monitoring group did not start chest compression within 5 minutes. Furthermore, adherence to the guidelines was better in the nonmonitoring group. Participants who were previously involved in BLS training did not show better performance.
  
  
  CONCLUSIONS
  The presence of cardiorespiratory monitoring significantly delayed or even prevented the initiation of chest compressions and impaired the quality of BLS in simulated pediatric cardiac arrest. Based on these data, specific training should be conducted for exposed personnel.
authors.affiliation: From the *Medical Simulation and Emergency Management Research Group, Department of Anesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Austria; and †Department of Anesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hörner
authors.forename: Karl
authors.initials: K
authors.lastname: Schebesta
authors.forename: Michael
authors.initials: M
authors.lastname: Hüpfl
authors.forename: Oliver
authors.initials: O
authors.lastname: Kimberger
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rössler
mesh_terms: D000328:Adult; D000465:Algorithms; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D016638:Critical Illness; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008348:Manikins; D008991:Monitoring, Physiologic; D016544:Patient Simulation; D011446:Prospective Studies; D011674:Pulse; D012129:Respiratory Function Tests; D016896:Treatment Outcome