title: Quantitative analysis of duty cycle in pediatric and adolescent in-hospital cardiac arrest.
abstract: Quality cardiopulmonary resuscitation (CPR) is associated with improved outcomes during cardiac arrest. Duty cycle (DC) represents an understudied element of CPR quality. Our objective was to quantitatively analyze DC during actual pediatric and adolescent in-hospital cardiac arrest (IHCA).
  
  
  
  Prospective observational study of IHCA at a large academic children's hospital. CPR variables included DC (%) up to the first 10min of recorded chest compressions (CCs). American Heart Association (AHA) DC compliance was prospectively defined as an average event DC of 50±5%. Percentage of events compliant with AHA DC was compared to a priori hypothesized compliance percentage of 25% using chi-square. Association between DC quartiles and categories of depth (<38, 38-49, ≥50mm) and rate (<100, 100-120, >120min(-1)) were analyzed by chi-square test for trend.
  
  
  
  Between October 2006 and June 2015, 97 events in 87 patients were analyzed. Mean DC for events was 40±2.8%. DC quartiles: Q1 (DC ≤38.3%), Q2 (>38.3-40.1%), Q3 (>40.1-42.1%), Q4 (>42.1%). Only 5 (5.2%) events met AHA DC compliance, significantly less than the a priori hypothesis of 25% (p<0.001). Average CC rates trended higher across DC quartiles: (Q1) 105±9; (Q2) 106±9; (Q3) 112±8; and (Q4) 118±14min(-1); p<0.001. Other CPR quality variables were not associated with DC. There was no association between DC and survival.
  
  
  
  Compression DC during resuscitation of actual child and adolescent IHCA met AHA recommendations in only 5% of events. In this series we found no association of DC with CC depth or survival.
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States. Electronic address: wolfeh@email.chop.edu.
authors.forename: Heather
authors.initials: H
authors.lastname: Wolfe
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Morgan
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Aaron
authors.initials: A
authors.lastname: Donoghue
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Dana E
authors.initials: DE
authors.lastname: Niles
authors.affiliation: The University of Washington, Department of Medicine, Division of Cardiology, Seattle, WA 98195-6422, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Kudenchuk
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011787:Quality of Health Care; D016019:Survival Analysis
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Chest compression; Duty cycle; Quality