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Comparative Study
. 2013 Dec;84(12):1680-4.
doi: 10.1016/j.resuscitation.2013.07.029. Epub 2013 Aug 15.

Pushing harder, pushing faster, minimizing interruptions… but falling short of 2010 cardiopulmonary resuscitation targets during in-hospital pediatric and adolescent resuscitation

Robert M Sutton  1 , Heather Wolfe, Akira Nishisaki, Jessica Leffelman, Dana Niles, Peter A Meaney, Aaron Donoghue, Matthew R Maltese, Robert A Berg, Vinay M Nadkarni
Affiliations
Comparative Study

Pushing harder, pushing faster, minimizing interruptions… but falling short of 2010 cardiopulmonary resuscitation targets during in-hospital pediatric and adolescent resuscitation

Robert M Sutton et al. Resuscitation. 2013 Dec.

Abstract

Aim: The objective of this study was to evaluate the effect of instituting the 2010 Basic Life Support Guidelines on in-hospital pediatric and adolescent cardiopulmonary resuscitation (CPR) quality. We hypothesized that quality would improve, but that targets for chest compression (CC) depth would be difficult to achieve.

Methods: Prospective in-hospital observational study comparing CPR quality 24 months before and after release of the 2010 Guidelines. CPR recording/feedback-enabled defibrillators collected CPR data (rate (CC/min), depth (mm), CC fraction (CCF, %), leaning (%>2.5kg)). Audiovisual feedback for depth was: 2005, ≥38mm; 2010, ≥50mm; for rate: 2005, ≥90 and ≤120CC/min; 2010, ≥100 and ≤120CC/min. The primary outcome was average event depth compared with Student's t-test.

Results: 45 CPR events (25 before; 20 after) occurred, resulting in 1336 thirty-second epochs (909 before; 427 after). Compared to 2005, average event depth (50±13mm vs. 43±9mm; p=0.047), rate (113±11CC/min vs. 104±8CC/min; p<0.01), and CCF (0.94 [0.93, 0.96] vs. 0.9 [0.85, 0.94]; p=0.013) increased during 2010. CPR epochs during the 2010 period more likely to meet Guidelines for CCF (OR 1.7; CI95: 1.2-2.4; p<0.01), but less likely for rate (OR 0.23; CI95: 0.12-0.44; p<0.01), and depth (OR 0.31; CI95: 0.12-0.86; p=0.024).

Conclusions: Institution of the 2010 Guidelines was associated with increased CC depth, rate, and CC fraction; yet, achieving 2010 targets for rate and depth was difficult.

Keywords: AHA; American Heart Association; CC35; CPR; Cardiopulmonary resuscitation; Pediatric; Quality appraisal; cardiopulmonary resuscitation; chest compression.

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Conflict of interest statement

Conflicts of Interest: The authors acknowledge the following potential conflicts of interest. Vinay Nadkarni, Dana Niles, Akira Nishisaki, and Matt Maltese receive unrestricted research grant support from the Laerdal Foundation for Acute Care Medicine. Robert Sutton is supported through a career development award from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (K23HD062629).

Figures

Figure 1
Figure 1
Percentage of CPR epochs achieving targets (mean (SE)). Targets for 2005 (n=909) were: depth ≥ 38mm; rate ≥ 90 and ≤ 120/min; CC Fraction > 90%; leaning ≤ 10% of compressions. Targets for 2010 (n=427) were: depth ≥ 50mm; rate ≥ 100/min and ≤120/min; CC Fraction > 90%; leaning ≤10% of compressions. Odds of achieving targets calculated using generalized estimating equations to adjust standard errors for within event correlation of CPR epochs. *p<0.01. †p=0.024.
See this image and copyright information in PMC

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