Resuscitation
Volume 80, Issue 5 , Pages 553-557, May 2009

Leaning is common during in-hospital pediatric CPR, and decreased with automated corrective feedback☆

  • Dana Niles

      Affiliations

    • Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, United States
    • Corresponding Author InformationCorresponding author at: Center for Simulation, Advanced Education and Innovation, Room 8NW100, Main Building, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA 19104, USA Tel.: +215 590 4039; fax: +215 590 2969.
    • ,
  • Jon Nysaether

      Affiliations

    • Laerdal Medical, Tanke Svilandsgate 30, N-4002, Stavanger, Norway
    • ,
  • Robert Sutton

      Affiliations

    • Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, United States
    • ,
  • Akira Nishisaki

      Affiliations

    • Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, United States
    • ,
  • Benjamin S. Abella

      Affiliations

    • Department of Emergency Medicine and Center for Resuscitation Science, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States
    • ,
  • Kristy Arbogast

      Affiliations

    • The Center for Injury Prevention and Research, The Children's Hospital of Philadelphia, 3535 Market Street, Philadelphia, PA 19104, United States
    • ,
  • Matthew R. Maltese

      Affiliations

    • The Center for Injury Prevention and Research, The Children's Hospital of Philadelphia, 3535 Market Street, Philadelphia, PA 19104, United States
    • ,
  • Robert A. Berg

      Affiliations

    • Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, United States
    • ,
  • Mark Helfaer

      Affiliations

    • Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, United States
    • ,
  • Vinay Nadkarni

      Affiliations

    • Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, United States
    • Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, United States

Received 29 July 2008; received in revised form 30 December 2008; accepted 17 February 2009. published online 19 March 2009.

Abstract 

Background

Cardiopulmonary Resuscitation (CPR) guidelines recommend complete release between chest compressions (CC). No study has evaluated prevalence of leaning and the effect of real-time automated audiovisual feedback during in-hospital pediatric CPR.

Objectives

We hypothesize that leaning during in-hospital pediatric CPR will be common, and that real-time automated feedback will be associated with reduced leaning prevalence and force.

Methods

A feedback-capable monitor/defibrillator equipped with force transducer and accelerometer recorded CC leaning force and depth during in-hospital cardiac arrests (≥8 years) at a children's hospital. Automated feedback was enabled at the resuscitation leader's discretion, and audiovisual prompts were given when leaning force exceeded 2.5kg. Leaning force and depth CC with No Feedback (NoF) vs. with Feedback (F) were compared.

Results

20 pediatric (mean age 14.7±3.8 years) pulse less arrests generated 37,396 evaluable CC. Median leaning force was 1.6kg [0.9–2.7kg] and leaning depth 2.9 (1.6–4.7)mm. Leaning force was greater with NoF (2.5kg, [1.6–3.5kg]; n=1921) vs. F (1.6kg [0.9–2.6kg]; n=35,164, p<0.001). Leaning>2.5kg (adult feedback threshold) occurred in 50% (n=969) of CC with NoF and 27% (n=9367) CC with F (p<0.001). CC without leaning, defined as a leaning force of<0.5kg, occurred in 2.2% (n=43) CC with NoF vs. 10.5% (n=3681) CC with F (p<0.001).

Conclusions

Leaning (residual force>2.5kg) was common during pediatric CPR. The prevalence and force of leaning were reduced with automated audiovisual feedback. Further study is necessary to determine the effect of the specific leaning threshold on CPR hemodynamics.

Keywords: Cardiopulmonary Resuscitation (CPR), Cardiac arrest, Children, Pediatric, Leaning, Feedback, Incomplete release, Force transducer

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

☆ A Spanish translated version of the summary of this article appears as appendix in the final online version at doi:10.1016/j.resuscitation.2009.02.012.

PII: S0300-9572(09)00103-8

doi:10.1016/j.resuscitation.2009.02.012

Resuscitation
Volume 80, Issue 5 , Pages 553-557, May 2009

Article Tools

* Image Usage & Resolution