Quantitative analysis of chest compression interruptions during in-hospital resuscitation of older children and adolescents☆
Received 22 April 2009; received in revised form 6 July 2009; accepted 2 August 2009. published online 07 September 2009.
Abstract
Aim
To quantitatively describe pauses in chest compression (CC) delivery during resuscitation from in-hospital pediatric and adolescent cardiac arrest. We hypothesized that CPR error will be more likely after a chest compression provider change compared to other causes for pauses.
Methods
CPR recording/feedback defibrillators were used to evaluate CPR quality for victims ≥8 years who received CPR in the PICU/ED. Audiovisual feedback was supplied in accordance with AHA targets. Etiology of CC pauses identified by post-event debriefing/reviews of stored CPR quality data.
Results
Analysis yielded 205 pauses during 304.8min of CPR from 20 consecutive cardiac arrests. Etiologies were: 57.1% for provider switch; 23.9% for pulse/rhythm analysis; 4.4% for defibrillation; and 14.6% “other.” Provider switch accounted for 41.2% of no-flow duration. Compared to other causes, CPR epochs following pauses due to provider switch were more likely to have measurable residual leaning (OR: 5.52; CI95: 2.94, 10.32; p<0.001) and were shallower (43±8 vs. 46±7mm; mean difference: −2.42mm; CI95: −4.71, −0.13; p=0.04). Individuals performing continuous CPR≥120s as compared to those switching earlier performed deeper chest compressions (42±6 vs. 38±7mm; mean difference: 4.44mm; CI95: 2.39, 6.49; p<0.001) and were more compliant with guideline depth recommendations (OR: 5.11; CI95: 1.67, 15.66; p=0.004).
Conclusions
Provider switches account for a significant portion of no-flow time. Measurable residual leaning is more likely after provider switch. Feedback systems may allow some providers to continue high quality CPR past the recommended switch time of 2min during in-hospital resuscitation attempts.
aThe Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 7th Floor, Central Wing 7C09, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States
bThe Children's Hospital of Philadelphia, Center for Simulation, Advanced Education, and Innovation, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 United States
cThe Children's Hospital of Philadelphia, Center for Injury Research and Prevention, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 United States
dUniversity of Pennsylvania School of Medicine, Department of Biostatistics and Epidemiology, 423 Guardian Drive, Philadelphia, PA 19104 United States
ABSTRACT