Quantitative analysis of chest compression interruptions during in-hospital resuscitation of older children and adolescents☆

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.

Abbreviations: AHA, American Heart Association, CPR, cardiopulmonary resuscitation, CC, chest compression

Keywords: Pediatric, Cardiopulmonary resuscitation, Quality appraisal