Advertisement

Videographic assessment of cardiopulmonary resuscitation quality in the pediatric emergency department

  • Aaron Donoghue
    Correspondence
    Corresponding author at: Emergency Medicine, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19004, United States.
    Affiliations
    Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, United States

    Division of Critical Care Medicine, Children's Hospital of Philadelphia, PA, United States

    Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, PA, United States
    Search for articles by this author
  • Ting-Chang Hsieh
    Affiliations
    Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, PA, United States
    Search for articles by this author
  • Sage Myers
    Affiliations
    Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, United States
    Search for articles by this author
  • Allison Mak
    Affiliations
    Tulane University School of Medicine, New Orleans, LA, United States
    Search for articles by this author
  • Robert Sutton
    Affiliations
    Division of Critical Care Medicine, Children's Hospital of Philadelphia, PA, United States
    Search for articles by this author
  • Vinay Nadkarni
    Affiliations
    Division of Critical Care Medicine, Children's Hospital of Philadelphia, PA, United States

    Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, PA, United States
    Search for articles by this author

      Abstract

      Objective

      To describe the adherence to guidelines for CPR in a tertiary pediatric emergency department (ED) where resuscitations are reviewed by videorecording.

      Methods

      Resuscitations in a tertiary pediatric ED are videorecorded as part of a quality improvement project. Patients receiving CPR under videorecorded conditions were eligible for inclusion. CPR parameters were quantified by retrospective review. Data were described by 30-s epoch (compression rate, ventilation rate, compression:ventilation ratio), by segment (duration of single providers’ compressions) and by overall event (compression fraction). Duration of interruptions in compressions was measured; tasks completed during pauses were tabulated.

      Results

      33 children received CPR under videorecorded conditions. A total of 650 min of CPR were analyzed. Chest compressions were performed at <100/min in 90/714 (13%) of epochs; 100–120/min in 309/714 (43%); >120/min in 315/714 (44%). Ventilations were 6–12 breaths/min in 201/708 (23%) of epochs and >12/min in 489/708 (70%). During CPR without an artificial airway, compression:ventilation coordination (15:2) was done in 93/234 (40%) of epochs. 178 pauses in CPR occurred; 120 (67%) were <10 s in duration. Of 370 segments of compressions by individual providers, 282/370 (76%) were <2 min in duration. Median compression fraction was 91% (range 88–100%).

      Conclusions

      CPR in a tertiary pediatric ED frequently met recommended parameters for compression rate, pause duration, and compression fraction. Hyperventilation and failure of C:V coordination were very common. Future studies should focus on the impact of training methods on CPR performance as documented by videorecording.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kleinman M.E.
        • DeCaen A.
        • Chameides L.
        • et al.
        Part 10: pediatric basic and advanced life support: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.
        Circulation. 2010; 122: S466-S515
        • Abella B.S.
        • Alvarado J.P.
        • Myklebust H.
        • et al.
        Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest.
        JAMA. 2005; 293: 305-310
        • Sutton R.M.
        • Niles D.
        • Nysaether J.
        • et al.
        Quantitative analysis of CPR quality during in-hospital resuscitation of older children and adolescents.
        Pediatrics. 2009; 124: 494-499
        • Wik L.
        • Kramer-Johansen J.
        • Myklebust H.
        • et al.
        Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest.
        JAMA. 2005; 293: 299-304
        • Edelson D.P.
        • Litzinger B.
        • Arora V.
        • et al.
        Improving in-hospital cardiac arrest process and outcomes with performance debriefing.
        Arch Intern Med. 2008; 168: 1063-1069
        • Soar J.
        • Edelson D.P.
        • Perkins G.D.
        Delivering high-quality cardiopulmonary resuscitation in-hospital.
        Curr Opin Crit Care. 2011; 17: 225-230
        • Niles D.
        • Sutton R.M.
        • Donoghue A.J.
        • et al.
        “Rolling refreshers”: a novel approach to maintain CPR psychomotor skill competence.
        Resuscitation. 2009; 80: 909-912
        • Wolfe H.
        • Zebuhr C.
        • Topjian A.A.
        • et al.
        Interdisciplinary ICU cardiac arrest debriefing improves survival outcomes.
        Crit Care Med. 2014; 42: 1688-1695
        • Zebuhr C.
        • Sutton R.M.
        • Morrison W.
        • et al.
        Evaluation of quantitative debriefing after pediatric cardiac arrest.
        Resuscitation. 2012; 83: 1124-1128
        • Carbine D.N.
        • Finer N.N.
        • Knodel E.
        • Rich W.
        Video recording as a means of evaluating neonatal resuscitation performance.
        Pediatrics. 2000; 106: 654-658
        • Gelbart B.
        • Hiscock R.
        • Barfield C.
        Assessment of neonatal resuscitation performance using video recording in a perinatal centre.
        J Paediatr Child Health. 2010; 46: 378-383
        • Rogers S.C.
        • Dudley N.C.
        • McDonnell W.
        • Scaife E.
        • Morris S.
        • Nelson D.
        Lights, camera, action … spotlight on trauma video review: an underutilized means of quality improvement and education.
        Pediatr Emerg Care. 2010; 26: 803-807
        • Cheng A.
        • Hunt E.
        • Donoghue A.J.
        • et al.
        Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial.
        JAMA Pediatr. 2013; 167: 528-536
        • Hunt E.A.
        • Walker A.R.
        • Shaffner D.H.
        • Miller M.R.
        • Pronovost P.J.
        Simulation of in-hospital pediatric medical emergencies and cardiopulmonary arrests: highlighting the importance of the first 5 minutes.
        Pediatrics. 2008; 121: pe34-pe43
        • Hossein-Nejad H.
        • Afzalimoghaddam M.
        • Hoseinidavarani H.
        • Hossein-Nejad Nedai H.
        The validity of cardiopulmonary resuscitation skills in the emergency department using video-assisted surveillance: an Iranian experience.
        Acta Med Iran. 2013; 51: 394-398
        • Park S.O.
        • Shin D.H.
        • Baek K.J.
        • et al.
        A clinical observational study analysing the factors associated with hyperventilation during actual cardiopulmonary resuscitation in the emergency department.
        Resuscitation. 2013; 84: 298-303
        • Jacobs I.
        • Nadkarni V.
        • Bahr J.
        • et al.
        Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).
        Circulation. 2004; 110: 3385-3397
        • Meaney P.A.
        • Bobrow B.J.
        • Mancini M.E.
        • et al.
        Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association.
        Circulation. 2013; 128: 417-435
        • Sutton R.M.
        • Niles D.
        • Meaney P.A.
        • et al.
        Low-dose, high-frequency CPR training improves skill retention of in-hospital pediatric providers.
        Pediatrics. 2011; 128: pe145-pe151
        • Niebauer J.M.
        • White M.L.
        • Zinkan J.L.
        • Youngblood A.Q.
        • Tofil N.M.
        Hyperventilation in pediatric resuscitation: performance in simulated pediatric medical emergencies.
        Pediatrics. 2011; 128: pe1195-pe1200
        • Idris A.H.
        • Guffey D.
        • Pepe P.E.
        • et al.
        Relationship between chest compression rates and outcomes from cardiac arrest.
        Circulation. 2012; 125: 3004-3012
        • Berg M.D.
        • Schexnayder S.M.
        • Chameides L.
        • et al.
        Pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Pediatrics. 2010; 126: pe1345-pe1360
        • Aufderheide T.P.
        • Sigurdsson G.
        • Pirrallo R.G.
        • et al.
        Hyperventilation-induced hypotension during cardiopulmonary resuscitation.
        Circulation. 2004; 109: 1960-1965
        • McInnes A.D.
        • Sutton R.M.
        • Orioles A.
        • et al.
        The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents.
        Resuscitation. 2011; 82: 1025-1029
        • Kerrey B.T.
        • Rinderknecht A.S.
        • Geis G.L.
        • Nigrovic L.E.
        • Mittiga M.R.
        Rapid sequence intubation for pediatric emergency patients: higher frequency of failed attempts and adverse effects found by video review.
        Ann Emerg Med. 2012; 60: 251-259
        • Kurosawa H.
        • Ikeyama T.
        • Achuff P.
        • et al.
        A randomized, controlled trial of in situ pediatric advanced life support recertification (“pediatric advanced life support reconstructed”) compared with standard pediatric advanced life support recertification for ICU frontline providers.
        Crit Care Med. 2014; 42: 610-618
        • Atkins D.L.
        • Everson-Stewart S.
        • Sears G.K.
        • et al.
        Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest.
        Circulation. 2009; 119: 1484-1491
        • Donoghue A.J.
        • Nadkarni V.
        • Berg R.A.
        • et al.
        Out-of-hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge.
        Ann Emerg Med. 2005; 46: 512-522
        • Abella B.S.
        • Edelson D.P.
        • Kim S.
        • et al.
        CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system.
        Resuscitation. 2007; 73: 54-61
        • Edelson D.P.
        • Abella B.S.
        • Kramer-Johansen J.
        • et al.
        Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest.
        Resuscitation. 2006; 71: 137-145