Abstract
Aim
To study the influence of patient characteristics and unit ergonomics and human factors
on the time to initiation of CPR.
Methods
A single center study of children, 0 to 21 years old, admitted to an ICU who experienced
cardiopulmonary arrest (CPA) requiring >1 min of chest compressions. Time of CPA was
determined by analysis of continuous ECG, plethysmography, arterial blood pressure,
and end-tidal CO2 (EtCO2) waveforms. Initiation of CPR was identified by the onset of cyclic artifact in the
ECG waveform. Patient characteristics and unit ergonomics and human factors were examined
including CPA cause, identification on the High-Risk Checklist (HRC), existing monitoring,
ICU type, time of day, nursing shift change, and outcome.
Results
The median time from CPA to initiation of CPR was 50.5 s (IQR 26.5 to 127.5) in 36
CPAs. Forty-seven percent of patients experienced time from CPA to initiation of CPR
of >1 min. There was no difference in CPA cause, ICU type, time of day, or nursing
shift change.
Conclusion
Nearly half of pediatric patients who experienced CPA in an ICU setting did not meet
AHA guidelines for early initiation of CPR. This is an opportunity to study the recognition
phase of CPA using continuous monitoring data with the aim of improving the understanding
of and factors contributing to delays in initiation of CPR.
Keywords
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Article info
Publication history
Published online: March 29, 2018
Accepted:
March 26,
2018
Received in revised form:
March 17,
2018
Received:
December 28,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.03.033.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
