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Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative*

Niles, Dana E. MS1; Duval-Arnould, Jordan MPH, DrPH2; Skellett, Sophie MA, MBBChir, MRCP3; Knight, Lynda MSN, BSN, RN, CPN4; Su, Felice MD5; Raymond, Tia T. MD6; Sweberg, Todd MD, MBA7; Sen, Anita I. MD8; Atkins, Dianne L. MD9; Friess, Stuart H. MD10; de Caen, Allan R. MD11; Kurosawa, Hiroshi MD12; Sutton, Robert M. MD, MSCE13; Wolfe, Heather MD, MSHP13; Berg, Robert A. MD13; Silver, Annemarie PhD14; Hunt, Elizabeth A. MD, MPH, PhD15; Nadkarni, Vinay M. MD, MS1,13; for the pediatric Resuscitation Quality (pediRES-Q) Collaborative Investigators

Pediatric Critical Care Medicine: May 2018 - Volume 19 - Issue 5 - p 421-432
doi: 10.1097/PCC.0000000000001520
Feature Articles

Objectives: Pediatric in-hospital cardiac arrest cardiopulmonary resuscitation quality metrics have been reported in few children less than 8 years. Our objective was to characterize chest compression fraction, rate, depth, and compliance with 2015 American Heart Association guidelines across multiple pediatric hospitals.

Design: Retrospective observational study of data from a multicenter resuscitation quality collaborative from October 2015 to April 2017.

Setting: Twelve pediatric hospitals across United States, Canada, and Europe.

Patients: In-hospital cardiac arrest patients (age < 18 yr) with quantitative cardiopulmonary resuscitation data recordings.

Interventions: None.

Measurements and Main Results: There were 112 events yielding 2,046 evaluable 60-second epochs of cardiopulmonary resuscitation (196,669 chest compression). Event cardiopulmonary resuscitation metric summaries (median [interquartile range]) by age: less than 1 year (38/112): chest compression fraction 0.88 (0.61–0.98), chest compression rate 119/min (110–129), and chest compression depth 2.3 cm (1.9–3.0 cm); for 1 to less than 8 years (42/112): chest compression fraction 0.94 (0.79–1.00), chest compression rate 117/min (110–124), and chest compression depth 3.8 cm (2.9–4.6 cm); for 8 to less than 18 years (32/112): chest compression fraction 0.94 (0.85–1.00), chest compression rate 117/min (110–123), chest compression depth 5.5 cm (4.0–6.5 cm). “Compliance” with guideline targets for 60-second chest compression “epochs” was predefined: chest compression fraction greater than 0.80, chest compression rate 100–120/min, and chest compression depth: greater than or equal to 3.4 cm in less than 1 year, greater than or equal to 4.4 cm in 1 to less than 8 years, and 4.5 to less than 6.6 cm in 8 to less than 18 years. Proportion of less than 1 year, 1 to less than 8 years, and 8 to less than 18 years events with greater than or equal to 60% of 60-second epochs meeting compliance (respectively): chest compression fraction was 53%, 81%, and 78%; chest compression rate was 32%, 50%, and 63%; chest compression depth was 13%, 19%, and 44%. For all events combined, total compliance (meeting all three guideline targets) was 10% (11/112).

Conclusions: Across an international pediatric resuscitation collaborative, we characterized the landscape of pediatric in-hospital cardiac arrest chest compression quality metrics and found that they often do not meet 2015 American Heart Association guidelines. Guideline compliance for rate and depth in children less than 18 years is poor, with the greatest difficulty in achieving chest compression depth targets in younger children.

1The Center for Simulation, Advanced Education, and Innovation, The Children’s Hospital of Philadelphia, Philadelphia, PA.

2Division of Health Sciences Informatics, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Medicine Simulation Center, Baltimore, MD.

3Department of Paediatric Intensive Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.

4REVIVE Initiative for Resuscitation Excellence, Lucile Packard Children’s Hospital Stanford, Stanford Children’s Health, Palo Alto, CA.

5Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA.

6Department of Pediatrics, Division of Cardiac Critical Care, Medical City Children’s Hospital, Dallas, TX.

7Department of Pediatric Critical Care Medicine, Cohen Children’s Medical Center, Northwell Health, New Hyde Park, NY.

8Department of Pediatrics, Columbia University Medical Center, New York, NY.

9Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA.

10Department of Pediatrics, Washington University in St Louis School of Medicine, St. Louis, MO.

11Pediatric Critical Care Medicine, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada.

12Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Hyogo, Japan.

13Department of Anesthesiology, Critical Care and Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.

14ZOLL Medical, Chelmsford, MA.

15Division of Health Sciences Informatics, Departments of Anesthesiology & Critical Care Medicine, Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Medicine Simulation Center, Baltimore, MD.

*See also p. 495.

A full list of the pediatric Resuscitation Quality (pediRES-Q) Collaborative Investigators are listed in Appendix 1.

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Ms. Niles and Drs. Wolfe and Nadkarni disclosed that The Children’s Hospital of Philadelphia receives support from an unrestricted research grant from ZOLL Medical. Ms. Niles’ and Drs. Duval-Arnould’s, Skellett’s, Raymond’s, and Sen’s institutions received funding from ZOLL Medical. Dr. Skellett disclosed other support in the form of a partial grant from ZOLL Medical, a part sponsor of the pediatric Resuscitation Quality (pediRES-Q) collaborative, for recruitment of patients to the pediRES-Q study, which goes to the research department at her hospital to a maximum of 5,000 U.S. dollars per year, and they recruited four patients at her hospital. She disclosed that she has received support from ZOLL Medical Corporation as a consultant and has received honoraria and travel expenses for speaking engagements. Drs. Su’s and Atkins’ institutions received funding from Children’s Hospital of Philadelphia. Dr. Friess’ institution received funding from Children’s Hospital of Philadelphia, National Institute of Neurological Disorders and Stroke, National Institute of Child Health and Human Development (NICHD), and he received support for article research from the National Institutes of Health (NIH). Drs. Sutton and Berg received support from the NIH: NICHD (2UG1HD063108-06) and NHLBI (1R01HL131544-01). Dr. Sutton’s institution received funding from National Heart, Lung, and Blood Institute (NHLBI) R01; he received funding from ZOLL Speakers Honoraria; and he disclosed that he is a member of the American Heart Association’s Get with the Guidelines Pediatric Research Task Force. Dr. Berg is an unpaid volunteer with the American Heart Association. Dr. Berg’s institution received funding from NICHD and NHLBI. Dr. Silver received funding from ZOLL Medical, and he is an employee of ZOLL Medical Corporation. Dr. Hunt’s institutions received funding from the NIH (she is a coinvestigator on a NIH grant on communication between teams during pediatric trauma resuscitation) and ZOLL Medical Corporation (as a consultant receiving honoraria and travel expenses for speaking engagements); she disclosed that she and her colleagues have been awarded patents for developing several educational simulation technologies for which ZOLL Medical Corporation has a nonexclusive license with the potential for royalties; and she received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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