Videographic assessment of cardiopulmonary resuscitation quality in the pediatric emergency department |
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| Affiliation: | 1. Division of Emergency Medicine, Children''s Hospital of Philadelphia, PA, United States;2. Division of Critical Care Medicine, Children''s Hospital of Philadelphia, PA, United States;3. Center for Simulation, Innovation, and Advanced Education, Children''s Hospital of Philadelphia, PA, United States;4. Tulane University School of Medicine, New Orleans, LA, United States;1. The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark;2. Department of Intensive Care, Santa Maria degli Angeli, Pordenone, Italy;3. Department of Intensive Care, Leeuwarden Medical Centrum, Leeuwarden, The Netherlands;4. Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden;5. Copenhagen Trial Unit, Centre of Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark;6. Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden;7. Department of Cardiology, Skåne University Hospital, Lund, Sweden;8. Department of Anesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden;9. Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland;10. Department of Intensive Care, Academic Medical Centrum, Amsterdam, The Netherlands;11. Department of Anesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway;12. Department of Anesthesia and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg;13. Department of Intensive Care, University Hospital of Wales, Cardiff, United Kingdom;14. Department of Intensive Care, Liverpool hospital, Sydney, New South Wales, Australia;1. Department of Pediatrics and Critical Care Medicine, Section of Pediatric Cardiac Intensive Care, Medical City Children''s Hospital, Dallas, TX, United States;2. Department of Pediatrics, Children''s Hospital of The King''s Daughters, Norfolk, VA, United States |
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| Abstract: | ObjectiveTo describe the adherence to guidelines for CPR in a tertiary pediatric emergency department (ED) where resuscitations are reviewed by videorecording.MethodsResuscitations 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.Results33 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%).ConclusionsCPR 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. |
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| Keywords: | Cardiac arrest Cardiopulmonary resuscitation Pediatric |
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