Clinical Paper2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival☆
Introduction
Thousands of children and adolescents suffer an in-hospital cardiac arrest each year in the United States.1, 2, 3 Adult investigations have demonstrated that cardiopulmonary resuscitation (CPR) quality is associated with survival outcomes.4, 5, 6, 7, 8, 9, 10, 11, 12 As a result, in an effort to improve cardiac arrest outcomes, the American Heart Association (AHA) now recommends monitoring and titrating CPR performance to specific CPR quality metrics.13
The International Liaison Committee on Resuscitation (ILCOR) comprehensively evaluates existing resuscitation science every 5 years to ensure that published CPR guidelines are based upon the best available scientific evidence.14 Unfortunately, pediatric resuscitation guidelines have largely been developed by expert clinical consensus, using extrapolated data due to a paucity of evidence collected from actual children in cardiac arrest.15 To the best of our knowledge, no study has associated CPR quality with survival outcomes during pediatric resuscitations, highlighting one of the major gaps in the pediatric resuscitation science knowledge base.
Therefore, the objective of this study was to evaluate the association between 2010 AHA recommended chest compression (CC) depths (≥51 mm)16 and survival during pediatric and adolescent in-hospital resuscitation attempts. As a secondary objective, we sought to determine the association between CC depth and other quality parameters, a relationship that has been evident in previous adult investigations.7, 11 We hypothesized that CC depths exceeding the 2010 AHA recommendations (≥51 mm) would be associated with improved 24-h survival after in-hospital pediatric and adolescent cardiac arrest.
Section snippets
Design – consent
This is a prospectively acquired, retrospectively analyzed, single-center observational study with the primary objective to evaluate the association of 2010 AHA chest compression (CC) depth compliance (≥51 mm)16 with survival outcomes for cardiac arrest events in an intensive care unit (ICU) or emergency department (ED). The Institutional Review Board at the Children's Hospital of Philadelphia approved this study protocol, including consent procedures, as well as the prospective in-hospital
Results
Between October 2006 and September 2013, a total of 89 CC events occurred, 87 with quantitative CPR data collected (23 AHA depth compliant). Of these events, 78 were index events (first arrest), 22 of which were AHA depth compliant (Fig. 1). Compliant events tended to occur more often in the PICU (p = 0.073), and these compliant events tended to be characterized by more bradycardia with poor perfusion and ventricular tachycardia/ventricular fibrillation (i.e., shockable rhythms) and less
Discussion
To the best of our knowledge, this is the first study to associate AHA compliant chest compression depth (≥51 mm) during the in-hospital resuscitation of real children and adolescents with survival outcome. We found significantly higher rates of ROSC and 24-h survival when CPR was provided in compliance with 2010 AHA depth guidelines (≥51 mm). This relationship was evident even after controlling for the effect of improved outcomes over time. In contrast to previous investigations,7, 11 we did not
Conclusions
In this study of children >1 year of age, performance of CPR compliant with the 2010 American Heart Association chest compression depth recommendations (≥51 mm) was associated with higher rates of ROSC and 24-h survival after in-hospital cardiac arrest. In contrast to previous investigations, we did not observe an association between CC depth and other quality variables – specifically, CC depth did not decline as rates increased. Larger studies are needed to assess the relationship of pediatric
Conflicts of interest statement
Dr. Vinay Nadkarni and Dana Niles received unrestricted research grant support from the Laerdal Foundation for Acute Care Medicine. Robert Sutton and Alexis Topjian are supported through National Institute of Health career development awards (RMS: K23HD062629; AT: K23NS075363).
Acknowledgement
This study was supported by a Laerdal Medical Foundation Center of Excellence Grant.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.05.007.