Introduction: This is a scarcity of data on CPR quality metrics during pediatric (<18 yrs) in-hospital cardiac arrests (IHCA) and compliance with American Heart Association (AHA) pediatric Basic Life Support (BLS) guideline targets, particularly in children <8 yrs. We sought to characterize pediatric chest compression (CC) metrics and compliance with 2015 AHA BLS guidelines using the first pediatric resuscitation quality collaborative (pediRES-Q).
Objective: Characterize CC metrics and compliance with 2015 AHA BLS guidelines for the quality metrics of CC fraction (CCF), rate, and depth during real pediatric IHCA events across 15 international sites.
Methods: We analyzed a prospective observational cohort of pediatric (<18 yo) IHCA events with quantitative CPR quality metrics (R-series, Zoll Medical, Chelmsford, MA) across 15 diverse international sites. We evaluated compliance with 2015 AHA BLS guidelines, defined as mean CC/60-sec epoch with: CCF ≥0.80, rate 100-120/min, and depth: for infants <1yo, ≥4.0 cm; and for children 1 to 18yo, ≥5 cm to ≤6 cm.
Results: Between Oct 2015 and Apr 2017, we analyzed 137 CPR events with complete quantitative CC metrics across 15 sites (range 1-21 events/site, median age 3.0 yrs [IQR 0.6, 9.9], yielding 2616 sixty-sec epochs of CPR (=249,381 CC). For the 43 (31%) <1 yo events (707 epochs), median (IQR) for CC metrics were: CCF 0.87 (0.55, 0.98), rate 119/min (110, 129), depth 2.3 cm (1.9, 3.0). The proportion of <1 yo CPR epochs meeting AHA compliance were 57% CCF, 46% rate, and 9% depth. For the 94 (69%) 1 to <18 yo events (1909 epochs), median (IQR) for CC metrics were: CCF 0.94 (0.81, 1.00), rate 116/min (110, 123), depth 4.2 cm (3.2, 5.8). The proportion of 1 to <18 yo CPR epochs meeting AHA compliance were 76% CCF, 60% rate, and 18% depth. Total guideline compliance (meeting all 3 metric targets) by epoch was 3.3% (23/707) for infants <1yo, and 9.5% (182/1909) for children 1 to <18 yo.
Conclusion: Across a large international pediatric resuscitation collaborative, we described the landscape of pediatric in-hospital CC quality metrics, and found they often do not meet 2015 AHA BLS guidelines. Compliance is poor for both infants and children, with the most difficulty in achieving compliance with current guideline CC depth targets.