Introduction: High-quality CPR, with chest compressions (CC) of optimal rate and depth, improves cardiac arrest survival. CPR quality has not been characterized immediately before and after interruptions in CC during real pediatric CPR events.
Objective: To characterize quantitative CC metrics immediately before and after interruptions in CPR during real pediatric in-hospital cardiac arrests (IHCA).
Methods: We analyzed a prospective observational cohort of quantitative CPR quality metrics (Zoll R-series, Chelmsford, MA) from pediatric (<18 years old) IHCA events across 15 international PediResQ resuscitation sites. CPR quality metrics of CC rate and CC depth were calculated and compared for the 5 consecutive CC, 1) before, and 2) after any interruption (>1.0 second) during CPR. Descriptive summaries were reported as median and IQR or mean and standard deviation based on sample distributions. Wilcoxon signed-rank test and paired t-test were used, where appropriate.
Results: Of the 137 events with complete CC data, 129 (94%) had at least one interruption in CC of >1.0 second. Of 2,042 total interruptions, the median duration was 2.9 [IQR 1.4,5.9] seconds. There were 299/2042 (15%) CC interruptions that were >10 seconds. CC rate was mean 23/min±11 slower post-interruption: Pre 120/min±16 vs. Post 98/min±12, p<0.001. CC depth was lower post-interruption for all age categories: CC depth difference for <1 yo: -0.4 [IQR -0.2,-0.6] cm, p<0.001; for 1-<8 yo: -0.7 [IQR -0.2,-1.1] cm, p<0.001; and for 8-<18 yo: -1.0 [IQR -0.4,-1.6] cm, p<0.001.
Conclusion: Interruptions of CPR during real pediatric IHCA events are associated with statistically significant reductions in measured CC rate and depth. Differences in CC depth persist when stratified by age category: <1 year-old, 1-<8 year-old, and 8-<18 year-old. Interruptions in CC during CPR may provide an opportunity for focused quality improvement training.