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Pediatr Crit Care Med. 2017 Aug;18(8):e311-e317. doi: 10.1097/PCC.0000000000001218.

Causes for Pauses During Simulated Pediatric Cardiac Arrest.

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1Department of Pediatrics, Columbia University Medical Center, Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY. 2Department of Medical Education, University of Alabama at Birmingham School of Medicine, Birmingham, AL. 3Department of Anesthesiology and Critical Care, Children's Hospital Los Angeles, University of California Los Angeles, Los Angeles, CA. 4Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. 5Department of Anesthesiology, Children's Medical Center of Dallas, UT Southwestern Medical Center, Dallas, TX. 6Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada. 7Departments of Pediatrics and Medical Education, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University School of Medicine, Chicago, IL. 8Department of Emergency Medicine, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI. 9Department of Pediatrics and Centre for Medical Education, McGill University, Montreal, QC, Canada. 10Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada. 11Department of Paediatric Intensive Care, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. 12Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada.



Pauses in cardiopulmonary resuscitation negatively impact clinical outcomes; however, little is known about the contributing factors. The objective of this study is to determine the frequency, duration, and causes for pauses during cardiac arrest.


This is a secondary analysis of video data collected from a prospective multicenter trial. Twenty-six simulated pediatric cardiac arrest scenarios each lasting 12 minutes in duration were analyzed by two independent reviewers to document events surrounding each pause in chest compressions.


Ten children's hospitals across Canada, the United, and the United Kingdom.


Resuscitation teams composed of three healthcare providers trained in cardiopulmonary resuscitation.


A simulated pediatric cardiac arrest case in a 5 year old.


The frequency, duration, and associated factors for each pause were recorded. Communication was rated using a four-point scale reflecting the team's shared mental model. Two hundred fifty-six pauses were reviewed with a median of 10 pauses per scenario (interquartile range, 7-12). Median pause duration was 5 seconds (interquartile range, 2-9 s), with 91% chest compression fraction per scenario (interquartile range, 88-94%). Only one task occurred during most pauses (66%). The most common tasks were a change of chest compressors (25%), performing pulse check (24%), and performing rhythm check (15%). Forty-nine (19%) of the pauses lasted greater than 10 seconds and were associated with shock delivery (p < 0.001), performing rhythm check (p < 0.001), and performing pulse check (p < 0.001). When a shared mental model was rated high, pauses were significantly shorter (mean difference, 4.2 s; 95% CI, 1.6-6.8 s; p = 0.002).


Pauses in cardiopulmonary resuscitation occurred frequently during simulated pediatric cardiac arrest, with variable duration and underlying causes. A large percentage of pauses were greater than 10 seconds and occurred more frequently than the recommended 2-minute interval. Future efforts should focus on improving team coordination to minimize pause frequency and duration.

[Indexed for MEDLINE]

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