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Resuscitation. 2019 Dec;145:158-165. doi: 10.1016/j.resuscitation.2019.08.015. Epub 2019 Aug 14.

Pauses in compressions during pediatric CPR: Opportunities for improving CPR quality.

Author information

1
Children's National Health System, Division of Emergency Medicine, United States. Electronic address: koconnel@childrensnational.org.
2
Children's National Health System, Division of Emergency Medicine, United States; Georgetown University School of Medicine, United States. Electronic address: ryanrkeane@gmail.com.
3
Children's National Health System, Division of Emergency Medicine, United States; Georgetown University School of Medicine, United States. Electronic address: nhc8@georgetown.edu.
4
Children's National Health System, Division of Emergency Medicine, United States. Electronic address: asandler@gwu.edu.
5
Children's Hospital of Philadelphia, Divisions of Emergency Medicine and Critical Care, United States; Perelman School of Medicine at the University of Pennsylvania, United States. Electronic address: Donoghue@email.chop.edu.
6
Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, United States; University of Cincinnati, College of Medicine, United States. Electronic address: Benjamin.kerrey@cchmc.org.
7
Children's Hospital of Philadelphia, Divisions of Emergency Medicine and Critical Care, United States; Perelman School of Medicine at the University of Pennsylvania, United States. Electronic address: myerss@email.chop.edu.
8
Children's Hospital of the King's Daughters, Division of Emergency Medicine, United States; Eastern Virginia Medical School, United States. Electronic address: turaj.vazifedan@chkd.org.
9
Children's Hospital of the King's Daughters, Division of Emergency Medicine, United States; Eastern Virginia Medical School, United States. Electronic address: mullan20@gmail.com.

Abstract

OBJECTIVE:

Minimizing pauses in chest compressions during cardiopulmonary resuscitation (CPR) is recommended by the American Heart Association (AHA) and is associated with improved patient outcomes. We studied the quality of pediatric CPR performed in a tertiary pediatric emergency department (ED) with a focus on pauses in chest compressions.

METHODS:

We conducted an observational study of CPR quality in two pediatric EDs using video review during pediatric cardiac arrest. Events were reviewed for AHA guideline adherence. Parameters of CPR performance were described according to individual compressor segment. Pauses in compressions were analyzed for duration and pause activities.

RESULTS:

From a 30-month period, 81 cardiac arrests were analyzed, including 1003 individual compressor segments and 900 pauses. Median chest compression fraction was 91%, with a median pause duration of 4 s (IQR 2, 10); 22% of pauses were prolonged (>10 s). Pulse checks occurred in 23% of pauses; 62% were prolonged. Checking a single pulse site (p < 0.001) and having fingers ready pre-pause (p = 0. 001) were associated with significantly shorter pause duration. Pause duration was correlated with the number of pause tasks (r = 0.559, p < 0.001). "Coordinated pauses" (pulse check, rhythm check and compressor change) were rare (6%) and long in duration (19 s; IQR 11, 30).

CONCLUSIONS:

Prolonged pauses in chest compressions occurred frequently during CPR and were associated with pulse checks and multiple simultaneous tasks. Checking a single pulse site with fingers ready on the pulse site pre-pause could decrease pause duration and improve CPR quality.

KEYWORDS:

CPR; Cardiopulmonary resuscitation; Pediatric; Resuscitation

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