Pediatric CPR quality monitoring: Analysis of thoracic anthropometric data

The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
Resuscitation (Impact Factor: 4.17). 08/2009; 80(10):1137-41. DOI: 10.1016/j.resuscitation.2009.06.031
Source: PubMed


Quantitative CPR quality feedback systems improve adult CPR performance. Extension to pediatric patients is desirable; however, the anthropometric measurements of the pediatric chest pertinent to guide the development of pediatric-specific CPR monitoring systems are largely unknown.
Adult-based CPR quality monitoring and feedback systems will require pediatric-specific tailoring and adaptation.
Anthropometric measurements pertinent to the development of pediatric-specific CPR quality monitoring systems were obtained in 150 children ages 6 months to 8 years. Standard descriptive statistics were calculated. Absolute depth point estimates and 95% confidence intervals were calculated for the American Heart Association (AHA) chest compression depth recommendations (1/3 and 1/2 Anterior-Posterior chest depth). Percentage of subjects for which the adult minimal feedback depth of 38mm would coach to achieve pediatric AHA target depths was determined.
Point estimate averages for measurements pertinent to pediatric adaptation of CPR monitoring technology were: sternal width: 25.1mm [22.0-29.2]; sternal length: 98.7mm [95.3-102.1]; internipple distance: 120.0mm [117.2-122.8]; chin to sternal notch: 35.3mm [31.2-39.4]; 1/3 AP chest depth: 37.0mm [36.1-37.8]; and 1/2 AP chest depth: 55.4mm [54.2-56.7]. A minimal feedback depth of 38mm would meet the minimum pediatric AHA target for depth in 55% (82/148) of subjects, and coach too deep in only 2% (3/148).
Extension of adult-based CPR quality monitoring and feedback systems will require pediatric-specific tailoring and adaptation. Future studies should examine chest compression depths in clinical settings with correlation to physiologic parameters to determine the best targets for pediatric CPR guidelines.

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    • "At our institution, the Heartstart MRx defibrillator with Q-CPR option, jointly designed by Philips Health Care (Andover, MA) and the Laerdal Medical Corporation (Stavanger, Norway) was used to collect quantitative CPR data and to provide real-time feedback if the CPR was not meeting Guidelines in place at the time. The primary differences being: (1) the CC depth target: 2005 – ≥38 mm; 2010 – ≥50 mm (absolute measurement-based depth targets were based upon CT and external anthropometric measurement studies [19] [20] [21] to coincide with the Guidelines recommendation of " at least 1/3 the Anterior–Posterior diameter " of the chest); and (2) the CC rate targets (in 2010, rate target was increased from " approximately " 100 CC/min to " at least " 100 CC/min). In both periods, CPR recording feedback-enabled defibrillators were deployed and there were ongoing daily CPR refresher trainings [16] [17] [18]. "
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    ABSTRACT: The objective of this study was to evaluate the effect of instituting the 2010 Basic Life Support Guidelines on in-hospital pediatric and adolescent cardiopulmonary resuscitation (CPR) quality. We hypothesized that quality would improve, but that targets for chest compression (CC) depth would be difficult to achieve. Prospective in-hospital observational study comparing CPR quality 24 months before and after release of the 2010 Guidelines. CPR recording/feedback-enabled defibrillators collected CPR data (rate (CC/min), depth (mm), CC fraction (CCF, %), leaning (%>2.5kg.)). Audiovisual feedback for depth was: 2005 ≥ 38mm; 2010 ≥ 50mm; for rate: 2005 ≥ 90 and ≤ 120 CC/min; 2010 ≥ 100 and ≤ 120 CC/min. The primary outcome was average event depth compared with Student's t-test. 45 CPR events (25 before; 20 after) occurred, resulting in 1336 thirty-second epochs (909 before; 427 after). Compared to 2005, average event depth (50±13 vs. 43±9mm; p=0.047), rate (113±11 vs. 104±8 CC/min; p<0.01), and CCF (0.94 [0.93, 0.96] vs. 0.9 [0.85, 0.94]; p=0.013) increased during 2010. CPR epochs during the 2010 period more likely to meet Guidelines for CCF (OR 1.7; CI95: 1.2-2.4; p<0.01), but less likely for rate (OR 0.23; CI95: 0.12-0.44; p<0.01), and depth (OR 0.31; CI95: 0.12-0.86; p=0.024). Institution of the 2010 Guidelines was associated with increased CC depth, rate, and CC fraction; yet, achieving 2010 targets for rate and depth was difficult.
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    ABSTRACT: To investigate the effectiveness of brief bedside "booster" cardiopulmonary resuscitation (CPR) training to improve CPR guideline compliance of hospital-based pediatric providers. Prospective, randomized trial. General pediatric wards at Children's Hospital of Philadelphia. Sixty-nine Basic Life Support-certified hospital-based providers. CPR recording/feedback defibrillators were used to evaluate CPR quality during simulated pediatric arrest. After a 60-sec pretraining CPR evaluation, subjects were randomly assigned to one of three instructional/feedback methods to be used during CPR booster training sessions. All sessions (training/CPR manikin practice) were of equal duration (2 mins) and differed only in the method of corrective feedback given to participants during the session. The study arms were as follows: 1) instructor-only training; 2) automated defibrillator feedback only; and 3) instructor training combined with automated feedback. Before instruction, 57% of the care providers performed compressions within guideline rate recommendations (rate >90 min(-1) and <120 min(-1)); 71% met minimum depth targets (depth, >38 mm); and 36% met overall CPR compliance (rate and depth within targets). After instruction, guideline compliance improved (instructor-only training: rate 52% to 87% [p .01], and overall CPR compliance, 43% to 78% [p < .02]; automated feedback only: rate, 70% to 96% [p = .02], depth, 61% to 100% [p < .01], and overall CPR compliance, 35% to 96% [p < .01]; and instructor training combined with automated feedback: rate 48% to 100% [p < .01], depth, 78% to 100% [p < .02], and overall CPR compliance, 30% to 100% [p < .01]). Before booster CPR instruction, most certified Pediatric Basic Life Support providers did not perform guideline-compliant CPR. After a brief bedside training, CPR quality improved irrespective of training content (instructor vs. automated feedback). Future studies should investigate bedside training to improve CPR quality during actual pediatric cardiac arrests.
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