The Center for Simulation, Advanced Education, and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA.
Division of Health Sciences Informatics, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Medicine Simulation Center, Baltimore, MD.
Pediatr Crit Care Med. 2018 May;19(5):421-432. doi: 10.1097/PCC.0000000000001520.
Pediatric in-hospital cardiac arrest cardiopulmonary resuscitation quality metrics have been reported in few children less than 8 years. Our objective was to characterize chest compression fraction, rate, depth, and compliance with 2015 American Heart Association guidelines across multiple pediatric hospitals.
Retrospective observational study of data from a multicenter resuscitation quality collaborative from October 2015 to April 2017.
Twelve pediatric hospitals across United States, Canada, and Europe.
In-hospital cardiac arrest patients (age < 18 yr) with quantitative cardiopulmonary resuscitation data recordings.
None.
There were 112 events yielding 2,046 evaluable 60-second epochs of cardiopulmonary resuscitation (196,669 chest compression). Event cardiopulmonary resuscitation metric summaries (median [interquartile range]) by age: less than 1 year (38/112): chest compression fraction 0.88 (0.61-0.98), chest compression rate 119/min (110-129), and chest compression depth 2.3 cm (1.9-3.0 cm); for 1 to less than 8 years (42/112): chest compression fraction 0.94 (0.79-1.00), chest compression rate 117/min (110-124), and chest compression depth 3.8 cm (2.9-4.6 cm); for 8 to less than 18 years (32/112): chest compression fraction 0.94 (0.85-1.00), chest compression rate 117/min (110-123), chest compression depth 5.5 cm (4.0-6.5 cm). "Compliance" with guideline targets for 60-second chest compression "epochs" was predefined: chest compression fraction greater than 0.80, chest compression rate 100-120/min, and chest compression depth: greater than or equal to 3.4 cm in less than 1 year, greater than or equal to 4.4 cm in 1 to less than 8 years, and 4.5 to less than 6.6 cm in 8 to less than 18 years. Proportion of less than 1 year, 1 to less than 8 years, and 8 to less than 18 years events with greater than or equal to 60% of 60-second epochs meeting compliance (respectively): chest compression fraction was 53%, 81%, and 78%; chest compression rate was 32%, 50%, and 63%; chest compression depth was 13%, 19%, and 44%. For all events combined, total compliance (meeting all three guideline targets) was 10% (11/112).
Across an international pediatric resuscitation collaborative, we characterized the landscape of pediatric in-hospital cardiac arrest chest compression quality metrics and found that they often do not meet 2015 American Heart Association guidelines. Guideline compliance for rate and depth in children less than 18 years is poor, with the greatest difficulty in achieving chest compression depth targets in younger children.
儿科院内心搏骤停心肺复苏质量指标在年龄小于 8 岁的儿童中报道较少。我们的目的是描述在美国、加拿大和欧洲的 12 家儿科医院中，2015 年美国心脏协会指南指导下的多个儿科医院的胸外按压分数、频率、深度和顺应性。
对 2015 年 10 月至 2017 年 4 月多中心复苏质量协作的数据进行回顾性观察研究。
美国、加拿大和欧洲的 12 家儿科医院。
院内心搏骤停患者（年龄 < 18 岁），具有定量心肺复苏数据记录。
无。
共有 112 例事件产生了 2046 个可评估的 60 秒心肺复苏（196669 次胸外按压）的 60 秒时间段。按年龄划分的事件心肺复苏指标摘要（中位数[四分位数范围]）：小于 1 岁（38/112）：胸外按压分数 0.88（0.61-0.98），胸外按压频率 119/min（110-129），胸外按压深度 2.3cm（1.9-3.0cm）；1 至 8 岁以下（42/112）：胸外按压分数 0.94（0.79-1.00），胸外按压频率 117/min（110-124），胸外按压深度 3.8cm（2.9-4.6cm）；8 至 18 岁以下（32/112）：胸外按压分数 0.94（0.85-1.00），胸外按压频率 117/min（110-123），胸外按压深度 5.5cm（4.0-6.5cm）。60 秒胸外按压“时段”的指南目标“顺应性”是预先设定的：胸外按压分数大于 0.80，胸外按压频率 100-120/min，胸外按压深度：1 岁以下大于或等于 3.4cm，1 至 8 岁大于或等于 4.4cm，8 至 18 岁大于或等于 4.5cm，小于 6.6cm。小于 1 岁、1 至 8 岁和 8 至 18 岁事件中，大于或等于 60%的 60 秒时段符合顺应性的比例（分别为）：胸外按压分数为 53%、81%和 78%；胸外按压频率为 32%、50%和 63%；胸外按压深度为 13%、19%和 44%。所有事件的总顺应性（满足所有三个指南目标）为 10%（11/112）。
在国际儿科复苏协作中，我们描述了儿科院内心搏骤停胸外按压质量指标的情况，发现它们通常不符合 2015 年美国心脏协会指南。在 18 岁以下的儿童中，率和深度的指南符合率较差，在年龄较小的儿童中，最难达到胸外按压深度的目标。
