Abstract Sun1106: Dynamic components of CPR performance in a pediatric emergency department: a video-based study

Abstract

Bakcground: Cardiac arrest in the pediatric emergency department (PED) is an uncommon event requiring rapid assembly of ad hoc multidisciplinary care teams. Effective cardiopulmonary resuscitation (CPR) is influenced by teamwork, leadership, and communication. A designated CPR coach has been shown to improve CPR performance in simulated resuscitations. Objective: To describe dynamic components of pediatric CPR using video review and compare these factors between events with and without a designated CPR coach. Methods: Prospective observational study in a tertiary PED with a resuscitation video review program. Events where a child received chest compressions under videorecorded conditions were included. A CPR coach was designated at the team leader’s discretion. Data on CPR performance was collected from video review. Chest compressions (CC) were defined in CC segments (the duration of CC given by a single provider before switching to a different providers). Pauses in CC were measured in seconds and tasks performed during pauses (e.g. pulse check, rhythm check) were recorded. Unadjusted univariate analysis between events with and without a CPR coach was performed by c2 analyses for dichotomous variables and nonparametric analysis for continuous variables. Results: 88 events were analyzed (OHCA n=74, IHCA n=14; ROSC 23/88 (26%); survival to admission 21/88 (24%)). The median duration of CPR was 18 minutes (IQR 12 – 27 minutes). Median CC segment duration was 71 sec (IQR 42 – 104 sec). 84% of segments were less than 2 minutes; 39% were less than 1 minute. A median of 12 pauses in chest compressions occurred per event (range 2-30). Median pause duration was 4 sec (IQR 3 – 9 sec); 18% of pauses exceeded 10 seconds. The coordination of compressor change, pulse check, and rhythm check were done in 182/934 (18%) of CC pauses. Median chest compression fraction across all events was 87% (IQR 76% – 93%). A CPR coach was designated in 24/88 (27%) events. On univariate analysis comparing events with and without a CPR coach, there were no significant differences in CCF, average CC segment duration, or number of pauses > 10 sec. Conclusions: Using video review, areas for improvement in team performance during pediatric CPR were identified. The presence of a designated CPR coach was not associated with significant differences in these parameters. Future studies should examine the impact of targeted CPR coach training on dynamic team function to improve CPR.