Authors: Sutton RM et al., Resuscitation 2014 May 16;
Compliance with the 2010 pediatric resuscitation guidelines portended better rates of return of spontaneous circulation and 24-hour survival for pediatric patients with in-hospital arrest.
Higher quality of cardiopulmonary resuscitation (CPR) in adults has been shown to be associated with improved survival to discharge, but measuring CPR quality in children is challenging, and expert consensus has therefore been used to develop resuscitation guidelines. To assess the degree of guideline compliance and its effect on patient outcomes, researchers retrospectively analyzed data from 87 resuscitations in children aged 1 to 18 years in the intensive care unit or emergency department of an academic children’s hospital during a 7-year period. Data were prospectively collected with a CPR measurement device (used off-label for children younger than 8). The study was supported by the maker of the device.
The researchers defined compliance with the 2010 American Heart Association (AHA) guidelines for compression depth as greater than 60% of 30-second intervals during the first 5 minutes of resuscitation having an average compression depth greater than 51 mm. Overall, 26% of cardiac compression events were compliant for depth, whereas 70% were compliant for rate and 91% were compliant for chest compression fraction (percentage of time with compressions). Compliance was associated with improved 24-hour survival (70% vs. 16%), even after controlling for potential confounders (initial rhythm, sex, and year of arrest; odds ratio, 10.3), and with greater return of spontaneous circulation (74% vs. 31%). Neurologically intact survival did not differ significantly.
Comment
Survival rates in this study are lower than one would expect from an inpatient population, suggesting that the patients had extreme illness, were a highly heterogeneous group, or both. These findings suggest that compliance with AHA pediatric CPR guidelines might improve return of spontaneous circulation. Until we know more, providers should do everything possible to comply with the guidelines.