Variability in quality of chest compressions provided during simulated cardiac arrest across nine pediatric institutions

Adam Cheng; Elizabeth A. Hunt; David Grant; Yiqun Lin; Vincent Grant; Jonathan P. Duff; Marjorie Lee White; Dawn Taylor Peterson; John Zhong; Ronald Gottesman; Stephanie Sudikoff; Quynh Doan; Vinay M. Nadkarni; Linda Brown; Frank Overly; Ilana Bank; Farhan Bhanji; David Kessler; Nancy Tofil; Jennifer Davidson; Mark Adler; Alex Bragg; Kimberly Marohn; Nicola Robertson; Jordan Duval-Arnould; Hubert Wong; Aaron Donoghue; Robert M. Sutton; Dana Niles; Jenny Chatfield; Nnenna Chime; International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) CPR Investigators

doi:10.1016/j.resuscitation.2015.08.024

Variability in quality of chest compressions provided during simulated cardiac arrest across nine pediatric institutions

Adam Cheng^*, Elizabeth A. Hunt, David Grant, Yiqun Lin, Vincent Grant, Jonathan P. Duff, Marjorie Lee White, Dawn Taylor Peterson, John Zhong, Ronald Gottesman, Stephanie Sudikoff, Quynh Doan, Vinay M. Nadkarni, Linda Brown, Frank Overly, Ilana Bank, Farhan Bhanji, David Kessler, Nancy Tofil, Jennifer DavidsonMark Adler, Alex Bragg, Kimberly Marohn, Nicola Robertson, Jordan Duval-Arnould, Hubert Wong, Aaron Donoghue, Robert M. Sutton, Dana Niles, Jenny Chatfield, Nnenna Chime, International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) CPR Investigators

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

36 Scopus citations

Abstract

Aim: The variability in quality of CPR provided during cardiac arrest across pediatric institutions is unknown. We aimed to describe the degree of variability in the quality of CPR across 9 pediatric institutions, and determine if variability across sites would be affected by Just-in-Time CPR training and/or visual feedback during simulated cardiac arrest. Methods: We conducted secondary analyses of data collected from a prospective, multi-center trial. Participants were equally randomized to either: (1) No intervention; (2) Real-time CPR visual feedback during cardiac arrest or (3) Just-in-Time CPR training. We report the variability in median chest compression depth and rate across institutions, and the variability in the proportion of 30-s epochs of CPR meeting 2010 American Heart Association guidelines for depth and rate. Results: We analyzed data from 528 epochs in the no intervention group, 552 epochs in the visual feedback group, and 525 epochs in the JIT training group. In the no intervention group, compression depth (median range 22.2-39.2mm) and rate (median range 116.0-147.6min^-1) demonstrated significant variability between study sites (p<0.001). The proportion of compressions with adequate depth (0-11.5%) and rate (0-60.5%) also varied significantly across sites (p<0.001). The variability in compression depth and rate persisted despite use of real-time visual feedback or JIT training (p<0.001). Conclusion: The quality of CPR across multiple pediatric institutions is variable. Variability in CPR quality across institutions persists even with the implementation of a Just-in-Time training session and visual feedback for CPR quality during simulated cardiac arrest.

Original language	English (US)
Pages (from-to)	13-19
Number of pages	7
Journal	Resuscitation
Volume	97
DOIs	https://doi.org/10.1016/j.resuscitation.2015.08.024
State	Published - 2015

Funding

Adam Cheng (study design, data collection and analysis, writing, editing and reviewing of manuscript) received grant funding from the Canadian Institute for Health Research and Stroke Foundation of Canada as principal investigator to conduct this study. Elizabeth Hunt (study design, writing, editing and review of manuscript) is supported by: Drs. David S. and Marilyn M. Zamierowski Endowed Directorship, Johns Hopkins Medicine Simulation Center and other grants (for research unrelated to this study) from the Hartwell Foundation and Laerdal Foundation for Acute Care Medicine. Vinay Nadkarni (study design, writing, editing and review of manuscript) is supported by: Endowed Chair, Critical Care Medicine, Children's Hospital of Philadelphia; and other research grants that are unrelated to this study, including: NIH U01 HL107681; NIH/NHLBI RO1HL114484; AHRQ RO3HS021583; Nihon Kohden America Research Grant; NIH/NHLBI 1U01HL094345-01; and NIH/NINDS 5R01HL058669-10. The remaining authors have no financial disclosures of conflict of interests relevant to this article. This study was funded by a research grant from the Heart and Stroke Foundation of Canada and the Canadian Institutes of Health Research (#OMF-110354). Funds from this grant were used for the design and conduct of the study, data collection, data management, and data analysis. The INSPIRE network receives infrastructure funding from the Laerdal Foundation for Acute Medicine. Funds from this grant were used to support the INSPIRE network administrative coordinator who supported this project. Laerdal Corporation loaned each recruitment site a SimJunior™ manikin for use in the study and donated CPRCards™ for the study. No financial compensation or grant funding was received from Laerdal Corporation for conducting this research.

Keywords

Cardiopulmonary resuscitation
Chest compressions
Pediatric
Quality
Registration ID: NCT02075450
Resuscitation
Variability
Www.clinicaltrials.gov

ASJC Scopus subject areas

Emergency
Cardiology and Cardiovascular Medicine
Emergency Medicine

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10.1016/j.resuscitation.2015.08.024

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Cheng, A., Hunt, E. A., Grant, D., Lin, Y., Grant, V., Duff, J. P., White, M. L., Peterson, D. T., Zhong, J., Gottesman, R., Sudikoff, S., Doan, Q., Nadkarni, V. M., Brown, L., Overly, F., Bank, I., Bhanji, F., Kessler, D., Tofil, N., ... International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) CPR Investigators (2015). Variability in quality of chest compressions provided during simulated cardiac arrest across nine pediatric institutions. Resuscitation, 97, 13-19. https://doi.org/10.1016/j.resuscitation.2015.08.024

@article{d304f7cb113e42529da02f3c81a57fe1,

title = "Variability in quality of chest compressions provided during simulated cardiac arrest across nine pediatric institutions",

abstract = "Aim: The variability in quality of CPR provided during cardiac arrest across pediatric institutions is unknown. We aimed to describe the degree of variability in the quality of CPR across 9 pediatric institutions, and determine if variability across sites would be affected by Just-in-Time CPR training and/or visual feedback during simulated cardiac arrest. Methods: We conducted secondary analyses of data collected from a prospective, multi-center trial. Participants were equally randomized to either: (1) No intervention; (2) Real-time CPR visual feedback during cardiac arrest or (3) Just-in-Time CPR training. We report the variability in median chest compression depth and rate across institutions, and the variability in the proportion of 30-s epochs of CPR meeting 2010 American Heart Association guidelines for depth and rate. Results: We analyzed data from 528 epochs in the no intervention group, 552 epochs in the visual feedback group, and 525 epochs in the JIT training group. In the no intervention group, compression depth (median range 22.2-39.2mm) and rate (median range 116.0-147.6min-1) demonstrated significant variability between study sites (p<0.001). The proportion of compressions with adequate depth (0-11.5\%) and rate (0-60.5\%) also varied significantly across sites (p<0.001). The variability in compression depth and rate persisted despite use of real-time visual feedback or JIT training (p<0.001). Conclusion: The quality of CPR across multiple pediatric institutions is variable. Variability in CPR quality across institutions persists even with the implementation of a Just-in-Time training session and visual feedback for CPR quality during simulated cardiac arrest.",

keywords = "Cardiopulmonary resuscitation, Chest compressions, Pediatric, Quality, Registration ID: NCT02075450, Resuscitation, Variability, Www.clinicaltrials.gov",

author = "Adam Cheng and Hunt, \{Elizabeth A.\} and David Grant and Yiqun Lin and Vincent Grant and Duff, \{Jonathan P.\} and White, \{Marjorie Lee\} and Peterson, \{Dawn Taylor\} and John Zhong and Ronald Gottesman and Stephanie Sudikoff and Quynh Doan and Nadkarni, \{Vinay M.\} and Linda Brown and Frank Overly and Ilana Bank and Farhan Bhanji and David Kessler and Nancy Tofil and Jennifer Davidson and Mark Adler and Alex Bragg and Kimberly Marohn and Nicola Robertson and Jordan Duval-Arnould and Hubert Wong and Aaron Donoghue and Sutton, \{Robert M.\} and Dana Niles and Jenny Chatfield and Nnenna Chime and \{International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) CPR Investigators\}",

note = "Publisher Copyright: {\textcopyright} 2015 Elsevier Ireland Ltd.",

year = "2015",

doi = "10.1016/j.resuscitation.2015.08.024",

language = "English (US)",

volume = "97",

pages = "13--19",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

}

Cheng, A, Hunt, EA, Grant, D, Lin, Y, Grant, V, Duff, JP, White, ML, Peterson, DT, Zhong, J, Gottesman, R, Sudikoff, S, Doan, Q, Nadkarni, VM, Brown, L, Overly, F, Bank, I, Bhanji, F, Kessler, D, Tofil, N, Davidson, J, Adler, M, Bragg, A, Marohn, K, Robertson, N, Duval-Arnould, J, Wong, H, Donoghue, A, Sutton, RM, Niles, D, Chatfield, J, Chime, N & International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) CPR Investigators 2015, 'Variability in quality of chest compressions provided during simulated cardiac arrest across nine pediatric institutions', Resuscitation, vol. 97, pp. 13-19. https://doi.org/10.1016/j.resuscitation.2015.08.024

TY - JOUR

T1 - Variability in quality of chest compressions provided during simulated cardiac arrest across nine pediatric institutions

AU - Cheng, Adam

AU - Hunt, Elizabeth A.

AU - Grant, David

AU - Lin, Yiqun

AU - Grant, Vincent

AU - Duff, Jonathan P.

AU - White, Marjorie Lee

AU - Peterson, Dawn Taylor

AU - Zhong, John

AU - Gottesman, Ronald

AU - Sudikoff, Stephanie

AU - Doan, Quynh

AU - Nadkarni, Vinay M.

AU - Brown, Linda

AU - Overly, Frank

AU - Bank, Ilana

AU - Bhanji, Farhan

AU - Kessler, David

AU - Tofil, Nancy

AU - Davidson, Jennifer

AU - Adler, Mark

AU - Bragg, Alex

AU - Marohn, Kimberly

AU - Robertson, Nicola

AU - Duval-Arnould, Jordan

AU - Wong, Hubert

AU - Donoghue, Aaron

AU - Sutton, Robert M.

AU - Niles, Dana

AU - Chatfield, Jenny

AU - Chime, Nnenna

AU - International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) CPR Investigators

PY - 2015

Y1 - 2015

N2 - Aim: The variability in quality of CPR provided during cardiac arrest across pediatric institutions is unknown. We aimed to describe the degree of variability in the quality of CPR across 9 pediatric institutions, and determine if variability across sites would be affected by Just-in-Time CPR training and/or visual feedback during simulated cardiac arrest. Methods: We conducted secondary analyses of data collected from a prospective, multi-center trial. Participants were equally randomized to either: (1) No intervention; (2) Real-time CPR visual feedback during cardiac arrest or (3) Just-in-Time CPR training. We report the variability in median chest compression depth and rate across institutions, and the variability in the proportion of 30-s epochs of CPR meeting 2010 American Heart Association guidelines for depth and rate. Results: We analyzed data from 528 epochs in the no intervention group, 552 epochs in the visual feedback group, and 525 epochs in the JIT training group. In the no intervention group, compression depth (median range 22.2-39.2mm) and rate (median range 116.0-147.6min-1) demonstrated significant variability between study sites (p<0.001). The proportion of compressions with adequate depth (0-11.5%) and rate (0-60.5%) also varied significantly across sites (p<0.001). The variability in compression depth and rate persisted despite use of real-time visual feedback or JIT training (p<0.001). Conclusion: The quality of CPR across multiple pediatric institutions is variable. Variability in CPR quality across institutions persists even with the implementation of a Just-in-Time training session and visual feedback for CPR quality during simulated cardiac arrest.

AB - Aim: The variability in quality of CPR provided during cardiac arrest across pediatric institutions is unknown. We aimed to describe the degree of variability in the quality of CPR across 9 pediatric institutions, and determine if variability across sites would be affected by Just-in-Time CPR training and/or visual feedback during simulated cardiac arrest. Methods: We conducted secondary analyses of data collected from a prospective, multi-center trial. Participants were equally randomized to either: (1) No intervention; (2) Real-time CPR visual feedback during cardiac arrest or (3) Just-in-Time CPR training. We report the variability in median chest compression depth and rate across institutions, and the variability in the proportion of 30-s epochs of CPR meeting 2010 American Heart Association guidelines for depth and rate. Results: We analyzed data from 528 epochs in the no intervention group, 552 epochs in the visual feedback group, and 525 epochs in the JIT training group. In the no intervention group, compression depth (median range 22.2-39.2mm) and rate (median range 116.0-147.6min-1) demonstrated significant variability between study sites (p<0.001). The proportion of compressions with adequate depth (0-11.5%) and rate (0-60.5%) also varied significantly across sites (p<0.001). The variability in compression depth and rate persisted despite use of real-time visual feedback or JIT training (p<0.001). Conclusion: The quality of CPR across multiple pediatric institutions is variable. Variability in CPR quality across institutions persists even with the implementation of a Just-in-Time training session and visual feedback for CPR quality during simulated cardiac arrest.

KW - Cardiopulmonary resuscitation

KW - Chest compressions

KW - Pediatric

KW - Quality

KW - Registration ID: NCT02075450

KW - Resuscitation

KW - Variability

KW - Www.clinicaltrials.gov

UR - http://www.scopus.com/inward/record.url?scp=84952034624&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84952034624&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2015.08.024

DO - 10.1016/j.resuscitation.2015.08.024

M3 - Article

C2 - 26417701

AN - SCOPUS:84952034624

SN - 0300-9572

VL - 97

SP - 13

EP - 19

JO - Resuscitation

JF - Resuscitation

ER -

Variability in quality of chest compressions provided during simulated cardiac arrest across nine pediatric institutions

Abstract

Funding

Keywords

ASJC Scopus subject areas

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