![]() ![]() As defined by 2005 guidelines 8, AHA recommended quality CPR was defined as rate ≥ 100 CC/min and depth ≥ 38 mm. These predictor variables were also analyzed in dichotomous form. Any calculated rates less than 30 per minute were assumed to have come from nonadjacent compressions (i.e., the first compression in a series) and were excluded from the analysis. Incomplete chest wall recoil (leaning between compressions) was accounted for in the analysis by subtracting the leaning depth (mm) from the maximum compression depth attained, with the final predictor variable equaling the effective “stroke depth” of compression. The predictor CPR quality variables were CC depth in millimeters (corrected for mattress deflection (see below) 14, 15 and instantaneous compression rate (calculated as 60 divided by the time between adjacent chest compressions). Systolic BP was sampled at the peak of the arterial pressure tracing diastolic BP was sampled during mid-diastole. This process allowed extraction of de-identified numerical X (time in seconds) and Y (arterial BP) data that was then time synchronized to the specific CC generating each pressure measured from the arterial catheter. 13 Arterial waveforms were printed from the PICU central monitoring system (GE Medical Systems, Inc.) and subsequently digitized using a graphics program (DigitizeIt Version 1.5.8). These thresholds were chosen not only based upon age-related norms 9, but specifically for diastolic pressure, because of the consistent relationship of this threshold (diastolic BP ≥ 30 mmHg) with improved short term survival in animal 10– 12 and adult investigations. The prospectively designated target arterial BPs for analysis were systolic ≥ 80 mmHg and diastolic ≥ 30 mmHg. The primary outcome variables of this study were systolic and diastolic arterial blood pressure (BP) recorded from an invasive arterial catheter in place at the time of cardiac arrest. Importantly, the software/algorithms for determining CPR quality parameters were unchanged in the modified compression sensor. ![]() In order to collect data on younger children (i.e., less than 8 years of age), a modification was made to the Q-CPR Sensor to accommodate the smaller sternum of younger subjects, the automated feedback was silenced (no quantitative absolute depth recommendations were available from the AHA in 2005), and written prospective consent was obtained from these subjects prior to their arrest event (i.e., potential subjects were pre-identified). At the time of this study, feedback was supplied in accordance with 2005 AHA Guidelines 8 (depth ≥ 38 mm (1.5 inches), rate ≥ 90 CC/min or ≤ 120 CC/min, pauses of ≤ 15 seconds, and measurable residual leaning force ≤ 2500 grams). The defibrillator monitor also provides real-time audiovisual feedback when CPR does not comply with American Heart Association (AHA) quality recommendations. ![]() The Q-CPR sensor records accelerometer and force signals and transmits this data to the MRx defibrillator for storage, and for later analysis of chest compression (CC) data (e.g., rate, depth, residual leaning force). Each defibrillator has an oval compression sensor or “puck” that is placed on the lower part of the sternum between the rescuer’s hand and the victim’s chest. The Heartstart MRx defibrillator with Quality-CPR (Q-CPR) Technology utilized in this investigation was jointly designed by Philips Healthcare (Andover, MA USA) and Laerdal Medical AS (Stavanger, Norway) and is currently marketed in the United States for use in children ≥ 8 years of age. We hypothesized that 2005 AHA recommended quality targets (rate ≥ 100/min depth ≥ 38 mm) would be associated with systolic blood pressures ≥ 80 mmHg and diastolic blood pressures ≥ 30 mmHg. Therefore, the objective of this study was, for the first time, to associate specific quantitative CPR quality targets (chest compression depth, rate, and incomplete release) to hemodynamic measurements prospectively obtained during actual in-hospital pediatric cardiac arrest resuscitation. This paucity of child-specific data highlights an important gap in the pediatric resuscitation knowledge base. However, these same quality targets in infants and children have largely been developed by expert clinical consensus, using data extrapolated from animal, manikin, mathematical modeling, and adult studies, with little data collected from actual children. Specific quality targets such as achieving adequate chest compression depths 1, 2 and rates 3, and limiting interruptions in CPR 1, 4– 7 have all been associated with improved survival outcomes after adult cardiac arrest. ![]() Cardiopulmonary resuscitation (CPR) quality has been highlighted as an important determinant of survival outcome after cardiac arrest. ![]()
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