A quantitative analysis of out-of-hospital pediatric and adolescent resuscitation quality - A report from the ROC epistry-cardiac arrest

on behalf of the ROC Investigators

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Aim: High-quality cardiopulmonary resuscitation (CPR) may improve survival. The quality of CPR performed during pediatric out-of-hospital cardiac arrest (p-OHCA) is largely unknown. The main objective of this study was to describe the quality of CPR performed during p-OHCA resuscitation attempts. Methods: Prospective observational multi-center cohort study of p-OHCA patients ≥1 and <19 years of age registered in the Resuscitation Outcomes Consortium (ROC) Epistry database. The primary outcome was an a priori composite variable of compliance with American Heart Association (AHA) guidelines for both chest compression (CC) rate and CC fraction (CCF). Event compliance was defined as a case with 60% or more of its minute epochs compliant with AHA targets (rate 100-120min<sup>-1</sup>; depth ≥38mm; and CCF ≥0.80). In a secondary analysis, multivariable logistic regression was used to evaluate the association between guideline compliance and return of spontaneous circulation (ROSC). Results: Between December 2005 and December 2012, 2564 pediatric events were treated by EMS providers, 390 of which were included in the final cohort. Of these events, 22% achieved AHA compliance for both rate and CCF, 36% for rate alone, 53% for CCF alone, and 58% for depth alone. Over time, there was a significant increase in CCF (p<. 0.001) and depth (p= 0.03). After controlling for potential confounders, there was no significant association between AHA guideline compliance and ROSC. Conclusions: In this multi-center study, we have established that there are opportunities for professional rescuers to improve prehospital CPR quality. Encouragingly, CCF and depth both increased significantly over time.

Original languageEnglish (US)
Pages (from-to)150-157
Number of pages8
JournalResuscitation
Volume93
DOIs
StatePublished - Aug 1 2015

Fingerprint

Pediatric Hospitals
Cardiopulmonary Resuscitation
Heart Arrest
Out-of-Hospital Cardiac Arrest
Resuscitation
Compliance
Guidelines
Cohort Studies
Logistic Models
Pediatrics
Survival

Keywords

  • Cardiopulmonary resuscitation
  • Emergency medical services
  • Pediatric

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

A quantitative analysis of out-of-hospital pediatric and adolescent resuscitation quality - A report from the ROC epistry-cardiac arrest. / on behalf of the ROC Investigators.

In: Resuscitation, Vol. 93, 01.08.2015, p. 150-157.

Research output: Contribution to journalArticle

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title = "A quantitative analysis of out-of-hospital pediatric and adolescent resuscitation quality - A report from the ROC epistry-cardiac arrest",
abstract = "Aim: High-quality cardiopulmonary resuscitation (CPR) may improve survival. The quality of CPR performed during pediatric out-of-hospital cardiac arrest (p-OHCA) is largely unknown. The main objective of this study was to describe the quality of CPR performed during p-OHCA resuscitation attempts. Methods: Prospective observational multi-center cohort study of p-OHCA patients ≥1 and <19 years of age registered in the Resuscitation Outcomes Consortium (ROC) Epistry database. The primary outcome was an a priori composite variable of compliance with American Heart Association (AHA) guidelines for both chest compression (CC) rate and CC fraction (CCF). Event compliance was defined as a case with 60{\%} or more of its minute epochs compliant with AHA targets (rate 100-120min-1; depth ≥38mm; and CCF ≥0.80). In a secondary analysis, multivariable logistic regression was used to evaluate the association between guideline compliance and return of spontaneous circulation (ROSC). Results: Between December 2005 and December 2012, 2564 pediatric events were treated by EMS providers, 390 of which were included in the final cohort. Of these events, 22{\%} achieved AHA compliance for both rate and CCF, 36{\%} for rate alone, 53{\%} for CCF alone, and 58{\%} for depth alone. Over time, there was a significant increase in CCF (p<. 0.001) and depth (p= 0.03). After controlling for potential confounders, there was no significant association between AHA guideline compliance and ROSC. Conclusions: In this multi-center study, we have established that there are opportunities for professional rescuers to improve prehospital CPR quality. Encouragingly, CCF and depth both increased significantly over time.",
keywords = "Cardiopulmonary resuscitation, Emergency medical services, Pediatric",
author = "{on behalf of the ROC Investigators} and Sutton, {Robert M.} and Erin Case and Brown, {Siobhan P.} and Atkins, {Dianne L.} and Nadkarni, {Vinay M.} and Jonathan Kaltman and Clifton Callaway and Ahamed Idris and Graham Nichol and Jamie Hutchison and Drennan, {Ian R.} and Michael Austin and Mohamud Daya and Sheldon Cheskes and Jack Nuttall and Heather Herren and James Christenson and Dug Andrusiek and Christian Vaillancourt and Menegazzi, {James J.} and Rea, {Thomas D.} and Berg, {Robert A.}",
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AU - on behalf of the ROC Investigators

AU - Sutton, Robert M.

AU - Case, Erin

AU - Brown, Siobhan P.

AU - Atkins, Dianne L.

AU - Nadkarni, Vinay M.

AU - Kaltman, Jonathan

AU - Callaway, Clifton

AU - Idris, Ahamed

AU - Nichol, Graham

AU - Hutchison, Jamie

AU - Drennan, Ian R.

AU - Austin, Michael

AU - Daya, Mohamud

AU - Cheskes, Sheldon

AU - Nuttall, Jack

AU - Herren, Heather

AU - Christenson, James

AU - Andrusiek, Dug

AU - Vaillancourt, Christian

AU - Menegazzi, James J.

AU - Rea, Thomas D.

AU - Berg, Robert A.

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N2 - Aim: High-quality cardiopulmonary resuscitation (CPR) may improve survival. The quality of CPR performed during pediatric out-of-hospital cardiac arrest (p-OHCA) is largely unknown. The main objective of this study was to describe the quality of CPR performed during p-OHCA resuscitation attempts. Methods: Prospective observational multi-center cohort study of p-OHCA patients ≥1 and <19 years of age registered in the Resuscitation Outcomes Consortium (ROC) Epistry database. The primary outcome was an a priori composite variable of compliance with American Heart Association (AHA) guidelines for both chest compression (CC) rate and CC fraction (CCF). Event compliance was defined as a case with 60% or more of its minute epochs compliant with AHA targets (rate 100-120min-1; depth ≥38mm; and CCF ≥0.80). In a secondary analysis, multivariable logistic regression was used to evaluate the association between guideline compliance and return of spontaneous circulation (ROSC). Results: Between December 2005 and December 2012, 2564 pediatric events were treated by EMS providers, 390 of which were included in the final cohort. Of these events, 22% achieved AHA compliance for both rate and CCF, 36% for rate alone, 53% for CCF alone, and 58% for depth alone. Over time, there was a significant increase in CCF (p<. 0.001) and depth (p= 0.03). After controlling for potential confounders, there was no significant association between AHA guideline compliance and ROSC. Conclusions: In this multi-center study, we have established that there are opportunities for professional rescuers to improve prehospital CPR quality. Encouragingly, CCF and depth both increased significantly over time.

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