Causes for Pauses During Simulated Pediatric Cardiac Arrest

David Oren Kessler, Dawn Taylor Peterson, Alexis Bragg, Yiqun Lin, John Zhong, Jonathan Duff, Mark Adler, Linda Brown, Farhan Bhanji, Jennifer Davidson, David Grant, Adam Cheng, for the International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE) CPR Investigators

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

OBJECTIVES:: Pauses in cardiopulmonary resuscitation negatively impact clinical outcomes; however, little is known about the contributing factors. The objective of this study is to determine the frequency, duration, and causes for pauses during cardiac arrest. DESIGN:: This is a secondary analysis of video data collected from a prospective multicenter trial. Twenty-six simulated pediatric cardiac arrest scenarios each lasting 12 minutes in duration were analyzed by two independent reviewers to document events surrounding each pause in chest compressions. SETTING:: Ten children’s hospitals across Canada, the United, and the United Kingdom. SUBJECTS:: Resuscitation teams composed of three healthcare providers trained in cardiopulmonary resuscitation. INTERVENTIONS:: A simulated pediatric cardiac arrest case in a 5 year old. MEASUREMENTS AND MAIN RESULTS:: The frequency, duration, and associated factors for each pause were recorded. Communication was rated using a four-point scale reflecting the team’s shared mental model. Two hundred fifty-six pauses were reviewed with a median of 10 pauses per scenario (interquartile range, 7–12). Median pause duration was 5 seconds (interquartile range, 2–9 s), with 91% chest compression fraction per scenario (interquartile range, 88–94%). Only one task occurred during most pauses (66%). The most common tasks were a change of chest compressors (25%), performing pulse check (24%), and performing rhythm check (15%). Forty-nine (19%) of the pauses lasted greater than 10 seconds and were associated with shock delivery (p < 0.001), performing rhythm check (p < 0.001), and performing pulse check (p < 0.001). When a shared mental model was rated high, pauses were significantly shorter (mean difference, 4.2 s; 95% CI, 1.6–6.8 s; p = 0.002). CONCLUSIONS:: Pauses in cardiopulmonary resuscitation occurred frequently during simulated pediatric cardiac arrest, with variable duration and underlying causes. A large percentage of pauses were greater than 10 seconds and occurred more frequently than the recommended 2-minute interval. Future efforts should focus on improving team coordination to minimize pause frequency and duration.

Original languageEnglish (US)
JournalPediatric Critical Care Medicine
DOIs
StateAccepted/In press - Jun 8 2017

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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    Kessler, D. O., Peterson, D. T., Bragg, A., Lin, Y., Zhong, J., Duff, J., Adler, M., Brown, L., Bhanji, F., Davidson, J., Grant, D., Cheng, A., & for the International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE) CPR Investigators (Accepted/In press). Causes for Pauses During Simulated Pediatric Cardiac Arrest. Pediatric Critical Care Medicine. https://doi.org/10.1097/PCC.0000000000001218