Quantitative Analysis of CPR Quality During In-Hospital Resuscitation of Older Children and Adolescents

Sutton, Robert M.; Niles, Dana; Nysæther, Jon; Abella, Benjamin S.; Arbogast, Kristy B.; Nishisaki, Akira; Maltese, Matthew R.; Donoghue, Aaron; Bishnoi, Ram J.; Helfaer, Mark A.; Myklebust, Helge; Nadkarni, Vinay

doi:10.1542/peds.2008-1930

Cited by 156 publications

(97 citation statements)

References 27 publications

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“…In human studies of CPR in out-of-hospital 81 and in-hospital settings, 78 -80 incomplete chest wall recoil was common, particularly when rescuers were fatigued. 78,81 Incomplete recoil during BLS CPR is associated with higher intrathoracic pressures and significantly decreased hemodynamics, including decreased coronary perfusion, cardiac index, myocardial blood flow, and cerebral perfusion. 76,82 Importantly, the incidence of incomplete chest wall recoil can be reduced during CPR by using electronic recording devices that provide real-time feedback.…”

Section: Technique: Chest Compressions (Box 4)mentioning

confidence: 99%

Part 5: Adult Basic Life Support

Berg¹,

Robin²,

Abella³

et al. 2010

Circulation

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702

495

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Basic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental aspects of BLS include immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system, early cardiopulmonary resuscitation (CPR), and rapid defibrillation with an automated external defibrillator (AED). Initial recognition and response to heart attack and stroke are also considered part of BLS. This section presents the 2010 adult BLS guidelines for lay rescuers and healthcare providers. Key changes and continued points of emphasis from the 2005 BLS Guidelines include the following:• Immediate recognition of SCA based on assessing unresponsiveness and absence of normal breathing (ie, the victim is not breathing or only gasping) Despite important advances in prevention, SCA continues to be a leading cause of death in many parts of the world. 1 SCA has many etiologies (ie, cardiac or noncardiac causes), circumstances (eg, witnessed or unwitnessed), and settings (eg, out-of-hospital or in-hospital). This heterogeneity suggests that a single approach to resuscitation is not practical, but a core set of actions provides a universal strategy for achieving successful resuscitation. These actions are termed the links in the "Chain of Survival." For adults they include When these links are implemented in an effective way, survival rates can approach 50% following witnessed out-ofhospital ventricular fibrillation (VF) arrest. 2 Unfortunately survival rates in many out-of-hospital and in-hospital settings fall far short of this figure. For example, survival rates following cardiac arrest due to VF vary from approximately 5% to 50% in both out-of-hospital and in-hospital settings. 3,4 This variation in outcome underscores the opportunity for improvement in many settings.Recognition of cardiac arrest is not always straightforward, especially for laypersons. Any confusion on the part of a rescuer can result in a delay or failure to activate the emergency response system or to start CPR. Precious time is lost if bystanders are too confused to act. Therefore, these adult BLS Guidelines focus on recognition of cardiac arrest with an appropriate set of rescuer actions. Once the lay bystander recognizes that the victim is unresponsive, that bystander must immediately activate (or send someone to activate) the emergency response system. Once the healthcare provider recognizes that the victim is unresponsive with no breathing or no normal breathing (ie, only gasping) the healthcare provider will activate the emergency response system. After activation, rescuers should immediately begin CPR.Early CPR can improve the likelihood of survival, and yet CPR is often not provided until the arrival of professional emergency responders. 5 Chest compressions are an especially critical component of CPR because perfusion during CPR

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Section: Technique: Chest Compressions (Box 4)mentioning

confidence: 99%

Part 5: Adult Basic Life Support

Berg¹,

Robin²,

Abella³

et al. 2010

Circulation

Self Cite

702

495

View full text Add to dashboard Cite

show abstract

“…One LOE 4 out-of-hospital case series 83 documented a 46% incidence of incomplete chest recoil by professional rescuers using the CPR technique recommended in 2000, and 2 in-hospital pediatric case series demonstrated a 23% incidence of incomplete recoil that was more common just after switching providers of chest compressions (LOE 4 84,85 ). Another LOE 4 study 86 electronically recorded chest recoil during in-hospital pediatric cardiac arrests and found that leaning on the chest occurred in half of all chest compressions.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 5: Adult Basic Life Support

Sayre¹,

Koster²,

Botha³

et al. 2010

Circulation

152

136

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“…31 Longer duration of CPR has also been associated with shallower chest compressions and excessive residual leaning force, which contribute to worse perfusion of heart and brain. 32 Nevertheless, prolonged duration of CPR was able to bridge many patients from pulselessness to return of spontaneous circulation and survival to discharge with a favorable neurological outcome. Although these data indicate that prolongation of CPR leads to worse outcomes, they also indicate that some children have a favorable neurological outcome even after prolonged CPR.…”

Section: Discussionmentioning

confidence: 99%

Duration of Cardiopulmonary Resuscitation and Illness Category Impact Survival and Neurologic Outcomes for In-hospital Pediatric Cardiac Arrests

et al. 2013

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Background-Pediatric cardiopulmonary resuscitation (CPR) for >20 minutes has been considered futile after pediatric inhospital cardiac arrests. This concept has recently been questioned, although the effect of CPR duration on outcomes has not recently been described. Our objective was to determine the relationship between CPR duration and outcomes after pediatric in-hospital cardiac arrests. Methods and Results-We examined the effect of CPR duration for pediatric in-hospital cardiac arrests from the Get WithThe Guidelines--Resuscitation prospective, multicenter registry of in-hospital cardiac arrests. We included 3419 children from 328 US and Canadian Get With The Guidelines-Resuscitation sites with an in-hospital cardiac arrest between January 2000 and December 2009. Patients were stratified into 5 patient illness categories: surgical cardiac, medical cardiac, general medical, general surgical, and trauma. Survival to discharge was 27.9%, but only 19.0% of all cardiac arrest patients had favorable neurological outcomes. Between 1 and 15 minutes of CPR, survival decreased linearly by 2.1% per minute, and rates of favorable neurological outcome decreased by 1.2% per minute. Adjusted probability of survival was 41% for CPR duration of 1 to 15 minutes and 12% for >35 minutes. Among survivors, favorable neurological outcome occurred in 70% undergoing <15 minutes of CPR and 60% undergoing CPR >35 minutes. Compared with general medical patients, surgical cardiac patients had the highest adjusted odds ratios for survival and favorable neurological outcomes, 2.5 (95% confidence interval, 1.8-3.4) and 2.7 (95% confidence interval, 2.0-3.9), respectively. Conclusions-CPR duration was independently associated with survival to hospital discharge and neurological outcome.Among survivors, neurological outcome was favorable for the majority of patients. Performing CPR for >20 minutes is not futile in some patient illness categories.

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Quantitative Analysis of CPR Quality During In-Hospital Resuscitation of Older Children and Adolescents

Cited by 156 publications

References 27 publications

Part 5: Adult Basic Life Support

Part 5: Adult Basic Life Support

Part 5: Adult Basic Life Support

Duration of Cardiopulmonary Resuscitation and Illness Category Impact Survival and Neurologic Outcomes for In-hospital Pediatric Cardiac Arrests

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