Is CPR Quality Worse on Nights and Weekends in the Cardiac ICU?

Is CPR Quality Worse on Nights and Weekends in the Cardiac ICU?

Abstract

Among children with in-hospital cardiac arrest (IHCA), survival to discharge is lower at night compared to daytime. We sought to describe the association of time of day and day of week with CPR quality in children with congenital heart disease (CHD) reported to the pediRES-Q multicenter collaborative database.

Publication
In The Pediatric Cardiac Intensive Care Society, PCICS.
Date

Introduction

The Pediatric Cardiac Intensive Care Society (PCICS) is an international organization dedicated to improving clinical care for critically ill pediatric patients with congenital and acquired heart disease. A yearly conference is held in various parts of the world where researchers present findings and discuss organizational efforts to contribute to this cause. The 14th annual meeting was held in Miami, Florida, from December 13th to the 16th where a poster from the pediRES-Q collaborative was presented on the topic “Is CPR Quality Worse on Nights and Weekends in the Cardiac ICU?” The presentation was delivered by Priscilla Yu, M.D., of University of Texas Southwest Medical Center.

Background

The purpose of this research was to investigate why pediatric in-hospital cardiac arrests have lower survival to hospital discharge rates at night and on weekends versus during the daytime and on weekdays. The team hypothesized that provider-side quality of cardiopulmonary resuscitation (CPR) metrics could be linked to this discrepancy. In the current landscape, CPR metrics are largely defined by chest compression depth, rate, and chest compression fraction (CCF), the latter of which is calculated as the percent of time spent in compressions during an arrest event or segment.

Hypothesis

We hypothesize that CPR quality metrics of chest compression (CC) rate, depth, fraction (CCF), and compliance with 2015 American Heart Association (AHA) guidelines will be worse during nights vs. days, and weekends

CPR

Methods

For each of these metrics there are quality target guidelines providers strive for given by the American Heart Association (AHA) in 2015:

  • Chest compression depth should be between:
    • 3.6 – 4.4cm in <1-year olds
    • 4.5 – 5.5cm in 1 - <8-year olds
    • 4.5 - <6.6cm in 8 - <18-year olds
  • Chest compression rate should be between 100 and 120 compressions per minute (cpm)
  • CCF should be above 80%

These metrics were used for determination of successful versus unsuccessful delivery of chest compressions. In addition, CPR event analysis was restricted to cardiac arrest patients where:

  • The arrest was considered an “index on hospital cardiac arrest,” meaning that there was no prior arrest to this event’s hospital admission
  • Subjects were <18 years old with congenital heart disease
  • Subjects were reported in the pediRES-Q database with quality CPR reporting from the Zoll R-Series defibrillator

From these criteria, 69 events were analyzed from 10 different institutions.

PCICS Poster 2018 PDF Version

Conclusions

At the time of this analysis there was no statistically significant difference between return of spontaneous circulation (ROSC) and survival to hospital discharge from the selected population. Additionally, there was no statically significant difference between patients who experienced in-hospital cardiac arrest during the day versus at night or during the weekdays versus on the weekends

Thoughts and Future Directions

Although the study was hampered by some limitations, it shows evidence that there needs to be further investigation into the relevance of night/day and weekday/weekend impact on CPR quality and its association with outcomes in pediatric patients undergoing cardiac arrest. The pediRES-Q collaborative will be continuing to research this area and looking forward to presenting future results on the subject!