Pediatric In-Hospital CPR Quality at Night and on Weekends

Pediatric In-Hospital CPR Quality at Night and on Weekends

Abstract

Survival after in-hospital cardiac arrest (IHCA) has been reported to be worse for arrests at night or during weekends.This study aimed to determine whether measured cardiopulmonary resuscitation (CPR) quality metrics might explain this difference in outcomes.

Publication
In Resuscitation.
Date

A Quick Word

Thanks to the hard work of all of the authors and contributors on this publication, I am thrilled to be a co-author on my first manuscript publication in Resuscitation since joining pediRES-Q. Although similar to one of our other poster publications on this site, the focus of this manuscript was not limited to solely CICU patients and those with congenital heart disease.

Overview and Details

All data came from the pediRES-Q REDCap database and assessed approximately four years’ worth of cardiac arrest events from 2015 to 2019. Exclusion criteria comprised of:

  • Out-of-Hospital cardiac arrests
  • Patients on extracorporeal membrane oxygenation (ECMO) at time of arrest
  • Apical/apex defibrillator pad placement (resulting in unreliable depth of compression readings)
  • Depth of compression recordings of <1.5 cm due to granularity in readings and inability to differentiate compressions versus artifact

The purpose behind this manuscript was to describe and evaluate an otherwise unknown area of resuscitation performance. It is presumed that nights and weekends have a multifactorial impact on CPR quality but it is unknown to what extent. In total, 239 arrest events were evaluated containing 5 or more 60-second epochs for a total of 6915 epochs originating from 18 different hospitals. Definitions of quality or compliant CPR were based on the American Heart Association (AHA) 2015 guidelines.

In contrast to beliefs about this impact, there was no statistically significant different in any of the CPR quality metrics (depth, rate, chest compression fraction (CCF)) or rate of return of spontaneous circulation (ROSC) between times of day or days of the week. However, it was found that higher survival to hospital discharge rates occurred, separate from CPR quality, in arrests occurring days and weekdays.

Parting Thoughts

One of the greatest parts of working with pediRES-Q and in the field of resuscitation is seeing how quickly the landscape is evolving and how much more work there is to do. As said in the manuscript, the details affecting CPR quality are multifactorial, widespread, and systematic. It is extraordinarily difficult to characterize and predict outcomes, especially in the pediatric population. As our data and research continue to grow, I’m confident in our ability to reach further, pose deeper questions, and obtain increasingly richer results. One such untapped area (that we are gearing up for) is association of hemodynamic and patient physiologic readouts with CPR quality. I expect in the upcoming year or two that this will be a main component of the research that comes out of our collaborative.

spyglass