Videography in Pediatric Emergency Research

CPR, Verbal Prompts, and Hand Placement in VIPER

Videography in Pediatric Emergency Research

CPR, Verbal Prompts, and Hand Placement in VIPER

Abstract

The VIPER project is a collaborative, multi-institutional effort to assess pediatric resuscitation in the ED using videography tools which can be reviewed for provider performance in emergency settings. In short, VIPER looks to measure and describe tracheal intubation (TI) and cardiopulmonary resuscitation (CPR) events for frequency and timing in pediatric populations.

Publication
In Resuscitation Science Symposium 2018, ReSS.
Date

Introduction

My contributions to the Videography in Pediatric Emergency Research (VIPER) were displayed during three poster presentations delivered at the Resuscitation Science Symposium (ReSS) in Chicago, IL, on November 10th – 11th. The VIPER project is a collaborative, multi-institutional effort to assess pediatric resuscitation in the ED using videography tools which can be reviewed for provider performance in emergency settings. In short, VIPER looks to measure and describe tracheal intubation (TI) and cardiopulmonary resuscitation (CPR) events for frequency and timing in pediatric populations.

ReSS is an incredible conference hosted by the American Heart Association (AHA) where leading institutions, physicians, scientists, and companies from all over the world present and discuss research findings for the advancement of both pediatric and adult resuscitation efforts. It’s an extremely humbling experience, supported by real-life survivor stories and cutting-edge scientific discoveries. While there are many talks and lectures delivered on varying subject matter, the poster presentations are an ongoing component of the conference where interested folks can meet collaborators first hand and learn about research. The following three posters were delivered for the VIPER collaborative for which I lend analytical support of provider-side CPR delivery and performance.

CPR in the Pediatric ED: Initial Findings from the VIPER Collaborative

CPR VIPER Poster

One of the VIPER collaborative’s goals is to identify and target poor quality CPR. While the rates of survival of cardiac arrest can be low (in both adult and pediatric populations), CPR remains one of, if not the leading, means of resuscitation for victims of arrest. According to the AHA, CPR can “double or triple a person’s chances of survival.” Using novel videography technology in the ED environment coupled with defibrillator data outputs allows for assessment of CPR delivery and quality.

VIPER CPR ReSS

Tying together observed provider delivery with CPR data over time, it is possible to assess individual provider performance for compliance with CPR metric target guidelines and minimization of CPR pauses in delivery. I encourage you to observe the results, where average compression depth (inches) and rate (compressions per minute) per provider were shown to rarely meet “high-quality” CPR recommendations. The green bands in the data indicate target guidelines, with individual data points representing the average CPR “event” under analysis. Populations were split up among infant and pediatric age groups.

The Effects of Hand Placement on Chest Compression Quality in Infants and Young Children: Initial Findings from the VIPER Collaborative

Hand Placement VIPER Poster

Building off of the above findings, this poster looked into proper hand placement and its effects in infant and toddler pediatric populations. Using similar, but different data sets, CPR segments were assessed for compliance with depth and rate target guidelines but also with hand placement recording. Using the videography system, two-thumb encircling (2T) compressions (deemed to be more effective for infants) were assessed along with two-finger (2F), one-handed (1H), and two-handed (2H) techniques. 1H and 2H techniques were not assessed for infant cases.

VIPER Hand Placement ReSS

Findings showed, as with the above poster, that very rarely did CPR meet high-quality AHA guidelines, but did confirm that 2T technique was the most preferred for achieving adequate compression rates in infants.

Verbal Prompts during Pediatric CPR in ED: A report from the VIPER Collaborative

Verbal Prompts VIPER Poster

My final contribution to the VIPER posters presented at ReSS involved analysis of verbal prompts delivered during CPR in infant and pediatric populations <8 years of age. Using the depth and rate compression data taken from the defibrillator recordings, compliance metrics were similarly assessed with AHA target guidelines. Verbal prompts were assessed by the origin of the provider who delivered them (i.e. Resuscitation Leader, CPR Coach, etc.) and whether they were delivered appropriately to the correct depths and rates.

VIPER Verbal Prompts ReSS

Results indicated that there was a low frequency of verbal prompts delivered during pediatric CPR, and comparison between age groups was insignificant. Fortunately there is much to be studied for future directions, where the VIPER collaborative will look to assess CPR provider response to verbal prompts and comparison between verbal prompt and defibrillator audio-feedback.

Conclusions

To wrap things up, the VIPER collaborative is an extremely novel, effective, and robust undertaking for emergency pediatric resuscitation science. It’s been an honor to contribute to the great work done here and I can’t emphasize enough how much of this is due to the amazing efforts of every author listed. I’m very excited to see the future avenues for research it offers and am confident in future findings that it will produce.