Abstract P171: Analysis of Corrected Absolute and Relative Chest Compression Depth during Real In-hospital Pediatric CPR Using Novel Forensic Engineering Reconstruction Techniques
Introduction: AHA recommends an absolute Chest Compression (CC) depth of 38–51mm for adults and a relative 1/3 to ½ Anterior-Posterior chest Depth (APD) in children <8 years old. We evaluated these compression parameters during real in-hospital CPR using an FDA approved CC sensor and novel forensic engineering reconstruction. We hypothesized that depth of CC during in-hospital pediatric CPR in children >8 years would be within the pediatric guideline target of 1/3 to ½ AP chest depth.
Methods: With IRB approval, CC depth and force were recorded with CC sensor during real CPR for consecutive children >8 years in cardiac arrest. At the end of each resuscitation, patient APD was measured. Forensic engineering reconstruction was conducted using the same bed, a weighted manikin torso and reconstructed backboard/mattress/patient configuration. CC depth was adjusted for mattress compression and incomplete release. Absolute CC depth and relative CC depth in %APD were assessed. Standard descriptive summaries (mean±SD) of compression depth were calculated and compared with AHA 2005 pediatric CPR guidelines for the first consecutive recorded CCs of each event, to a maximum of 500 CC/event. Descriptive statistics, inferential statistics by one-sample t-test were used, as appropriate.
Results: 8181 CCs from 18 CPR events (16 patients, age 15±4yrs) were recorded, reconstructed and analyzed. Mean CC force was 32.0±7.8 kg. Mean APD was 185±36 mm. Mean corrected absolute CC depth was 40±11 mm and mean relative %APD was 22.7±7.2%, significantly lower than 33% (p<0.0001). The 10th and 90th percentiles of relative CC depth were 13.8% and 31.0%APD, respectively. For all CCs: 34% (2759/8181) were 10–20%APD, 58% (4758/8181) CCs were >20–33%APD, and only 6% (529/8181) CCs were >33–50%APD.
Conclusions: Depth of CC delivered to in-hospital pediatric cardiac arrest victims >8 years was less than 1/3 relative AP chest depth for 94% of compressions. Forensic engineering techniques can be used to evaluate the quality of CPR and assess implementation of CPR recommendations created by consensus opinion. Supported by Laerdal Center of Excellence and Endowed Chair Grants