Abstract 14610: Determination of Pediatric CPR Compression Rate During In-Hospital Resuscitation From Continuous Patient-Monitoring ECG Waveforms
Introduction: AHA pediatric/neonatal cardiopulmonary arrest (CPA) resuscitation guidelines for chest compression (CC) rate and depth have not been optimized to the same extent as adults. Due to a lower prevalence, data is more difficult to obtain. However, numerous CPA events occur in pediatric hospitals and are captured by the patient monitoring system. In this observational study, we examine if CC rate (CCR) can be visually determined from routinely monitored ECG waveforms by examination of the CC-induced “artifact”.
Methods: Digital data from 75 pediatric/neonatal CPA patients in the cardiovascular, pediatric, and neonatal ICUs at two tertiary care pediatric hospitals were examined (Sep/2013-Jan/2016). Routinely monitored waveforms from the Philips patient-monitoring system were retrospectively reviewed. CPA events were identified based on ECG rhythm, ETCO2 reduction, or loss of arterial waveform. CC onset was determined by the sudden appearance of cyclical waveform artifact. CCR was measured with electronic calipers spanning a 6-10 second window at 30 and 90 seconds post-onset and was extrapolated to CC-per-minute (cpm). The methodology was repeated for up to three subsequent CC periods following pauses.
Results: ECG-extracted CCR was determined with a high degree of certainty in all but a few waveform regions where CC artifact could not be positively distinguished from the underlying rhythm (e.g., Torsades). PEA and bradycardia were the most frequent cause of CPA. Distinguishing CC from VT was challenging but possible. Mean CCR was 123 cpm, (n=310) with range from 56-251 cpm and SD ±28.1. Of note, 51% of the measured rates were above the AHA 2013 interim and 2015 guideline upper limit of 120 cpm; 15% were below 100 cpm.
Discussion and Conclusion: CC rates tended to be high, and were not strongly inversely correlated with age, as might be expected (r2 = 0.03). Large studies validating the current CPR guidelines for the pediatric/neonatal population are still needed. Although both CCR and depth would ideally be measured, we have shown that CCR can be determined from routinely monitored in-hospital continuous ECG waveforms and used for guideline refinement and compliance studies. Future work will focus on developing algorithms for automated CCR extraction.
Author Disclosures: E.D. Helfenbein: Employment; Significant; Philips Healthcare full-time employee. Ownership Interest; Modest; Philips stockholder. A. Rogers: None. A. Carroll: None. L.J. Knight: None. F. Su: None. C.J. Newth: None. S. Babaeizadeh: Employment; Significant; Philips Healthcare full-time employee.
- © 2016 by American Heart Association, Inc.