Related Experiment Video
Updated: Feb 27, 2026
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Improving quality in measuring time to initiation of CPR during in-hospital resuscitation
Ashley Siems1, Elyse Tomaino1, Anne Watson1
1Children's National Health System, 111 Michigan Avenue NW, Washington, DC, United States.
Insights
Delays in starting cardiopulmonary resuscitation (CPR) after cardiac arrest are often unrecognized. This study highlights discrepancies between actual patient deterioration time and recorded recognition time, emphasizing the need for improved resuscitation record-keeping.
Area of Science:
- Pediatric Intensive Care
- Cardiopulmonary Resuscitation
- Quality Improvement
Background:
- Timely initiation of cardiopulmonary resuscitation (CPR) is crucial for survival and end-organ function after cardiac failure.
- Current resuscitation quality metrics may not accurately reflect the time from patient deterioration to CPR initiation.
- In-hospital cardiac events require precise timing for effective quality assessment.
Purpose of the Study:
- To investigate the discrepancy between the actual time of patient deterioration and the recognized time of initiating chest compressions during in-hospital cardiac events.
- To develop a system for accurately identifying the onset of deterioration during cardiac emergencies.
- To evaluate the impact of delays in CPR on patient outcomes.
Main Methods:
- A retrospective review of prospectively collected resuscitation records and monitor data from pediatric intensive care units.
- Comparison of recorded times for chest compression initiation against actual event onset.
- Analysis of outcomes including return of spontaneous circulation, survival, and functional status changes.
Main Results:
- A significant difference was observed between the median time from event onset to chest compressions (47 seconds) and the reported recognition time (0 seconds).
- Discrepancies in timing were noted in 59 cardiac events across pediatric cardiac and general pediatric intensive care units.
- The quality standard of initiating CPR within one minute was met differently based on the review method (81% vs. 63%, p=0.04).
Conclusions:
- Resuscitation records often underestimate the delay between patient deterioration and the initiation of chest compressions.
- Current methods for recording resuscitation events require modification to capture the actual timing of patient decline.
- Accurate timing data is essential for improving quality metrics and patient outcomes in cardiac resuscitation.
Objective:
Time from the onset of "low or no flow" indicators of cardiac failure to initiation of cardiopulmonary resuscitation is an important quality metric thought to improve the likelihood of survival and preservation of end organ function. We hypothesized that delays in initiation of chest compressions were under recognized during in-hospital resuscitation and aimed to develop a system which identifies the actual time of deterioration during cardiac events.
Methods:
Retrospective review on prospectively identified resuscitation records and monitor data were compared. Return of spontaneous circulation, survival, and changes in functional status of patients pre- and post-events with chest compressions were collected as outcome measures.
Results:
Between October 2012 and April 2015, 59 events which met eligibility criteria occurred in either our pediatric cardiac or general pediatric intensive care units. The median time from event onset to initiation of chest compressions was 47s(s) (interquartile range (IQR) 28-80s) as assessed using monitor data, while the resuscitation record reported a median time of 0s (IQR 0-60s), reflecting the time from recognition to initiation of chest compressions. According to the resuscitation record, 81% vs. 63% of events achieved the quality standard of less than one minute depending on which review method was used (p=0.04).
Conclusions:
There is a significant difference between time of deterioration to initiation of chest compressions and the time of recognition to initiation of chest compressions. Resuscitation records should be modified to include more information about the actual timing of patient deterioration.
More Related Videos
Related Concept Videos
01:21Cardiopulmonary Resuscitation I: Adult
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:23Cardiopulmonary Resuscitation III: AED Use
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:19Special considerations while measuring oxygen saturation
Ensuring accuracy in vital sign recordings while prioritizing patient comfort and minimizing anxiety is...