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Variability in the time to initiation of CPR in continuously monitored pediatric ICUs

M Olson1, E Helfenbein2, L Su1

  • 1Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.

Resuscitation
|April 2, 2018
PubMed

Insights

Nearly half of pediatric ICU patients experienced delays in cardiopulmonary resuscitation (CPR) initiation after cardiac arrest (CPA), missing American Heart Association guidelines. Further study of CPA recognition is needed to improve timeliness.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiovascular Research
  • Health Systems Science

Background:

  • Delays in cardiopulmonary resuscitation (CPR) initiation following pediatric cardiac arrest (CPA) can negatively impact patient outcomes.
  • Understanding factors influencing the time from CPA to CPR is crucial for improving pediatric intensive care unit (ICU) care.

Purpose of the Study:

  • To investigate patient characteristics and unit ergonomics influencing the time to CPR initiation in pediatric ICU patients.
  • To identify potential areas for improving the recognition and response to CPA in critically ill children.

Main Methods:

  • A single-center study analyzed continuous monitoring data (ECG, plethysmography, blood pressure, EtCO2) in children (0-21 years) experiencing CPA requiring >1 minute of chest compressions.
  • CPR initiation was identified by ECG artifact. Patient factors (CPA cause, High-Risk Checklist identification, monitoring) and unit factors (ICU type, time of day, shift change) were examined.

Main Results:

  • The median time from CPA to CPR initiation was 50.5 seconds (IQR 26.5-127.5) in 36 events.
  • Forty-seven percent of patients experienced a delay of >1 minute from CPA to CPR initiation.
  • No significant differences in delay were observed based on CPA cause, ICU type, time of day, or nursing shift change.

Conclusions:

  • A significant proportion of pediatric ICU patients experiencing CPA do not receive CPR within recommended timeframes.
  • Continuous monitoring data offers an opportunity to better understand CPA recognition and factors contributing to delayed CPR.
  • Improving the recognition phase of CPA is essential for enhancing adherence to early CPR guidelines in pediatric ICUs.
Abstract

Keywords:
CPRCardiopulmonary arrestContinuous monitoringResuscitation

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