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Pediatric in-hospital CPR quality at night and on weekends

Ivie Esangbedo1, Priscilla Yu1, Tia Raymond2

  • 1UT Southwestern Medical Center, Dept of Pediatrics, Division of Critical Care Medicine, Dallas, Texas, United States.

Resuscitation
|November 18, 2019
PubMed

Insights

Survival rates for pediatric in-hospital cardiac arrest (IHCA) are lower during nights and weekends. This difference is not explained by cardiopulmonary resuscitation (CPR) quality metrics.

Area of Science:

  • Pediatric Emergency Medicine
  • Resuscitation Science
  • Clinical Outcomes Research

Background:

  • In-hospital cardiac arrest (IHCA) survival rates have historically shown disparities based on the timing of the event, with lower survival reported for nighttime and weekend arrests.
  • The underlying reasons for these observed outcome differences remain incompletely understood, prompting investigation into potential contributing factors such as resuscitation quality.

Purpose of the Study:

  • To investigate whether variations in cardiopulmonary resuscitation (CPR) quality metrics explain the observed differences in survival rates for pediatric IHCA occurring during different times of day or days of the week.
  • To analyze the relationship between CPR quality (chest compression rate, depth, and fraction) and survival outcomes in pediatric IHCA.

Main Methods:

  • Utilized data from the Pediatric Resuscitation Quality (pediRES-Q) collaborative, including patients under 18 years old.
  • Measured CPR quality metrics (chest compression rate, depth, fraction) using monitor-defibrillator pads for 6915 sixty-second epochs from 239 pediatric patients.
  • Compared CPR quality metrics, rate of return of circulation, and survival to hospital discharge between day vs. night and weekday vs. weekend IHCA events.

Main Results:

  • No significant differences were found in CPR quality metrics (chest compression rate, depth, fraction) between day and night, or between weekdays and weekends.
  • The rate of return of circulation did not differ significantly based on the time of day or day of the week.
  • Survival to hospital discharge was significantly higher for IHCA events occurring during the day (39.1%) compared to nighttime (22.4%), and on weekdays (39.9%) compared to weekends (19.1%).

Conclusions:

  • For pediatric IHCA, measured CPR quality metrics and the rate of return of circulation do not explain the disparities in survival based on time of day or day of week.
  • Higher survival rates observed during daytime and weekday IHCA events are not attributable to differences in CPR quality, suggesting other factors may be involved.
Abstract

Keywords:
CPRCardiac arrestCardiopulmonary resuscitationChest compressionsPediatricQualityReturn of spontaneous circulation

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