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Poor Concordance of One-Third Anterior-Posterior Chest Diameter Measurements With Absolute Age-Specific Chest
Gene Y Ong1,2, Zhao Jin Chen3,4, Dana E Niles5
1KK Women's and Children's Hospital Singapore.
Insights
Current guidelines for pediatric cardiac arrest suggest chest compressions one-third of anterior-posterior diameter (APD), but this study found poor concordance with target depths, especially in infants. Further research is needed to optimize compression depth for better outcomes.
Area of Science:
- Pediatric Resuscitation
- Cardiology
- Emergency Medicine
Background:
- Pediatric cardiac arrest guidelines recommend chest compressions of one-third anterior-posterior diameter (APD).
- This is presumed to meet absolute depth targets: 4 cm for infants and 5 cm for children.
- No clinical studies have validated this presumption in pediatric cardiac arrest.
Purpose of the Study:
- To assess the agreement between measured one-third APD and absolute age-specific chest compression depth targets in pediatric cardiac arrest patients.
- To identify discrepancies in chest compression depth during resuscitation efforts.
Main Methods:
- Retrospective observational study using data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q).
- Included in-hospital cardiac arrest patients aged ≤12 years with recorded APD measurements (October 2015 - March 2022).
- Analyzed 182 patients: 118 infants and 64 children.
Main Results:
- Infants' mean one-third APD was 3.2 cm, significantly less than the 4 cm target (P<0.001); only 17% met the target range.
- Children's mean one-third APD was 4.3 cm.
- 39% of children met the 5 cm target range; most children had shallower compressions than the target (P<0.05), except older and overweight children.
Conclusions:
- There is poor concordance between the recommended one-third APD and target chest compression depths in pediatric cardiac arrest, particularly for infants.
- Current guidelines may not ensure adequate compression depth.
- Further studies are required to validate pediatric chest compression depth targets and improve resuscitation outcomes.
Abstract:
Background Current pediatric cardiac arrest guidelines recommend depressing the chest by one-third anterior-posterior diameter (APD), which is presumed to equate to absolute age-specific chest compression depth targets (4 cm for infants and 5 cm for children). However, no clinical studies during pediatric cardiac arrest have validated this presumption. We aimed to study the concordance of measured one-third APD with absolute age-specific chest compression depth targets in a cohort of pediatric patients with cardiac arrest. Methods and Results This was a retrospective observational study from a multicenter, pediatric resuscitation quality collaborative (pediRES-Q [Pediatric Resuscitation Quality Collaborative]) from October 2015 to March 2022. In-hospital patients with cardiac arrest ≤12 years old with APD measurements recorded were included for analysis. One hundred eighty-two patients (118 infants >28 days old to <1 year old, and 64 children 1 to 12 years old) were analyzed. The mean one-third APD of infants was 3.2 cm (SD, 0.7 cm), which was significantly smaller than the 4 cm target depth (P<0.001). Seventeen percent of the infants had one-third APD measurements within the 4 cm ±10% target range. For children, the mean one-third APD was 4.3 cm (SD, 1.1 cm). Thirty-nine percent of children had one-third APD within the 5 cm ±10% range. Except for children 8 to 12 years old and overweight children, the measured mean one-third APD of the majority of the children was significantly smaller than the 5 cm depth target (P<0.05). Conclusions There was poor concordance between measured one-third APD and absolute age-specific chest compression depth targets, particularly for infants. Further study is needed to validate current pediatric chest compression depth targets and evaluate the optimal chest compression depth to improve cardiac arrest outcomes. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02708134.
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