Integrated CPR coach and compressor training improves CPR quality in a pediatric emergency department

Care teams frequently struggle to meet CPR quality metrics during pediatric cardiac arrest. In a pediatric emergency department (PED), we aimed to increase our chest compression compliance with American Heart Association's (AHA) recommendations for depth (baseline 14%) and rate (baseline 69%) to >80% and to maintain chest compression fraction (CCF) at 89%.

We completed a quality improvement study, leveraging an existing CPR quality assurance program. Our primary intervention was designing a simulation-based CPR coach curriculum for existing coaches supplemented with compressor training and metronome guided feedback. We collected data from video review and an accelerometer equipped defibrillator. Run charts at the patient level assessed chest compression compliance for depth, rate, and CCF. Statistical control charts evaluated mean depth and mean rate compliance.

Between October 2022 and December 2025, 140 total patients presented in cardiac arrest. One hundred and six patients, consisting of 54 infants, 24 children, and 28 adolescents, were included. Median percent depth compliance for all ages increased from 14% to 61%. For infants, mean depth increased from 3.1 cm to 4.4 cm. Mean depth did not increase for children and adolescents, though special cause variation was observed in children. Median percent rate compliance increased from 69% to 80%. Consecutive encounters meeting AHA mean rate target increased. CCF remained at 89%.

In a PED, a multimodal intervention incorporating CPR coach training, compressor training, and metronome guided feedback improved chest compression depth and rate compliance while maintaining CCF. Improvement was enhanced by an existing quality assurance program and required supplementary education and resources.