Quality of chest compressions in pediatrics misses the mark

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Advanced training of pediatric providers does not ensure adequate delivery of chest compressions, according to a study in the June issue of Resuscitation.

Justin T. Hamrick, MD, a fellow at the University of California San Diego, and colleagues noted that recent adult reports have demonstrated sub-optimal performance of basic skills in cardiopulmonary resuscitation (CPR) advanced training scenarios and real life arrest situations, but such information is lacking for the pediatric population.

Researchers designed a prospective observational study of pediatric providers performing external closed-chest compressions on a child mannequin that is designed to assess adequacy based on depth and rate of chest compressions.

The study was conducted from 2008 to 2009, in which 42 subjects were screened and enrolled for participation. Each subject underwent a basic life support scenario that included two minutes of uninterrupted external closed-chest compressions that were assessed for adequacy based on depth and rate.

For the 42 subjects, the researchers had a  total of 168 30-second time segments for analysis. Chest compressions were performed at a median rate of 110 (interquartile range of 75-145) compressions per minute.

Hamrick and colleagues found no significant decay in rate of chest compressions over the two-minute evaluation. However, chest compression depth was adequate in only 9.4 percent of total delivered chest compressions.

They found no statistical significance related to training and delivery of effective chest compressions.

The investigators concluded that rate standards and adequate depth of chest compressions are infrequently achieved and both may need more emphasis in CPR training and attention during resuscitations.