Abstract 107: The Effects of Hand Placement on Chest Compression Quality in the Pediatric Emergency Department: Findings From the Videography in Pediatric Emergency Research Collaborative

Abstract

Introduction: Guidelines for infant cardiopulmonary resuscitation (CPR) recommend two finger (2F) technique for one-rescuer chest compressions (CCs) and a two-thumb encircling (2T) for two-rescuers CCs. Pediatric guidelines recommend either a one-handed (1H) or two-handed (2H) technique based on provider judgement. Previous small, single site studies suggest that 2T compressions are more effective for infant CPR than 2F and 1H. Hypothesis: To combine video review and monitor-defibrillator CC analysis to determine the effects of hand placement on CC quality in a pediatric emergency department (PED). Methods: Data was obtained from the Videography in Pediatric Emergency Resuscitation (VIPER) Collaborative, a prospective observational resuscitation database from 3 tertiary PEDs. Participating sites review resuscitations for quality, safety, and research purposes. Rate and depth for continuous CC segments delivered by a single compressor (epoch) were obtained from Zoll R-series monitor-defibrillator, epoch duration and hand position from video, and patient demographics from medical records. Epochs with analyzable video and CC data were eligible for inclusion. Quality of CC rate and depth were evaluated for adherence to 2015 AHA standards. Results: A total of 248 minutes of CCs for 19 patients [14 infants ≤1 year; 5 toddlers 2-4 years] were analyzed. Median CC rates were adherent to AHA standards for toddlers but not infants, where CCs were often too fast (Table 1). CC depth was inadequate in both infant and toddlers. The 2T technique in infants was significantly associated with adherence to AHA standards for rate ( X 2 =4.97; X 2 =3.64) (Table 1). Conclusions: Infant CC rate and depth and toddler CC depth were not adherent to AHA standards. Performing CCs on infants using the 2T technique was most likely to produce CCs at the recommended rate. Further understanding and implementation of techniques to assist with providing high-quality CCs in young patients is needed.