Comparison of relative and actual chest compression depths during cardiac arrest in children, adolescents, and young adults

Abstract

AimCardiopulmonary resuscitation (CPR) guidelines recommend specific chest compression (CC) target depths for children. We quantitatively describe relative anterior–posterior diameter (APD) depth, actual depth, and force of CCs during real CPR events in children. MethodsCC depth and force were recorded during real CPR events in children ≥8 years using FDA-approved CC sensor. Patient chest APD was measured at conclusion of each CPR event. CC data was stratified and analyzed according to age (pre-puberty, 8–14 years; post-puberty, 15+ years). Relative (% APD) and actual CC depth, corrected for mattress deflection, were assessed and compared with American Heart Association (AHA) 2005 and 2010 pediatric CPR guidelines. Results35 events in 32 subjects included 16,158 CCs for data analysis: 16 pre-puberty (CCs=7484, age 11.9±2 years, APD 164.6±25.1mm); 19 post-puberty (CCs=8674, age 18.0±2.7 years, APD 196.5±30.4mm). After correction for mattress deflection, 92% of CC delivered to pre-puberty were <1/3 relative APD and 60% of CC were <38mm actual depth. Mean actual CC depth (36.2±9.6mm vs. 36.8±9.9mm, p=0.64), mean relative APD (22.5%±7.0% vs. 19.5±6.7%, p=0.13), and mean CC force (30.7±7.6kg vs. 33.6±9.4kg, p=0.07) were not significantly less in pre-puberty vs. post-puberty. ConclusionsDuring in-hospital cardiac arrest of children ≥8 years, CCs delivered by resuscitation teams were frequently <1/3 relative APD and <38mm actual depth after mattress deflection correction, below pediatric and adult target guidelines. Mean CC actual depth and force were not significantly different in pre-puberty and post-puberty. Additional investigation to determine depth of CCs to optimize hemodynamics and outcomes is needed to inform future CPR guidelines.