Abstract Body: Introduction: Despite advances in resuscitation science and training, the quality of CPR performed during pediatric IHCA remains suboptimal in many cases. CPR coaches provide real-time guidance on CPR performance metrics to improve chest compression depth, rate, and fraction using a defibrillator with audiovisual feedback. While studies in simulation show improved guideline adherence with CPR coaches, there remains a gap in clinical data for IHCA.
Hypothesis: CPR coaches using Zoll feedback defibrillators improve adherence to CPR quality metrics in IHCA patients in the PICU.
Methods: This was a retrospective single center study at Cincinnati Children’s Hospital Medical Center of chest compression quality before and after CPR coach implementation for PICU patients with IHCA from August 2017 to October 2022. Study population included all patients <18 years of age who had a cardiac arrest occurring entirely within the PICU. Measured CPR quality metrics included chest compression rate, depth, and fraction obtained using data collected from the Zoll defibrillator. Statistical analysis used Student’s t-test for continuous variables and chi-square or Fisher’s exact test for categorical variables. Compliance was defined as the average depth, rate, and fraction over the entire event meeting guideline recommendations.
Results: During the study period, there were 93 IHCA patients, 12 patients were excluded due to incomplete data. Of the remaining 81 events, 29 were pre-CPR coach implementation and 52 patients were post-CPR coach.
Depth compliance improved from 14% pre-CPR coach to 56% post-CPR coach (p <0.001). Improvement in depth compliance was most noticeable for IHCA events >20 minutes, 0% pre-CPR coach to 62% post-CPR coach (p=0.006). Compression rate improved from 76% to 89% (p=0.206), and compression fraction improved from 72% to 81% (p=0.386). Return of spontaneous circulation increased from 38% to 69% with the implementation of CPR coaching (p=0.006).
Total CPR duration was similar between the pre (25 ± 28 minutes) and post-CPR coach groups (18 ± 18 minutes, p=0.218). The average age for the pre-CPR coach group was lower (4.2 ± 5 years) compared to the post-CPR coach (6.8 ± 6 years, p= 0.05). Immediate causes of CPR were similar between the two groups.
Conclusion: CPR coach presence was associated with improved adherence to CPR depth guidelines.