William P Landis1, Ryan W Morgan2, Ron W Reeder3, Kathryn Graham2, Ashley Siems4, J Wesley Diddle4, Murray M Pollack4, Tensing Maa5, Richard P Fernandez5, Andrew R Yates5, Bradley Tilford6, Tageldin Ahmed6, Kathleen L Meert6, Carleen Schneiter7, Robert Bishop7, Peter M Mourani7, Maryam Y Naim2, Stuart Friess8, Candice Burns8, Arushi Manga8, Deborah Franzon9, Sarah Tabbutt9, Patrick S McQuillen9, Christopher M Horvat10, Matthew Bochkoris10, Joseph A Carcillo10, Leanna Huard11, Myke Federman11, Anil Sapru11, Shirley Viteri12, David A Hehir12, Daniel A Notterman13, Richard Holubkov3, J Michael Dean3, Vinay M Nadkarni2, Robert A Berg2, Heather A Wolfe2, Robert M Sutton2. 1. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: landiswp@email.chop.edu. 2. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States. 3. Department of Pediatrics, University of Utah, Salt Lake City, UT, United States. 4. Department of Pediatrics, Children's National Medical Center, Washington DC, United States. 5. Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States. 6. Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, United States. 7. Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, United States. 8. Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States. 9. Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States. 10. Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States. 11. Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, United States. 12. Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States. 13. Department of Molecular Biology, Princeton University, Princeton, NJ, United States.
Abstract
AIM: The mathematical method used to calculate chest compression (CC) rate during cardiopulmonary resuscitation varies in the literature and across device manufacturers. The objective of this study was to determine the variability in calculated CC rates by applying four published methods to the same dataset. METHODS: This study was a secondary investigation of the first 200 pediatric cardiac arrest events with invasive arterial line waveform data in the ICU-RESUScitation Project (NCT02837497). Instantaneous CC rates were calculated during periods of uninterrupted CCs. The defined minimum interruption length affects rate calculation (e.g., if an interruption is defined as a break in CCs ≥ 2 s, the lowest possible calculated rate is 30 CCs/min). Average rates were calculated by four methods: 1) rate with an interruption defined as ≥ 1 s; 2) interruption ≥ 2 s; 3) interruption ≥ 3 s; 4) method #3 excluding top and bottom quartiles of calculated rates. American Heart Association Guideline-compliant rate was defined as 100-120 CCs/min. A clinically important change was defined as ±5 CCs/min. The percentage of events and epochs (30 s periods) that changed Guideline-compliant status was calculated. RESULTS: Across calculation methods, mean CC rates (118.7-119.5/min) were similar. Comparing all methods, 14 events (7%) and 114 epochs (6%) changed Guideline-compliant status. CONCLUSION: Using four published methods for calculating CC rate, average rates were similar, but 7% of events changed Guideline-compliant status. These data suggest that a uniform calculation method (interruption ≥ 1 s) should be adopted to decrease variability in resuscitation science.
AIM: The mathematical method used to calculate chest compression (CC) rate during cardiopulmonary resuscitation varies in the literature and across device manufacturers. The objective of this study was to determine the variability in calculated CC rates by applying four published methods to the same dataset. METHODS: This study was a secondary investigation of the first 200 pediatric cardiac arrest events with invasive arterial line waveform data in the ICU-RESUScitation Project (NCT02837497). Instantaneous CC rates were calculated during periods of uninterrupted CCs. The defined minimum interruption length affects rate calculation (e.g., if an interruption is defined as a break in CCs ≥ 2 s, the lowest possible calculated rate is 30 CCs/min). Average rates were calculated by four methods: 1) rate with an interruption defined as ≥ 1 s; 2) interruption ≥ 2 s; 3) interruption ≥ 3 s; 4) method #3 excluding top and bottom quartiles of calculated rates. American Heart Association Guideline-compliant rate was defined as 100-120 CCs/min. A clinically important change was defined as ±5 CCs/min. The percentage of events and epochs (30 s periods) that changed Guideline-compliant status was calculated. RESULTS: Across calculation methods, mean CC rates (118.7-119.5/min) were similar. Comparing all methods, 14 events (7%) and 114 epochs (6%) changed Guideline-compliant status. CONCLUSION: Using four published methods for calculating CC rate, average rates were similar, but 7% of events changed Guideline-compliant status. These data suggest that a uniform calculation method (interruption ≥ 1 s) should be adopted to decrease variability in resuscitation science.
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