{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T10:36:10Z","timestamp":1788690970382,"version":"build-2803163510"},"reference-count":27,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,8,1]]},"abstract":"<jats:p>OBJECTIVE: Few data exist on pediatric cardiopulmonary resuscitation (CPR) quality. This study is the first to evaluate actual in-hospital pediatric CPR. We hypothesized that with bedside CPR training and corrective feedback, CPR quality can approach American Heart Association (AHA) targets.<\/jats:p>\n               <jats:p>PATIENTS AND METHODS: Using CPR recording\/feedback defibrillators, quality of CPR was assessed for patients \u22658 years of age who suffered a cardiac arrest in the PICU or emergency department (ED). Before and during the study, a bedside CPR training program was initiated.<\/jats:p>\n               <jats:p>RESULTS: Between October 2006 and February 2008, twenty events in 18 patients met inclusion criteria and resulted in 36749 evaluable chest compressions (CCs) during 392.3 minutes of arrest. CCs were shallow (&amp;lt;38 mm or &amp;lt;1.5 in) in 27.2% (9998 of 36749), with excessive residual leaning force (\u22652500 g) in 23.4% (8611 of 36749). Segmental analysis of the first 5 minutes of the events demonstrated that shallow CCs and excessive residual leaning force were less prevalent during the first 5 minutes. AHA targets were not achieved for CC rate in 62 (43.1%) of 144 segments, CC depth in 52 (36.1%) of 144 segments, and residual leaning force in 53 (36.8%) of 144 segments.<\/jats:p>\n               <jats:p>CONCLUSIONS: This prospective, observational study demonstrates feasibility of monitoring in-hospital pediatric CPR. Even with bedside CPR retraining and corrective audiovisual feedback, CPR quality frequently did not meet AHA targets. Importantly, no flow fraction target of 10% was achieved. Future studies should investigate novel educational methods and targeted feedback technologies.<\/jats:p>","DOI":"10.1542\/peds.2008-1930","type":"journal-article","created":{"date-parts":[[2009,7,7]],"date-time":"2009-07-07T00:13:01Z","timestamp":1246925581000},"page":"494-499","source":"Crossref","is-referenced-by-count":154,"title":["Quantitative Analysis of CPR Quality During In-Hospital Resuscitation of Older Children and Adolescents"],"prefix":"10.1542","volume":"124","author":[{"given":"Robert M.","family":"Sutton","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Niles","sequence":"additional","affiliation":[{"name":"Center for Simulation, Advanced Education, and Innovation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Nysaether","sequence":"additional","affiliation":[{"name":"Laerdal Medical, Stavanger, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin S.","family":"Abella","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristy B.","family":"Arbogast","sequence":"additional","affiliation":[{"name":"Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Nishisaki","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R.","family":"Maltese","sequence":"additional","affiliation":[{"name":"Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Donoghue","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram","family":"Bishnoi","sequence":"additional","affiliation":[{"name":"Center for Simulation, Advanced Education, and Innovation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Helfaer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helge","family":"Myklebust","sequence":"additional","affiliation":[{"name":"Laerdal Medical, Stavanger, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay","family":"Nadkarni","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2009,8,1]]},"reference":[{"key":"2021120905303897000_R1","unstructured":"ECC Committee, Subcommittees and Task Forces of the American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation.\u20082005;112(24 suppl):1\u2013203"},{"key":"2021120905303897000_R2","doi-asserted-by":"crossref","unstructured":"Abella BS, Sandbo N, Vassilatos P, et al. Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation.\u20082005;111(4):428\u2013434","DOI":"10.1161\/01.CIR.0000153811.84257.59"},{"key":"2021120905303897000_R3","doi-asserted-by":"crossref","unstructured":"Abella BS, Alvarado JP, Myklebust H, et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA.\u20082005;293(3):305\u2013310","DOI":"10.1001\/jama.293.3.305"},{"key":"2021120905303897000_R4","doi-asserted-by":"crossref","unstructured":"Wik L, Kramer-Johansen J, Myklebust H, et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA.\u20082005;293(3):299\u2013304","DOI":"10.1001\/jama.293.3.299"},{"key":"2021120905303897000_R5","doi-asserted-by":"crossref","unstructured":"Milander MM, Hiscok PS, Sanders AB, Kern KB, Berg RA, Ewy GA. Chest compression and ventilation rates during cardiopulmonary resuscitation: the effects of audible tone guidance. Acad Emerg Med.\u20081995;2(8):708\u2013713","DOI":"10.1111\/j.1553-2712.1995.tb03622.x"},{"key":"2021120905303897000_R6","doi-asserted-by":"crossref","unstructured":"Valenzuela TD, Kern KB, Clark LL, et al. Interruptions of chest compressions during emergency medical systems resuscitation. Circulation.\u20082005;112(9):1259\u20131265","DOI":"10.1161\/CIRCULATIONAHA.105.537282"},{"key":"2021120905303897000_R7","doi-asserted-by":"crossref","unstructured":"Aase SO, Myklebust H. Compression depth estimation for CPR quality assessment using DSP on accelerometer signals. IEEE Trans Biomed Eng.\u20082002;49(3):263\u2013268","DOI":"10.1109\/10.983461"},{"key":"2021120905303897000_R8","doi-asserted-by":"crossref","unstructured":"Losert H, Risdal M, Sterz F, et al. Thoracic-impedance changes measured via defibrillator pads can monitor signs of circulation. Resuscitation.\u20082007;73(2):221\u2013228","DOI":"10.1016\/j.resuscitation.2006.10.001"},{"key":"2021120905303897000_R9","doi-asserted-by":"crossref","unstructured":"Losert H, Risdal M, Sterz F, et al. Thoracic impedance changes measured via defibrillator pads can monitor ventilation in critically ill patients and during cardiopulmonary resuscitation. Crit Care Med.\u20082006;34(9):2399\u20132405","DOI":"10.1097\/01.CCM.0000235666.40378.60"},{"key":"2021120905303897000_R10","doi-asserted-by":"crossref","unstructured":"Handley AJ, Handley SA. Improving CPR performance using an audible feedback system suitable for incorporation into an automated external defibrillator. Resuscitation.\u20082003;57(1):57\u201362","DOI":"10.1016\/S0300-9572(02)00400-8"},{"key":"2021120905303897000_R11","doi-asserted-by":"crossref","unstructured":"Abella BS, Edelson DP, Kim S, et al. CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system. Resuscitation.\u20082007;73(1):54\u201361","DOI":"10.1016\/j.resuscitation.2006.10.027"},{"key":"2021120905303897000_R12","doi-asserted-by":"crossref","unstructured":"Kramer-Johansen J, Myklebust H, Wik L, et al. Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study. Resuscitation.\u20082006;71(3):283\u2013292","DOI":"10.1016\/j.resuscitation.2006.05.011"},{"key":"2021120905303897000_R13","doi-asserted-by":"crossref","unstructured":"Kramer-Johansen J, Edelson DP, Losert H, Kohler K, Abella BS. Uniform reporting of measured quality of cardiopulmonary resuscitation (CPR). Resuscitation.\u20082007;74(3):406\u2013417","DOI":"10.1016\/j.resuscitation.2007.01.024"},{"key":"2021120905303897000_R14","doi-asserted-by":"crossref","unstructured":"Van Hoeyweghen RJ, Bossaert LL, Mullie A, et al. Quality and efficiency of bystander CPR: Belgian cerebral resuscitation study group. Resuscitation.\u20081993;26(1):47\u201352","DOI":"10.1016\/0300-9572(93)90162-J"},{"key":"2021120905303897000_R15","doi-asserted-by":"crossref","unstructured":"Yu T, Weil MH, Tang W, et al. Adverse outcomes of interrupted precordial compression during automated defibrillation. Circulation.\u20082002;106(3):368\u2013372","DOI":"10.1161\/01.CIR.0000021429.22005.2E"},{"key":"2021120905303897000_R16","doi-asserted-by":"crossref","unstructured":"Marn-Pernat A, Weil MH, Tang W, Pernat A, Bisera J. Optimizing timing of ventricular defibrillation. Crit Care Med.\u20082001;29(12):2360\u20132365","DOI":"10.1097\/00003246-200112000-00019"},{"key":"2021120905303897000_R17","doi-asserted-by":"crossref","unstructured":"Berg RA, Sanders AB, Kern KB, et al. Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Circulation.\u20082001;104(20):2465\u20132470","DOI":"10.1161\/hc4501.098926"},{"key":"2021120905303897000_R18","doi-asserted-by":"crossref","unstructured":"Yannopoulos D, McKnite S, Aufderheide TP, et al. Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest. Resuscitation.\u20082005;64(3):363\u2013372","DOI":"10.1016\/j.resuscitation.2004.10.009"},{"key":"2021120905303897000_R19","doi-asserted-by":"crossref","unstructured":"Ornato JP, Levine RL, Young DS, Racht EM, Garnett AR, Gonzalez ER. The effect of applied chest compression force on systemic arterial pressure and end-tidal carbon dioxide concentration during CPR in human beings. Ann Emerg Med.\u20081989;18(7):732\u2013737","DOI":"10.1016\/S0196-0644(89)80005-8"},{"key":"2021120905303897000_R20","doi-asserted-by":"crossref","unstructured":"Bellamy RF, DeGuzman LR, Pedersen DC. Coronary blood flow during cardiopulmonary resuscitation in swine. Circulation.\u20081984;69(1):174\u2013180","DOI":"10.1161\/01.CIR.69.1.174"},{"key":"2021120905303897000_R21","doi-asserted-by":"crossref","unstructured":"Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation.\u20082004;109(16):1960\u20131965","DOI":"10.1161\/01.CIR.0000126594.79136.61"},{"key":"2021120905303897000_R22","doi-asserted-by":"crossref","unstructured":"Aufderheide TP, Lurie KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med.\u20082004;32(9 Suppl):S345\u2013S351","DOI":"10.1097\/01.CCM.0000134335.46859.09"},{"key":"2021120905303897000_R23","doi-asserted-by":"crossref","unstructured":"Aufderheide TP, Pirrallo RG, Yannopoulos D, et al. Incomplete chest wall decompression: a clinical evaluation of CPR performance by EMS personnel and assessment of alternative manual chest compression-decompression techniques. Resuscitation.\u20082005;64(3):353\u2013362","DOI":"10.1016\/j.resuscitation.2004.10.007"},{"key":"2021120905303897000_R24","unstructured":"Yannopoulos D, Tang W, Roussos C, Aufderheide TP, Idris AH, Lurie KG. Reducing ventilation frequency during cardiopulmonary resuscitation in a porcine model of cardiac arrest. Respir Care.\u20082005;50(5):628\u2013635"},{"key":"2021120905303897000_R25","doi-asserted-by":"crossref","unstructured":"Edelson DP, Abella BS, Kramer-Johansen J, et al. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation.\u20082006;71(2):137\u2013145","DOI":"10.1016\/j.resuscitation.2006.04.008"},{"key":"2021120905303897000_R26","doi-asserted-by":"crossref","unstructured":"Niles D, Sutton RM, Donoghue AJ, et al. Rolling refreshers: a novel approach to maintain CPR psychomotor skill competence. Resuscitation.\u20082009; May 19: published ahead of print","DOI":"10.1016\/j.resuscitation.2009.04.021"},{"key":"2021120905303897000_R27","doi-asserted-by":"crossref","unstructured":"Nishisaki A, Nysaether J, Sutton R, et al. Effect of mattress deflection on CPR quality assessment for older children and adolescents. Resuscitation.\u20082009;80(5):540\u2013545","DOI":"10.1016\/j.resuscitation.2009.02.006"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/124\/2\/494\/1103307\/zpe00809000494.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/124\/2\/494\/1103307\/zpe00809000494.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T23:03:12Z","timestamp":1639090992000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/124\/2\/494\/72404\/Quantitative-Analysis-of-CPR-Quality-During-In"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,8,1]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2009,8,1]]},"published-print":{"date-parts":[[2009,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2008-1930","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,8,1]]}}}