A quantitative analysis of out-of-hospital pediatric and adolescent resuscitation quality--A report from the ROC epistry-cardiac arrest

Resuscitation. 2015 Aug;93:150-7. doi: 10.1016/j.resuscitation.2015.04.010. Epub 2015 Apr 25.


Aim: High-quality cardiopulmonary resuscitation (CPR) may improve survival. The quality of CPR performed during pediatric out-of-hospital cardiac arrest (p-OHCA) is largely unknown. The main objective of this study was to describe the quality of CPR performed during p-OHCA resuscitation attempts.

Methods: Prospective observational multi-center cohort study of p-OHCA patients ≥ 1 and < 19 years of age registered in the Resuscitation Outcomes Consortium (ROC) Epistry database. The primary outcome was an a priori composite variable of compliance with American Heart Association (AHA) guidelines for both chest compression (CC) rate and CC fraction (CCF). Event compliance was defined as a case with 60% or more of its minute epochs compliant with AHA targets (rate 100-120 min(-1); depth ≥ 38 mm; and CCF ≥ 0.80). In a secondary analysis, multivariable logistic regression was used to evaluate the association between guideline compliance and return of spontaneous circulation (ROSC).

Results: Between December 2005 and December 2012, 2564 pediatric events were treated by EMS providers, 390 of which were included in the final cohort. Of these events, 22% achieved AHA compliance for both rate and CCF, 36% for rate alone, 53% for CCF alone, and 58% for depth alone. Over time, there was a significant increase in CCF (p < 0.001) and depth (p = 0.03). After controlling for potential confounders, there was no significant association between AHA guideline compliance and ROSC.

Conclusions: In this multi-center study, we have established that there are opportunities for professional rescuers to improve prehospital CPR quality. Encouragingly, CCF and depth both increased significantly over time.

Keywords: Cardiopulmonary resuscitation; Emergency medical services; Pediatric.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cardiopulmonary Resuscitation* / adverse effects
  • Cardiopulmonary Resuscitation* / methods
  • Cardiopulmonary Resuscitation* / standards
  • Child
  • Child, Preschool
  • Cohort Studies
  • Emergency Medical Services / methods
  • Emergency Medical Services / standards
  • Female
  • Humans
  • Infant
  • Male
  • Medical Records
  • Out-of-Hospital Cardiac Arrest / epidemiology
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Outcome and Process Assessment, Health Care
  • Quality Assurance, Health Care*
  • Quality Improvement
  • Thoracic Injuries* / diagnosis
  • Thoracic Injuries* / etiology
  • United States / epidemiology