P0478 - Real Time CPR Feedback and Coaching Improves Pediatric CPR Quality

Introduction:
High-quality cardiopulmonary resuscitation (CPR) is paramount in pediatric cardiac arrest. Because pediatric cardiac arrest is a rare event, the skills required to deliver high-quality CPR are easily lost over time. Moreover, the metrics of high-quality CPR such as depth and rate are difficult to quantify during a stressful code event. Advanced defibrillators now offer real-time feedback on depth, rate, and recoil. Peer CPR coaches can then translate machine feedback into improved compressor performance. For a matched pre- and post-intervention cohort of pediatric intensive care unit (PICU) skilled providers, we hypothesized that the provision of real-time CPR feedback by utilizing both an advanced defibrillator as well as a designated CPR coach would increase CPR quality.

Methods:
Study participants completed one round of CPR blinded to CPR feedback on a low-fidelity pediatric mannequin. Participants then received didactic instruction regarding goals for high-quality CPR, and were introduced to CPR machine feedback and the role of the CPR coach. Following this training, participants completed a second round of CPR on the same mannequin, with feedback on depth, rate, and recoil provided by the defibrillator as well as the CPR coach. Measurements of CPR quality were recorded in both the pre- and post-intervention CPR rounds.

Results:
Fifty-one participants took part in the study. Participants were PICU attending physicians, nurses, and nurse practitioners. Prior to the intervention, the mean percentage of compressions within all targets was 9%, mean compressions within target depth was 14.2%, and mean percentage of compressions within target rate was 39.5%. Post-intervention, mean compressions within all targets was 34.9%, mean compressions within target depth was 40.5%, and mean compressions within target rate was 73.2%. There was an improvement of 22% in compressions in target overall, 22.4% improvement in compression depth, and 34.7% improvement in compression rate (see figure).

Conclusions:
Pediatric providers can make significant improvements in CPR quality, which may directly lead to decreased morbidity and mortality in pediatric in-hospital cardiac arrests. CPR feedback and coaching is not only an important part of real-time skill delivery but also in continuing medical education for in-hospital pediatric providers. Even skilled and trained providers lose skills in high-quality CPR over time, as evidenced by fairly low-quality compressions in the pre-intervention period. An educational plan that encompasses rolling refreshers with CPR feedback on a regular basis as well as in situ mock codes to practice peer CPR coaching may directly improve performance and thus patient outcomes in pediatric in-hospital cardiac arrests.