• Robert M Sutton, Erin Case, Siobhan P Brown, Dianne L Atkins, Vinay M Nadkarni, Jonathan Kaltman, Clifton Callaway, Ahamed Idris, Graham Nichol, Jamie Hutchison, Ian R Drennan, Michael Austin, Mohamud Daya, Sheldon Cheskes, Jack Nuttall, Heather Herren, James Christenson, Dug Andrusiek, Christian Vaillancourt, James J Menegazzi, Thomas D Rea, Robert A Berg, and ROC Investigators.
• The Children's Hospital of Philadelphia, 34th Street, Civic Center Boulevard, Philadelphia, PA 19104, United States. Electronic address: suttonr@chop.edu.
• Resuscitation. 2015 Aug 1; 93: 150157150-7.

AimHigh-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.MethodsProspective 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).ResultsBetween 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.ConclusionsIn 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.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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