Aim The objective of this study is to report, for the first time, quantitative data on CPR quality during the resuscitation of children under 8 years of age. We hypothesized that the CPR performed would often not achieve 2010 Pediatric Basic Life Support (BLS) Guidelines, but would improve with the addition of audiovisual feedback. Methods Prospective observational cohort evaluating CPR quality during chest compression (CC) events in children between 1 and 8 years of age. CPR recording defibrillators collected CPR data (rate (CC/min), depth (mm), CC fraction (CCF), leaning (% > 2.5 kg.)). Audiovisual feedback was according to 2010 Guidelines in a subset of patients. The primary outcome, “excellent CPR” was defined as a CC rate ≥ 100 and ≤ 120 CC/min, depth ≥ 50mm, CCF > 0.80, and < 20 % of CC with leaning. Results 8 CC events resulted in 285 thirty-second epochs of CPR (15,960 CCs). Percentage of epochs achieving targets was 54% (153 / 285) for rate, 19% (54 / 285) for depth, 88% (250 / 285) for CCF, 79% (226 / 285) for leaning, and 8% (24 / 285) for excellent CPR. The median percentage of epochs per event achieving targets increased with audiovisual feedback for rate [88 (IQR: 79, 94) vs. 39 (IQR 18, 62) %; p=0.043] and excellent CPR [28 (IQR: 7.2, 52) vs. 0 (IQR: 0, 1) %; p=0.018]. Conclusions In-hospital pediatric CPR often does not meet 2010 Pediatric BLS Guidelines, but compliance is better when audiovisual feedback is provided to rescuers.

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Background: There is limited evidence regarding the heart rate (HR) during the first minutes of life. Nonetheless, resuscitative actions within the first minute are partly guided by different HR levels. The advent of an electrocardiographic (ECG) HR sensor with early HR detection has provided the opportunity to study changes immediately following delivery. Objective: The objectives were to determine immediately following delivery: (i) the time to achievement of reliable ECG signals using dry electrodes, (ii) changes in HR, and (iii) the influence of the onset of breathing and cord clamping on the HR. Methods: Healthy term neonates were randomly included between July and October 2013. The HR was recorded by the ECG sensor, placed over the abdomen immediately after birth. Results: Fifty-five newborns were included. The median time from birth to placement of the HR sensor was 3 s (quartiles: 2 and 5), and the median time to the start of breathing was 6 s (quartiles: 2 and 15). The HR was around 120 beats/min (bpm) in the first seconds of life. As determined via breakpoint analysis, the HR increased by 1 beat in the first 40 s to 149 ± 33 bpm, followed by a moderate increase until 130 s and stabilization thereafter. After the onset of breathing, the HR decreased for 10 s and then increased. Minimal HR changes were observed after cord clamping. Conclusion: A dry-electrode ECG sensor detected reliable ECG signals almost immediately after birth. The normal HR increased significantly in spontaneously breathing infants during the first minute, influenced by the onset of breathing. Delayed cord clamping had a minimal impact on the HR, likely reflecting an earlier onset of breathing.

Objective-Hyperventilation is both common and detrimental during cardiopulmonary resuscitation (CPR). Chest wall impedance algorithms have been developed to detect ventilations during CPR. However, impedance signals are challenged by noise artifact from multiple sources, including chest compressions. Capnography has been proposed as an alternate method to measure ventilations. We sought to assess and compare the adequacy of these two approaches.Methods-Continuous chest wall impedance and capnography were recorded during consecutive in-hospital cardiac arrests. Algorithms utilizing each of these data sources were compared to a manually determined "gold standard" reference ventilation rate. In addition, a combination algorithm, which utilized the highest of the impedance or capnography values in any given minute, was similarly evaluated.Results-Data were collected from 37 cardiac arrests, yielding 438 min of data with continuous chest compressions and concurrent recording of impedance and capnography. The manually calculated mean ventilation rate was 13.3±4.3/min. In comparison, the defibrillator's impedancebased algorithm yielded an average rate of 11.3±4.4/min (p=0.0001) while the capnography rate was 11.7±3.7/min (p=0.0009). There was no significant difference in sensitivity and positive predictive value between the two methods. The combination algorithm rate was 12.4±3.5/min (p=0.02), which yielded the highest fraction of minutes with respiratory rates within 2/min of the reference. The Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-Both the impedance and capnography-based algorithms underestimated the ventilation rate. Reliable ventilation rate determination may require a novel combination of multiple algorithms during resuscitation. Conflict of Interest