<p><strong>Study aim: </strong>To determine the impact of high-frequency CPR training on performance during simulated and real pediatric CPR events in a pediatric emergency department (ED).</p>

<p><strong>Methods: </strong>Prospective observational study. A high-frequency CPR training program (Resuscitation Quality Improvement (RQI)) was implemented among ED providers in a children's hospital. Data on CPR performance was collected longitundinally during quarterly retraining sessions; scores were analyzed between quarter 1 and quarter 4 by nonparametric methods. Data on CPR performance during actual patient events was collected by simultaneous combination of video review and compression monitor devices to allow measurement of CPR quality by individual providers; linear mixed effects models were used to analyze the association between RQI components and CPR quality.</p>

<p><strong>Results: </strong>159 providers completed four consecutive RQI sessions. Scores for all CPR tasks during retraining sessions significantly improved during the study period. 28 actual CPR events were captured during the study period; 49 observations of RQI trained providers performing CPR on children were analyzed. A significant association was found between the number of prior RQI sessions and the percent of compressions meeting guidelines for rate (β coefficient -0.08; standard error 0.04; p = 0.03).</p>

<p><strong>Conclusions: </strong>Over a 15 month period, RQI resulted in improved performance during training sessions for all skills. A significant association was found between number of sessions and adherence to compression rate guidelines during real patient events. Fewer than 30% of providers performed CPR on a patient during the study period. Multicenter studies over longer time periods should be undertaken to overcome the limitation of these rare events.</p>

<p><strong>OBJECTIVES: </strong>To describe chest compression (CC) quality by individual providers in two pediatric emergency departments (EDs) using video review and compression monitor output during pediatric cardiac arrests.</p>

<p><strong>METHODS: </strong>Prospective observational study. Patients &lt;18 yo receiving CC for &gt;1 min were eligible. Data was collected from video review and CC monitor device in a synchronized fashion and reported in 'segments' by individual providers. Univariate comparison by age (&lt;1 yo, 1-8 yo, &gt;8 yo) was performed by chi-square testing for dichotomous variables ('high-quality' CPR) and nonparametric testing for continuous variables (CC rate and depth). Univariate comparison of ventilation rate (V) was made between segments with an advanced airway versus without.</p>

<p><strong>RESULTS: </strong>524 segments had data available; 42/524 (8%) met criteria for 'high-quality CC'. Patients &gt;8 yo had more segments meeting criteria (18% vs. 2% and 0.5%; p &lt; 0.001). Segments compliant for rate were less frequent in &lt;1 yo (17% vs. 24% vs. 27%; p = 0.03). Segments compliant for depth were less frequent in &lt;1 year olds and 1-8 year olds (5% and 9% vs. 20%, p &lt; 0.001.) Mean V for segments with an advanced airway was higher than with a natural airway (24 ± 18 vs. 14 ± 10 bpm, p &lt; 0.001). Hyperventilation was more prevalent in CPR segments with an advanced airway (66% vs. 32%, p &lt; 0.001).</p>

<p><strong>CONCLUSIONS: </strong>CC depth is rarely guideline compliant in infants. Hyperventilation is more prevalent during CPR periods with an advanced airway in place. Measuring individual provider CPR quality is feasible, allowing future studies to evaluate the impact of CPR training.</p>

<p><strong>INTRODUCTION: </strong>Survival after in-hospital cardiac arrest (IHCA) has been reported to be worse for arrests at night or during weekends.This study aimed to determine whether measured cardiopulmonary resuscitation (CPR) quality metrics might explain this difference in outcomes.</p>

<p><strong>METHODS: </strong>IHCA data was collected by the Pediatric Resuscitation Quality (pediRES-Q) collaborative for patients &lt;18 years. Metrics of CPR quality [chest compression rate, depth and fraction] were measured using monitordefibrillator pads, and events were compared by time of day and day of week.</p>

<p><strong>RESULTS: </strong>We evaluated 6915 sixty-second epochs of chest compression (CC) data from 239 subjects between October 2015 and March 2019, across 18 hospitals. There was no significant difference in CPR quality metrics during day (07:00-22:59) versus night (23:00-06:59), or weekdays (Monday 07:00 to Friday 22:59) versus weekends (Friday 23:00 to Monday 06:59).There was also no difference in rate of return of circulation. However, survival to hospital discharge was higher for arrests that occurred during the day (39.1%) vs. nights (22.4%, p = 0.015), as well as on weekdays (39.9%) vs. weekends (19.1%, p = 0.003).</p>

<p><strong>CONCLUSIONS: </strong>For pediatric IHCA where CC metrics were obtained, there was no significant difference in CPR quality metrics or rate of return of circulation by time of day or day of week. There was higher survival to hospital discharge when arrests occurred during the day (vs. nights), or on weekdays (vs. weekends), and this difference was not related to disparities in CC quality.</p>