CPR coach presence is associated with increased cardiopulmonary resuscitation guideline adherence in pediatric in-hospital cardiac arrest: a retrospective cohort study.

Abstract

High-quality cardiopulmonary resuscitation (CPR) improves patient outcomes but remains challenging to perform consistently. CPR coaches can support the team leader in ensuring high quality CPR. However, no studies have demonstrated improved pediatric patient outcomes with the use of a dedicated CPR coach during in-hospital cardiac arrest (IHCA). This was a retrospective, single center study at a quaternary care, free-standing children's hospital pediatric intensive care unit (PICU), examining chest compression quality before and after trained CPR coach implementation from August 2017 to October 2022. In August 2019, trained CPR coaches began attending all code events. Patients < 18 years of age who had a cardiac arrest event within the PICU were included. Ninety-three IHCA events in patients < 18 years of age in the PICU occurred from August 2017 to October 2022. There were 29 events pre-CPR coach implementation and 52 events post-implementation. Twelve patients were excluded due to lack of complete CPR data. CPR depth compliance improved from 0% to 31% (p < 0.001). No change was seen for rate or chest compression fraction. Return of spontaneous circulation (ROSC) increased from 38% to 69% following the implementation of CPR coaching (p = 0.006). Implementation of a CPR coach was associated with improved rate of ROSC compared to pre-coach implementation. Significant improvement was seen in compliance with target depth, but not with rate or chest compression fraction. While a small study, it is the first study we know to demonstrate improvement in outcomes from use of a CPR coach.