Upstate Golisano Children's Hospital - Upstate University, New York
Disclosure(s): No relevant financial relationship(s) to disclose.
Introduction: Each year, more than 15,000 children undergo cardiopulmonary resuscitation (CPR) in hospital settings. Delivering high-quality CPR is a key factor in improving survival rates and neurological outcomes. An essential component of high-quality CPR is maintaining an appropriate chest compression rate of 100–120 compressions per minute. The American Heart Association (AHA) Get With The Guidelines (GWTG) sets a benchmark of greater than 80% of compressions falling within this target range during a resuscitation. Before implementing this project, the mean percentage in target rate compliance at our hospital was 43.6%.
Methods: During our initial Plan-Do-Study-Act (PDSA) cycle, a portable metronome was provided to our Pediatric SWAT nurses. Additionally, our Pediatric Emergency Department attached the metronome to the Zoll defibrillators. However, implementation was limited by factors such as battery life and inconsistent use. To address these issues, a second PDSA cycle was initiated 8 months later, during which the built-in metronome feature was activated on all Zoll defibrillators across the organization. CPR data was subsequently extracted from Zoll OneStep™ pads when available, and proper placement was confirmed during each event.
Results: Using a metronome was associated with a marked improvement in compliance with target chest compression rates during resuscitation events. Activating the metronome feature on Zoll defibrillators significantly facilitated maintenance of proper compression rates, provided Zoll OneStep™ pads were in use. Overall, there was a 23.6% improvement in compression rate compliance following the initiation of PDSA Cycle 1. Furthermore, a t-test comparison of cases with and without metronome use demonstrated a 27.9% increase in on-target compression rates when a metronome was used (95% CI: 14%–42%; p = < 0.001).
Conclusions: Using a metronome during pediatric resuscitation significantly improves compliance with recommended chest compression rates. Automating the metronome through the defibrillator reduces the risk of omissions and helps promote greater consistency in CPR delivery. Additionally, training staff to recognize and respond to the metronome’s auditory cue is essential for maintaining proper compression pace and optimizing resuscitation quality.
