Background

Constant search for better outcomes after pediatric cardiac arrest (CA), has justified the need to focus on quality cardiopulmonary resuscitation (CPR).

Objectives

To determine from the clinical perspective, which tools can help increase quality during CPR and their association with an increase in survival.

Methods

Systematic review of the population in the context of the intervention.

Results

Several tools have been analyzed to measure quality CPR. Physiologic tools include end-tidal CO2 (ETCO2) and arterial diastolic blood pressure (DBP) values. On the other hand, real-time CPR feedback devices and structured postresuscitation debriefings have been regarded as novel approaches to ensure quality CPR.

Measurement of ETCO2 is currently the only noninvasive clinical tool for estimating organ perfusion during CPR. ETCO2 levels below 10 mmHg were highly predictive of mortality. However, accuracy of ETCO2 as a predictor of ROSC is significantly affected by respiratory aetiology of CA changes in ventilation patterns, and the effects of adrenaline or sodium bicarbonate.

DBP measurements are only available in invasively monitored CA. However, it can provide a valuable approach to coronary perfusion and levels above 30 mmHg in children are associated with ROSC.

Guaranteeing CPR metrics has proved to achieve better CA outcomes. The introduction of real-time CPR feedback devices with proper coaching and training benefits ROSC and would help determine optimal targets for pediatric populations. Finally, structured debriefing, has proved to be a valuable and affordable tool to assess quality CPR and outcome improvement.

Conclusion

Ensuring quality CPR needs a multidisciplinary approach, with special focus in team training and debriefing.