The Effect of Step Stool Use on Chest Compression Quality During CPR in Young Children: Findings From the Videography in Pediatric Emergency Research (VIPER) Collaborative

Objective: This study aimed to determine the effect of stepstool use on chest compression (CC) quality during cardiopulmonary resuscitation (CPR) in young children. Methods: We conducted a prospective observational study of children <8 years of age who received CC for >2 minutes in the emergency department. Data were collected through CC monitor device and video review. Data were analyzed in "CC segments" (periods of CC by individual providers). CC segments were coded "yes" or "no" for stepstool use based on video review. Univariate analyses of CC rate and depth between stepstool use and hand positions were performed through nonparametric testing, stratified by age category. Results: Forty-two patients received 566 minutes of CC. Overall, American Heart Association (AHA)-compliant (rate and depth) CPR was achieved in 10% of CC segments for children <1 year and only 6% in children >1 year. A stepstool was used in 73% of CC segments in children <1 year and 88% in children >1 year. In children >1 year, stepstool use was associated with deeper CCs ( P < 0.001) and a more compliant CC rate ( P < 0.01). In children >1 year, 7% of those with a stepstool in use achieved AHA compliance, compared to those without a stepstool, where none achieved AHA compliance. Conclusions: In children >1 year, stepstool use resulted in greater CC depth and more AHA-compliant CC rate. No CC segments in children >1 year achieved AHA compliance without a stepstool. These data support uniform stepstool use during pediatric CPR in children >1 year of age.