Abstract
Aim: The primary aim of this study was to evaluate the association between chest compression rates and 1) arterial blood pressure and 2) survival outcomes during pediatric in-hospital cardiopulmonary resuscitation (CPR). Methods: Prospective observational study of children ≥37 weeks gestation and <19 years old who received CPR in an intensive care unit (ICU) as part of the Pediatric Intensive Care Unit Quality of CPR Study (PICqCPR) of the Collaborative Pediatric Critical Care Research Network (CPCCRN). Arterial blood pressure and compression rate were determined from manually extracted arterial line waveform data during the first 10 min of CPR. The primary outcome was survival to hospital discharge. Modified Poisson regression models assessed the association between rate categories (80–<100, 100–120 [Guidelines], >120–140, >140) and outcomes. Results: Compression rate data were available for 164 patients. More than half (98/164; 60%) were <1 year old. Return of circulation was achieved in 148/164 (90%); survival to hospital discharge in 77/164 (47%). Percentage of events with average rate within Guidelines was 32.9%. Compared to Guidelines, higher rate categories were associated with lower systolic blood pressures (>120–140, p = 0.010; >140, p = 0.077), but not survival. A rate between 80-<100 per minute was associated with a higher rate of survival to hospital discharge (aRR 1.92, CI95 1.13, 3.29, p = 0.017) and survival with favorable neurological outcome (aRR 2.12, CI95 1.09, 4.13, p = 0.027) compared to Guidelines. Conclusion: Non-compliance with compression rate Guidelines was common in this multicenter cohort. Among ICU patients, slightly lower rates were associated with improved outcomes compared to Guidelines.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 159-166 |
| Number of pages | 8 |
| Journal | Resuscitation |
| Volume | 130 |
| DOIs | |
| State | Published - Sep 2018 |
Funding
This study was supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Department of Health and Human Services : UG1HD050096 , UG1HD049981 , UG1HD049983 , UG1HD063108, UG1HD083171 , UG1HD083166 , UG1HD083170 , U10HD050012 , U10HD063106 , U10HD063114 and U01HD049934 . The authors report no conflicts of interest related specifically to this manuscript. Unrelated disclosures include the following: Robert M. Sutton reports grant funding from the National Institutes of Health (NIH); Murray M. Pollack reports grant funding from the NIH and the Department of Defense, collaborative projects with Cerner Corporation, and philanthropy from Mallinckrodt Pharmaceuticals; Frank W. Moler reports NIH funding paid to his institution; Daniel A. Notterman reports grant funding from the NIH; and Christopher J. Newth reports consulting services for both Philips Research of North America and Medtronics. CPCCRN is a network of pediatric institutions that conducts investigations related to pediatric critical care practice in their pediatric and pediatric cardiac ICUs [ 15 ]. The clinical sites and the data coordinating center (DCC) supporting the Network have been funded by the National Institute of Child Health and Human Development since 2004. Further details on the Network can be found at https://www.cpccrn.org .
Keywords
- Cardiac arrest
- Cardiopulmonary resuscitation
- Intensive care unit
- Pediatric
ASJC Scopus subject areas
- Emergency Medicine
- Emergency
- Cardiology and Cardiovascular Medicine