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Chest compression rates and pediatric in-hospital cardiac arrest survival outcomes
Robert M Sutton1, Ron W Reeder2, William Landis1
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
Insights
Pediatric cardiopulmonary resuscitation (CPR) guidelines recommend specific chest compression rates. This study found that rates between 80-100 compressions per minute were associated with better survival outcomes in pediatric intensive care unit patients compared to guideline rates.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiopulmonary Resuscitation Research
- Clinical Outcomes Analysis
Background:
- Chest compression rate is a critical factor during cardiopulmonary resuscitation (CPR).
- Current guidelines provide a target range for compression rates in pediatric patients.
- Adherence to these guidelines in real-world clinical settings requires evaluation.
Purpose of the Study:
- To assess the association between chest compression rates and arterial blood pressure.
- To evaluate the relationship between chest compression rates and survival outcomes in pediatric in-hospital CPR.
- To compare outcomes based on different chest compression rate categories relative to established guidelines.
Main Methods:
- Prospective observational study of pediatric patients (<19 years) undergoing CPR in intensive care units.
- Arterial blood pressure and compression rates were extracted from arterial line waveform data.
- Modified Poisson regression models analyzed associations between compression rate categories and survival to hospital discharge.
Main Results:
- Higher compression rates (>120-140/min and >140/min) were linked to lower systolic blood pressures compared to guideline rates.
- A compression rate of 80-100/min was associated with a significantly higher rate of survival to hospital discharge (aRR 1.92) and favorable neurological outcome (aRR 2.12).
- Only 32.9% of CPR events met the recommended compression rate guidelines.
Conclusions:
- Non-compliance with chest compression rate guidelines is prevalent in pediatric intensive care units.
- Compression rates slightly lower than guideline recommendations (80-100/min) may be associated with improved survival outcomes.
- Further research is warranted to optimize chest compression rates for pediatric CPR.
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.
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