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Pediatric cardiopulmonary resuscitation quality during intra-hospital transport
Morgann Loaec1, Adam S Himebauch2, Todd J Kilbaugh2
1Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
Insights
Pediatric cardiopulmonary resuscitation (CPR) quality remained consistent during intra-hospital transport for extracorporeal membrane oxygenation (ECMO)-CPR. This suggests that transporting patients for ECMO cannulation is a viable strategy for ECPR systems.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiopulmonary Resuscitation
- Extracorporeal Membrane Oxygenation
Background:
- Intra-hospital transport is a critical phase for pediatric patients requiring extracorporeal membrane oxygenation-cardiopulmonary resuscitation (ECMO-CPR).
- Maintaining high-quality cardiopulmonary resuscitation (CPR) during transport is essential for patient outcomes.
Purpose of the Study:
- To evaluate the quality of pediatric CPR during intra-hospital transport.
- To compare chest compression (CC) rate, depth, and fraction (CCF) before and during transport for ECMO-CPR.
Main Methods:
- An observational study included pediatric patients (<18 years) undergoing intra-hospital transport for ECMO-CPR.
- CPR mechanics data (rate, depth, CCF) were analyzed comparing pre-transport and intra-transport periods.
- Secondary analysis assessed adherence to guideline recommendations for CPR parameters during 60-second epochs.
Main Results:
- Seven pediatric patients met eligibility criteria; 86% survived the event, and 28% survived to hospital discharge.
- No significant differences were observed in CC rate, depth, or CCF between pre-transport and intra-transport periods.
- Proportions of CPR epochs meeting guideline recommendations remained equivalent between pre- and intra-transport phases.
Conclusions:
- Pediatric CPR quality is maintained during intra-hospital transport.
- Transporting patients for ECMO cannulation is a reasonable consideration for ECPR systems.
Aim:
To evaluate pediatric cardiopulmonary resuscitation (CPR) quality during intra-hospital transport to facilitate extracorporeal membrane oxygenation (ECMO)-CPR (ECPR). We compared chest compression (CC) rate, depth, and fraction (CCF) between the pre-transport and intra-transport periods.
Methods:
Observational study of children <18 years with either in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) who underwent transport between two care locations within the hospital for ECPR and who had CPR mechanics data available. Descriptive patient and arrest characteristics were summarized. The primary analysis compared pre- to intra-transport CC rate, depth, and fraction. A secondary analysis compared the proportion of pre- versus intra-transport 60-s epochs meeting guideline recommendations for rate (100-120/min), depth (≥4 cm for infants; ≥5 cm for children ≥1 year), and CCF (≥0.80).
Results:
Seven patients (four IHCA; three witnessed OHCA) met eligibility criteria. Six (86%) patients survived the event and two (28%) survived to hospital discharge. Median transport CPR duration was 7 [IQR 5.5, 8.5] minutes. There were no differences in pre- vs. intra-transport CC rate (115 [113, 118] vs. 118 [114, 127] CCs/minute; p = 0.18), depth (3.2 [2.7, 4.4] vs. 3.6 [2.5, 4.6] cm; p = 0.50), or CCF (0.89 [0.82, 0.90] vs. 0.92 [0.79, 0.97]; p = 0.31). Equivalent proportions of 60-s CPR epochs met guideline recommendations between pre- and intra-transport (rate: 66% vs. 57% [p = 0.22]; depth: 14% vs. 19% [p = 0.39]; CCF: 80% vs. 75% [p = 0.43]).
Conclusions:
Pediatric CPR quality was maintained during intra-hospital patient transport, suggesting that it is reasonable for ECPR systems to incorporate patient transport to facilitate ECMO cannulation.
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