Association between time of day and CPR quality as measured by CPR hemodynamics during pediatric in-hospital CPR
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Published on: January 30, 2020
Heather A Wolfe1, Ryan W Morgan1, Robert M Sutton1
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.
Insights
Nighttime in-hospital cardiac arrests in children did not show lower diastolic blood pressure during CPR compared to daytime arrests. This study found no significant difference in chest compression quality or survival rates based on the time of arrest.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiology
- Emergency Medicine
Background:
- In-hospital cardiac arrest (IHCA) survival rates in children are lower when arrests occur at night.
- Diastolic blood pressure (DBP) during cardiopulmonary resuscitation (CPR) is a key indicator of chest compression quality and is linked to survival in pediatric IHCA.
- Previous research suggests a potential disparity in IHCA outcomes based on the time of day.
Purpose of the Study:
- To investigate whether diastolic blood pressure (DBP) during CPR differs between nighttime and daytime in pediatric patients experiencing IHCA.
- To determine if the time of day impacts the quality of chest compressions, as measured by DBP, during pediatric IHCA.
- To explore the association between nighttime versus daytime IHCA and key outcomes like Return of Spontaneous Circulation (ROSC) and survival to hospital discharge.
Main Methods:
- A secondary analysis was conducted using data from the Pediatric Intensive Care Quality of Cardiopulmonary Resuscitation Study.
- Patients in pediatric intensive care units who received at least one minute of chest compressions and had invasive arterial blood pressure monitoring were included.
- Nighttime was defined as 11:00 PM to 6:59 AM, and daytime as 7:00 AM to 10:59 PM. Outcomes included achieving target DBP, mean DBP, ROSC, and survival to discharge.
Main Results:
- A total of 164 pediatric IHCA events were analyzed, with 27% occurring at nighttime and 73% during daytime.
- Average diastolic blood pressure (DBP) during CPR was not significantly different between nighttime (28.3 mmHg) and daytime (29.6 mmHg) arrests (p=0.64).
- No significant differences were observed in the proportion of arrests meeting DBP thresholds, Return of Spontaneous Circulation (ROSC) rates, or survival to hospital discharge between nighttime and daytime IHCA.
Conclusions:
- This study found no significant difference in diastolic blood pressure during CPR for pediatric in-hospital cardiac arrest between nighttime and daytime.
- The quality of chest compressions, as indicated by DBP, does not appear to be significantly affected by the time of day in pediatric ICUs.
- The time of day (nighttime vs. daytime) did not significantly impact ROSC or survival to hospital discharge in this cohort of pediatric IHCA patients.
Introduction:
Patients who suffer in-hospital cardiac arrest (IHCA) are less likely to survive if the arrest occurs during nighttime versus daytime. Diastolic blood pressure (DBP) as a measure of chest compression quality was associated with survival from pediatric IHCA. We hypothesized that DBP during CPR for IHCA is lower during nighttime versus daytime.
Methods:
This is a secondary analysis of data collected from the Pediatric Intensive Care Quality of Cardiopulmonary Resuscitation Study. Pediatric or Pediatric Cardiac Intensive Care Unit patients who received chest compressions for ≥1 min and who had invasive arterial BP monitoring were enrolled. Nighttime was defined as 11:00PM to 6:59AM and daytime as 7:00AM until 10:59PM. Primary outcome was attainment of DBP ≥ 25 mmHg in infants <1 year and ≥30 mmHg in older children. Secondary outcomes were mean DBP, ROSC, and survival to hospital discharge. Univariable and multivariate analyses evaluated the relationships between time (nighttime vs. daytime) and outcomes.
Results:
Between July 1, 2013 and June 30, 2016, 164 arrests met all inclusion/exclusion criteria: 45(27%) occurred at nighttime and 119(73%) during daytime. Average DBPs achieved were not different between groups (DBP: nighttime 28.3 mmHg[25.3, 36.5] vs. daytime 29.6 mmHg[21.8, 38.0], p = 0.64). Relative risk of DBP threshold met during nighttime vs. daytime was 1.27, 95%CI [0.80, 1.98], p = 0.30. There was no significant nighttime vs. daytime difference in ROSC (28/45[62%] vs. 84/119[71%] p = 0.35) or survival to hospital discharge (16/45[36%] vs. 61/119[51%], p = 0.08).
Conclusions:
In this cohort of pediatric ICU patients with IHCA, there was no significant difference in DBP during CPR between nighttime and daytime.
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