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Updated: Sep 22, 2025
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Association of chest compression pause duration prior to E-CPR cannulation with cardiac arrest survival outcomes
Kasper G Lauridsen1, Javier J Lasa2, Tia T Raymond3
1Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Emergency Department, Randers Regional Hospital, Randers, Denmark; Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA.
Insights
Prolonged chest compression pauses during pediatric cardiopulmonary resuscitation (CPR) before extracorporeal-CPR (E-CPR) cannulation are common. Longer pauses significantly decrease survival and favorable neurological outcomes in these critical cases.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary resuscitation quality
- Extracorporeal membrane oxygenation (ECMO) support
Background:
- Chest compression (CC) interruptions during cardiopulmonary resuscitation (CPR) can negatively impact patient outcomes.
- Optimizing CPR quality is crucial, especially in pediatric cardiac arrest cases requiring advanced support like extracorporeal-CPR (E-CPR).
- Understanding the impact of CC pause duration in the immediate pre-cannulation phase is vital for improving E-CPR protocols.
Purpose of the Study:
- To quantify chest compression (CC) pause durations in the final 5 minutes before extracorporeal-CPR (E-CPR) cannulation in pediatric patients.
- To determine the association between the longest CC pause duration and survival outcomes, including survival to discharge and favorable neurological outcome.
Main Methods:
- A cohort study was conducted using data from a resuscitation quality collaborative, focusing on pediatric E-CPR cardiac arrest events of at least 10 minutes.
- Chest compression interruptions were analyzed during the last 5 minutes of defibrillator-electrode recorded CPR prior to cannulation.
- Multivariable logistic regression was used to assess the association between the longest CC pause duration and survival outcomes, adjusting for age and CPR duration.
Main Results:
- The study included 49 pediatric E-CPR events, with a median age of 2.0 years; 55% survived to hospital discharge, and 37% had a favorable neurological outcome.
- The median longest CC pause duration in the last 5 minutes of CPR was 14.0 seconds, with 66% of cases having pauses exceeding 10 seconds.
- Each 5-second increase in the longest CC pause duration was significantly associated with lower odds of survival to hospital discharge (aOR 0.89) and favorable neurological outcome (aOR 0.77).
Conclusions:
- Significant chest compression pauses are frequent in the period preceding E-CPR cannulation in pediatric patients.
- Longer durations of chest compression pauses are independently associated with reduced survival rates and poorer neurological outcomes.
- Minimizing CC interruptions during critical pre-E-CPR phases may improve outcomes for pediatric cardiac arrest patients.
Objective:
To characterize chest compression (CC) pause duration during the last 5 minutes of pediatric cardiopulmonary resuscitation (CPR) prior to extracorporeal-CPR (E-CPR) cannulation and the association with survival outcomes.
Methods:
Cohort study from a resuscitation quality collaborative including pediatric E-CPR cardiac arrest events ≥ 10 min with CPR quality data. We characterized CC interruptions during the last 5 min of defibrillator-electrode recorded CPR (prior to cannulation) and assessed the association between the longest CC pause duration and survival outcomes using multivariable logistic regression.
Results:
Of 49 E-CPR events, median age was 2.0 [Q1, Q3: 0.6, 6.6] years, 55% (27/49) survived to hospital discharge and 18/49 (37%) with favorable neurological outcome. Median duration of CPR was 51 [43, 69] min. During the last 5 min of recorded CPR prior to cannulation, median duration of the longest CC pause was 14.0 [6.3, 29.4] sec: 66% >10 sec, 25% >29 sec, 14% >60 sec, and longest pause 168 sec. Following planned adjustment for known confounders of age and CPR duration, each 5-sec increase in longest CC pause duration was associated with lower odds of survival to hospital discharge [adjusted OR 0.89, 95 %CI: 0.79-0.99] and lower odds of survival with favorable neurological outcome [adjusted OR 0.77, 95 %CI: 0.60-0.98].
Conclusions:
Long CC pauses were common during the last 5 min of recorded CPR prior to E-CPR cannulation. Following adjustment for age and CPR duration, each 5-second incremental increase in longest CC pause duration was associated with significantly decreased rates of survival and favorable neurological outcome.
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