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High Variability in the Duration of Chest Compression Interruption is Associated With Poor Outcomes in Pediatric
Peggy Han1,2, Lindsey Rasmussen1,3, Felice Su1,2
1Division of Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Insights
Minimizing chest compression interruptions (CCI) during extracorporeal cardiopulmonary resuscitation (ECPR) cannulation in children improves survival. Shorter interruption duration and less variability are key for better outcomes in pediatric cardiac arrest.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Research
- Resuscitation Science
Background:
- Extracorporeal cardiopulmonary resuscitation (ECPR) is a life-saving intervention for pediatric refractory cardiac arrest.
- Chest compression interruption (CCI) is a critical factor during the ECPR cannulation procedure.
- Optimizing CCI patterns may improve survival rates in this vulnerable patient population.
Purpose of the Study:
- To investigate the association between chest compression interruption (CCI) patterns and survival outcomes in pediatric patients undergoing ECPR.
- To analyze the impact of CCI duration and variability during ECPR cannulation on patient survival to discharge.
Main Methods:
- Retrospective analysis of pediatric ECPR cases (2013-2021) using defibrillator and monitor waveform data.
- Quantification of CCI duration and variability during the cannulation phase.
- Statistical analysis including logistic regression with cluster-robust standard errors to assess the association with survival to discharge.
Main Results:
- Survival to hospital discharge was observed in 37% of 41 ECPR events.
- Survival was inversely associated with maximum CCI duration (OR 0.91) and CCI duration variability (OR 0.96).
- Lowest survival rates (12%) were seen in cases with both above-average CCI duration and higher variability.
Conclusions:
- Shorter CCI duration and lower variability during ECPR cannulation are associated with improved survival in pediatric refractory cardiac arrest.
- Minimizing interruptions and their variability is crucial for optimizing outcomes in pediatric ECPR.
- Further research into strategies for reducing CCI during ECPR is warranted.
Objectives:
To determine the association between chest compression interruption (CCI) patterns and outcomes in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR).
Design:
Cardiopulmonary resuscitation (CPR) data were collected using defibrillator-electrode and bedside monitor waveforms from pediatric ECPR cases between 2013 and 2021. Duration and variability of CCI during cannulation for ECPR was determined and compared with survival to discharge using Fishers exact test and logistic regressions with cluster-robust se s for adjusted analyses.
Setting:
Quaternary care children's hospital.
Patients:
Pediatric patients undergoing ECPR.
Interventions:
None.
Measurements And Main Results:
Of 41 ECPR events, median age was 0.7 years (Q1, Q3: 0.1, 5.4), 37% (15/41) survived to hospital discharge with 73% (11/15) of survivors having a favorable neurologic outcome. Median duration of CPR from start of ECPR cannulation procedure to initiation of extracorporeal membrane oxygenation (ECMO) flow was 21 minutes (18, 30). Median duration of no-flow times associated with CCI during ECMO cannulation was 11 seconds (5, 28). Following planned adjustment for known confounders, survival to discharge was inversely associated with maximum duration of CCI (odds ratio [OR] 0.91 [0.86-0.95], p = 0.04) as well as the variability in the CCI duration (OR 0.96 [0.93-0.99], p = 0.04). Cases with both above-average CCI duration and higher CCI variability ( sd > 30 s) were associated with lowest survival (12% vs. 54%, p = 0.009). Interaction modeling suggests that lower variability in CCI is associated with improved survival, especially in cases where average CCI durations are higher.
Conclusions:
Shorter duration of CCI and lower variability in CCI during cannulation for ECPR were associated with survival following refractory pediatric cardiac arrest.
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