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Association Between Chest Compression Pause Duration and Survival After Pediatric In-Hospital Cardiac Arrest
Kasper G Lauridsen1,2,3, Ryan W Morgan3, Robert A Berg3
1Research Center for Emergency Medicine, Aarhus University, Denmark (K.G.L.).
Insights
Longer chest compression pauses in pediatric cardiac arrest decrease survival chances. Minimizing these pauses is crucial for better outcomes in children experiencing in-hospital cardiac arrest.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular research
- Resuscitation science
Background:
- The impact of chest compression (CC) pause duration on pediatric in-hospital cardiac arrest (IHCA) survival is not well-established.
- Current guidelines recommend minimizing CC pauses to under 10 seconds without strong supporting evidence.
- This study investigates the association between CC pause duration and survival outcomes in pediatric IHCA.
Purpose of the Study:
- To examine the relationship between the longest chest compression pause duration and survival outcomes in pediatric in-hospital cardiac arrest.
- To evaluate the association of CC pause duration with survival and favorable neurological outcomes.
- To determine if specific pause durations (>10 or >20 seconds) impact resuscitation success.
Main Methods:
- A cohort study analyzed data from pediatric in-hospital cardiac arrests reported in pediRES-Q from July 2015 to December 2021.
- The longest chest compression pause duration was analyzed in 5-second increments for its association with survival and neurological outcomes.
- Secondary analyses included pauses exceeding 10 or 20 seconds and their frequency.
Main Results:
- Each 5-second increase in the longest CC pause duration was linked to a 3% lower relative risk of survival with favorable neurological outcome (aRR, 0.97; P=0.02).
- Longer CC pauses were also associated with reduced survival to hospital discharge (aRR, 0.98; P=0.01) and return of spontaneous circulation (aRR, 0.93; P<0.001).
- Pauses >10 or >20 seconds, and their frequency, were associated with lower return of spontaneous circulation but not survival or neurological outcomes.
Conclusions:
- Extended chest compression pause durations during pediatric in-hospital cardiac arrest are associated with diminished survival and neurological outcomes.
- Even short, prolonged pauses (>10 or >20 seconds) negatively impact the return of spontaneous circulation.
- These findings underscore the importance of minimizing chest compression interruptions in pediatric resuscitation efforts.
Background:
The association between chest compression (CC) pause duration and pediatric in-hospital cardiac arrest survival outcomes is unknown. The American Heart Association has recommended minimizing pauses in CC in children to <10 seconds, without supportive evidence. We hypothesized that longer maximum CC pause durations are associated with worse survival and neurological outcomes.
Methods:
In this cohort study of index pediatric in-hospital cardiac arrests reported in pediRES-Q (Quality of Pediatric Resuscitation in a Multicenter Collaborative) from July of 2015 through December of 2021, we analyzed the association in 5-second increments of the longest CC pause duration for each event with survival and favorable neurological outcome (Pediatric Cerebral Performance Category ≤3 or no change from baseline). Secondary exposures included having any pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds per 2 minutes.
Results:
We identified 562 index in-hospital cardiac arrests (median [Q1, Q3] age 2.9 years [0.6, 10.0], 43% female, 13% shockable rhythm). Median length of the longest CC pause for each event was 29.8 seconds (11.5, 63.1). After adjustment for confounders, each 5-second increment in the longest CC pause duration was associated with a 3% lower relative risk of survival with favorable neurological outcome (adjusted risk ratio, 0.97 [95% CI, 0.95-0.99]; P=0.02). Longest CC pause duration was also associated with survival to hospital discharge (adjusted risk ratio, 0.98 [95% CI, 0.96-0.99]; P=0.01) and return of spontaneous circulation (adjusted risk ratio, 0.93 [95% CI, 0.91-0.94]; P<0.001). Secondary outcomes of any pause >10 seconds or >20 seconds and number of CC pauses >10 seconds and >20 seconds were each significantly associated with adjusted risk ratio of return of spontaneous circulation, but not survival or neurological outcomes.
Conclusions:
Each 5-second increment in longest CC pause duration during pediatric in-hospital cardiac arrest was associated with lower chance of survival with favorable neurological outcome, survival to hospital discharge, and return of spontaneous circulation. Any CC pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds were significantly associated with lower adjusted probability of return of spontaneous circulation, but not survival or neurological outcomes.
