Pediatric Cardiopulmonary Resuscitation Ventilation Rates and Outcomes

Evaluate the association between cardiopulmonary resuscitation (CPR) ventilation rates and survival to hospital discharge, and identify novel ventilation targets.

Multicenter prospective ancillary observational cohort study of the ICU-RESUS trial (NCT02837497).

A total of 18 ICUs from 10 U.S. clinical sites from October 2016 to March 2021.

Hospitalized children (≤ 18 yr) with endotracheal or tracheostomy tubes and evaluable intra-arrest end-tidal carbon dioxide data to calculate ventilation rate.

None.

Among 234 included events, 86 events (36.8%) had guideline-recommended (20-30 beats per min [bpm]) average ventilation rates during CPR. The association between guideline-recommended CPR ventilation rate and survival to hospital discharge was evaluated with Poisson regression using generalized estimating equations, controlling for a priori covariables (initial pulse status, immediate cause of arrest). We found no association between guideline-recommended ventilation rates and survival to hospital discharge (adjusted relative risk [aRR], 0.95; 95% CI, 0.75-1.21; p = 0.68). In exploratory analyses, novel age-stratified ventilation rates were identified using natural cubic splines and subsequently evaluated in multivariable models. We identified potential thresholds (< 8 yr, ≥ 26 bpm; ≥ 8 yr, < 26 bpm). For children younger than 8 years, average CPR ventilation rate greater than or equal to 26 bpm was associated with improved survival to hospital discharge compared with less than 26 bpm (aRR, 1.32; 95% CI, 1.00-1.73; p = 0.048).

CPR ventilation rates in the currently recommended range (20-30 bpm) were not associated with survival in children with in-hospital cardiac arrest. In exploratory analyses in children younger than 8 years, higher ventilation rates (≥ 26 bpm) were associated with improved survival and warrant confirmation in future studies.