Chest compression rates and pediatric in-hospital cardiac arrest survival outcomes

Robert M Sutton; Ron W Reeder; William Landis; Kathleen L Meert; Andrew R Yates; John T Berger; Christopher J Newth; Joseph A Carcillo; Patrick S McQuillen; Rick E Harrison; Frank W Moler; Murray M Pollack; Todd C Carpenter; Daniel A Notterman; Richard Holubkov; J Michael Dean; Vinay M Nadkarni; Robert A Berg; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) Investigators

doi:10.1016/j.resuscitation.2018.07.015

Chest compression rates and pediatric in-hospital cardiac arrest survival outcomes

Resuscitation. 2018 Sep:130:159-166. doi: 10.1016/j.resuscitation.2018.07.015. Epub 2018 Jul 18.

Authors

Robert M Sutton¹, Ron W Reeder², William Landis³, Kathleen L Meert⁴, Andrew R Yates⁵, John T Berger⁶, Christopher J Newth⁷, Joseph A Carcillo⁸, Patrick S McQuillen⁹, Rick E Harrison¹⁰, Frank W Moler¹¹, Murray M Pollack¹², Todd C Carpenter¹³, Daniel A Notterman¹⁴, Richard Holubkov², J Michael Dean², Vinay M Nadkarni³, Robert A Berg³; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) Investigators

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) Investigators:
Athena F Zuppa³, Katherine Graham³, Carolann Twelves³, Mary Ann Diliberto³, Elyse Tomanio⁶, Jeni Kwok⁷, Michael J Bell¹⁵, Alan Abraham⁸, Anil Sapru¹⁶, Mustafa F Alkhouli⁹, Sabrina Heidemann⁴, Ann Pawluszka⁴, Mark W Hall⁵, Lisa Steele⁵, Thomas P Shanley¹⁷, Monica Weber¹¹, Heidi J Dalton¹⁸, Aimee La Bell¹³, Peter M Mourani¹³, Kathryn Malone¹³, Russell Telford², Christopher Locandro², Whitney Coleman², Alecia Peterson², Julie Thelen², Allan Doctor¹⁹

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: suttonr@email.chop.edu.
² Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
³ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
⁵ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
⁶ Department of Pediatrics, Children's National Medical Center, Washington D.C., USA.
⁷ Department of Anesthesiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
⁸ Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
⁹ Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
¹⁰ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
¹¹ Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, MI, USA.
¹² Department of Pediatrics, Children's National Medical Center, Washington D.C., USA; Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, USA.
¹³ Department of Pediatrics, Denver Children's Hospital, University of Colorado, Denver, CO, USA.
¹⁴ Department of Molecular Biology, Princeton University, Princeton, NJ, USA.
¹⁵ Department of Pediatrics, Children's National Medical Center, Washington D.C., USA; Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁶ Department of Anesthesiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
¹⁷ Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, MI, USA; Department of Pediatrics, Lurie Children's Hospital, Northwestern University, Chicago, IL, USA.
¹⁸ Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, USA.
¹⁹ Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.

PMID: 30031055
PMCID: PMC6170369
DOI: 10.1016/j.resuscitation.2018.07.015

Abstract

Aim: The primary aim of this study was to evaluate the association between chest compression rates and 1) arterial blood pressure and 2) survival outcomes during pediatric in-hospital cardiopulmonary resuscitation (CPR).

Methods: Prospective observational study of children ≥37 weeks gestation and <19 years old who received CPR in an intensive care unit (ICU) as part of the Pediatric Intensive Care Unit Quality of CPR Study (PICqCPR) of the Collaborative Pediatric Critical Care Research Network (CPCCRN). Arterial blood pressure and compression rate were determined from manually extracted arterial line waveform data during the first 10 min of CPR. The primary outcome was survival to hospital discharge. Modified Poisson regression models assessed the association between rate categories (80-<100, 100-120 [Guidelines], >120-140, >140) and outcomes.

Results: Compression rate data were available for 164 patients. More than half (98/164; 60%) were <1 year old. Return of circulation was achieved in 148/164 (90%); survival to hospital discharge in 77/164 (47%). Percentage of events with average rate within Guidelines was 32.9%. Compared to Guidelines, higher rate categories were associated with lower systolic blood pressures (>120-140, p = 0.010; >140, p = 0.077), but not survival. A rate between 80-<100 per minute was associated with a higher rate of survival to hospital discharge (aRR 1.92, CI95 1.13, 3.29, p = 0.017) and survival with favorable neurological outcome (aRR 2.12, CI95 1.09, 4.13, p = 0.027) compared to Guidelines.

Conclusion: Non-compliance with compression rate Guidelines was common in this multicenter cohort. Among ICU patients, slightly lower rates were associated with improved outcomes compared to Guidelines.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Intensive care unit; Pediatric.

Publication types

Observational Study
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Blood Pressure Determination / methods
Child
Child, Preschool
Guideline Adherence / statistics & numerical data
Heart Arrest* / mortality
Heart Arrest* / therapy
Heart Massage / methods*
Hospital Mortality
Hospitals, Pediatric / standards
Hospitals, Pediatric / statistics & numerical data
Humans
Infant
Intensive Care Units, Pediatric / standards
Intensive Care Units, Pediatric / statistics & numerical data
Male
Nervous System Diseases* / etiology
Nervous System Diseases* / prevention & control
Outcome and Process Assessment, Health Care
Practice Guidelines as Topic
Pressure
Quality Improvement
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding