2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival

Abstract

Aim: Gaps exist in pediatric resuscitation knowledge due to limited data collected during cardiac arrest in real children. The objective of this study was to evaluate the relationship between the 2010 American Heart Association (AHA) recommended chest compression (CC) depth (≥51 mm) and survival following pediatric resuscitation attempts.

Methods: Single-center prospectively collected and retrospectively analyzed observational study of children (>1 year) who received CCs between October 2006 and September 2013 in the intensive care unit (ICU) or emergency department (ED) at a tertiary care children's hospital. Multivariate logistic regression models controlling for calendar year and known potential confounders were used to estimate the association between 2010 AHA depth compliance and survival outcomes. The primary outcome was 24-h survival. The primary predictor variable was event AHA depth compliance, prospectively defined as an event with ≥60% of 30-s epochs achieving an average CC depth ≥51 mm during the first 5 min of the resuscitation.

Results: There were 89 CC events, 87 with quantitative CPR data collected (23 AHA depth compliant). AHA depth compliant events were associated with improved 24-h survival on both univariate analysis (70% vs. 16%, p<0.001) and after controlling for potential confounders (calendar year of arrest, gender, first documented rhythm; aOR 10.3; CI(95): 2.75-38.8; p<0.001).

Conclusions: 2010 AHA compliant chest compression depths (≥51 mm) are associated with higher 24-h survival compared to shallower chest compression depths, even after accounting for potentially confounding patient and event factors.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Quality.

Figure 1

Utstein style diagram.

Figure 2

Rates, adjusted for age, for 24-hour survival and AHA Depth Compliance (≥ 60 percent of epochs with average CC Depth ≥ 51mm) over calendar year. *No estimate for compliance in 2010 (zero cell).

Figure 3

Multivariable logistic regression controlling for potential confounders. ROSC refers to Return of Spontaneous Circulation ≥ 20 minutes. Discharge indicates Survival to Hospital Discharge. Good Neuro indicates Survival to Discharge with PCPC score of 1 - 2 at discharge or no change compared to admission PCPC status. *indicates aOR 4.21, CI⁹⁵: 1.34 – 13.2, p = 0.014 after all CPR events. †indicates aOR 10.3, CI95: 2.75 – 38.8, p<0.001 after all CPR events. Univariate analysis for ‡survival to discharge (23% vs. 7%, p=0.11) and ^§good neurological outcome (18% vs. 5%, p=0.094) after index events.