Observational Study

. 2018 Sep:130:159-166.

doi: 10.1016/j.resuscitation.2018.07.015. Epub 2018 Jul 18.

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

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, Affiliations

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

Observational Study

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

Robert M Sutton et al. Resuscitation. 2018 Sep.

. 2018 Sep:130:159-166.

doi: 10.1016/j.resuscitation.2018.07.015. Epub 2018 Jul 18.

Authors

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.

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Conflict of interest statement

Conflicts of Interest

The authors report no conflicts of interest related specifically to this manuscript. Unrelated disclosures include the following: Robert M. Sutton reports grant funding from the National Institutes of Health (NIH); Murray M. Pollack reports grant funding from the NIH and the Department of Defense, collaborative projects with Cerner Corporation, and philanthropy from Mallinckrodt Pharmaceuticals; Frank W. Moler reports NIH funding paid to his institution; Daniel A. Notterman reports grant funding from the NIH; and Christopher J. Newth reports consulting services for both Philips Research of North America and Medtronics.

Figures

**Figure 1:**
Utstein-style flow diagram of patients included in this secondary analysis of the Pediatric Intensive Care Quality of Cardiopulmonary Resuscitation (PICqCPR) study. ROSC indicates Return of Spontaneous Circulation; ROC, return of circulation with extracorporeal support; neuro, neurological; favorable neuro outcome, Pediatric Cerebral Performance Category of 1–3 or no worse.

**Figure 2:**
Box plot minute-level average diastolic blood pressures (A) and systolic blood pressures (B) across compression rate categories. DBP indicates diastolic blood pressure, SBP, systolic blood pressure. Circles inside of each box represent the mean BP. The horizontal line inside of each box represents the median BP. The bottom and top edges of the box indicate the interquartile range (IQR). The whiskers that extend from each box indicate the range of values that are outside of the IQR (up to a distance of 1.5*IQR from the box). Any points that are more than 1.5*IQR from the box are considered outliers and are represented by circles beyond the edge of the whiskers.

See this image and copyright information in PMC

References

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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical