Chest compressions for pediatric organized rhythms: A hemodynamic and outcomes analysis

Shairbanu S Zinna¹, Ryan W Morgan¹, Ron W Reeder², Tageldin Ahmed³, Michael J Bell⁴, Robert Bishop⁵, Matthew Bochkoris⁶, Candice Burns⁷, Joseph A Carcillo⁶, Todd C Carpenter⁵, Kellimarie K Cooper¹, J Michael Dean², J Wesley Diddle⁴, Myke Federman⁸, Richard Fernandez⁹, Ericka L Fink⁶, Deborah Franzon¹⁰, Aisha H Frazier¹¹, Stuart H Friess¹², Kathryn Graham¹, Mark Hall⁹, Monica L Harding², David A Hehir¹, Christopher M Horvat⁶, Leanna L Huard⁸, William P Landis¹, Tensing Maa⁹, Arushi Manga¹², Patrick S McQuillen¹⁰, Kathleen L Meert³, Peter M Mourani¹³, Vinay M Nadkarni¹, Maryam Y Naim¹, Daniel Notterman¹⁴, Murray M Pollack⁴, Anil Sapru⁸, Carleen Schneiter⁵, Matthew P Sharron⁴, Neeraj Srivastava⁸, Bradley Tilford³, Shirley Viteri¹⁵, David Wessel⁴, Heather A Wolfe¹, Andrew R Yates⁹, Athena F Zuppa¹, Robert A Berg¹, Robert M Sutton¹⁶

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
² Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
³ Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
⁴ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
⁵ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
⁶ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
⁷ Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA.
⁸ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
⁹ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
¹⁰ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
¹¹ Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
¹² Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
¹³ University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
¹⁴ Department of Molecular Biology, Princeton University, Princeton, NJ, USA.
¹⁵ Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE, USA.
¹⁶ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: suttonr@chop.edu.

PMID: 38052273
PMCID: PMC10843614
DOI: 10.1016/j.resuscitation.2023.110068

Observational Study

Chest compressions for pediatric organized rhythms: A hemodynamic and outcomes analysis

Shairbanu S Zinna et al. Resuscitation. 2024 Jan.

. 2024 Jan:194:110068.

doi: 10.1016/j.resuscitation.2023.110068. Epub 2023 Dec 3.

Authors

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
² Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
³ Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
⁴ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
⁵ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
⁶ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
⁷ Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA.
⁸ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
⁹ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
¹⁰ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
¹¹ Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
¹² Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
¹³ University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
¹⁴ Department of Molecular Biology, Princeton University, Princeton, NJ, USA.
¹⁵ Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE, USA.
¹⁶ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: suttonr@chop.edu.

PMID: 38052273
PMCID: PMC10843614
DOI: 10.1016/j.resuscitation.2023.110068

Abstract

Aim: Pediatric cardiopulmonary resuscitation (CPR) guidelines recommend starting CPR for heart rates (HRs) less than 60 beats per minute (bpm) with poor perfusion. Objectives were to (1) compare HRs and arterial blood pressures (BPs) prior to CPR among patients with clinician-reported bradycardia with poor perfusion ("BRADY") vs. pulseless electrical activity (PEA); and (2) determine if hemodynamics prior to CPR are associated with outcomes.

Methods and results: Prospective observational cohort study performed as a secondary analysis of the ICU-RESUScitation trial (NCT028374497). Comparisons occurred (1) during the 15 seconds "immediately" prior to CPR and (2) over the two minutes prior to CPR, stratified by age (≤1 year, >1 year). Poisson regression models assessed associations between hemodynamics and outcomes. Primary outcome was return of spontaneous circulation (ROSC). Pre-CPR HRs were lower in BRADY vs. PEA (≤1 year: 63.8 [46.5, 87.0] min^-1 vs. 120 [93.2, 150.0], p < 0.001; >1 year: 67.4 [54.5, 87.0] min^-1 vs. 100 [66.7, 120], p < 0.014). Pre-CPR pulse pressure was higher among BRADY vs. PEA (≤1 year (12.9 [9.0, 28.5] mmHg vs. 10.4 [6.1, 13.4] mmHg, p > 0.001). Pre-CPR pulse pressure ≥ 20 mmHg was associated with higher rates of ROSC among PEA (aRR 1.58 [CI95 1.07, 2.35], p = 0.022) and survival to hospital discharge with favorable neurologic outcome in both groups (BRADY: aRR 1.28 [CI95 1.01, 1.62], p = 0.040; PEA: aRR 1.94 [CI95 1.19, 3.16], p = 0.008). Pre-CPR HR ≥ 60 bpm was not associated with outcomes.

Conclusions: Pulse pressure and HR are used clinically to differentiate BRADY from PEA. A pre-CPR pulse pressure >20 mmHg was associated with improved patient outcomes.

Keywords: Bradycardia; Cardiopulmonary resuscitation; Hemodynamics; Pediatrics.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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References

1. Holmberg MJ, Ross CE, Fitzmaurice GM, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes 2019;12(7):e005580. - PMC - PubMed
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Chest compressions for pediatric organized rhythms: A hemodynamic and outcomes analysis

Affiliations

Chest compressions for pediatric organized rhythms: A hemodynamic and outcomes analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous