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. 2024 Sep 11:20:100765.
doi: 10.1016/j.resplu.2024.100765. eCollection 2024 Dec.

Cardiopulmonary resuscitation employing only abdominal compressions in infants after cardiac surgery: A secondary sub-analysis of the ICU-RESUS study

Richard P Fernandez  1 , Patrick I McConnell  1 , Ron W Reeder  2 , Jessica S Alvey  2 , Robert A Berg  3 , Kathleen L Meert  4 , Ryan W Morgan  3 , Vinay M Nadkarni  3 , Heather A Wolfe  3 , Robert M Sutton  3 , Andrew R Yates  1 ; Eunice Kennedy Shriver; National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network and ICU-RESUScitation Project Investigators
Affiliations

Cardiopulmonary resuscitation employing only abdominal compressions in infants after cardiac surgery: A secondary sub-analysis of the ICU-RESUS study

Richard P Fernandez et al. Resusc Plus. .

Abstract

Importance: Patients with underlying cardiac disease form a considerable proportion of pediatric patients who experience in-hospital cardiac arrest. In pediatric patients after cardiac surgery, CPR with abdominal compressions alone (AC-CPR) may provide an alternative to standard chest compression CPR (S-CPR) with additional procedural and physiologic advantages.

Objective: Quantitatively describe hemodynamics during cardiopulmonary resuscitation (CPR) and outcomes of infants who received only abdominal compressions (AC-CPR).

Design: This is a sub-group analysis of the prospective, observational cohort from the ICU-RESUS trial NCT028374497.

Setting & patients: A single site quaternary care pediatric cardiothoracic intensive care unit enrolled in the ICU-RESUS trial. Patients less than 1 year of age with congenital heart disease who required compressions during cardiac arrest.

Interventions: Use of AC-CPR during cardiac arrest resuscitation.

Measurements and main results: Invasive arterial line waveforms during CPR were analyzed for 11 patients (10 surgical cardiac and 1 medical cardiac). Median weight was 3.3 kg [IQR 3.0, 4.0]; and median duration of CPR was 5.0 [3.0, 20.0] minutes. Systolic (median 57 [IQR 48, 65] mmHg) and diastolic (median 32 [IQR 24, 43] mmHg) blood pressures were achieved with a median rate of 114 [IQR 100, 124] compressions per minute. Return of spontaneous circulation was obtained in 9 of 11 (82%) patients; 2 patients (18%) were cannulated for extracorporeal cardiopulmonary resuscitation (ECPR) and 6 (55%) survived to hospital discharge with favorable neurologic outcome.

Conclusions: AC-CPR may offer an alternative method to maintain perfusion for infants who experience cardiac arrest. This may have particular benefit in pediatric patients after cardiac surgery for whom external chest compressions may be harmful due to anatomic and physiologic considerations.

Keywords: Abdominal compressions; Cardiopulmonary resuscitation; Compressions; Pediatric cardiac intensive care.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Richard P. Fernandez, MD reports financial support, administrative support, and statistical analysis were provided by National Institute of Child Health and Human Development. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Systolic and diastolic blood pressures during CPR.
See this image and copyright information in PMC

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