Association of Chest Compression Metrics during Pediatric CPR with Intra-Arrest Blood Pressure and Survival Outcomes in the United States: Insights from ICU-RESUS
TL;DR
New potential pediatric CPR targets that were associated with SHD are identified: rate 130-160 CC/min, depths of 23-27 mm for patients <1 year, and CCF >90%.
Abstract
Background: High-quality cardiopulmonary resuscitation (CPR) is associated with improved outcomes, however specific targets for younger age groups are largely based on extrapolations from adult studies and small pediatric cohort studies. Methods: Prospectively designed embedded study within the ICU RESUScitation Project (“ICU-RESUS”, NCT: 02837497). Children (≤18yr) who received CPR in 10 intensive care units (ICUs) in the United States were enrolled between 2016-2021. We excluded patients with documented limitations of care, were brain dead or had OHCA. The exposures were AHA recommended chest compression (CC) targets for rate (100-120 cc/min), depth (≥40mm for age <1year and ≥50mm for age ≥1year), and chest compression fraction (CCF) (>80%). Associations between achieving CC targets over the first 10 minutes of CPR with outcomes were quantified using multivariable Poisson regression models [primary outcome: survival to hospital discharge (SHD)]. In exploratory analyses, cubic splines further explored the relationship between CC metrics and outcomes to identify exploratory targets. Results: Among 543 patients with evaluable data, recommended rate target was met in 46.3%, depth in 25.7%, and CCF in 88.5%. Mean age was 3.6 (SD 5.3) years and 54.3% were male. None of these recommended CC targets were associated with SHD (rate: aRR 0.91 (95% CI: 0.78, ), depth: aRR 0.81 (95% CI: 0.51, 1.29), and CCF: aRR 1.19 (95% CI: 0.92, 1.54), respectively). Using cubic spline analyses, the following exploratory targets were identified and were associated with survival to hospital discharge: rate 130-160 cc/min [aRR 1.23 (95% CI: 1.04, 1.46)], depths of 23-27 mm for patients <1 year [aRR 1.76 (1.14, 2.72)], and CCF >90% (aRR 1.24 (1.03, 1.49)). Conclusions: Currently recommended CC rate, depth, and fraction targets were not associated with SHD in this cohort. In contrast, we identified new potential pediatric CPR targets that were associated with SHD: rate 130-160 CC/min, depths of 23-27 mm for patients <1 year, and CCF >90%. These criteria need validation in future prospective trials. Trial Registration: ClinicalTrials.gov Identifier: NCT02837497