Long chest compression pauses in pediatric in-hospital cardiac arrest may worsen survival
Longer chest compression pause duration for in-hospital cardiac arrest was associated with worse survival outcomes among pediatric patients, a speaker reported.
“We know that from adults with out-of-hospital cardiac arrest, primarily in cohorts with shockable rhythms, that longer chest compression pauses are associated with worse survival outcomes. But we also know that pediatric cardiac arrest may differ from adults,” Kasper G. Lauridsen, MD, PhD student at Aarhus University Hospital, Denmark, and research fellow at the Children’s Hospital of Philadelphia, said during a presentation at the virtual American Heart Association Resuscitation Science Symposium. “The aim of this study was to investigate the association of chest compression pause duration with survival and neurological outcomes during pediatric in-hospital cardiac arrest.”
Researchers analyzed 371 pediatric patients from the pediRES-Q registry (median age, 3 years; 46% girls; 47% white) who underwent CPR for in-hospital cardiac arrest (median CPR duration, 11 minutes), with data on chest compression pauses recorded by Zoll defibrillators.
The median longest pause duration for chest compressions was 17 seconds (interquartile range, 8-27).
After adjustment for age, defibrillation, intubation and several other variables, for each 5-second increment in chest compression pause duration, there was:
- 5% lower odds for return of spontaneous circulation (adjusted OR = 0.95; 95% CI, 0.92-0.97);
- 2% lower odds of survival to discharge (aOR = 0.98; 95% CI, 0.97-0.99); and
- 3% lower odds of survival with favorable neurological outcomes (aOR = 0.97; 95% CI, 0.96-0.99).
In a sensitivity analysis, researchers observed no significant association between worse survival outcomes and chest compression fraction more than 80% (aOR = 0.81; 95% CI, 0.35-1.87), the number of pauses longer than 10 seconds (aOR = 0.94; 95% CI, 0.96-1.03) and number of pauses longer than 20 seconds (aOR = 0.89; 95% CI, 0.75-1.05).
“The important take-home message from our data here is that the very long passes are the most detrimental,” Lauridsen said during a Q&A session after his presentation. “The key thing is to ensure that we keep the pauses short when we pause for defibrillation or intubation. In situations that may cause a very long pause, such as intubation, we need to keep those pauses shorter.”
Collapse
Lauridsen KG, et al. Abstract 124. Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).
Read more about