Longer chest compression pause worsens outcomes after paediatric IHCA

Longer chest compression interruption was associated with neurological outcome, survival to hospital discharge, and return of spontaneous circulation in children with in-hospital cardiac arrest (IHCA). In a Danish cohort study, each 5-second increment of longest chest compression pause duration was associated with 6% lower odds for survival with favourable neurological outcome [1].

Extracorporeal cardiopulmonary resuscitation often requires interruptions to chest compression (CC); the possible impact on survival and neurological outcomes has been unknown. This cohort study included all index paediatric IHCAs ≥1 min in Pediatric Resuscitation Quality (PediRES-Q), a worldwide collaborative network, from July 2015 through December 2019. Age was by definition <18 years. Favourable neurological outcome was defined as Pediatric Cerebral Performance Category (PCPC) ≤3 at discharge or no change from baseline.

A total of 371 index IHCAs were identified. Median (Q1, Q3) age was 2.6 (0.6–9.4) years, 46% were girls, 13% had shockable rhythm, CPR duration was 23 (9–47) minutes. The longest pause had a median length of 17 (8–27) seconds. Each increment of 5 seconds in longest CC interruption was associated with 6% lower odds for survival with favourable neurological outcome. This held true even after adjusting for the following established confounders: age, defibrillation, intubation, extracorporeal CPR, illness category, hypotension as aetiology for arrest, and CC depth, as well as clustering by location (adjusted OR 0.94; 95% CI 0.88–0.99; P=0.04). The longest CC interruption was found to be associated with lower odds for survival to hospital discharge (adjusted OR 0.94; 95% CI 0.90–0.99; P=0.02) and for return of spontaneous circulation (adjusted OR 0.91; 0.86–0.96; P=0.001).

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   1. Lauridsen KG, et al. Chest Compression Pause Duration is Associated with Worse Survival Outcomes Following Pediatric In-hospital Cardiac Arrest. Abstract 124, AHA Scientific Sessions 2020, 13-17 Nov.

 



Posted on 18 February 202118 February 2021