Association of chest compression pause duration prior to E-CPR cannulation with cardiac arrest survival outcomes

Kasper G Lauridsen; Javier J Lasa; Tia T Raymond; Priscilla Yu; Dana Niles; Robert M Sutton; Ryan W Morgan; Mary Fran Hazinski; Heather Griffis; Richard Hanna; Xuemei Zhang; Robert A Berg; Vinay M Nadkarni; pediRES-Q Investigators

doi:10.1016/j.resuscitation.2022.05.004

Association of chest compression pause duration prior to E-CPR cannulation with cardiac arrest survival outcomes

Resuscitation. 2022 Aug:177:85-92. doi: 10.1016/j.resuscitation.2022.05.004. Epub 2022 May 16.

Authors

Collaborators

pediRES-Q Investigators:
Kamal Abulebda⁹, Diane Atkins¹⁰, Shilpa Balikai¹⁰, Marc Berg¹¹, Robert Berg¹², Utpal Bhalala¹³, Matthew S Braga¹⁴, Corinne Buysse¹⁵, Adam Cheng¹⁶, Andrea Christoff¹⁷, Kelly Corbett¹⁴, Allan DeCaen¹⁸, Katherine Daniels¹⁹, Gabry deJong¹⁵, Jimena Del Castillo²⁰, Maya Dewan²¹, Aaron Donoghue¹², Ivie Esangbedo²², Michael Flaherty²³, Stuart Friess²⁴, Sandeep Gangadharan²⁵, Orsola Gawronski²⁶, Jonathan Gilleland¹⁶, Heather Griffis²⁷, James Gray²¹, Helen Harvey²⁸, Ilana Harwayne-Gidansky²⁹, Sarah Haskell¹⁰, Jennifer Hayes³⁰, Kiran Heber¹⁹, Betsy Hunt³¹, Takanari Ikeyama³², Priti Jani³³, Monica Kleinman³⁴, Lynda Knight³⁵, Hiroshi Kurosawa³⁶, Kasper Glerup Lauridsen³⁷, Tara Lemoine³⁸, Tensing Maa³⁹, Elizabeth Masse⁴⁰, Luz Marina Mejia⁴¹, Yee Hui Mok⁴², Ryan Morgan¹², Vinay Nadkarni¹², Sholeen Nett¹⁴, Dana Niles¹², Amanda O'Halloran¹², Michelle Olson⁴³, Gene Ong⁴², Prakad Rajapreyar⁴⁴, Tia Raymond⁴⁵, Joan Roberts⁴⁰, Anita Sen⁴⁶, Sophie Skellet⁴⁷, Daniel Stromberg⁴⁸, Felice Su³⁵, Robert Sutton¹², Todd Sweberg⁴⁹, Oscar Tegg⁵⁰, Ken Tegtmeyer⁵¹, Alexis Topjian¹², Wendy Van Ittersum⁵², Javier Urbano Villaescusa⁵³, Ichiro Watanabe⁵⁴, Denise Welsby⁴⁷, Jesse Wenger⁴⁰, Heather Wolfe¹², Andrea Yeo⁵⁵, Pricilla Yu⁵⁶

Affiliations

¹ Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Emergency Department, Randers Regional Hospital, Randers, Denmark; Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA. Electronic address: lauridsekg@email.chop.edu.
² Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, USA.
³ Department of Pediatrics, Cardiac Intensive Care, Medical City Children's Hospital, Dallas, USA.
⁴ Dept of Pediatrics, Division of Critical Care Medicine, UT Southwestern Medical Center, Dallas, USA.
⁵ Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA.
⁶ Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA.
⁷ Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA.
⁸ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA.
⁹ Riley Hospital for Children, Indianapolis, IN, USA.
¹⁰ University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA.
¹¹ Lucile Packard Children's Hospital, Palo Alto, CA, USA.
¹² The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹³ Children's Hospital of San Antonio, San Antonio, TX, USA.
¹⁴ Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
¹⁵ Erasmus MC-Sophia Children's Hospital, Rotterdam, NL, USA.
¹⁶ Alberta Children's Hospital, Calgary, AB, Canada.
¹⁷ Children's Hospital at Westmead, Sydney, NSW, Australia.
¹⁸ Stollery Children's Hospital, Edmonton, AB, Canada.
¹⁹ Children's Healthcare of Atlanta, Atlanta, GA, USA.
²⁰ Hospital Maternoinfantil Gregorio Marañón, Madrid, ES, USA.
²¹ Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
²² Seattle Children's Medical Center, Seattle, WA, USA.
²³ Massachusetts General Hospital, Boston, MA, USA.
²⁴ St. Louis Children's Hospital, St. Louis, MO, USA.
²⁵ Mount Sinai Kravis Children's Hospital, New York, NY, USA.
²⁶ Ospedale Pediatrico Bambino Gesù, Rome, Italy.
²⁷ Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
²⁸ Rady Children's Hospital, San Diego, CA, USA.
²⁹ Albany Medica Center, Albany, NY, USA.
³⁰ Children's Hospital of Orange County, Los Angeles, CA, USA.
³¹ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³² Aichi Children's Health and Medical Center, Obu, Aichi, Japan.
³³ The University of Chicago Medicine Comer Children's Hospital, Chicago, IL, USA.
³⁴ Boston Children's Hospital, Boston, MA, USA.
³⁵ Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.
³⁶ Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
³⁷ The Children's Hospital of Philadelphia, Philadelphia, PA, US; Aarhus University Hospital, Aarhus, Denmark.
³⁸ Valley Children's Hospital, Madera, CA, USA.
³⁹ Nationwide Children's Hospital, Columbus, OH, USA.
⁴⁰ Seattle Children's Hospital, Seattle, WA, USA.
⁴¹ Instituto de Ortopedia Infantil Roosevelt, Bogota, Colombia.
⁴² KK Women's & Children's Hospital, Singapore.
⁴³ Children's Hospital of Richmond, Richmond, VA, USA.
⁴⁴ Children's Hospital of Wisconsin, Milwaukee, WI, USA.
⁴⁵ Medical City Children's Hospital, Dallas, TX, USA.
⁴⁶ NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
⁴⁷ Great Ormond Street Hospital, London, UK.
⁴⁸ Dell Children's Medical Center, Austin, TX, USA.
⁴⁹ Cohen Children's Medical Center, New Hyde Park, NY, USA.
⁵⁰ The Children's Hospital at Westmead, Sydney, NSW.
⁵¹ Cincinnati Children's Hospital, Cincinnati, OH, USA.
⁵² Akron Children's Hospital, Akron, OH, USA.
⁵³ Hospital Maternoinfantil Gregorio Marañón, Madrid, Spain.
⁵⁴ Tokyo Metropolitan Children's Hospital, Fuchū, Tokyo, Japan.
⁵⁵ National University Children's Medical Institute, Singapore.
⁵⁶ UT Southwestern Dallas Children's Medical Center, Dallas, TX, USA.

PMID: 35588971
DOI: 10.1016/j.resuscitation.2022.05.004

Abstract

Objective: To characterize chest compression (CC) pause duration during the last 5 minutes of pediatric cardiopulmonary resuscitation (CPR) prior to extracorporeal-CPR (E-CPR) cannulation and the association with survival outcomes.

Methods: Cohort study from a resuscitation quality collaborative including pediatric E-CPR cardiac arrest events ≥ 10 min with CPR quality data. We characterized CC interruptions during the last 5 min of defibrillator-electrode recorded CPR (prior to cannulation) and assessed the association between the longest CC pause duration and survival outcomes using multivariable logistic regression.

Results: Of 49 E-CPR events, median age was 2.0 [Q1, Q3: 0.6, 6.6] years, 55% (27/49) survived to hospital discharge and 18/49 (37%) with favorable neurological outcome. Median duration of CPR was 51 [43, 69] min. During the last 5 min of recorded CPR prior to cannulation, median duration of the longest CC pause was 14.0 [6.3, 29.4] sec: 66% >10 sec, 25% >29 sec, 14% >60 sec, and longest pause 168 sec. Following planned adjustment for known confounders of age and CPR duration, each 5-sec increase in longest CC pause duration was associated with lower odds of survival to hospital discharge [adjusted OR 0.89, 95 %CI: 0.79-0.99] and lower odds of survival with favorable neurological outcome [adjusted OR 0.77, 95 %CI: 0.60-0.98].

Conclusions: Long CC pauses were common during the last 5 min of recorded CPR prior to E-CPR cannulation. Following adjustment for age and CPR duration, each 5-second incremental increase in longest CC pause duration was associated with significantly decreased rates of survival and favorable neurological outcome.

Keywords: Cardiopulmonary resuscitation; Chest compression pauses; Extracorporeal circulation; In-hospital cardiac arrest; Pediatrics; Survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiopulmonary Resuscitation*
Catheterization
Child
Child, Preschool
Cohort Studies
Humans
Out-of-Hospital Cardiac Arrest* / therapy
Thorax