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

Kasper G. Lauridsen*, Javier J. Lasa, for the pediRES-Q Investigators, 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

*Corresponding author for this work

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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.

Original languageEnglish
Pages (from-to)85-92
Number of pages8
JournalResuscitation
Volume177
DOIs
Publication statusPublished - Aug 2022

Bibliographical note

Funding
The pediRES-Q is supported by an unrestricted research grant to the Children’s Hospital of Philadelphia from ZOLL Medical. The sponsor had no role in the design, interpretation, writing, editing, or submission of the manuscript.

Publisher Copyright: © 2022 The Author(s)

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