Chest Compression Release Velocity and Associated Clinical Outcomes in Pediatric Cardiac Arrest

Saturday, January 21, 2023

5:45 PM – 6:00 PM PT

Location: 308

First Author(s)

Thomas E. Rappold, MD

Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania

Disclosure information not submitted.

Co-Author(s)

HJ

Hayes Jennifer, MSN, RN, CCRN-K

Supervisor, Resuscitation Program
Children's Hospital of Orange County, United States

Disclosure information not submitted.
DN

Dana Niles, MS

Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

Disclosure information not submitted.
ZX

Zhang Xuemi, N/A

Research Statistician
Children’s Hospital of Philadelphia, United States

Disclosure information not submitted.
HG

Heather Griffis, PhD

Director of Data Science and Biostatistics
Children's Hospital of Philadelphia, United States

Disclosure information not submitted.
AS

Annemarie Silver, N/A

Vice President, Clinical and Scientific Affairs at ZOLL Medical
Zoll Medical Corporation, United States

Disclosure information not submitted.
MB

Marc Berg, MD

Clinical Professor
Stanford University School of Medicine, United States

Disclosure information not submitted.
Robert M. Sutton, MD, FCCM

Professor of Anesthesia, Critical Care, & Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

Disclosure information not submitted.
HW

Heather A. Wolfe, MD,

Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

Disclosure information not submitted.
Tia Raymond, MD, FAAP, FAHA

Pediatric Cardiac Intensivist
Pediatric Cardiac Intensivists of North Texas, PLLC
Dallas, Texas

Disclosure(s): New England Research Institute: Consultant (Ongoing)
Vinay Nadkarni, MD, MS, FCCM (he/him/his)

Professor, Anesthesiology, Critical Care and Pediatrics
University of Pennsylvania Perelman School of Medicine, CHOP
Media, Pennsylvania, United States

Disclosure(s): Defibtech: Grant/Research Support (Ongoing); HeartHero: Grant/Research Support (Ongoing); Laerdal Medical: Grant/Research Support (Ongoing); Nihon-Kohden: Grant/Research Support (Ongoing); RQI Partners, LLC: Grant/Research Support (Ongoing); Zoll Medical: Grant/Research Support (Ongoing)

Disclosure(s):

Tia Raymond, MD, FAAP, FAHA: New England Research Institute: Consultant (Ongoing)

Vinay Nadkarni, MD, MS, FCCM: Defibtech: Grant/Research Support (Ongoing); HeartHero: Grant/Research Support (Ongoing); Laerdal Medical: Grant/Research Support (Ongoing); Nihon-Kohden: Grant/Research Support (Ongoing); RQI Partners, LLC: Grant/Research Support (Ongoing); Zoll Medical: Grant/Research Support (Ongoing)

INTRODUCTION: Adult studies of out-of-hospital cardiac arrest show an association of chest compression release velocity (CCRV) with improved survival outcomes. Outcome data for CCRV in pediatrics is not known. Our primary hypothesis is that CCRV is associated with return of spontaneous circulation (ROSC) following pediatric in-hospital cardiac arrest.

METHODS : Using a multicenter prospective observational cohort from 2015 to 2021, we analyzed patients < 18 years who received cardiopulmonary resuscitation (CPR) with quantitative metrics across 30 sites. The CCRV up to the first ten minutes was analyzed. ROSC was assessed for all 464 events and survival to hospital discharge (SHD)/favorable neurologic outcome in 341 index events. Chi-square tests were used to compare outcomes between CCRV “slow” (lowest 25%ile) and “fast” (highest 25%ile). Mixed effect logistic regression models were used to evaluate the relationship between CCRV and survival outcomes.

RESULTS: There were 464 ( < 1 yr N=163, 1– < 8 yr N=156, and 8 – < 18 yrs N=145) total events and 341 ( < 1 yr N=119, 1 – < 8 yrs N=112, and 8 – < 18 yrs N=110) index events used for the analysis. Median (IQR) CCRV in first ten minutes for < 1 yr: 157 (125, 189) mm/s; 1 – < 8 yr: 228 (180, 274) mm/s; and 8 – < 18 yr: 393 (281, 471) mm/s. Within each age bracket, there was no significant association of lower 25%ile (“slow”) compared with upper 25%ile (“fast”) CCRV for ROSC ( < 1 yr slow 60% vs fast 58% (p>0.99); 1 – < 8 yr slow 51% vs fast 56% (p=0.82); 8– < 18 yrs slow 56% vs fast 50% (p=0.81). There was no significant association of slow vs fast CCRV with SHD or favorable neurologic outcome in each age group (p>0.09 for all tests). After adjusting for a priori variables of illness category, shockable/non-shockable rhythm, time of day/week, and clustering in site/patient covariates, the mixed effect logistic regression demonstrated no significant difference comparing slow vs fast CCRV in ROSC, (OR=0.88, CI [0.60,1.29], p=0.50), SHD (OR=1.26, CI [0.75,2.11], p=0.39) or survival with favorable neurologic outcome (OR=1.08, CI [0.56, 2.10], p=0.81).

CONCLUSIONS: In this cohort of pediatric in-hospital cardiac arrest patients with CCRV recorded during CPR, CCRV was not significantly associated with ROSC, SHD, or favorable neurologic outcome.