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

• Published in: Resuscitation 2022-08, Vol.177, p.85-92
• Main Authors: Lauridsen, Kasper G., Lasa, Javier J., Raymond, Tia T., Yu, Priscilla, Niles, Dana, Sutton, Robert M., Morgan, Ryan W., Fran Hazinski, Mary, Griffis, Heather, Hanna, Richard, Zhang, Xuemei, Berg, Robert A., Nadkarni, Vinay M., Abulebda, Kamal, Atkins, Diane, Balikai, Shilpa, Berg, Marc, Berg, Robert, Bhalala, Utpal, Braga, Matthew S., Buysse, Corinne, Cheng, Adam, Christoff, Andrea, Corbett, Kelly, DeCaen, Allan, Daniels, Katherine, deJong, Gabry, del Castillo, Jimena, Dewan, Maya, Donoghue, Aaron, Esangbedo, Ivie, Flaherty, Michael, Friess, Stuart, Gangadharan, Sandeep, Gawronski, Orsola, Gilleland, Jonathan, Gray, James, Harvey, Helen, Harwayne-Gidansky, Ilana, Haskell, Sarah, Hayes, Jennifer, Heber, Kiran, Hunt, Betsy, Ikeyama, Takanari, Jani, Priti, Kleinman, Monica, Knight, Lynda, Kurosawa, Hiroshi, Glerup Lauridsen, Kasper, Lemoine, Tara, Maa, Tensing, Masse, Elizabeth, Marina Mejia, Luz, Hui Mok, Yee, Morgan, Ryan, Nadkarni, Vinay, Nett, Sholeen, O'Halloran, Amanda, Olson, Michelle, Ong, Gene, Rajapreyar, Prakad, Raymond, Tia, Roberts, Joan, Sen, Anita, Skellet, Sophie, Stromberg, Daniel, Su, Felice, Sutton, Robert, Sweberg, Todd, Tegg, Oscar, Tegtmeyer, Ken, Topjian, Alexis, Van Ittersum, Wendy, Urbano Villaescusa, Javier, Watanabe, Ichiro, Welsby, Denise, Wenger, Jesse, Wolfe, Heather, Yeo, Andrea, Yu, Pricilla
• Format: Article
• Language: English
• Subjects: Cardiopulmonary resuscitation; Chest compression pauses; Extracorporeal circulation; In-hospital cardiac arrest; Pediatrics; Survival
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2022.05.004

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. 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. 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]. 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.