Abstract 19313: Characteristics of CPR Performance Metrics Early vs Late in Pediatric In-hospital Resuscitations

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Introduction: Compliance with CPR performance metrics during pediatric in-hospital cardiac arrest (IHCA) is associated with outcome. The evolution of CPR performance over time (early vs. late) has not been described.

Hypothesis: During pediatric IHCA events >25 min, compliance of CPR performance (CC rate, depth, fraction) with 2015 American Heart Association (AHA) pediatric Basic Life Support (BLS) guidelines will be better early (min 3-8) vs. late (min 20-25).

Methods: Using a multicenter prospective observational cohort from 2015 to 2017, we analyzed pediatric (age <18 yr) IHCA events of >25 min with quantitative CPR metrics (Zoll R-series, Chelmsford, MA) across 13 international sites. ECMO-CPR events were excluded. Average CC rate, depth, and fraction (CCF) were calculated for 60-sec epochs in early (min 3-8) and late (min 20-25) periods of CPR. Performance targets were defined as: CC rate 100-120/min; depth ≥4.0 cm in <1 yo, and ≥5 to ≤6 cm in 1-<18 yo; and CCF ≥0.80. Descriptive summaries, chi-square and Wilcoxon signed rank test were used where appropriate.

Results: Of 137 events, 35 were ≥25 min in duration with quantitative CC data. There were 12 (34%) <1yo, and 23 (66%) 1-<18yo events, yielding 350 sixty-sec epochs. CPR events were median duration of 46 min (IQR 38, 60). For those <1 yo, median (IQR) metrics were: early vs. late CC rate 119/min (109, 128) vs. 117/min (110, 122), and depth 2.2 cm (2.0, 3.2) vs. 2.3 cm (1.9, 2.8) were not significantly different (p>0.05); but early CCF 0.72 (0.40, 0.96) was lower than late CCF 0.93 (0.64, 1.00), (p=.04). For those 1-<18yo: early vs. late CC rate 116/min (109, 121) vs. 117/min (110, 121); depth 4.2 cm (3.1, 5.3) vs. 4.5 cm (2.8, 5.7); and CCF 0.93 (0.8, 1.00) vs. 0.94 (0.83, 1.00) were not significantly different (p >.05). Proportion of CPR epochs meeting AHA targets were not significantly different for early vs. late CC rate (54% vs 58%, p>.05), depth (12% vs. 16%, p>.05), or CCF (63% vs. 74%, p>.05).

Conclusion: During pediatric IHCA events >25 min duration, CC rate and depth metrics and compliance with 2015 AHA BLS guidelines were not significantly different during early (min 3-8) vs late (min 20-25) CPR. However, CC fraction and compliance with AHA BLS guidelines were improved during late CPR, specifically in those <1 yr of age.

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