Abstract 124: Chest Compression Pause Duration is Associated with Worse Survival Outcomes Following Pediatric In-hospital Cardiac Arrest

Abstract

Introduction: The association between chest compression (CC) pause duration and pediatric in-hospital cardiac arrest (IHCA) survival outcomes is unknown. We hypothesized that longer maximum CC pause durations are associated with worse survival and neurological outcomes. Methods: Cohort study of all index pediatric IHCAs (<18 years of age) ≥1 min in the Pediatric Resuscitation Quality (PediRES-Q) Network from July 2015 through December 2019. We used multivariate logistic regression with mixed effects and robust standard errors to analyze association of 5-sec increments of longest CC pause duration with survival and neurologic outcomes. Favorable neurological outcome was defined as Pediatric Cerebral Performance Category (PCPC) at discharge ≤3 or no change from baseline. Results: We identified 371 index IHCAs: median [Q1,Q3] age 2.6 [0.6,9.4] years, female 46%, shockable rhythm 13%, CPR duration 23 [9,47] min. Median length of the longest pause was 17 [8,27] sec. Each 5 sec increase in longest CC pause duration was associated with 6% lower odds for survival with favorable neurological outcome, even after adjusting for age, defibrillation, intubation, extracorporeal CPR, illness category, hypotension as etiology for arrest, CC depth, and clustering by site (aOR 0.94 [95% CI:0.88-0.99], p=0.04). Analyses controlling for the same factors demonstrated an association of longest pause duration with lower odds for survival to hospital discharge (aOR 0.94 [95% CI: 0.90-0.99, p=0.02) and return of spontaneous circulation (aOR 0.91 [(95% CI: 0.86-0.96], p=0.001). Conclusions: Longest CC pause duration is associated with favorable neurological outcome, survival to hospital discharge, and return of spontaneous circulation following pediatric IHCA, even when controlling for known confounders and clustering by site. Each 5 sec. increment in longest CC pause duration was associated with 6% lower odds for survival with favorable neurological outcome.