Abstract 18265: Determining the Adequacy of Pediatric CPR: CPP Associated With ROSC

Abstract

Introduction: Human adult studies have shown that the coronary perfusion pressure (CPP) correlates positively with return of spontaneous circulation (ROSC) during CPR. Paradis et al have shown that a CPP of at least 15 mmHg during CPR was associated with ROSC in adult patients. We reviewed in-hospital CPR of pediatric patients between July 2010 and June 2012 at Arkansas Children’s hospital (ACH), who were admitted to the PICU or CVICU at the time of the cardiac arrest and had monitoring lines allowing determination of CPP. Hypothesis: We hypothesized that CPP increases during CPR and the necessary CPP for ROSC in pediatric patients is lower than reported for adults. Methods: Patients with cardiac arrests were identified through ACH CPR registry. CPP was calculated by subtracting the end-diastolic central venous pressure (CVP) from the end-diastolic arterial blood pressure (BP), representing the CPP prior to the next chest compression as defined by the Utstein criteria. We identified 43 patients that had invasive arterial BP and CVP monitoring at the time of the cardiac arrest. Complete monitoring data was available for 10 patients. The mean CPP was calculated in 15 seconds epochs. Results: The mean age for our 10 patients was 320 days (range 12 days - 5.53 years). 8 of the 10 patients had a diagnosis of congenital heart disease and 7 of these 8 patients were admitted to the CVICU for postoperative care. 6 patients were male and 4 were female. Mean weight was 5.8 kg. The mean duration of CPR was 194 seconds. All patients had ROSC; however one patient died within 24 hours of the cardiac arrest, two patients died more than 24 hours after the cardiac arrest. 7 of the 10 patients survived to hospital discharge. Mean CPP was significantly higher for the last 15 second epoch before ROSC compared to the initial 15 second epoch of CPR (22.96 mmHg (SD +/- 9.96 mmHg vs. 5.4 mmHg (SD: +/- 8.2 mmHg), P<0.001). The mean CPP for the minute of CPR prior to ROSC was 15.95 mmHg (standard deviation (SD): +/- 4.8 mmHg). Conclusion: CPP increased during CPR and was significantly higher just prior to ROSC. Mean values in the minute prior to ROSC were similar to that reported in adults. To our knowledge, this is the first descriptive study of CPP during CPR in pediatric patients.