Abstract 208: Patient And Event Characteristics Associated With Duration Of Resuscitation In Children Undergoing In-hospital Cpr

Abstract

Introduction: Duration of cardiopulmonary resuscitation (CPR) in patients without return of spontaneous circulation (ROSC) is a proxy measure for the persistence of intense resuscitation efforts. We evaluated the association between patient and event characteristics and resuscitation duration among children who did not survive a CPR event. Methods: Retrospective cohort study using the American Heart Association’s Get With The Guidelines ® -Resuscitation registry. Pediatric CPR events without ROSC (non-survivors) from 2000-2021 were included. Multivariable hierarchical logistic regression evaluated which patient and event characteristics with a bivariate association (p<0.05) were associated with CPR duration among non-survivors. Results: Of 13,899 eligible pediatric CPR events, 3850 did not have ROSC and comprised the primary cohort. Median CPR duration was 28 min (IQR: 16-46 min). After multivariable adjustment, several patient and event characteristics were associated with CPR duration. CPR duration was briefer by: age group (neonates compared to older children [-4.9 min, 95% CI: -8.9 to -0.9 min, p=0.02]); need for mechanical ventilation (-7.6 min [95% CI: -10.3 to -4.9 min, p<0.001); and event location: ED vs. PICU (-4.0 min [95% CI: -7.5 to -0.6 min], p=0.02). CPR duration was longer by initial event rhythm as compared with asystole: bradycardia (8.4 min [95% CI: 5.7 to 11.0 min], p<0.001); PEA (8.2 min [95% CI: 5.7 to 11.0 min), p<0.001), and pulseless VT (6.2 min [95% CI: 0.1 to 12.3 min], p=0.047). CPR duration was similar by sex and race. Conclusions: Several factors including age, rhythm, and event location are associated with resuscitation duration in pediatric patients requiring CPR but there were no sex or racial differences. Further investigation is needed to determine current practices regarding termination of resuscitation and to generate guidelines for this complex decision-making.