Abstract 236: Clinician-reported Physiologic Monitoring Of Cardiopulmonary Resuscitation Quality During Pediatric In-hospital Cardiac Arrest: A Propensity-weighted Cohort Study

Abstract

Objectives: The primary objective was to investigate the association between clinician-reported use of end-tidal CO2 (ETCO2) or diastolic blood pressure (DBP) to monitor cardiopulmonary resuscitation (CPR) quality during pediatric in-hospital cardiac arrest (IHCA) and survival outcomes. The secondary objective was to investigate the change in use of ETCO2 or DBP monitoring over time. Design: A retrospective cohort study was performed in two cohorts: 1) Patients with an invasive airway in place at the time of arrest to evaluate ETCO2 use, and 2) patients with an arterial line in place at the time of arrest to evaluate DBP use. The primary exposure was clinician-reported use of ETCO2 and DBP in each respective cohort. The primary outcome was return of spontaneous circulation (ROSC). Propensity-weighted logistic regression evaluated the association between monitoring and outcomes. The proportions of patients with clinician-reported ETCO2 or DBP monitoring were examined per calendar year. Setting: Hospitals reporting to the American Heart Association’s Get With The Guidelines ® - Resuscitation registry. Patients: Children <18 years of age with an index IHCA arrest lasting at least one minute who had an invasive airway or arterial line in place at the time of arrest. Interventions: None. Measurements and Main Results: Between 2007 and 2021, 9710 arrests met all inclusion and exclusion criteria: 6824 in the invasive airway cohort and 2886 in the arterial line cohort. Clinicians reported using ETCO2 to monitor CPR quality in 1333 (20%) arrests and DBP in 1042 (36%). Neither ETCO2 nor DBP monitoring was associated with ROSC. Among secondary outcomes, ETCO2 monitoring was associated with higher odds of return of circulation (ROC; ROSC plus extracorporeal CPR [ECPR] (aOR 1.21 [1.03, 1.42], p = 0.02) and 24-hour survival (aOR 1.16 [1.00, 1.34], p = 0.04). Clinician-reported use of both ETCO2 and DBP monitoring increased over time (p < 0.001). Conclusions: Despite increasing clinician-reported use of physiologic monitoring during IHCA, neither ETCO2 nor DBP monitoring was associated with ROSC. Monitoring of ETCO2 was associated with ROC and 24-hour survival.