Abstract 274: Association of Tracheal Intubation Associated Interruptions in Cardiopulmonary Resuscitation and Chest Compression Fraction During Pediatric Cardiac Arrest: A Report From the Videography in Pediatric Resuscitation Collaborative

Abstract

Background: Performing tracheal intubation during pediatric cardiopulmonary resuscitation has been consistently associated with worsened clinical outcomes in observational studies. One theoretical explanation for these differences is that pauses in chest compressions during attempt(s) at TI result in a decreased chest compression fraction (CCF). Objective: To examine the impact of TI attempts on CCF in children during CPR in a network of tertiary pediatric EDs. Methods: Prospective observation study from the Videography In Pediatric Resuscitation (VIPER) Collaborative. All patients receiving CPR under videorecorded conditions were eligible for enrollment. Using video review, data was collected on CPR duration, TI attempts, and the occurrence and duration of CPR interruptions during TI attempts. CCF was calculated as the total duration of CPR (100%) minus the total time of all CPR interruptions (including pauses for TI). Using nonparametric methods, univariate comparison was made between CPR events with TI-associated CPR interruptions versus CPR events without TI associated interruptions (i.e. CPR event with CPR uninterrupted during TI attempts or with no TI attempts made). Results: 111 CPR events across four sites were analyzed. The median CCF across all events was 92% (IQR 87 - 94%). At least one TI attempt was made in 40/111 (36%) of CPR events; 29/40 (75%) of these CPR events had at least 1 CPR interruption associated with TI attempt(s). There was no significant difference in CCF between CPR events with at least one TI attempt and CPR events without any TI-associated pauses (89% vs. 92%, p=0.06). Conclusions: Pediatric cardiac arrests with TI attempts made during CPR did not have significantly shorter CCF than arrests without TI attempts. Our findings refute the hypothesis that worsened clinical outcomes in children who undergo TI during CPR are due to poorer CCF, and further research should try to examine other explanations for the association between TI during CPR and poor outcomes.