Pediatric Cardiopulmonary Resuscitation Research Articles

Infant Cardiopulmonary Resuscitation Quality While Walking Fast: A Simulation Study.

This study focuses on the characteristics (feasibility, resuscitation quality, and physical demands) of infant cardiopulmonary resuscitation (CPR) on the forearm during fast walking, performed by a trained lay rescuer. Twenty-one university students from the infant education degree participated in a randomized crossover simulation study to compare a standard pediatric CPR versus a walking pediatric CPR with a manikin on the rescue forearm. Each rescuer performed 2 resuscitation tests of 2 minutes on the infant manikin. Cardiopulmonary resuscitation, physiological, and perceived effort variables were measured. The quality of chest compressions was higher in standard pediatric CPR than in walking pediatric CPR (72% vs 51%; P < 0.001) and overall CPR quality (59% vs 49%; P = 0.02). There were no differences between ventilation quality (47% vs 46%). Walking pediatric CPR presented a higher percentage of maximum heart rate (52% vs 69%; P < 0.001) and perceived exertion rate (2 vs 5; P < 0.001). Participants walked an average of 197 m during the test. In conclusion, pediatric walking CPR is feasible although it represents a slight quality decrease in a simulation infant CPR setting. The option "CPR while walking fast to a safe place" seems to be suitable in terms of safety both for the victim and the rescuer, as well as CPR quality in special circumstances.

Pediatric cardiopulmonary resuscitation: comparison between emergency department and inpatients setting at a tertiary academic hospital in Oman

Objective: The aim of this study was to compare cardiopulmonary resuscitation (CPR) between emergency department (ED) and inpatients setting at Sultan Qaboos University Hospital (SQUH). Methods: The study was a retrospective cohort chart review of pediatric CPR at Sultan Qaboos University Hospital (SQUH) from January 2012 till August 2017. The CPR sheets were reviewed for four main variables: patient related, event related, treatment and outcomes. Results: A total of 83 cases were included, 48 males (58%) and 35 females (42%). Two Thirds of the patients (n=56) were in-patient; whereas one third of cases were from ED (n=27). Overall, most common cause for arrest that accounted 73.5% (n=61) was due to respiratory arrest. Events were more common in younger age group with 50% in less than 1 year (n=41). Bradycardia with hypo-perfusion represented most of arrest type 65% (n=54) followed by asystole 31% (n=26). Only 10% of patient survived to discharge (n=8). In comparison, 89% of ED arrest were unwitnessed. On the other hand, PICU and ward arrests predominantly were monitored 98% (n=55). ED patients’ survival appeared better at 19.2% (n=5) within 24hrs post arrest and 11.5% (n=3) within 1-year in comparison to PICU/Ward of 8.9% (n=5) survival within 24hrs and 1-year post event yet it was not statistically significant. Conclusion: The survival outcome in resuscitation was almost similar between ED &amp; In-patient setting (PICU/wards) cardiopulmonary arrests despite having few significant differences based on variables. Overall, 10% of patients survived to discharge and higher survival rates are associated with duration of CPR less than 20 minutes . Intraosseous route is underutilized and should be applied earlier especially in ED to prevent delay in administration of resuscitation medications.

Novedades en las recomendaciones de reanimación cardiopulmonar pediátrica y líneas de desarrollo en España

ObjectivesTo analyse the 2020 international and European recommendations for paediatric cardiopulmonary resuscitation (CPR), highlight the most important changes and propose lines of development in Spain. MethodsCritical analysis of the paediatric cardiopulmonary resuscitation recommendations of the European Resuscitation Council. ResultsThe most relevant changes in the CPR recommendations for 2020 are in basic CPR the possibility of activating the emergency system after performing the five rescue ventilations with the mobile phone on loudspeaker, and in advanced CPR, bag ventilation between two rescuers if possible, the administration of epinephrine as soon as a vascular access is obtained, the increase in the respiratory rate in intubated children between 10 and 25bpm according to their age and the importance of controlling the quality and coordination of CPR. In CPR training, the importance of training non-technical skills such as teamwork, leadership and communication and frequent training to reinforce and maintain competencies is highlighted. ConclusionsIt is essential that training in paediatric CPR in Spain follows the same recommendations and is carried out with a common methodology, adapted to the characteristics of health care and the needs of the students. The Spanish Paediatric and Neonatal Cardiopulmonary Resuscitation Group should coordinate this process, but the active participation of all paediatricians and health professionals who care for children is also essential.

Evaluating Knowledge Level of the Medical Students about Children Cardiopulmonary Resuscitation in Aliebne University of Medical Science

Introduction: Awareness of pediatric cardiopulmonary resuscitation (CPR) is obligatory for every graduated medical student. In fact, only correct and effective Cardiopulmonary resuscitation can increase the survival rate of patients with cardiopulmonary arrest and since CPR techniques and maneuvers should be done in a specific way for children, it is important to evaluate the knowledge of pediatric resuscitation. Methods: In a cross-sectional study, multiple-choice questions were designed about basic and advanced pediatric cardiopulmonary resusitation (under 8 years) and 100 medical students enrolled in undergraduate training. Results were analyzed using the software SPSS 15. Results: The interns' advanced awareness was significantly less than the basic knowledge (P-Value &lt; 0.001). The awareness of students who studied in CPR was higher than students who did not (P-Value &lt; 0.027). Moreover, students who participated in the rehabilitation of children were more aware (P-Value &lt; 0.002) and interns who attended the Heart Ward had a higher level of awareness (P-Value &lt; 0.001). Conclusion: In general, results obtained from the interns' awareness in the present showed the importance of pediatric resuscitation training courses and participation in resuscitation operations. So, this training course should be considered as a training strategy course in the internship program.

Can Video Assistance Improve the Quality of Pediatric Dispatcher-Assisted Cardiopulmonary Resuscitation?

This study aimed to evaluate the impact of adding video conferencing to dispatcher-assisted telephone cardiopulmonary resuscitation (CPR) on pediatric bystander CPR quality. We conducted a prospective, randomized manikin study among volunteers with no CPR training and among bachelor nurses. Volunteers randomly received either video or audio assistance in a 6-minute pediatric cardiac arrest scenario. The main outcome measures were the results of the Cardiff Test to assess compression and ventilation performance. Of 255 candidates assessed for eligibility, 120 subjects were randomly assigned to 1 of the 4 following groups: untrained telephone-guided (U-T; n = 30) or video-guided (U-V; n = 30) groups and trained telephone-guided (T-T; n = 30) or video-guided (T-V; n = 30) groups. Cardiac arrest was appropriately identified in 86.7% of the U-T group and in 100% in the other groups (P = 0.0061). Hand positioning was adequate in 76.7% of T-T, 80% of T-V, and 60% of U-V, as compared with 23.4% of the U-T group (P = 0.0001). Fewer volunteers managed to deliver 2 rescue breaths/cycle (P = 0.0001) in the U-T (16.7%) compared with the U-V (43.3%), the T-T (56.7%), and the T-V groups (60%).Subjects in the video groups had a lower fraction of minute to ventilate as compared with the telephone groups (P = 0.0005). In dispatcher-instructed children CPR simulation, using video assistance improves cardiac arrest recognition and CPR quality with more appropriate chest compression technique and ventilation delivering. The long interruptions in chest compression combined with the mixed success rate to deliver proper ventilation raise question about ventilation quality and its effectiveness.

"Elbow-Lock" Chest Compression Method in the Setting of Single Rescuer Pediatric Cardiopulmonary Resuscitation: A Crossover Simulation Study.

We designed a new 1-handed chest compression method, the "elbow-lock" chest compression (ELCC), for a single rescuer in pediatric cardiopulmonary resuscitation (CPR). Then, we compared the effectiveness between the ELCC and standard chest compression (SCC) method. This prospective, randomized controlled, crossover simulation trial studied 34 emergency medical professionals, including physicians, nurses, and EMTs. We compare the quality of chest compression and fatigue point time between the ELCC and the SCC. Participants who performed the ELCC method maintained a proper depth of compression compared with SCC method (50.0 ± 0.3 mm vs 40.5 ± 0.4 mm, P < 0.001). However, the 2 methods did not differ in terms of compression velocity since neither reached the standard velocity (96.7 ± 7.1/minutes vs 91.7 ± 7.0/minutes, P < 0.016). With respect to the overall score, ELCC was more effective than the SCC (91.6 ± 3.7% vs 85.3 ± 8.8%, P = 0.002). In addition, the fatigue point time was slower in the ELCC group than the SCC group (7.3 ± 0.3/minutes vs 6.1 ± 0.4/minutes, P < 0.001). The single rescuer ELCC method is an effective alternative to the SCC method for pediatric CPR because the ELCC method can prevent elbow flexion.Trial registration: Our research is simulation manikin study. So we do not need to "trial registration".

Pediatric Emergency Medical Care in Yerevan, Armenia: A Knowledge and Attitudes Survey of Out-of-hospital Emergency Nurses

BackgroundEmergency Medical Services (EMS) system in Armenia follows the Franco-German model in which physician - nurse dyads staff ambulances. This study aims to evaluate the knowledge and attitudes of EMS nurses regarding pediatric rapid assessment and resuscitation. MethodsThis is a cross-sectional, anonymous, self-administered survey study of a convenience sample of 200 out-of-hospital emergency nurses in June and July 2015. ResultsResponse rate was 87.5%. Half of respondents failed to achieve the pre-defined passing score of 70% on the 10-question knowledge test (sample mean 6.32 ± 1.85 SD). Test score was positively correlated with pediatric training, current pediatric continuing medical education (CME), years with EMS and female gender. Questions regarding recognition of shock and initiation of neonatal and pediatric cardiopulmonary resuscitation were most frequently missed. Nurses were least confident in their ability to care for neonates and infants. 79.4% indicated that they would benefit from further pediatric training, and 86.1% indicated that knowledge from the Anglo-American model of emergency medicine could improve pediatric emergency care (PEC) in Armenia. ConclusionsThere is a need for additional PEC training and continuing education for EMS nurses in Yerevan, Armenia. Training EMS nurses would improve first responder awareness of pediatric acute management and resuscitation and enhance the quality of emergency care of children.

Impact of a shared decision-making mHealth tool on caregivers\u2019 team situational awareness, communication effectiveness, and performance during pediatric cardiopulmonary resuscitation: study protocol of a cluster randomized controlled trial

BackgroundEffective team communication, coordination, and situational awareness (SA) by team members are critical components to deliver optimal cardiopulmonary resuscitation (CPR). Complexity of care during CPR, involvement of numerous providers, miscommunication, and other exogenous factors can all contribute to negatively influencing patient care, thus jeopardizing survival. We aim to investigate whether an mHealth supportive tool (the Interconnected and Focused Mobile Apps on patient Care Environment [InterFACE]) developed as a collaborative platform to support CPR providers in real-time and share patient-centered information would increase SA during pediatric CPR.MethodsWe will conduct a prospective, cluster randomized controlled trial by groups of 6 participants in a tertiary pediatric emergency department (33,000 consultations/year) with pediatric physicians and nurses. We will compare the impact of the InterFACE tool with conventional communication methods on SA and effective team communication during a standardized pediatric in-hospital cardiac arrest and a polytrauma high-fidelity simulations. Forty-eight participants will be randomized (1:1) to consecutively perform two 20-min video-recorded scenarios using either the mHealth tool or conventional methods. The primary endpoint is the SA score, measured with the Situation Awareness Global Assessment Technique (SAGAT) instrument. Enrollment will start in late 2020 and data analysis in early 2021. We anticipate that the intervention will be completed by early 2021 and study results will be submitted in mid 2021 for publication.DiscussionThis clinical trial will assess the impact of a collaborative mHealth tool on increasing situational awareness and effective team communication during in-hospital pediatric resuscitation. As research in this area is scarce, the results generated by this study may become of paramount importance in improving the care of children receiving in-hospital CPR, in the era of increasing communication technology.Trial registrationClinicalTrials.gov NCT04464603. Registered on 9 July 2020.

A randomized and blinded trial of inhaled nitric oxide in a piglet model of pediatric cardiopulmonary resuscitation

AimInhaled nitric oxide (iNO) during cardiopulmonary resuscitation (CPR) improved systemic hemodynamics and outcomes in a preclinical model of adult in-hospital cardiac arrest (IHCA) and may also have a neuroprotective role following cardiac arrest. The primary objectives of this study were to determine if iNO during CPR would improve cerebral hemodynamics and mitochondrial function in a pediatric model of lipopolysaccharide-induced shock-associated IHCA. MethodsAfter lipopolysaccharide infusion and ventricular fibrillation induction, 20 1-month-old piglets received hemodynamic-directed CPR and were randomized to blinded treatment with or without iNO (80 ppm) during and after CPR. Defibrillation attempts began at 10 min with a 20-min maximum CPR duration. Cerebral tissue from animals surviving 1-h post-arrest underwent high-resolution respirometry to evaluate the mitochondrial electron transport system and immunohistochemical analyses to assess neuropathology. ResultsDuring CPR, the iNO group had higher mean aortic pressure (41.6 ± 2.0 vs. 36.0 ± 1.4 mmHg; p = 0.005); diastolic BP (32.4 ± 2.4 vs. 27.1 ± 1.7 mmHg; p = 0.03); cerebral perfusion pressure (25.0 ± 2.6 vs. 19.1 ± 1.8 mmHg; p = 0.02); and cerebral blood flow relative to baseline (rCBF: 243.2 ± 54.1 vs. 115.5 ± 37.2%; p = 0.02). Among the 8/10 survivors in each group, the iNO group had higher mitochondrial Complex I oxidative phosphorylation in the cerebral cortex (3.60 [3.56, 3.99] vs. 3.23 [2.44, 3.46] pmol O2/s mg; p = 0.01) and hippocampus (4.79 [4.35, 5.18] vs. 3.17 [2.75, 4.58] pmol O2/s mg; p = 0.02). There were no other differences in mitochondrial respiration or brain injury between groups. ConclusionsTreatment with iNO during CPR resulted in superior systemic hemodynamics, rCBF, and cerebral mitochondrial Complex I respiration in this pediatric cardiac arrest model.

Epinephrine Plus Vasopressin vs Epinephrine Plus Placebo in Pediatric Intensive Care Unit Cardiopulmonary Resuscitation: A Randomized Double Blind Controlled Clinical Trial

To compare the efficacy of epinephrine plus vasopressin vs epinephrine plus placebo in the pediatric intensive care unit (PICU) cardiopulmonary resuscitation (CPR). Randomized, double-blind controlled clinical trial. PICU in a tertiary care institute from February, 2019 to May, 2020. Children aged one month to 13 years who required CPR during PICU stay. Patients in whom vascular access was not available or return of spontaneous circulation (ROSC) was achieved by defibrillation without epinephrine were excluded. Patients were randomized to receive vasopressin 0.1 mL per kg (=0.8 unit per kg) or placebo (0.1 mL per kg normal saline) in addition to epinephrine (1:10000) 0.1 mL per kg. The drugs were given as bolus doses every three minutes until the ROSC or up to a maximum of five doses, whichever was earlier. The primary outcome was the proportion of patients who achieved ROSC. The secondary outcomes were survival rate and functional status (at 24-hour, PICU, hospital, and 90-day post-discharge), need for organ supports, length of stay (PICU and hospital), and adverse effect(s) of the study drugs. 90 patients (epinephrine plus vasopressin group, n=45 and epinephrine plus placebo group, n=45) were analyzed on intention-to-treat basis. There was no significant difference in the primary outcome between epinephrine plus vasopressin (n=25, 55.5%) and epinephrine plus placebo groups (n=24, 53.3%) (Relative risk 1.04, 95% CI 0.71 to 1.52). There was no significant difference in survival rate at 24-hour (n=7, 15.6% vs. n=8, 17.8%), at PICU, hospital, and 90-day post-discharge (n=1, 2.2% vs n=1, 2.2%). There was no difference in other secondary outcomes. No trial drug-related serious adverse events were observed. A combination of epinephrine plus vasopressin did not improve the rate of return of spontaneous circulation in the pediatric intensive care unit cardiopulmonary resuscitation as compared with epinephrine plus placebo.

Outcomes of Pediatric Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis.

The goal of this work is to provide insight into survival and neurologic outcomes of pediatric patients supported with extracorporeal cardiopulmonary resuscitation. A systematic search of Embase, PubMed, Cochrane, Scopus, Google Scholar, and Web of Science was performed from January 1990 to May 2020. A comprehensive list of nonregistry studies with pediatric patients managed with extracorporeal cardiopulmonary resuscitation was included. Study characteristics and outcome estimates were extracted from each article. Estimates were pooled using random-effects meta-analysis. Differences were estimated using subgroup meta-analysis and meta-regression. The Meta-analyses Of Observational Studies in Epidemiology guideline was followed and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation system. Twenty-eight studies (1,348 patients) were included. There was a steady increase in extracorporeal cardiopulmonary resuscitation occurrence rate from the 1990s until 2020. There were 32, 338, and 1,094 patients' articles published between 1990 and 2000, 2001 and 2010, and 2010 and 2020, respectively. More than 70% were cannulated for a primary cardiac arrest. Pediatric extracorporeal cardiopulmonary resuscitation patients had a 46% (CI 95% = 43-48%; p < 0.01) overall survival rate. The rate of survival with favorable neurologic outcome was 30% (CI 95% = 27-33%; p < 0.01). The use of extracorporeal cardiopulmonary resuscitation is rapidly expanding, particularly for children with underlying cardiac disease. An overall survival of 46% and favorable neurologic outcomes add credence to this emerging therapy.

Evaluation of the pediatric life support instructors courses

ObjectiveTo evaluate the results and quality of pediatric cardiopulmonary resuscitation (CPR) instructor training courses.MethodsA retrospective analysis was performed of the results of 24 pediatric CPR instructor courses held over 21 years (1999 to 2019). The results of participants’ evaluation of theory and practice sessions were analyzed. In addition, participants were asked to answer an anonymous survey to assess their opinion on the quality of theory and practice lessons, course organization and methodology, and instructor training. The results were compared by professional groups.ResultsA total of 560 participants completed the instructor course. Of them, 554 passed theory and practice tests (98.9 %). The mean score obtained in theory tests was 9.2 (0.8) out of 10. The mean score obtained in all practice tests was > 3.5 out of 5. Participants evaluated all the aspects of the course (theory and practice content, organization, teaching methodology, and instructors) with mean scores over 8 out of 10.ConclusionsSpecific pediatric and neonatal CPR instructor courses are a cornerstone in the process of CPR training and ensuring the homogeneity and quality of training. Most of the participants obtained the qualification of instructors and their evaluation of the course was very positive.

Presence of Family Members During Pediatric Cardiopulmonary Resuscitation: Nursing Students Opinions

Presence of Family Members During Pediatric Cardiopulmonary Resuscitation: Nursing Students Opinions

Workload of learners during simulated paediatric cardiopulmonary resuscitation

IntroductionLearner workload during simulated team-based resuscitations is not well understood. In this descriptive study, we measured the workload of learners in different team roles during simulated paediatric cardiopulmonary resuscitation.MethodsPaediatric emergency...

Abstract 204: Association Between Presence of Advanced Airway and Hyperventilation During Pediatric Cardiopulmonary Resuscitation: A Report from the VIPER Collaborative

Background: Hyperventilation is common during pediatric CPR and has known deleterious hemodynamic consequences. It is not known whether the presence of an advanced airway (AA) is independently associated with hyperventilation. Objective: To determine the independent association between the presence of an AA and hyperventilation during pediatric CPR in a collaborative of pediatric emergency departments using video review during resuscitations. Methods/Design: We present a report from the Videography in Pediatric Emergency Resuscitation (VIPER) Collaborative, a prospective review database. All events where CPR was performed and manual ventilations could be counted for at least 30 seconds were eligible for inclusion. Ventilation rates were counted and expressed in segments corresponding to individual CPR providers (‘compressor segments') and extrapolated to breaths per minute (bpm) where applicable. Hyperventilation was defined as a rate greater than 12 bpm, in accordance with American Heart Association recommendations. Ventilation rates were compared between CPR segments with a natural airway (bag-valve mask device; NA) versus an advanced airway (endotracheal tube or supraglottic airway; AA). Univariate analysis was done by two sided t-testing. Repeated measures logistic regression with random effects modeling (patient as intercept) was performed to determine the independent association of the presence of an AA with hyperventilation. Results/Discussion: 595 compressor segments in 67 CPR events were analyzed. Twenty-six patients underwent intubation and had segments with both NA and AA analyzed. Across all patients, 402/595 (68%) of segments occurred with an AA. Ventilation rates were significantly higher in patients with an AA compared with NA (14 + 10 bpm vs. 24 + 17 bpm, p &lt; 0.001). By multivariate analysis, the presence of an advanced airway was independently associated with hyperventilation (AOR 12.2, 95% CI 5.0 - 30.3) during pediatric CPR. Future studies should examine methods of limiting manual hyperventilation during pediatric CPR, as well as the impact of ventilation rates on patient outcomes.

Abstract 121: A Pre-Clinical Randomized Blinded Trial of Inhaled Nitric Oxide During Pediatric Cardiopulmonary Resuscitation

Introduction: Inhaled nitric oxide (iNO) may result in higher systemic BP during CPR and may have a neuroprotective role post-arrest, but its effects on cerebral perfusion pressure (CePP), cerebral blood flow (CBF), and mitochondrial function when administered during CPR are unknown. Hypotheses: We hypothesized that administration of iNO during CPR would lead to higher CePP, higher CBF, and less brain injury as measured by cerebral mitochondrial function, neuronal apoptosis, and microglial activation. Methods: In 1-month-old swine (n=20), lipopolysaccharide was intravenously infused to induce a shock state, followed by induction of VF and treatment with hemodynamic-directed CPR (HD-CPR). Animals were randomized to blinded treatment with either: 1) HD-CPR with iNO (beginning 1 minute into CPR), or 2) HD-CPR without iNO. Defibrillation attempts began at 10 minutes with a maximum CPR duration of 20 minutes. Among animals surviving 1-hour post-arrest, cerebral tissue underwent high-resolution respirometry to evaluate the mitochondrial electron transport system and quantification of neuronal apoptosis and microglial activation. Chi-square test, Fisher’s exact test, Student’s t-test, Wilcoxon rank-sum test, and a generalized estimating equation regression model compared the two groups. Results: During CPR, the iNO group had higher mean aortic pressure (41.6±2.0 vs. 36.0±1.4 mmHg; p=0.005); diastolic BP (32.4±2.4 vs. 27.1±1.7 mmHg; p=0.03); CePP (25.0±2.6 vs. 19.1±1.8 mmHg; p=0.02); and CBF relative to pre-CPR baseline (243.2±54.1 vs. 115.5±37.2%; p=0.02). Among the 8/10 survivors in each group, the iNO group had higher mitochondrial Complex I oxidative phosphorylation in the cerebral cortex (3.60 [3.56, 3.99] vs. 3.23 [2.44, 3.46] pmol O 2 /s*mg; p=0.01) and hippocampus (4.79 [4.35, 5.18] vs. 3.17 [2.75, 4.58] pmol O 2 /s*mg; p=0.02). There were no other differences in mitochondrial respiration or brain injury between groups. Conclusions: Blinded treatment with iNO during CPR in a model of pediatric shock-associated cardiac arrest resulted in superior CePP, CBF, and cerebral mitochondrial Complex I respiration. These data suggest that iNO treatment during CPR may lead to improved neurologic outcomes from pediatric cardiac arrest.

Abstract 249: Association of Diastolic Blood Pressure and Myocardial Perfusion Pressure with Survival During Pediatric Cardiopulmonary Resuscitation

Introduction: Myocardial perfusion pressure (MPP), defined as the aortic diastolic pressure minus the central venous diastolic pressure, is an important determinant of return of spontaneous circulation (ROSC) in cardiac arrest. However, measuring MPP requires both arterial and venous catheters and is often not possible. When only invasive arterial monitoring is available, diastolic blood pressure (DBP) is suggested as a surrogate for MPP during resuscitation and is also associated with survival after cardiac arrest. Hypothesis: We hypothesized that DBP measured during chest compression delivery would mirror MPP during resuscitation and both would be associated with survival. Methods: We performed a retrospective, secondary analysis of 102 swine resuscitations. Pediatric swine underwent asphyxial cardiac arrest and were resuscitated with predefined periods of basic and advanced life support (BLS and ALS). MPP and DBP were recorded every 30 s during chest compression delivery. Results: For both survivors and non-survivors, DBP mirrored MPP throughout resuscitation ( Figure 1A, B ). During BLS, both MPP and DBP were significantly greater in survivors (MPP: 8.5 0.6 vs. 1.1 0.5 mmHg; p &lt; 0.0001; DBP 17.3 0.6 vs. 8.7 0.5 mmHg; p &lt; 0.0001). During ALS, MPP and DBP were greater in survivors than non-survivors (MPP: 20.5 1.0 vs. 0.7 0.3 mmHg; p &lt; 0.0001; DBP 32.3 0.9 vs. 8.8 0.2 mmHg; p &lt; 0.0001). During ALS, the magnitude of change in both MPP and DBP after the first epinephrine administration in survivors was greater than in non-survivors (MPP: 24.4 3.3 vs. 4.8 0.9 mmHg; p &lt; 0.0001; DBP: 24.5 3.1 vs. 5.4 0.8 mmHg; p &lt; 0.0001). Conclusion: These observations confirm that both DBP and MPP are associated with survival in cardiac arrest and validate the use of DBP as a surrogate for MPP. Figure 1: Myocardial perfusion pressure (MPP) and diastolic blood pressure (DBP) during BLS and ALS in survivors (A) and non-survivors (B). Arrows indicate administration of epinephrine during ALS.

Abstract 132: Cardiopulmonary Resuscitation with Chest Compressions During Sustained Inflations in a Pediatric Porcine Model - A Randomized Control Animal Trial

Background: Pediatric resuscitation guidelines recommend continuous chest compressions (CC) with asynchronized ventilation (CCaV) during cardiopulmonary resuscitation (CPR) once an airway has been secured. However, the optimal CC technique remains unknown. Aim: To determine if CCs during sustained inflations (SI) improves return of spontaneous circulation (ROSC) of asphyxiated pediatric piglets compared to CCaV. Intervention and measurements: Piglets (age 20-23 days) were anesthetized, intubated, instrumented, and asphyxiated. Protocolized resuscitation was initiated when mean arterial blood pressure was &lt;25mmHg with bradycardia. Piglets (n=12/group) were randomized to receive CCaV resuscitation (CCaV group) according to the current resuscitation guidelines, or CC during SI (CC+SI group). The CC+SI group received a SI with a peak inflating pressure of 25 cmH 2 O for 30sec, CCs were provided at a rate of 100/min, and SI was interrupted after 30 sec for one second before a further 30sec SI was provided. CC and SI were continued until ROSC. Respiratory parameters, carotid blood flow, systemic artery pressures, and cerebral oxygenation were measured. Main results: Median (IQR) time to ROSC was significantly decreased in the CC+SI group compared to CCaV with 248 (41-346)sec vs. 720 (167-720)sec (p=0.049), respectively. CC+SI had a 100% higher rate of ROSC compared to CCaV with 10(83%) vs. 5(42%) (p=0.089), respectively. Piglets in the CC+SI group received a median (IQR) 3.5 (0-5.8) intravenous epinephrine boluses compared to 8.0 (1.8-11) in the CCaV group (p=0.123). Conclusions: Combining CC and SI significantly improved time to ROSC and survival in asphyxiated pediatric piglets when compared to the current standard of CCs with CCaV during pediatric CPR.

Abstract 266: Quantifying the Effect of Technological Advancements and Guidelines on Pediatric Extracorporeal Cardiopulmonary Resuscitation Survival Outcomes

Introduction: The 2009 H1N1 pandemic resulted in a substantial increase in the use of extracorporeal cardiopulmonary resuscitation (ECPR). The concurrent release of guidelines by the French Ministry of Health also led to the standardization of ECPR protocol. We conducted a systematic review and meta-analysis to examine if the simultaneous development of guidelines and expanded usage led to an increase in survival to hospital discharge (SHD) in pediatric ECPR and to investigate if predictors of survival have changed since 2009. Methods: PubMed, SCOPUS, Google Scholar, Cochrane, and EMBASE were searched to identify studies examining survival outcome and predictors of survival for pediatric ECPR. A random-effects model was applied. Additional pre-specified subgroup analysis was performed using a fixed-effects model. A univariate meta-regression analysis was conducted. Results: The meta-analysis included 3,454 patients from 30 studies. Total survival rates have not improved in pediatric ECPR between subgroups (Mann-Whitney U test: p &gt; 0.05). Extracorporeal membrane oxygenation (ECMO) duration for survivors was not significantly different than nonsurvivors before 2009 RR -0.02 [95% CI: -0.19 - 0.14], but was significantly lower than nonsurvivors after 2009 RR -0.32 [-0.48 - -0.15, p &lt; 0.05]. Meta-regression analysis revealed the ratio of ECMO duration for survivors compared to non-survivors has significantly decreased from 1998 to 2020 (p &lt; 0.05). Patient age was a significant predictor of survival pre-2009 RR but is not correlated with survival post-2009 (p &gt; 0.05). PaO2 was significantly higher in survivors than nonsurvivors pre-2009 RR 0.15 [0.12 - 0.18, p &lt; 0.05] but was not significantly different post-2009 (p &gt; 0.05). End-tidal CO2, CPR duration, pre-CPR serum lactate, and pre-CPR creatinine were not significantly different (p &gt; 0.05) between survivors and non-survivors in either pre-2009 or post-2009. Conclusion: Pediatric ECPR did not see major improvement in survival rates since 2009. In addition, predictors of survival for pediatric ECPR cases have changed over the last 10 years. As such, clinicians may be advised to rely much more heavily on recent research regarding predictors of survival in pediatric ECPR cases.

Simulation Training in Extracorporeal Cardiopulmonary Resuscitation (ECPR).

Extracorporeal cardiopulmonary resuscitation (ECPR) is the rapid deployment of extracorporeal membrane oxygenation (ECMO) to provide circulatory support to patients in whom conventional CPR is unsuccessful in achieving the return of spontaneous circulation.1 ECPR is a complex, resource-intense, and multidisciplinary therapy.1 Training is essential to perform ECPR well. In “Impacts of a Pediatric Extracorporeal Cardiopulmonary Resuscitation (ECPR) Simulation Training Program”,2 we used a mixed-method, time-series design to examine the impact of high-fidelity ECPR simulations in a tertiary children's hospital.