Compliance with American Heart Association (AHA) Guidelines was defined as a compression rate of 100–120 per minute ( 21). Interruptions in compression delivery were defined as any interruption in compression delivery > 1.5 seconds (i.e., a compression rate < 40). For each minute of CPR, an average of compression rate, CCF, systolic blood pressure, and diastolic blood pressure was calculated (minute-level average), and then for each event, the average of all the available epochs was calculated (event-level average). Chest compression fraction (CCF proportion of time compressions are performed during arrest) was defined as: 1 – (pause time / (60 – missing data time)). Chest compression rate was defined as the “instantaneous” rate between adjacent compressions during periods of uninterrupted compression delivery by the following equation: 60 / time between compressions (sec). For each one minute epoch, the following data points were extracted from the waveform data: 1) the number of compressions given 2) the time (sec) that compressions were not being performed (pause time) 3) total time (sec) that rate could not be determined (e.g., missing data due to arterial line interruption) and 4) mean SBP and DBP (mmHg). The first 10 minutes of CPR data were collected for each event. Please see previous publication for more details regarding the methods of the CPCCRN PICqCPR study ( 16). Blood pressures were extracted from arterial waveform printouts by manual digitization (PlotDigitizer Version 2.0 Department of Physics, University of South Alabama). Because the primary objective of PICqCPR was to associate arterial blood pressure with outcomes, all patients had an arterial line in place at the time of the arrest. Data collected on subjects included Utstein-style standardized cardiac arrest and CPR data ( 17), with assessments of neurological outcomes (pediatric cerebral performance category (PCPC)( 18) and functional status scale (FSS)( 19, 20)) for pre-admission status and at hospital discharge. PICqCPR was approved with waiver of informed consent by the Institutional Review Board at each clinical site and the DCC. This study represents a secondary observational analysis of this multi-center cohort study. īetween July 2013 and June 2016, CPCCRN conducted the PICqCPR Study to evaluate the association between invasively monitored arterial blood pressures during pediatric CPR and cardiac arrest survival outcomes ( 16). Further details on the Network can be found at. The clinical sites and the data coordinating center (DCC) supporting the Network have been funded by the National Institute of Child Health and Human Development since 2004. Using this dataset, the objectives of this investigation were to 1) quantitatively describe compression rates during pediatric cardiac arrest in a multi-institutional collaborative, 2) describe variability in compression rates across the institutions, and 3) associate compression rate with both arterial blood pressure and survival outcomes.ĬPCCRN is a network of pediatric institutions that conducts investigations related to pediatric critical care practice in their pediatric and pediatric cardiac ICUs ( 15). This study prospectively collected data on pediatric cardiac arrests that occurred in the network ICUs over a three-year period. To that end, the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)( 15) Pediatric Intensive Care Unit Quality of CPR (PICqCPR)( 16) study provides a unique opportunity to evaluate chest compression rates across several pediatric institutions. Thus, larger prospective pediatric studies that can evaluate the association between CPR quality metrics and outcomes are necessary. Unfortunately, most of the corresponding pediatric data has been collected from out-of-hospital resuscitations ( 10) or from single center studies ( 3, 11– 14), and may not be generalizable. Several large adult studies have demonstrated that achieving evidence-based targets for chest compression rate ( 4) and depth ( 8), release velocity (i.e., recoil between compressions)( 9), and chest compression fraction ( 5, 6) (i.e., percentage of time that compressions are provided during arrest) improves survival. Of those who survive, neurological morbidity is common ( 1).ĬPR quality has been implicated as a modifiable risk factor to improve survival from cardiac arrest ( 3– 8). Although survival rates have been improving over the last 20 years, still more than half of these children do not live to hospital discharge ( 2). Thousands of hospitalized children are treated with cardiopulmonary resuscitation (CPR) for a cardiac arrest each year in the United States ( 1).
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