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Influence of Chest Compression Duration on Pediatric In-Hospital Cardiac Arrest Survival

07 May 2024
pediatric cardiac arrest

The impact of chest compression (CC) pause duration on survival outcomes in pediatric in-hospital cardiac arrests remains unclear, despite the American Heart Association’s recommendation to limit pauses to less than 10 seconds for children without solid evidence. A recent study published in Circulation explored whether longer maximum CC pause durations correlate with poorer survival and neurological outcomes.

Researchers conducted a cohort study analyzing data from pediatric in-hospital cardiac arrests reported in pediRES-Q (Quality of Pediatric Resuscitation in a Multicenter Collaborative) between July 2015 and December 2021. They examined the association between the longest CC pause duration for each event, categorized in 5-second increments, with survival and favorable neurological outcome. Secondary exposures included any pause longer than 10 seconds or 20 seconds, as well as the number of pauses exceeding these durations per 2 minutes.

Investigators reported 562 index in-hospital cardiac arrests with a median age of 2.9 years, 43% of whom were female, and 13% had a shockable rhythm. The median length of the longest CC pause for each event was 29.8 seconds. After adjusting for confounding factors, each 5-second increase in the longest CC pause duration was associated with a 3% decrease in the relative risk of survival with favorable neurological outcome. Longer CC pause duration was also linked to lower rates of survival to hospital discharge and return of spontaneous circulation. Secondary outcomes showed that any pause longer than 10 seconds or 20 seconds, and an increased number of pauses exceeding these durations, were significantly associated with lower rates of return of spontaneous circulation, but not with survival or neurological outcomes.

The authors concluded that each 5-second increment in the longest CC pause duration during pediatric in-hospital cardiac arrest was found to be associated with reduced chances of survival with favorable neurological outcome, survival to hospital discharge, and return of spontaneous circulation. While longer CC pauses were linked to poorer outcomes, the association was primarily with return of spontaneous circulation rather than survival or neurological outcomes.

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Original article: Lauridsen KG et al. Circulation 2024; 149: 1493-1500.

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