Association Between Chest Compression Pause Duration and Survival After Pediatric In-Hospital Cardiac Arrest.

Background: The association between chest compression (CC) pause duration and pediatric in-hospital cardiac arrest survival outcomes is unknown. The American Heart Association has recommended minimizing pauses in CC in children to <10 seconds, without supportive evidence. We hypothesized that longer maximum CC pause durations are associated with worse survival and neurological outcomes.
Methods: In this cohort study of index pediatric in-hospital cardiac arrests reported in pediRES-Q (Quality of Pediatric Resuscitation in a Multicenter Collaborative) from July of 2015 through December of 2021, we analyzed the association in 5-second increments of the longest CC pause duration for each event with survival and favorable neurological outcome (Pediatric Cerebral Performance Category ≤3 or no change from baseline). Secondary exposures included having any pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds per 2 minutes.
Results: We identified 562 index in-hospital cardiac arrests (median [Q1, Q3] age 2.9 years [0.6, 10.0], 43% female, 13% shockable rhythm). Median length of the longest CC pause for each event was 29.8 seconds (11.5, 63.1). After adjustment for confounders, each 5-second increment in the longest CC pause duration was associated with a 3% lower relative risk of survival with favorable neurological outcome (adjusted risk ratio, 0.97 [95% CI, 0.95-0.99]; P =0.02). Longest CC pause duration was also associated with survival to hospital discharge (adjusted risk ratio, 0.98 [95% CI, 0.96-0.99]; P =0.01) and return of spontaneous circulation (adjusted risk ratio, 0.93 [95% CI, 0.91-0.94]; P <0.001). Secondary outcomes of any pause >10 seconds or >20 seconds and number of CC pauses >10 seconds and >20 seconds were each significantly associated with adjusted risk ratio of return of spontaneous circulation, but not survival or neurological outcomes.
Conclusions: Each 5-second increment in longest CC pause duration during pediatric in-hospital cardiac arrest was associated with lower chance of survival with favorable neurological outcome, survival to hospital discharge, and return of spontaneous circulation. Any CC pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds were significantly associated with lower adjusted probability of return of spontaneous circulation, but not survival or neurological outcomes.
Competing Interests: Disclosures Dr Lauridsen received funding from the AP Møller Foundation and EliteForsk from the Danish Ministry for Higher Education and Research. Dr Nadkarni received unrestricted research funding to his institution from the National Institutes of Health, Agency for Healthcare Research and Quality, Zoll Medical, and Nihon-Kohden Inc, and volunteers on scientific advisory committees for the American Heart Association, Citizen CPR Foundation, INSPIRE simulation research network, and Citizen CPR Foundation. Dr Nadkarni is president of the Society of Critical Care Medicine (2023–2024). The views presented in this article reflect his views as an individual and are not intended to represent the opinions of the Society of Critical Care Medicine. D.E. Niles was an employee of Children’s Hospital of Philadelphia at the time of data collection and analysis and is currently an employee of Philips Medical. Dr Morgan receives funding from the National Institutes of Health career development award from the National Heart, Lung, and Blood Institute (award K23HL148541). Dr Raymond receives compensation as an adjudicator for the Pediatric Heart Network COMPASS trial from New England Research Institutes, Inc.