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How Dangerous Are Pauses In Pediatric Chest Compressions?

June 4, 2024

Written by Michael Stocker

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Data supporting pediatric cardiac arrest guidelines are limited. This study found increases in the longest pause in chest compressions (CC) during pediatric in-hospital cardiac arrest (pIHCA) were inversely associated with survival and ROSC.

When kids arrest, stay on the chest
This 27-hospital observational study sought to characterize the relationship between prolonged pauses in CC and outcomes of pIHCA. 562 pIHCA cases with at least 1 minute of defibrillator recorded external CCs on patients ages 37 weeks to 17 years were included. The majority of events (80.8%) took place in an intensive or cardiac intensive care setting. The primary exposure was the longest CC pause, and the primary outcome was neurologically favorable survival. Causal diagrams identified confounders, and adjustments were made for factors such as age, location within the hospital, and average CC depth. CC pauses were analyzed by increasing 5-second increments. As the duration of the longest CC pause increased, every 5-second increment represented a 3% decrease in the relative risk of neurologically favorable survival (aRR 0.97; 95%CI 0.95-0.99, p=0.02), as well as decreased relative risk of survival to hospital discharge (aRR 0.98; 95%CI 0.96-0.99, p=0.01) and ROSC (aRR 0.93; 95%CI 0.91-0.94). Secondary exposures, such as any CC pause >10 or 20 seconds or number of prolonged pauses per 2 minutes were inversely associated with chance of ROSC but not survival outcomes. Relying on defibrillator data presents limitations, as this cannot account for cases in which pads were never placed nor data on CC prior to pad placement.

How will this change my practice?
While I do not practice inpatient primarily, this study reaffirms my focus on high-quality CPR and the role of limiting interruptions in improving outcomes regardless of the patient’s age. Though few things are more distressing than coding kids, we cannot let that detract from executing the basics.

Association Between Chest Compression Pause Duration and Survival After Pediatric In-Hospital Cardiac Arrest. Circulation. 2024 May 7;149(19):1493-1500. doi: 10.1161/CIRCULATIONAHA.123.066882. Epub 2024 Apr 2. PMID: 38563137; PMCID: PMC11073898.

What are your thoughts?