2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival

Abstract

Aim Gaps exist in pediatric resuscitation knowledge due to limited data collected during cardiac arrest in real children. The objective of this study was to evaluate the relationship between the 2010 American Heart Association (AHA) recommended chest compression (CC) depth (≥ 51mm) and survival following pediatric resuscitation attempts. Methods Single-center prospectively collected and retrospectively analyzed observational study of children (> 1 year) who received CCs between October 2006 and September 2013 in the intensive care unit (ICU) or emergency department (ED) at a tertiary care children's hospital. Multivariate logistic regression models controlling for calendar year and known potential confounders were used to estimate the association between 2010 AHA depth compliance and survival outcomes. The primary outcome was 24-hour survival. The primary predictor variable was event AHA depth compliance, prospectively defined as an event with ≥ 60 percent of 30-second epochs achieving an average CC depth ≥ 51mm during the first 5 minutes of the resuscitation. Results There were 89 CC events, 87 with quantitative CPR data collected (23 AHA Depth Compliant). AHA depth compliant events were associated with improved 24-hour survival on both univariate analysis (70% vs. 16%, p<0.001) and after controlling for potential confounders (calendar year of arrest, gender, first documented rhythm; aOR 10.3; CI95: 2.75 – 38.8; p<0.001). Conclusions 2010 AHA compliant chest compression depths (≥ 51mm) are associated with higher 24-hour survival compared to shallower chest compression depths, even after accounting for potentially confounding patient and event factors.

Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support

“…For the critical outcomes of survival with good neurologic outcome and survival to hospital discharge, we identified very-lowquality evidence (downgraded for indirectness and imprecision) from 1 pediatric observational study of in-hospital cardiac arrest (IHCA) 47 (89 cardiac arrest events) showing that chest compression depths of greater than 51 mm (greater than 2 inches) are associated with statistically significant improvement in outcomes (good neurologic outcome: RR, 3.71; 95% CI, 0.90-15.33; survival to discharge: RR, 3.48; 95% CI, 1.02-11.84).…”

“…For the important outcomes of 24-hour survival and ROSC, we identified very-low-quality evidence (downgraded for indirectness and imprecision) from 1 pediatric observational study of IHCA 47 For the important outcome of physiologic endpoints (a predefined blood pressure target), we identified very-lowquality evidence (downgraded for risk of bias, indirectness, and imprecision) from 2 pediatric observational studies of IHCA and out-of-hospital cardiac arrest (OHCA) (6 subjects 48 and 9 subjects 49 ) showing that targeting a real-time measured chest compression depth or a subjective anterior-posterior diameter during CPR is not associated with a statistically significant difference in outcome (Sutton 49 …”

Singapore Paediatric Resuscitation Guidelines 2016

“…A paediatric (involving patients aged > 1 year) observational study (24) (25,26) of IHCA and out-of-hospital cardiac arrest (OHCA), with six and nine subjects, respectively, showed that targeting a real-time measured chest compression depth or a subjective anteroposterior diameter during CPR is not associated with a statistically signifi cant difference in outcome (Sutton et …”

Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality

“…17 Another report of 87 pediatric resuscitation events, most involving children older than 8 years, found that compression depth greater than 51 mm for more than 60% of the compressions during 30-second epochs within the first 5 minutes was associated with improved 24-hour survival. 18 …”