Association of Chest Compression Metrics During Pediatric CPR With Intra-Arrest Blood Pressure and Survival Outcomes in the United States: Insights From ICU-RESUS

BACKGROUND: High-quality cardiopulmonary resuscitation is associated with improved outcomes; however, specific targets for younger age groups are largely based on extrapolations from adult studies and small pediatric cohort studies. METHODS: Prospectively designed embedded study within the ICU RESUScitation Project (ICU-RESUS). Children (≤18 years) who received cardiopulmonary resuscitation in 10 intensive care units in the United States were enrolled between 2016 and 2021. We excluded patients with documented limitations of care, who were brain dead, or who had OHCA. The exposures were American Heart Association-recommended chest compression (CC) targets for rate (100–120 cm 3 /min), depth (≥40 mm for age <1 year and ≥50 mm for age ≥1 year), and CC fraction (CCF; >80%). Associations between achieving CC targets over the first 10 minutes of cardiopulmonary resuscitation and outcomes were quantified using multivariable Poisson regression models (primary outcome: survival to hospital discharge [SHD]). In exploratory analyses, cubic splines further explored the relationship between CC metrics and outcomes to identify exploratory targets. RESULTS: Among 543 patients with evaluable data, the recommended rate target was met in 46.3%, depth in 25.7%, and CCF in 88.5%. Mean age was 3.6 (SD, 5.3) years, and 54.3% were male. None of these recommended CC targets were associated with SHD (rate: adjusted relative risk [aRR], 0.91 [95% CI, 0.78]; depth: aRR, 0.81 [95% CI, 0.51–1.29]; and CCF: aRR, 1.19 [95% CI, 0.92–1.54], respectively). Using cubic spline analyses, the following exploratory targets were identified and were associated with SHD: rate 130 to 160 cm 3 /min (aRR, 1.23 [95% CI, 1.04–1.46]), depths of 23 to 27 mm for patients <1 year (aRR, 1.76 [1.14–2.72]), and CCF >90% (aRR, 1.24 [1.03–1.49]). CONCLUSIONS: Currently recommended CC rate, depth, and fraction targets were not associated with SHD in this cohort. In contrast, we identified new potential pediatric cardiopulmonary resuscitation targets that were associated with SHD: rate 130 to 160 CC/min, depths of 23 to 27 mm for patients <1 year, and CCF >90%. These criteria need validation in future prospective trials. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02837497.