Research Center for Emergency Medicine, Aarhus University, Denmark (K.G.L.).
Department of Anesthesiology and Critical Care Medicine, Randers Regional Hospital, Denmark (K.G.L.).
Circulation. 2024 May 7;149(19):1493-1500. doi: 10.1161/CIRCULATIONAHA.123.066882. Epub 2024 Apr 2.
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.
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.
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]; =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]; =0.01) and return of spontaneous circulation (adjusted risk ratio, 0.93 [95% CI, 0.91-0.94]; <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.
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.
目前尚不清楚胸外按压（CC）暂停时间与儿科院内心搏骤停生存结局之间的关系。美国心脏协会建议将儿童 CC 暂停时间减至<10 秒，但并无支持性证据。我们假设，最长 CC 暂停时间越长，生存和神经功能结局越差。
在这项儿科院内心搏骤停队列研究中，我们分析了 pediRES-Q（多中心协作中儿科复苏质量）报告的 2015 年 7 月至 2021 年 12 月期间的索引儿科院内心搏骤停事件中，最长 CC 暂停时间每增加 5 秒与生存和有利的神经功能结局（小儿脑功能分类≤3 或与基线相比无变化）之间的关联。次要暴露因素包括任何暂停>10 秒或>20 秒，以及每 2 分钟>10 秒或>20 秒的暂停次数。
我们确定了 562 例索引院内心搏骤停事件（中位数[四分位距 1，3]年龄 2.9 岁[0.6，10.0]，43%为女性，13%为可除颤节律）。每个事件的最长 CC 暂停时间中位数为 29.8 秒（11.5，63.1）。在调整混杂因素后，最长 CC 暂停时间每增加 5 秒，生存且神经功能良好的相对风险降低 3%（校正风险比，0.97[95%CI，0.95-0.99]；=0.02）。最长 CC 暂停时间也与出院时的生存（校正风险比，0.98[95%CI，0.96-0.99]；=0.01）和自主循环恢复（校正风险比，0.93[95%CI，0.91-0.94]；<0.001）有关。次要结局中任何暂停>10 秒或>20 秒，以及>10 秒和>20 秒的 CC 暂停次数，均与自主循环恢复的校正风险比显著相关，但与生存或神经功能结局无关。
在儿科院内心搏骤停期间，最长 CC 暂停时间每增加 5 秒，生存且神经功能良好的几率、出院时的生存率和自主循环恢复的几率均降低。任何 CC 暂停>10 秒或>20 秒，以及>10 秒和>20 秒的 CC 暂停次数，均与自主循环恢复的校正概率显著降低有关，但与生存或神经功能结局无关。
