Ventilation Rates and Pediatric In-Hospital Cardiac Arrest Survival Outcomes.

TitleVentilation Rates and Pediatric In-Hospital Cardiac Arrest Survival Outcomes.
Publication TypeJournal Article
Year of Publication2019
AuthorsSutton, RM, Reeder, RW, Landis, WP, Meert, KL, Yates, AR, Morgan, RW, Berger, JT, Newth, CJ, Carcillo, JA, McQuillen, PS, Harrison, RE, Moler, FW, Pollack, MM, Carpenter, TC, Notterman, DA, Holubkov, R, J Dean, M, Nadkarni, VM, Berg, RA
Corporate Authors
JournalCrit Care Med
Volume47
Issue11
Pagination1627-1636
Date Published2019 11
ISSN1530-0293
KeywordsArterial Pressure, Capnography, Cardiopulmonary Resuscitation, Female, Heart Arrest, Hospital Mortality, Humans, Hypotension, Infant, Intensive Care Units, Pediatric, Male, Patient Discharge, Prospective Studies, Pulmonary Ventilation, Respiratory Insufficiency, Systole
Abstract

<p><b>OBJECTIVES: </b>The objective of this study was to associate ventilation rates during in-hospital cardiopulmonary resuscitation with 1) arterial blood pressure during cardiopulmonary resuscitation and 2) survival outcomes.</p><p><b>DESIGN: </b>Prospective, multicenter observational study.</p><p><b>SETTING: </b>Pediatric and pediatric cardiac ICUs of the Collaborative Pediatric Critical Care Research Network.</p><p><b>PATIENTS: </b>Intubated children (≥ 37 wk gestation and < 19 yr old) who received at least 1 minute of cardiopulmonary resuscitation.</p><p><b>INTERVENTIONS: </b>None.</p><p><b>MEASUREMENTS AND MAIN RESULTS: </b>Arterial blood pressure and ventilation rate (breaths/min) were manually extracted from arterial line and capnogram waveforms. Guideline rate was defined as 10 ± 2 breaths/min; high ventilation rate as greater than or equal to 30 breaths/min in children less than 1 year old, and greater than or equal to 25 breaths/min in older children. The primary outcome was survival to hospital discharge. Regression models using Firth penalized likelihood assessed the association between ventilation rates and outcomes. Ventilation rates were available for 52 events (47 patients). More than half of patients (30/47; 64%) were less than 1 year old. Eighteen patients (38%) survived to discharge. Median event-level average ventilation rate was 29.8 breaths/min (interquartile range, 23.8-35.7). No event-level average ventilation rate was within guidelines; 30 events (58%) had high ventilation rates. The only significant association between ventilation rate and arterial blood pressure occurred in children 1 year old or older and was present for systolic blood pressure only (-17.8 mm Hg/10 breaths/min; 95% CI, -27.6 to -8.1; p < 0.01). High ventilation rates were associated with a higher odds of survival to discharge (odds ratio, 4.73; p = 0.029). This association was stable after individually controlling for location (adjusted odds ratio, 5.97; p = 0.022), initial rhythm (adjusted odds ratio, 3.87; p = 0.066), and time of day (adjusted odds ratio, 4.12; p = 0.049).</p><p><b>CONCLUSIONS: </b>In this multicenter cohort, ventilation rates exceeding guidelines were common. Among the range of rates delivered, higher rates were associated with improved survival to hospital discharge.</p>

DOI10.1097/CCM.0000000000003898
Alternate JournalCrit. Care Med.
PubMed ID31369424
Grant ListUG1 HD050096 / HD / NICHD NIH HHS / United States
UG1 HD049981 / HD / NICHD NIH HHS / United States
UG1 HD049983 / HD / NICHD NIH HHS / United States
UG1 HD063108 / HD / NICHD NIH HHS / United States
UG1 HD083171 / HD / NICHD NIH HHS / United States
UG1 HD083166 / HD / NICHD NIH HHS / United States
UG1 HD083170 / HD / NICHD NIH HHS / United States
U10 HD050012 / HD / NICHD NIH HHS / United States
U10 HD063106 / HD / NICHD NIH HHS / United States
U10 HD063114 / HD / NICHD NIH HHS / United States
U01 HD049934 / HD / NICHD NIH HHS / United States