Despite the survival rate of children with in-hospital cardiac arrest (IHCA) markedly
improved over the last two decades, more than half of them still do not survive at
hospital discharge.
1.
,
2.
,
- Berg R.A.
- Sutton R.M.
- Reeder R.W.
- et al.
Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative
Pediatric Critical Care Research Network (CPCCRN) Pediatric Intensive Care Quality
of Cardio-Pulmonary Resuscitation (PICqCPR) investigators. Association between diastolic
blood pressure during pediatric in-hospital cardiopulmonary resuscitation and survival.
Circulation. 2018; 137: 1784-1795
3.
Survival outcome is associated with several factors, including the patient’s underlying
disease, event’s cause, initial cardiac arrest (CA) rhythm, quality of cardiopulmonary
resuscitation (CPR) delivered, duration of CA and quality of post-cardiac arrest care.
4.
High-quality CPR has the goal of supporting vital organ perfusion until the return
of spontaneous circulation (ROSC) is attained, or while extracorporeal CPR (ECPR)
is started in patients with reversible clinical conditions who are not responding
to conventional CPR. Nowadays, advances in technology allow for defining high-quality
CPR in quantitative terms, usually utilizing CPR quality-monitoring defibrillators.
5.
Several CPR delivery metrics include adequate rate and depth of chest compressions
(CC), full chest wall recoil, chest compression fraction (CCF) and frequency and length
of pauses, among others.
6.
The AHA guidelines underline the value of minimizing pause duration to improve CPR
quality, recommending a CCF > 80% and CC pause duration of less than 10 s.
7.
In fact, prolonged CPR interruptions may markedly compromise coronary and cerebral
blood flow, and are associated with worse survival outcomes. In a prospective study,
Brouwer et al. evaluated defibrillator data from 319 out-of- hospital arrests in adults
and found that the odds for survival decreased for each 5-second increase in the longest
CC pause.
- Topjian A.A.
- Raymond T.T.
- Atkins D.
- et al.
on behalf of the Pediatric Basic and Advanced Life Support Collaborators. Part 4:
pediatric basic and advanced life support: 2020 American Heart Association Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Circulation. 2020; 142: S469-S523
8.
Other authors reported low CPR quality performance due to poor CCF and avoidable
CC interruption time in pediatric clinical and simulation settings.
9.
,
10.
However, some CC pauses are necessary during CPR. For instance, to diagnose or manage
reversible causes of CA, or to accomplish difficult procedures, such as attempts at
tracheal intubation or ECPR cannulation.To read this article in full you will need to make a payment
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References
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- Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) Pediatric Intensive Care Quality of Cardio-Pulmonary Resuscitation (PICqCPR) investigators. Association between diastolic blood pressure during pediatric in-hospital cardiopulmonary resuscitation and survival.Circulation. 2018; 137: 1784-1795
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Article info
Publication history
Published online: June 21, 2022
Accepted:
June 14,
2022
Received:
June 13,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
