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Crit Care Med. 2019 Nov;47(11):1627-1636. doi: 10.1097/CCM.0000000000003898.

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

Author information

1
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
2
Department of Pediatrics, University of Utah, Salt Lake City, UT.
3
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI.
4
Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
5
Department of Pediatrics, Children's National Medical Center, Washington, DC.
6
Department of Anesthesiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA.
7
Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
8
Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA.
9
Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
10
Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
11
Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ.
12
Department of Pediatrics, Denver Children's Hospital, University of Colorado, Denver, CO.
13
Department of Molecular Biology, Princeton University, Princeton, NJ.

Abstract

OBJECTIVES:

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.

DESIGN:

Prospective, multicenter observational study.

SETTING:

Pediatric and pediatric cardiac ICUs of the Collaborative Pediatric Critical Care Research Network.

PATIENTS:

Intubated children (≥ 37 wk gestation and < 19 yr old) who received at least 1 minute of cardiopulmonary resuscitation.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

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).

CONCLUSIONS:

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.

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