Chest compression release velocity and associated clinical outcomes in pediatric cardiac arrest

Introduction: Adult studies of out-of-hospital cardiac arrest show an association of chest compression release velocity (CCRV) with improved survival outcomes. Outcome data for CCRV in pediatrics is not known. Our primary hypothesis is that CCRV is associated with return of spontaneous circulation (ROSC) following pediatric in-hospital cardiac arrest. Methods: Using a multicenter prospective observational cohort from 2015 to 2021, we analyzed patients < 18 years who received cardiopulmonary resuscitation (CPR) with quantitative metrics across 30 sites. The CCRV up to the first ten minutes was analyzed. ROSC was assessed for all 464 events and survival to hospital discharge (SHD)/favorable neurologic outcome in 341 index events. Chi-square tests were used to compare outcomes between CCRV “slow” (lowest 25%ile) and “fast” (highest 25%ile). Mixed effect logistic regression models were used to evaluate the relationship between CCRV and survival outcomes. Results: There were 464 (< 1 yr N=163, 1– < 8 yr N=156, and 8 – < 18 yrs N=145) total events and 341 (< 1 yr N=119, 1 – < 8 yrs N=112, and 8 – < 18 yrs N=110) index events used for the analysis. Median (IQR) CCRV in first ten minutes for < 1 yr: 157 (125, 189) mm/s; 1 – < 8 yr: 228 (180, 274) mm/s; and 8 – < 18 yr: 393 (281, 471) mm/s. Within each age bracket, there was no significant association of lower 25%ile (“slow”) compared with upper 25%ile (“fast”) CCRV for ROSC (< 1 yr slow 60% vs fast 58% (p>0.99); 1 – < 8 yr slow 51% vs fast 56% (p=0.82); 8– < 18 yrs slow 56% vs fast 50% (p=0.81). There was no significant association of slow vs fast CCRV with SHD or favorable neurologic outcome in each age group (p>0.09 for all tests). After adjusting for a priori variables of illness category, shockable/non-shockable rhythm, time of day/week, and clustering in site/patient covariates, the mixed effect logistic regression demonstrated no significant difference comparing slow vs fast CCRV in ROSC, (OR=0.88, CI [0.60,1.29], p=0.50), SHD (OR=1.26, CI [0.75,2.11], p=0.39) or survival with favorable neurologic outcome (OR=1.08, CI [0.56, 2.10], p=0.81). Conclusions: In this cohort of pediatric in-hospital cardiac arrest patients with CCRV recorded during CPR, CCRV was not significantly associated with ROSC, SHD, or favorable neurologic outcome.