Are chest compression quality metrics different in children with and without congenital heart disease? A report from the pediatric resuscitation quality collaborative

Objective

To evaluate the association of CPR quality metrics with survival outcomes in children with and without congenital heart disease experiencing in-hospital cardiac arrest.

Design

Retrospective cohort study of data from the Pediatric Resuscitation Quality (pediRES-Q) Collaborative.

Setting

28 participating sites.

Patients

Patients who were < 18 years of age at time of arrest, ≥ 37 weeks gestational age, with ≥ 1 min of monitor-defibrillator chest compression quality metric data recorded.

Interventions

None.

Measurements and Main Results

There were a total of 742 index in-hospital cardiac arrest events in 675 unique patients analyzed between July 2015 and August 2021. Amongst these events, 205 (27.6%) occurred in patients with congenital heart disease and 537 (72.4%) in patients without congenital heart disease. After adjusting for age and use of extracorporeal CPR during arrest, children with congenital heart disease were less likely to have chest compression depth that met compliance with American Heart Association guidelines than children without congenital heart disease. Despite differences in CC depth, the presence of congenital heart disease was not associated with return of spontaneous circulation, survival to hospital discharge, or SHD with favorable neurologic outcome on multivariable logistic mixed effects modeling.

Conclusions

In a large multi-center international pediatric resuscitation collaborative, patients with congenital heart disease compared to those without were less likely to have guideline-compliant CC depth yet no differences in return of spontaneous circulation, survival to hospital discharge or survival to discharge with favorable neurologic outcome were observed on multivariable analysis.