BACKGROUND:The association between chest compression (CC) pause duration and pediatric in-hospital cardiac arrest survival outcomes is unknown. The American Heart Association has recommended minimizing pauses in CC in children to <10 seconds, without supportive evidence. We hypothesized that longer maximum CC pause durations are associated with worse survival and neurologicalal outcomes.METHODS:In this cohort study of index pediatric in-hospital cardiac arrests reported in pediRES-Q (Quality of Pediatric Resuscitation in a Multicenter Collaborative) from July of 2015 through December of 2021, we analyzed the association in 5-second increments of the longest CC pause duration for each event with survival and favorable neurological outcome (Pediatric Cerebral Performance Category ≤3 or no change from baseline). Secondary exposures included having any pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds per 2 minutes.RESULTS:We identified 562 index in-hospital cardiac arrests (median [Q1, Q3] age 2.9 years [0.6, 10.0], 43% female, 13% shockable rhythm). Median length of the longest CC pause for each event was 29.8 seconds (11.5, 63.1). After adjustment for confounders, each 5-second increment in the longest CC pause duration was associated with a 3% lower relative risk of survival with favorable neurological outcome (absolute risk reduction, 0.97 [95% CI, 0.95–0.99]; P=0.02). Longest CC pause duration was also associated with survival to hospital discharge (absolute risk reduction, 0.98 [95% CI, 0.96–0.99]; P=0.01) and return of spontaneous circulation (absolute risk reduction, 0.93 [95% CI, 0.91–0.94]; P<0.001). Secondary outcomes of any pause >10 seconds or >20 seconds and number of CC pauses >10 seconds and >20 seconds were each significantly associated with lower absolute risk reduction of return of spontaneous circulation, but not survival or neurological outcomes.CONCLUSIONS:Each 5-second increment in longest CC pause duration during pediatric in-hospital cardiac arrest was associated with lower chance of survival with favorable neurological outcome, survival to hospital discharge, and return of spontaneous circulation. Any CC pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds were significantly associated with lower adjusted probability of return of spontaneous circulation, but not survival or neurological outcomes.

中文翻译：

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胸外按压暂停持续时间与儿科院内心脏骤停后生存率之间的关系

背景：胸外按压 (CC) 暂停持续时间与儿童院内心脏骤停生存结果之间的关联尚不清楚。美国心脏协会建议将儿童 CC 的停顿时间减少到 <10 秒，但没有证据支持。我们假设较长的最大 CC 暂停持续时间与较差的生存率和神经系统结果相关。 方法：在这项对 2015 年 7 月 pediRES-Q（多中心协作儿科复苏质量）中报告的儿科院内心脏骤停指标进行的队列研究中截至 2021 年 12 月，我们以 5 秒为增量分析了每个事件的最长 CC 暂停持续时间与生存和良好神经系统结果（儿科脑功能类别≤3 或与基线相比无变化）之间的关联。二次暴露包括任何> 10秒或> 20秒的暂停以及每2分钟> 10秒和> 20秒的暂停次数。 结果：我们确定了562例院内心脏骤停（中位[Q1，Q3]年龄2.9岁[ 0.6, 10.0]，43% 女性，13% 可电击节律）。每个事件的最长 CC 暂停的中位长度为 29.8 秒 (11.5, 63.1)。调整混杂因素后，最长 CC 暂停持续时间每增加 5 秒，相对生存风险就会降低 3%，且神经学结果良好（绝对风险降低，0.97 [95% CI，0.95–0.99]；P = 0.02 ）。最长的 CC 暂停持续时间也与出院生存率（绝对风险降低，0.98 [95% CI，0.96-0.99]；P = 0.01）和自主循环恢复（绝对风险降低，0.93 [95% CI，0.91- 0.94]；P <0.001）。任何暂停 >10 秒或 >20 秒的次要结果以及 CC 暂停 >10 秒和 >20 秒的次数均与自主循环恢复的绝对风险降低显着相关，但与生存或神经系统结果无关。 结论：每 5 -儿科院内心脏骤停期间最长 CC 暂停持续时间的第二次增加与具有良好神经学结果、出院生存和自主循环恢复的生存机会较低相关。任何 CC 暂停 >10 秒或 >20 秒以及暂停次数 >10 秒和 >20 秒均与较低的自发循环恢复概率显着相关，但与生存或神经系统结果无关。