Pediatric Cardiopulmonary Resuscitation Ventilation Rates and Outcomes

Objectives: Evaluate the association between cardiopulmonary resuscitation (CPR) ventilation rates and survival to hospital discharge, and identify novel ventilation targets. Design: Multicenter prospective ancillary observational cohort study of the ICU-RESUS trial (NCT02837497). Setting: A total of 18 ICUs from 10 U.S. clinical sites from October 2016 to March 2021. Patients: Hospitalized children (≤ 18 yr) with endotracheal or tracheostomy tubes and evaluable intra-arrest end-tidal carbon dioxide data to calculate ventilation rate. Interventions: None. Measurements and Main Results: Among 234 included events, 86 events (36.8%) had guideline-recommended (20–30 beats per min [bpm]) average ventilation rates during CPR. The association between guideline-recommended CPR ventilation rate and survival to hospital discharge was evaluated with Poisson regression using generalized estimating equations, controlling for a priori covariables (initial pulse status, immediate cause of arrest). We found no association between guideline-recommended ventilation rates and survival to hospital discharge (adjusted relative risk [aRR], 0.95; 95% CI, 0.75–1.21; p = 0.68). In exploratory analyses, novel age-stratified ventilation rates were identified using natural cubic splines and subsequently evaluated in multivariable models. We identified potential thresholds (< 8 yr, ≥ 26 bpm; ≥ 8 yr, < 26 bpm). For children younger than 8 years, average CPR ventilation rate greater than or equal to 26 bpm was associated with improved survival to hospital discharge compared with less than 26 bpm (aRR, 1.32; 95% CI, 1.00–1.73; p = 0.048). Conclusions: CPR ventilation rates in the currently recommended range (20–30 bpm) were not associated with survival in children with in-hospital cardiac arrest. In exploratory analyses in children younger than 8 years, higher ventilation rates (≥ 26 bpm) were associated with improved survival and warrant confirmation in future studies.