103 - Chest Compression Pauses during Pediatric Extracorporeal Cardiopulmonary Resuscitation

Poster Number: 103
Publication Number: 103.307

Elena M. Insley, NewYork-Presbyterian Morgan Stanley Children's Hospital, NEW YORK, NY, United States; Anita I. Sen, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States

Background: High quality CPR is defined by the American Heart Association (AHA) as chest compression (CC) pauses shorter than 10 seconds (every 2 minutes) and a chest compression fraction (CCF) of greater than 80%. Prolonged CC pauses in cardiopulmonary resuscitation (CPR) and lower CCF are associated with worse survival during in-hospital cardiac arrests. Reducing the duration of CC pauses during CPR is a target of ongoing resuscitation quality improvement. As extracorporeal cardiopulmonary resuscitation (ECPR), in which patients are transitioned to extracorporeal membrane oxygenation (ECMO) during CPR, is becoming more frequent in the pediatric population, improving ECPR quality is also a quality improvement goal. However, a paucity of data characterizing CC quality before and during ECMO cannulation in pediatric patients exists.

Objective: To compare the characteristics of CC pauses as a metric of CPR quality before and during ECMO cannulation in pediatric patients undergoing ECPR.

Design/Methods: A retrospective chart review of pediatric patients who underwent ECPR between May 2016 and July 2021 in the pediatric intensive care unit (PICU) at an urban tertiary-care hospital was performed. CC pause characteristics pre- and during ECMO cannulation were compared using paired t-test for the CPR events with sufficient telemetry (including arterial waveform) tracings. Data were analyzed in two discreet epochs for each patient allowing for comparison within the same event.

Results: During the study period, 54 PICU patients suffered a cardiac arrest for which the ECMO team was activated. Of the 54 total patients identified, 27 had some telemetry tracings available, and of those, 11 patients had sufficient data to be analyzed. Of these 11 patients, 6 underwent peripheral ECMO cannulation and 5 central ECMO cannulation. Duration of mean CC pause pre- ECMO cannulation vs during ECMO cannulation was 13 seconds vs 32 seconds (p = 0.02). The longest pause for each event was shorter pre-ECMO [32 seconds] vs during ECMO cannulation [131 seconds] (p = 0.02). CCF pre- ECMO cannulation was 86% and during ECMO cannulation 68% (p = 0.01). Conclusion(s): In our cohort of pediatric ECPR patients, CC pauses were longer and CCF was lower during ECMO cannulation when compared to pre-ECMO cannulation, for both peripheral and central ECMO. While longer pauses may be necessary for successful cannulation during ECPR, future studies can correlate our findings with clinical outcomes and identify quality improvement opportunities to potentially shorten CC pauses during ECPR cannulation.
Inclusion CriteriaAC01C02F-BE51-44DF-9A15-ABC0A2DB9497.jpegInclusion criteria for retrospective review of pediatric cardiac arrests with ECPR.
Mean Duration of Chest Compression Pauses Before and During ECMO CannulationF758B987-00E5-4AA7-93A2-537FF0DD537A.jpegMean duration of chest compression pauses for peripheral ECMO cannulations (Patients 1-6) and central ECMO cannulations (Patients 7-11).