Abstract Body: Background: Prior studies have reported that a longer duration of prehospital cardiopulmonary resuscitation (CPR) before return of spontaneous circulation (ROSC) is associated with poor patient outcomes for adults with out-of-hospital cardiac arrest (OHCA). The association of CPR duration with survival has not been fully investigated for pediatric patients.
Aim: To quantify the time-dependent probability of survival as a function of CPR duration among pediatric patients with OHCA.
Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective multicenter OHCA registry at 10 sites in the US and Canada from 2011 through 2015. We included pediatric patients (<18 years) with emergency medical services (EMS)-treated OHCA. We estimated the time-dependent probability of subsequently surviving to hospital discharge if patients without prehospital ROSC at each minute of CPR duration received further CPR beyond the time point. The numerator was the number of patients without ROSC at each minute and subsequently survived to hospital discharge. The denominator was the number of patients without ROSC at each minute, excluding those who had termination of resuscitation before or at each minute.
Results: Of 1,313 eligible pediatric patients (median [IQR] age, 1 [0-9] year; 773 [58.9%] were male), 236 (18.0%) achieved prehospital ROSC. The median interval from initiation of CPR by EMS clinicians to ROSC was 10 minutes (IQR 5-16 minutes). The time-dependent probabilities (95% CIs) of survival to hospital discharge among patients without ROSC were 7.9% (6.4%-9.4%) at 1 minute, 5.6% (4.3%-6.9%) at 5 minutes, 2.6% (1.6%-3.5%) at 10 minutes, 1.1% (0.4%-1.8%) at 15 minutes, and 0.6% (0.02%-1.3%) at 20 minutes of CPR duration. The point estimate of the probability became less than 1% at 17 minutes of CPR duration.
Conclusions: In this analysis of a large multicenter OHCA registry, we quantified the time-dependent probability of survival to hospital discharge in each minute of CPR duration for pediatric OHCA. These findings provide EMS clinicians, patients, and their surrogates with insights into the likelihood of survival if pediatric patients without ROSC continue to receive further CPR.