Abstract Body: Background: CPR quality is an important modifiable component of cardiac arrest care. Current chest compression (CC) guidelines were primarily generated from out-of-hospital arrest data. However, they are applied to cardiac arrests in all contexts, including in-hospital.
Aims: We aimed to: 1) quantitatively describe in-hospital cardiac arrest (IHCA) CC metrics; 2) determine the association of current AHA guideline-recommended CC metrics with IHCA outcomes; and 3) discover new CC targets using IHCA data and quantify their association with outcomes. We hypothesized that existing CC targets (rate 100-120 compressions per minute [cpm], depth 50-60 mm, CCF>80%) would be associated with improved outcomes.
Methods: Retrospective cohort using the AHA GWTG-Resuscitation adult IHCA registry. Events in 2015-2022 lasting ≥1 min with recorded CC metrics were included. To discover alternative CC targets, we utilized a combination of cubic splines, ROC curves, and clinician judgment. Multivariable logistic regression evaluated the association between exposures (guideline-recommended depth [50-60 mm], rate [100-120 cpm], CCF [>80%]; novel targets for depth, rate, CCF) and outcomes (primary: survival to discharge; secondary: survival with favorable neurological outcome).
Results: Of 587,588 IHCAs, 3391 events at 42 sites were included (rate: n=3380; depth: n=2892; CCF: n=2698). Median age was 65 years [IQR 54, 73]. Median rate was 112 cpm (IQR 105, 120); depth 61 mm (IQR 53.3, 68.6); and CCF 90% (IQR 82%, 95%). There was no association between current guideline-recommended CC targets and survival to discharge (rate: aOR 1.08 [95CI 0.88, 1.32], p=0.46; depth: aOR 0.88 [95CI 0.71, 1.08], p=0.22; CCF: aOR 0.79 [95CI 0.62, 1.01], p=0.058). In our spline/ROC curve analysis, we identified alternative targets of rate 100-110 cpm, depth 40-50 mm, and CCF>95%, which were associated with higher odds of survival to discharge (rate: aOR 1.32 [95CI 1.10, 1.58], p<0.01; depth: aOR 1.41 [95CI 1.07, 1.86], p=0.015; CCF: aOR 2.08 [95CI 1.67, 2.60], p<0.01) and survival with favorable neurological outcome (rate: aOR 1.38 [95CI 1.13, 1.69], p<0.01; depth: aOR 1.52 [95CI 1.14, 2.05], p<0.01; CCF: aOR 2.14 [95CI 1.66, 2.75], p<0.01).
Conclusions: In this adult IHCA study, contrary to our hypothesis, existing guideline-recommended CC targets were not associated with outcomes. Alternative targets derived from GWTG-R (rate 100-110 cpm; depth 40-50 mm; CCF>95%) were associated with improved outcomes.