Abstract Body: Background: The optimal ventilation rate during pediatric in-hospital cardiac arrest is not known.

Research Question/Hypothesis: Is guideline-compliant ventilation during cardiopulmonary resuscitation (CPR) associated with improved survival? We hypothesized that CPR events with guideline-compliant average ventilation rates would have increased rates of survival to hospital discharge.

Aims: The overall objective of this study was to assess the association between pediatric CPR ventilation rates and survival outcomes.

Methods/Approach: Multicenter prospective observational cohort ancillary study of the ICU-RESUS trial (NCT02837497). Hospitalized children (≤18 years) with cardiac arrest and an endotracheal tube at the onset of CPR and evaluable intra-arrest end tidal carbon dioxide (ETCO2) data to calculate ventilation rate were included. The association between the existing AHA CPR ventilation rate target (20-30 breaths per minute [bpm]) and survival to hospital discharge was evaluated with Poisson regression using generalized estimating equations, controlling for a priori covariates (initial rhythm, immediate cause of arrest). In an exploratory analysis, natural cubic splines, controlling for the same a priori covariates, stratified by age (<8 and ≥8 years), were used to identify novel target intra-arrest ventilation rates for subsequent evaluation in multivariable models.

Results: Among 234 included events, 36.8% (n=86) had guideline-compliant average ventilation rates (20-30 bpm). After adjusting for confounders, there was no association between guideline-complaint ventilation rates and survival to hospital discharge (aRR 0.95, 95% CI: 0.75, 1.21, p=0.68). Our exploratory analysis identified novel age-based potential thresholds (<8 years: ≥26 bpm; ≥8 years: <26 bpm) (Figure 1). In children <8 years, an event-level average CPR ventilation rate of ≥26 bpm, compared to <26 bpm, was associated with increased survival to hospital discharge (aRR 1.32, 95% CI: 1.00, 1.73, p=0.048).

Conclusions: In our multicenter study of intra-arrest ventilation in children with IHCA with an invasive airway in place at the start of CPR, we did not find an association between guideline-compliant average ventilation rate and survival. In children <8 years old we identified a target ventilation threshold of ≥26 breaths per minute, which was associated with improved survival to hospital discharge.