Abstract Body: Introduction
Pediatric out-of-hospital cardiac arrest (P-OHCA) is far less common than adult OHCA with limited improvement in outcomes despite decades of progress in adults. Effective ventilation during resuscitation may improve survival, but little is known about the frequency or quality of ventilation monitoring in P-OHCA.
Aims
We aimed to determine the frequency of end-tidal carbon dioxide (ETCO2) monitoring during the advanced life support (ALS) phase of P-OHCA. Secondary objectives were to characterize ETCO2 values and ventilation rates in resuscitation.
Hypotheses
We hypothesized that analyzable ETCO2 would be collected <50% of the time and be lower in younger patients. We also expected mean post-advanced airway ETCO2 to fall below normal range (35-45mmHg) and ventilation rates during CPR to fall below the American Heart Association’s (AHA) target of 20-30 breaths/minute (bpm).
Methods
This retrospective, observational study included treated P-OHCA cases from three EMS agencies (2015–2022) serving >2.5 million people. ALS monitor files were analyzed for presence and duration of ETCO2 waveforms before/after advanced airway placement, during arrest and after return of spontaneous circulation (ROSC). Primary outcome was the proportion of cases with ETCO2, stratified by age (<1, 1–8, 9–17 years). Secondary outcomes included proportion of patients with mean post-airway ETCO2 within 35–45 mmHg and ventilation rates within 20-30 bpm during CPR.
Results
Of 245 P-OHCA cases, 196 had ALS monitor files; 151 (77%) had analyzable ETCO2. In those, analyzable ETCO2 data was present in 79% (95% CI: 74.6%-81.4%) of the case. Among infants (<1 year), 69.5% had any ETCO2, with waveform data present for 78% of the case duration on average. Of 147 patients with usable ETCO2, 19% had a post-airway mean ETCO2 in normal range while 31% of patients exceeded 45 mmHg. Mean (SD) ventilation rate was 10 (7) bpm during CPR and 17 (9) bpm during ROSC. During OHCA, mean ETCO2 in infants (29.3 mmHg) was lower than in ages 1-8 (34.4 mmHg), mean difference -5.1 (95% CI: −6.8 to −3.4). Only 11% of patients had a mean OHCA ventilation rate within the AHA target.
Conclusion
Most P-OHCA cases contained analyzable ETCO2 readings, yet most had ventilation rates below the AHA target during OHCA. These findings highlight the need for better ventilation monitoring. This study is limited by unknown ventilation in periods without ETCO2 data.