AIM: Animal studies have established deleterious hemodynamic effects of interrupting chest compressions. The objective of this study was to evaluate the effect of interruptions on invasively measured blood pressures (BPs) during pediatric in-hospital cardiac arrest (IHCA). METHODS: This was a single-center, observational study of pediatric (<18 years) intensive care unit IHCAs in patients with invasive arterial catheters in place. Interruptions were defined as ≥1 s between chest compressions. Diastolic BP (DBP) and systolic BP (SBP) were determined for individual compressions. For the primary analysis, the average DBP and SBP of the 20 compressions preceding each interruption were compared to the average DBP and SBP of the first 20 compressions following each interruption utilizing non-parametric paired analyses. Linear regression evaluated the change in DBP during interruptions and following interruptions. RESULTS: Thirty-two IHCA events met inclusion criteria, yielding 161 evaluable interruptions. The median age was 2.1 years. Return of circulation was achieved in 24 (75%). The median interruption duration was 2.4 [1.4, 7.0] seconds. Most patients were intubated pre-arrest and received epinephrine during CPR. BPs were not different pre- vs. post-interruption (DBP: 28.7 [21.6, 38.2] vs. 28.3 [21.0, 37.4] mmHg, p = 0.81; SBP: 82.0 [51.7, 116.7] vs. 85.4 [55.7, 122.2] mmHg, p = 0.07). DBP decreased 8.41 ± 0.73 mmHg (p < 0.001) during the first second of interruptions and 0.19 ± 0.02 mmHg/s (p < 0.001) in subsequent seconds. CONCLUSIONS: BPs following chest compression interruptions did not differ from pre-interruption BPs. These findings suggest that in the setting of high-quality in-hospital CPR, brief chest compression interruptions do not have persistent detrimental hemodynamic impact.
AIM: Animal studies have established deleterious hemodynamic effects of interrupting chest compressions. The objective of this study was to evaluate the effect of interruptions on invasively measured blood pressures (BPs) during pediatric in-hospital cardiac arrest (IHCA). METHODS: This was a single-center, observational study of pediatric (<18 years) intensive care unit IHCAs in patients with invasive arterial catheters in place. Interruptions were defined as ≥1 s between chest compressions. Diastolic BP (DBP) and systolic BP (SBP) were determined for individual compressions. For the primary analysis, the average DBP and SBP of the 20 compressions preceding each interruption were compared to the average DBP and SBP of the first 20 compressions following each interruption utilizing non-parametric paired analyses. Linear regression evaluated the change in DBP during interruptions and following interruptions. RESULTS: Thirty-two IHCA events met inclusion criteria, yielding 161 evaluable interruptions. The median age was 2.1 years. Return of circulation was achieved in 24 (75%). The median interruption duration was 2.4 [1.4, 7.0] seconds. Most patients were intubated pre-arrest and received epinephrine during CPR. BPs were not different pre- vs. post-interruption (DBP: 28.7 [21.6, 38.2] vs. 28.3 [21.0, 37.4] mmHg, p = 0.81; SBP: 82.0 [51.7, 116.7] vs. 85.4 [55.7, 122.2] mmHg, p = 0.07). DBP decreased 8.41 ± 0.73 mmHg (p < 0.001) during the first second of interruptions and 0.19 ± 0.02 mmHg/s (p < 0.001) in subsequent seconds. CONCLUSIONS: BPs following chest compression interruptions did not differ from pre-interruption BPs. These findings suggest that in the setting of high-quality in-hospital CPR, brief chest compression interruptions do not have persistent detrimental hemodynamic impact.
Authors: Katherine Cashen; Ron W Reeder; Tageldin Ahmed; Michael J Bell; Robert A Berg; Candice Burns; Joseph A Carcillo; Todd C Carpenter; J Michael Dean; J Wesley Diddle; Myke Federman; Ericka L Fink; Aisha H Frazier; Stuart H Friess; Kathryn Graham; Mark Hall; David A Hehir; Christopher M Horvat; Leanna L Huard; Tensing Maa; Arushi Manga; Patrick S McQuillen; Ryan W Morgan; Peter M Mourani; Vinay M Nadkarni; Maryam Y Naim; Daniel Notterman; Chella A Palmer; Murray M Pollack; Carleen Schneiter; Matthew P Sharron; Neeraj Srivastava; David Wessel; Heather A Wolfe; Andrew R Yates; Athena F Zuppa; Robert M Sutton; Kathleen L Meert Journal: Pediatr Crit Care Med Date: 2022-07-26 Impact factor: 3.971
Authors: William P Landis; Ryan W Morgan; Ron W Reeder; Kathryn Graham; Ashley Siems; J Wesley Diddle; Murray M Pollack; Tensing Maa; Richard P Fernandez; Andrew R Yates; Bradley Tilford; Tageldin Ahmed; Kathleen L Meert; Carleen Schneiter; Robert Bishop; Peter M Mourani; Maryam Y Naim; Stuart Friess; Candice Burns; Arushi Manga; Deborah Franzon; Sarah Tabbutt; Patrick S McQuillen; Christopher M Horvat; Matthew Bochkoris; Joseph A Carcillo; Leanna Huard; Myke Federman; Anil Sapru; Shirley Viteri; David A Hehir; Daniel A Notterman; Richard Holubkov; J Michael Dean; Vinay M Nadkarni; Robert A Berg; Heather A Wolfe; Robert M Sutton Journal: Resuscitation Date: 2020-02-20 Impact factor: 5.262
Authors: Ryan W Morgan; Ron W Reeder; Kathleen L Meert; Russell Telford; Andrew R Yates; John T Berger; Kathryn Graham; William P Landis; Todd J Kilbaugh; Christopher J Newth; Joseph A Carcillo; Patrick S McQuillen; Rick E Harrison; Frank W Moler; Murray M Pollack; Todd C Carpenter; Daniel Notterman; Richard Holubkov; J Michael Dean; Vinay M Nadkarni; Robert A Berg; Robert M Sutton Journal: Crit Care Med Date: 2020-06 Impact factor: 7.598
Authors: Martha F Kienzle; Ryan W Morgan; Jennifer A Faerber; Kathryn Graham; Hannah Katcoff; William P Landis; Alexis A Topjian; Todd J Kilbaugh; Vinay M Nadkarni; Robert A Berg; Robert M Sutton Journal: Am J Respir Crit Care Med Date: 2021-10-15 Impact factor: 30.528