Abstract P175: Chest Compression Depth/Force Needed for Excellent Aortic Pressures During Real In-Hospital Pediatric Cardiac Arrest
Introduction: Pediatric chest compression (CC) depth guideline recommendations were developed by expert clinical consensus. Little clinical data exists relating target hemodynamic outcomes (systolic BP, diastolic BP) to CC depths/applied chest force during real pediatric CPR.
Hypothesis: CCs that generate SBP ≥100 mmHg and DBP ≥40 mmHg during CPR are deeper and more forceful than CCs that fail to generate these pressures.
Methods: With IRB approval, CPR-recording/feedback defibrillators were used to assess CPR quality during consecutive in-hospital cardiac arrests in children ≥8yrs with existing arterial BP catheters. Data included: CC depth (% anterior-posterior chest depth), CC force (kg), and BP (mmHg). Simultaneous BP associated with the depth and force of each CC was calculated and summarized. A priori targets for hemodynamic outcome were SBP ≥100 mmHg and DBP ≥40 mmHg. Statistical comparison between CCs achieving vs. not achieving a priori BP targets by Student t-test.
Results: Analysis yielded 1508 evaluable CCs during 4 cardiac arrests: (age 14.5–16.9 yrs, chest depth 140 –210mm): mean CC depth was 47.2±8.8 mm, and mean CC force was 31.2±6.5 kg. SBP ≥100 mmHg was achieved in 107 (7.1%) CCs, and DBP ≥40 mmHg in only 89 (5.9%). CC depth and CC force that generated SBP ≥100 mmHg was significantly higher than CCs that did not: (CC depth 37.4±4.1% vs. 27.9±6.7%, p<0.0001; Force: 39.1±5.8 kg vs. 30.6±6.1 kg, p<0.0001). Similarly, CC depth and CC force that generated DBP ≥40 mmHg was significantly higher than CCs that did not: (Depth 36.0±5.0% vs. 28.1±6.8%, p<0.0001; Force: 36.8±6.2 kg vs. 30.9±6.3 kg, p<0.0001).
Conclusions: CCs that generated SBP ≥100 mmHg and DBP ≥40 mmHg during CPR were deeper and more forceful than CCs that failed to generate these pressures. During real pediatric CPR, SBP ≥100 mmHg and DBP ≥40 mmHg required CC depth approximately one-third AP diameter. In contrast, lower pressures were generated when CC depth was approximately one-quarter AP diameter.