Abstract 14728: Hyperventilation During Pediatric CPR: Does an Advanced Airway Hurt or Help? A Video-based Analysis
Introduction: Hyperventilation during cardiopulmonary resuscitation (CPR) is common, particularly in pediatric CPR. Adult studies have shown that hyperventilation is more prevalent during CPR with an artificial airway. Our group has previously reported on the use of video review in the pediatric ED to characterize CPR performance.
Hypothesis: Children will be more likely to experience hyperventilation during CPR performed with an artificial airway (AA) in place than during CPR with a natural airway (NA).
Methods: Single center observational study from Feb. 2012 to April 2016, resuscitations in a tertiary pediatric ED are videorecorded as part of continuous quality improvement. Events where a child received > 2 minutes of chest compressions under videorecorded conditions were included. Ventilations were measured by video review and expressed in breaths per minute (bpm) in 30-second epochs. Hyperventilation was defined as >12 bpm. Prevalence of hyperventilation was compared between epochs with and without an artificial airway in place by unadjusted c2 analysis. Repeated measured logistic regression was performed to determine the association between presence of an artificial airway and hyperventilation while controlling for within-event covariance.
Results: 68 CPR events occurred during the study period; 1142 30-second epochs of ventilation were analyzed. 47 of 68 patients had an AA in place for all or part of their events; 631/1142 (55%) of CPR epochs were done in patients with an AA in place. Ventilation rates were between 6 and 12 bpm in 433/1142 (38%) of epochs; <6 bpm in 139/1142 (12%) of epochs; and >12 bpm in 570/1142 (50%) of epochs. Ventilation rates were significantly more likely to exceed 12 bpm with an AA (419/631 (66%)) versus a NA (150/510 (29%)) (p < 0.001). On multivariate analysis, presence of an AA was significantly associated with ventilation rates >12 bpm (OR 4.95, 95% CI 3.60 – 6.89).
Conclusions: Children with an AA were more likely to be hyperventilated during CPR compared to children receiving CPR with a NA. Future investigations should focus on clinical outcomes in children related to presence of hyperventilation as well as training strategies to minimize hyperventilation during CPR.
Author Disclosures: T. Hsieh: None. S. Myers: None. V. Nadkarni: None. A. Donoghue: Research Grant; Modest; Zoll Foundation, NIH.
- © 2016 by American Heart Association, Inc.