Recommended CPR ventilation rates in children were not linked to survival

Design

Multicentre prospective observational cohort (ancillary to the ICU-RESUS trial)

Population

234 in-hospital cardiopulmonary resuscitation events in children with a tracheal tube, 18 US intensive care units

Primary outcome

Survival to hospital discharge by CPR ventilation rate

Effect

Recommended rate aRR 0.95 (95% CI 0.75 to 1.21); under 8 years with 26 or more per minute aRR 1.32 (95% CI 1.00 to 1.73)

This prospective observational study, an ancillary analysis of the ICU-RESUS trial, used end-tidal carbon dioxide data to calculate ventilation rates in 234 resuscitations in hospitalised children with a tracheal tube or tracheostomy across 18 US intensive care units.

Only 86 events (36.8%) had an average rate in the recommended 20 to 30 breaths per minute. That range was not associated with survival to discharge (adjusted RR 0.95, 95% CI 0.75 to 1.21). In exploratory analyses, children under 8 years had better survival with an average rate of 26 or more breaths per minute (adjusted RR 1.32, 95% CI 1.00 to 1.73; p = 0.048), while a threshold below 26 was suggested for older children.

The lower bound of the interval is exactly 1.00, the thresholds were derived from the same data, and the analysis is observational. It is a hypothesis for a future trial, not a reason to change the rate you ventilate at.

• Only 36.8% of arrests had an average ventilation rate within the 20 to 30 per minute recommendation.
• The recommended range was not associated with survival (adjusted RR 0.95).
• Exploratory finding: 26 or more breaths per minute in children under 8 was linked to survival (RR 1.32, lower bound 1.00).
• Continue to follow current resuscitation guidance until trials confirm any change.
• Use end-tidal carbon dioxide and a metronome or monitor to check what rate you actually deliver.

Why it matters

It shows how seldom the recommended rate is achieved, and questions whether the target itself is optimal.

Don't overread it

The age-specific thresholds were found in the same data used to test them and are hypothesis-generating only.

The statistics, in plain English

A thresholds search through the same dataset tends to find a pattern even when none exists, so the exploratory result needs a new study to confirm it. The interval 1.00 to 1.73 only just excludes no effect.

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