- Design
- Prospective observational cohort within the ICU-RESUS trial
- Population
- 234 in-hospital cardiac arrests in intubated or tracheostomised children in 18 US ICUs
- Primary outcome
- Survival to hospital discharge
- Effect
- Guideline rate aRR 0.95 (0.75 to 1.21); under 8 years ≥26/min aRR 1.32 (1.00 to 1.73)
Using end-tidal carbon dioxide recordings from paediatric ICU cardiac arrests, researchers measured how fast children were actually ventilated during CPR and whether that related to survival.
Most events fell outside the recommended range. Being within it was not associated with survival. In exploratory analysis, younger children ventilated faster did better.
The exploratory threshold was derived and tested in the same data, which tends to overstate effects. The practical point now is that ventilation rate during CPR is poorly controlled and should be paced and monitored.
- Only 37% of events achieved the recommended 20 to 30 breaths a minute.
- Guideline-range ventilation was not associated with survival (aRR 0.95).
- In children under eight, rates of 26 or more were associated with higher survival (aRR 1.32).
- End-tidal carbon dioxide monitoring can be used to count actual ventilation rate.
- Assign one team member to pace ventilation during prolonged CPR.
Why it matters
Ventilation rate during CPR is rarely measured, and the recommended range is based on limited data.
Don't overread it
The under-eight finding came from an exploratory analysis with an interval touching 1.0, and guidelines have not changed.
The statistics, in plain English
An adjusted relative risk of 1.32 with a lower bound of exactly 1.00 is borderline. Thresholds found by searching the data need testing in a separate group.
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