- Design
- Multicentre prospective observational ancillary cohort of the ICU-RESUS trial
- Population
- 234 in-hospital cardiac arrests in intubated children in 18 US ICUs
- Primary outcome
- Survival to hospital discharge by CPR ventilation rate
- Effect
- Guideline range vs not: aRR 0.95 (0.75–1.21); under-8s ≥26/min: aRR 1.32 (1.00–1.73)
An observational ancillary study of the ICU-RESUS trial, published in Critical Care Medicine on 14 October, used end-tidal CO2 tracings to measure ventilation rates during 234 in-hospital cardiac arrests in intubated children across 18 US ICUs.
Only 37% of events had average rates within the recommended 20 to 30 breaths per minute, and being in that range was not associated with survival to discharge. In exploratory analysis, children under 8 ventilated at 26 or more breaths per minute had better survival than those ventilated more slowly, with a confidence interval just reaching 1.
This raises questions about one-size-fits-all ventilation targets in paediatric CPR. It does not justify changing practice: the age threshold was found by exploring the data and needs testing.
The practical point is measurement. Most children were outside the recommended range, which suggests ventilation during resuscitation is rarely counted.
- Count ventilation rate during paediatric CPR; most events were outside the recommended range.
- Use end-tidal CO2 to guide quality of resuscitation in intubated children.
- Keep to current guideline rates until the age-specific finding is confirmed.
- Assign one team member to track ventilations during arrest.
Why it matters
It suggests the recommended range may not suit all ages, and that it is rarely met anyway.
Don't overread it
The higher-rate finding in under-8s is exploratory and its confidence interval reaches 1.
The statistics, in plain English
The adjusted relative risk of survival within the recommended range was 0.95 (0.75 to 1.21), consistent with no effect. The under-8 finding (aRR 1.32, 1.00 to 1.73) is borderline, and thresholds found by searching data tend to shrink when tested.
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