title: American Heart Association cardiopulmonary resuscitation quality targets are associated with improved arterial blood pressure during pediatric cardiac arrest.
abstract: OBJECTIVE
  To evaluate the association between cardiopulmonary resuscitation (CPR) quality and hemodynamic measurements during in-hospital pediatric cardiac arrest. We hypothesized that AHA recommended CPR rate and depth targets would be associated with systolic blood pressures≥80mmHg and diastolic blood pressures≥30mmHg.
  
  
  METHODS
  In children and adolescents <18 years of age who suffered a cardiac arrest with an invasive arterial catheter in place, a CPR monitoring defibrillator collected CPR data which was synchronized to arterial blood pressure (BP) tracings. Chest compression (CC) depths were corrected for mattress deflection. Generalized least squares regression estimated the association between BP and CPR quality, treated as continuous variables. Mixed-effects logistic regression estimated the association between systolic BP≥80mmHg/diastolic BP≥30mmHg and the AHA targets of depth≥38mm and/or rate≥100/min.
  
  
  RESULTS
  Nine arrests resulted in 4156 CCs. The median mattress corrected depth was 32mm (IQR 28-38); median rate was 111CC/min (IQR 103-120). AHA depth was achieved in 1090/4156 (26.2%) CCs; rate in 3441 (83.7%). Systolic BP≥80mmHg was attained in 2516/4156 (60.5%) compressions; diastolic≥30mmHg in 2561/4156 (61.6%). A rate≥100/min was associated with systolic BP≥80mmHg (OR 1.32; CI(95) 1.04, 1.66; p=0.02) and diastolic BP≥30mmHg (OR 2.15; CI(95) 1.65, 2.80; p<0.001). Exceeding both (rate≥100/min and depth≥38mm) was associated with systolic BP≥80mmHg (OR 2.02; CI(95) 1.45, 2.82; p<0.001) and diastolic BP≥30mmHg (OR 1.48; CI(95) 1.01, 2.15; p=0.042).
  
  
  CONCLUSIONS
  AHA quality targets (rate≥100/min and depth≥38mm) were associated with systolic BPs≥80mmHg and diastolic BPs≥30mmHg during CPR in children.
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. suttonr@email.chop.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.forename: Dana E
authors.initials: DE
authors.lastname: Niles
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Maltese
authors.forename: Lori
authors.initials: L
authors.lastname: Boyle
authors.forename: Mette
authors.initials: M
authors.lastname: Stavland
authors.forename: Joar
authors.initials: J
authors.lastname: Eilevstjønn
authors.forename: Kristy B
authors.initials: KB
authors.lastname: Arbogast
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012955:Societies, Medical