Resuscitation: Duration of emergency medical services-initiated prehospital cardiopulmonary resuscitation efforts and survival for pediatric patients with out-of-hospital cardiac arrest

Background: While longer duration of cardiopulmonary resuscitation (CPR) is associated with unfavorable patient outcomes after pediatric out-of-hospital cardiac arrest (OHCA), it remains unclear how the probability of survival changes as a function of CPR duration.

Methods: We conducted a retrospective cohort study of the Resuscitation Outcomes Consortium Epidemiologic Registry, including consecutive patients with non-traumatic OHCA at ten regional coordinating sites in the US and Canada from 2011 to 2015. We included pediatric patients (age <18 years) with emergency medical services (EMS)-treated OHCA. The exposure was EMS-initiated prehospital CPR duration in minutes, defined as the interval between the start of chest compressions by EMS clinicians and prehospital return of spontaneous circulation (ROSC), prehospital termination of resuscitation (TOR), or hospital arrival. The outcome was survival to hospital discharge. Time-dependent probability of subsequently surviving to hospital discharge if patients with ongoing CPR at each minute received further CPR beyond that time point was estimated, assuming that all decisions on TOR prior to or at that time point were adequate.

Results: Among 1313 included patients (median [IQR] age, 1[0-9]), 236 (18.0%) achieved prehospital ROSC with a median CPR duration of 10 min (IQR 5.5-16.5 min); 1077 did not; and 136 (10.4%) survived to hospital discharge. The time-dependent probabilities of survival to hospital discharge for patients with ongoing CPR were 7.9% (95% CI: 6.4-9.3%) at 1 min and decreased to less than 1% at 14.8 min (95% CI: 11.1-22.0 min) of EMS-initiated prehospital CPR duration. The upper bound of 95% CI of the probabilities of survival decreased to less than 1% (0.86%, 95% CI: 0.34-0.94%) at 22.0 min.

Conclusion: In this North American retrospective cohort study of pediatric patients with OHCA, we quantified the time-dependent probability of survival to hospital discharge as a function of prehospital CPR duration. The findings provide EMS clinicians and patients' surrogates with objective insights into the likelihood of survival when CPR is continued beyond 15 min.