Chest compressions for pediatric organized rhythms: A hemodynamic and outcomes analysis

Shairbanu S. Zinna, Ryan W. Morgan, Ron W. Reeder, Tageldin Ahmed, Michael J. Bell, Robert Bishop, Matthew Bochkoris, Candice Burns, Joseph A. Carcillo, Todd C. Carpenter, Kellimarie K. Cooper, J. Michael Dean, J. Wesley Diddle, Myke Federman, Richard Fernandez, Ericka L. Fink, Deborah Franzon, Aisha H. Frazier, Stuart H. Friess, Kathryn GrahamMark Hall, Monica L. Harding, David A. Hehir, Christopher M. Horvat, Leanna L. Huard, William P. Landis, Tensing Maa, Arushi Manga, Patrick S. McQuillen, Kathleen L. Meert, Peter M. Mourani, Vinay M. Nadkarni, Maryam Y. Naim, Daniel Notterman, Murray M. Pollack, Anil Sapru, Carleen Schneiter, Matthew P. Sharron, Neeraj Srivastava, Bradley Tilford, Shirley Viteri, David Wessel, Heather A. Wolfe, Andrew R. Yates, Athena F. Zuppa, Robert A. Berg, Robert M. Sutton

Research output: Contribution to journalArticlepeer-review


Aim: Pediatric cardiopulmonary resuscitation (CPR) guidelines recommend starting CPR for heart rates (HRs) less than 60 beats per minute (bpm) with poor perfusion. Objectives were to (1) compare HRs and arterial blood pressures (BPs) prior to CPR among patients with clinician-reported bradycardia with poor perfusion (“BRADY”) vs. pulseless electrical activity (PEA); and (2) determine if hemodynamics prior to CPR are associated with outcomes. Methods and Results: Prospective observational cohort study performed as a secondary analysis of the ICU-RESUScitation trial (NCT028374497). Comparisons occurred (1) during the 15 seconds “immediately” prior to CPR and (2) over the two minutes prior to CPR, stratified by age (≤1 year, >1 year). Poisson regression models assessed associations between hemodynamics and outcomes. Primary outcome was return of spontaneous circulation (ROSC). Pre-CPR HRs were lower in BRADY vs. PEA (≤1 year: 63.8 [46.5, 87.0] min−1 vs. 120 [93.2, 150.0], p < 0.001; >1 year: 67.4 [54.5, 87.0] min−1 vs. 100 [66.7, 120], p < 0.014). Pre-CPR pulse pressure was higher among BRADY vs. PEA (≤1 year (12.9 [9.0, 28.5] mmHg vs. 10.4 [6.1, 13.4] mmHg, p > 0.001). Pre-CPR pulse pressure ≥ 20 mmHg was associated with higher rates of ROSC among PEA (aRR 1.58 [CI95 1.07, 2.35], p = 0.022) and survival to hospital discharge with favorable neurologic outcome in both groups (BRADY: aRR 1.28 [CI95 1.01, 1.62], p = 0.040; PEA: aRR 1.94 [CI95 1.19, 3.16], p = 0.008). Pre-CPR HR ≥ 60 bpm was not associated with outcomes. Conclusions: Pulse pressure and HR are used clinically to differentiate BRADY from PEA. A pre-CPR pulse pressure >20 mmHg was associated with improved patient outcomes.

Original languageEnglish (US)
Article number110068
StatePublished - Jan 2024

All Science Journal Classification (ASJC) codes

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine


  • Bradycardia
  • Cardiopulmonary resuscitation
  • Hemodynamics
  • Pediatrics


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