Abstract Sat701: Prolonged In-Hospital CPR in Pediatric OHCA Patients with Estimated Poor Neurological Prognosis: Challenges in Termination Resuscitation in Children

Abstract

Introduction: Pediatric out-of-hospital cardiac arrest (OHCA) patients often present with a poor predicted neurological prognosis. While prolonged cardiopulmonary resuscitation (CPR) duration is associated with unfavorable neurological outcomes in both children and adults, in-hospital CPR duration across age group using a prognostic model has not been sufficiently investigated. Objective: To investigate whether in-hospital CPR duration differs between pediatric and adult OHCA patients, when the probability of a favorable neurological outcome upon hospital arrival is exceedingly low. Methods: We analyzed data from the nationwide, prospective OHCA registry by the Japanese Association for Acute Medicine (JAAM OHCA registry). Multivariable logistic regression models were developed separately for five age groups to estimate the probability of achieving a favorable neurological outcome, defined as a Cerebral Performance Categories score or Pediatric Cerebral Performance Categories score ≤2 at 30 days. Patients with an estimated probability of <0.1% were included in the analysis. In-hospital CPR durations were compared across age groups. (Figure) Results: A total of 63,958 OHCA patients who did not achieve a return of spontaneous circulation (ROSC) at hospital arrival were included for the model development. Using this model, 29,463 were identified as having an estimated <0.1% probability of a favorable neurological outcome (≤17 years: 777; ≤40 years: 1146; ≤60 years: 1232; ≤80 years: 7405; >80 years: 18,903). Observed rates of favorable outcomes were 0% (0/777), 0% (0/1146), 0% (0/1232), 0.04% (3/7405), and 0.03% (6/18,903), respectively. The median duration of in-hospital CPR was significantly longer in pediatric group (≤17 years: 35 min [IQR: 22–51]) compared to older age groups (≤40 years: 22 min [13–34], ≤60 years: 21 min [13–33], ≤80 years: 21 min [13–33], >80 years: 20 min [12–34], all p < 0.001). Conclusions: Pediatric OHCA patients received a significantly longer in-hospital resuscitation compared to adults among estimated exceedingly poor neurological prognosis group. This finding underscores the challenges of making termination-of-resuscitation decisions in pediatric populations.