Pediatric Chest Compression Duty Cycle Using Arterial Pressure Waveforms
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Resuscitation, Cardiovascular, Pediatrics, 2022
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INTRODUCTION/HYPOTHESIS: Chest compression duty cycle (DC) remains understudied in pediatric cardiopulmonary resuscitation (CPR) and can be calculated by dividing the area under the force curve by the total area of one compression–decompression (area duty cycle [ADC]). In our pilot laboratory testing, there was high concordance between force-determined ADC and invasive arterial blood pressure (ABP) waveform-determined ADC. Our objective was to utilize this novel ADC method to 1) quantitatively describe DC during pediatric in-hospital CPR and 2) evaluate its association with intra-arrest hemodynamics and patient outcomes.  METHODS: Subjects included children ≤18 years old and ≥37 weeks corrected gestational age who received chest compressions while admitted to one of the 18 participating intensive care units of The ICU-RESUScitation Project (NCT028374497). In this convenience sample, ADC was calculated as the ratio between the area under the invasive ABP waveform and the total area of the compression cycle (base of area calculation = line at compression cycle diastolic BP [DBP]). American Heart Association (AHA) DC guideline compliance was defined as an average event DC of 50 ± 5%. Percentage of events compliant with AHA DC was compared to an a priori hypothesized compliance percentage of 10% using Chi-square test. Differences across DC quartiles for intra-arrest BPs were analyzed by Kruskal-Wallis test and outcomes by Chi-square test. RESULTS: Among 160 patients, median [IQR] age was 2.9 [0.12, 3.1] years; during CPR systolic BP (SBP) 81.9 [61.6, 111.3] mmHg; DBP 43.0 [33.5, 54.7] mmHg. Return of spontaneous circulation occurred in 112 (70%) with survival to discharge in 96 (60%). ADC quartiles were: Q1 (≤30.6%), Q2 ( >30.6–35.1%), Q3 ( >35.1–38.2%), Q4 ( >38.2%). Only 5 (3.1%) events met AHA DC compliance, significantly less than the a priori hypothesis of 10% (p  CONCLUSIONS: Using a novel method of ADC calculated from the ABP waveform, DC during pediatric ICU CPR is rarely compliant with AHA recommendations. The SBP differed across ADC quartiles; however, DBP and outcomes were similar.
Meta Tag
Content Type Presentation
Knowledge Area Resuscitation
Knowledge Area Cardiovascular
Knowledge Area Pediatrics
Knowledge Level Advanced
Membership Level Select
Tag Cardiopulmonary Resuscitation CPR
Tag Hemodynamic Monitoring
Tag Pediatrics
Tag Cardiac Arrest
Tag Outcomes Research
Tag Cardiothoracic Critical Care
Year 2022
duty cycle
pediatric chest compressions
blood flow
systolic blood pressures


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