(1517) Termination of Resuscitation: CPR Duration for Nonresponders in a Pediatric Resuscitation Network

Introduction: No consensus exists for optimal attempted CPR duration during pediatric cardiac arrests without return of circulation (ROC). Our objective is to describe the variability in CPR duration in children who had termination of resuscitation (TOR) among PICUs in the international Pediatric Resuscitation Quality Collaborative (PediRES-Q). We hypothesized that: 1) there is considerable variability in CPR duration prior to TOR in event non-survivors; and 2) hospital characteristics (e.g. ECPR capability, geography)  impact site CPR duration prior to TOR.

Methods: Retrospective cohort study of the international PediRES-Q database including pediatric patients with index PICU cardiac arrests lasting >/=2 min between 2015-2024 that resulted in TOR without ROC. As a proxy for site resuscitation intensity, median CPR duration among event non-survivors was calculated for each site with >/=10 total events and >/=5 events without ROC. Descriptive statistics were presented as counts with percentages or medians with IQRs.

Results: Of the 22 included sites, the majority (18/22; 81.8%) were in North America; 2 were in Europe, 1 in South America, and 1 in Oceania. Ten of the sites (45%) had >30 PICU beds and 17/22 (77%) utilized extracorporeal CPR (ECPR). Among 982 eligible events, there were 227 event non-survivors. The median CPR duration among all event non-survivors was 30 min (IQR 17, 48). Site-level median CPR duration among event non-survivors ranged from 19-62 min. When considering sites with the shortest ( < 24 min; n=5 sites) and longest (>40 min; n=4 sites) median CPR durations, 3/5 (60%) and 3/4 (75%) utilized ECPR, respectively. None of the four sites located outside of North America had median CPR durations >40 min.

Conclusions: This initial report of CPR duration prior to TOR in PICUs enrolled in an international resuscitation collaborative identified substantial variability (19-62 min) in site median CPR duration in event non-survivors among sites. In the absence of guidelines, site-, patient-, and clinician-level factors impacting decisions pertaining to TOR timing deserve further characterization.