Association of AHA Chest Compression Depth Targets and Arterial Blood Pressure During CPR in Infants

Introduction: Active CPR coaching for depth and rate of compressions based on real-time feedback from accelerometer-based devices is becoming standard of care in pediatric cardiac arrests. This includes a goal compression depth of 1.5 in (4cm) in infants that is based on compressing 1/3 of the anterior-posterior diameter of the chest, but this goal has had little physiologic evidence that it improves clinical outcomes.
Previous studies have shown that mean diastolic blood pressures (DBP) ≥25 mm Hg during CPR are associated with increased likelihood of survival and favorable neurologic outcomes, but here have not been data that have shown a correlation of compression depth and DBP in infants. This study looks to evaluate the relationship of compression depth and invasive DBP to determine appropriateness of current compression depth targets.


Methods: This study obtained multicenter resuscitation data from the PediRES-Q collaborative. Patients included were < 1 year of age with in-hospital cardiac arrest with associated ZOLL compression depth recordings and invasive arterial line waveform data. Arterial line tracings were analyzed using WebPlotDigitizer to find DBP during the chest compressions. Blood pressures were then matched to compression depth averages over 15 second epochs to correlate depth to average DBP.


Results: Preliminary evaluation includes 7 patients with a total of 154 15 second data intervals. Average compression depth was 1.07(0.88-1.22)in with 92% being less than 1.5in (AHA goal). Despite this, patients had an average DBP of 42(35-46)mmHg and only 6% of intervals had DBP less than the goal of 25mmg. In our data increasing compression depth shows a weakly positive correlation with DBP (R2 0.23). Using this best fit line, adequate DBP (≥25 mm Hg) can be achieved with 0.7 in of compression depth, which is less than half of the current guidelines.


Conclusions: Based on preliminary data, current compression depth recommendations in infants may be significantly deeper than necessary to achieve appropriate DBP targets, although deeper compressions do correlate to increased average DBP. We have received additional data from the pediRES-Q and are working on the inclusion of additional CPR events that will be helpful to further evaluate and strengthen these conclusions.