Abstract 120: Epidemiology and Outcomes of Cardiopulmonary Resuscitation Events in the Neonatal Intensive Care Unit

Abstract

Introduction: Limited data exists regarding cardiopulmonary resuscitation (CPR) in infants in the Neonatal Intensive Care Unit (NICU). Objectives included determining the incidence, demographics, diagnoses, and outcomes of infants who require CPR across 10 NICUs in San Antonio, Texas. Methods: We conducted a retrospective review of in-NICU CPR events requiring chest compressions for 1 minute from 2012 - 2017. Included NICUs provided the following levels of care: two level IV, two high acuity level III, four low acuity level III, and two level II. Case identification occurred by reviewing death summaries and CPR coding in the electronic medical record. Results: In total, 139 infants (81 or 58% male) required 211 episodes of CPR. CPR incidence per 1000 patient days was 0.68, 0.37, 0.02 and 0 among level IV, high acuity level III, low acuity level III, and level II NICUs, respectively. Median birth weight was 945 (IQR 630, 2243) grams, gestational age at birth 27 (IQR 24, 34) weeks and age at CPR 11 (IQR 1, 42) days. Only 27 events (13%) occurred in term infants. Ninety-three CPR events (44%) had a primary respiratory etiology, 38 (18%) circulatory, 36 (17%) infectious, and 24 (11%) metabolic. Term and preterm infants had significantly different CPR etiologies (p=0.036). Circulatory etiologies were more common in term infants (37% vs 15%) with respiratory etiologies being less common (33.3% vs 46.2%). The most common rhythm documented leading to initiation of CPR was bradycardia (63%), followed by asystole (19%), and pulseless electrical activity (14%). The median duration of CPR was 10 (IQR 4, 25.5) minutes and chest compressions 8 (IQR 3, 18) minutes. While 135 of 211 CPR events (64%) had ROSC, only 22 of 139 patients (16%) survived to hospital discharge. The rate of ROSC among Level IV NICUs was significantly higher than in high acuity level III NICUs (68.2% vs 51.9%, p = 0.034). Conclusions: NICU CPR events occur most commonly in premature infants and are respiratory in origin. Bradycardia is the most common initial rhythm requiring CPR in the NICU. The incidence of CPR and the rate of ROSC are higher in level IV than level III NICUs. Further investigation is needed into factors associated with ROSC for in-NICU CPR.