The Temporal Association of the COVID-19 Pandemic and Pediatric Cardiopulmonary Resuscitation Quality and Outcomes*

Abstract

Objectives: The COVID-19 pandemic resulted in adaptations to pediatric resuscitation systems of care. The objective of this study was to determine the temporal association between the pandemic and pediatric in-hospital cardiac arrest (IHCA) process of care metrics, cardiopulmonary resuscitation (cardiopulmonary resuscitation) quality, and patient outcomes. Design: Multicenter retrospective analysis of a dataset comprising observations of IHCA outcomes pre pandemic (March 1, 2019 to February 29, 2020) versus pandemic (March 1, 2020 to February 28, 2021). Setting: Data source was the ICU-RESUScitation Project (“ICU-RESUS;” NCT028374497), a prospective, multicenter, cluster randomized interventional trial. Patients: Children (≤ 18 yr) who received cardiopulmonary resuscitation while admitted to the ICU and were enrolled in ICU-RESUS. Interventions: None. Measurements and Main Results: Among 429 IHCAs meeting inclusion criteria, occurrence during the pandemic period was associated with higher frequency of hypotension as the immediate cause of arrest. Cardiac arrest physiology, cardiopulmonary resuscitation quality metrics, and postarrest physiologic and quality of care metrics were similar between the two periods. Survival with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1–3 or unchanged from baseline) occurred in 102 of 195 subjects (52%) during the pandemic compared with 140 of 234 (60%) pre pandemic ( p = 0.12). Among survivors, occurrence of IHCA during the pandemic period was associated with a greater increase in Functional Status Scale (FSS) (i.e., worsening) from baseline (1 [0–3] vs 0 [0–2]; p = 0.01). After adjustment for confounders, IHCA survival during the pandemic period was associated with a greater increase in FSS from baseline (+1.19 [95% CI, 0.35–2.04] FSS points; p = 0.006) and higher odds of a new FSS-defined morbidity (adjusted odds ratio, 1.88 [95% CI, 1.03–3.46]; p = 0.04). Conclusions: Using the ICU-RESUS dataset, we found that relative to the year prior, pediatric IHCA during the first year of the COVID-19 pandemic was associated with greater worsening of functional status and higher odds of new functional morbidity among survivors.

The More Things Changed—Preservation of Cardiopulmonary Resuscitation Quality Despite Pandemic Impacts on the PICU Population*

“…Although not statistically significant in their sample, the proportion of subjects on a vasopressor was higher (52.3 vs 45%) in the pandemic period (1).…”

“…Although there was no difference in the baseline FSS scores before and during the pandemic, worsening of FSS scores postarrest was greater in the pandemic group than prior (1). On further analysis, breaking the pandemic period into "early" (through May 2020) and "late" (June 2020 through February 2021), the FSS worsening was more pronounced in the second era (1).…”

“…The authors found that the high level of CPR performance in the prepandemic period did not worsen during the pandemic and that survival after inhospital cardiac arrest (IHCA) was not lower during the pandemic, as they had hypothesized (1). The preservation of high CPR quality, especially during…”

“…These centers were all participating in a multicenter, hybrid stepped-wedge cluster-randomized trial of CPR quality interventions (1). As such, it is a retrospective analysis of prospectively collected data from 10 large academic pediatric centers, with over 400 instances of CPR (1). The authors analyzed multiple data elements related to CPR quality as well as the clinical characteristics before and after the arrest.…”

“…In the early pandemic, although pediatric ICUs were largely spared from caring for children with life-threatening pulmonary disease seen in adults, not one of us remained untouched by the impact of the pandemic on our communities, including many children. In this issue of Pediatric Critical Care Medicine , Morgan et al (1) report cardiopulmonary resuscitation (CPR) data from PICUs and cardiac intensive care units, specifically comparing the metrics and outcomes collected before the onset of the pandemic with the period immediately after its onset (through February 2021). These centers were all participating in a multicenter, hybrid stepped-wedge cluster-randomized trial of CPR quality interventions (1).…”