American journal of respiratory and critical care medicine · 2026
Alveolar Ventilation Efficiency Assessed via Capnography is Associated with Improved Outcomes in Pediatric Cardiac Arrest.
СтатьяНазвание и аннотация: Перевод в очереди
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Sutton Robert M, Bender Dieter, Thakur Vinod S, Reeder Ron W, Alvey Jessica S, Graham Kathryn, O'Halloran Amanda J, Shepard Lindsay N, Nadkarni Vinay M, Berg Robert A, Nataraj C, Morgan Ryan W
Аннотация
RATIONALE: Airway opening index (AOI) is a metric recently described in adults to infer airway patency during cardiopulmonary resuscitation (CPR). The underlying premise is that higher AOI values suggest more patent airways, which leads to improved ventilation/ outcomes.
OBJECTIVES: 1) To quantitatively describe AOI during pediatric CPR and 2) to evaluate the association of AOI with outcomes.
METHODS: Prospective multicenter observational cohort study of children (≤18 years) with invasive airways and capnography data. AOI was calculated as the average of ((delta CO2)/max CO2) associated with each chest compression during a ventilation (range: 0 [closed] to 1 [open]). Cubic splines/ receiver operating characteristic curves identified an AOI cutpoint for evaluation in modified Poisson regression models. A sensitivity analysis excluded extracorporeal CPR patients (E-CPR).
MEASUREMENTS: The primary outcome was survival to hospital discharge.
MAIN RESULTS: Among 99 events (median age: 0.34 [0.04, 3.26] yrs), median AOI was 0.38 [0.25, 0.53]. Event-level average AOI ≥0.35 was associated with improved survival to hospital discharge (aRR 1.53 [CI95 1.03, 2.28], p = 0.04) and favorable neurological outcome (aRR 1.56 [CI95 1.01, 2.41], p = 0.04) compared to AOI <0.35. Findings were robust when excluding E-CPR patients. After return of circulation, events with AOI ≥0.35 had lower peak arterial lactates (6.0 [2.8, 11.0] vs. 11.5 [6.4, 19.0] mmol/L, p = 0.006), despite similar CPR durations (≥0.35: 9 [3, 36] vs. <0.35: 8.5 [3, 21] min, p = 0.64).
CONCLUSIONS: In this multicenter study, an AOI ≥0.35 was associated with improved survival outcomes. Events with AOI ≥0.35 had evidence of improved post-arrest physiology.
OBJECTIVES: 1) To quantitatively describe AOI during pediatric CPR and 2) to evaluate the association of AOI with outcomes.
METHODS: Prospective multicenter observational cohort study of children (≤18 years) with invasive airways and capnography data. AOI was calculated as the average of ((delta CO2)/max CO2) associated with each chest compression during a ventilation (range: 0 [closed] to 1 [open]). Cubic splines/ receiver operating characteristic curves identified an AOI cutpoint for evaluation in modified Poisson regression models. A sensitivity analysis excluded extracorporeal CPR patients (E-CPR).
MEASUREMENTS: The primary outcome was survival to hospital discharge.
MAIN RESULTS: Among 99 events (median age: 0.34 [0.04, 3.26] yrs), median AOI was 0.38 [0.25, 0.53]. Event-level average AOI ≥0.35 was associated with improved survival to hospital discharge (aRR 1.53 [CI95 1.03, 2.28], p = 0.04) and favorable neurological outcome (aRR 1.56 [CI95 1.01, 2.41], p = 0.04) compared to AOI <0.35. Findings were robust when excluding E-CPR patients. After return of circulation, events with AOI ≥0.35 had lower peak arterial lactates (6.0 [2.8, 11.0] vs. 11.5 [6.4, 19.0] mmol/L, p = 0.006), despite similar CPR durations (≥0.35: 9 [3, 36] vs. <0.35: 8.5 [3, 21] min, p = 0.64).
CONCLUSIONS: In this multicenter study, an AOI ≥0.35 was associated with improved survival outcomes. Events with AOI ≥0.35 had evidence of improved post-arrest physiology.