Abstract 133: Association of End Tidal Carbon Dioxide >20mmhg with Pediatric In-hospital Cardiac Arrest Quality of Cpr and Survival
Bibliographic record
Abstract
Introduction: AHA recommends titrating chest compressions (CC) to achieve end-tidal carbon dioxide (ETCO2)>20mmHg, based on laboratory, adult, and very limited pediatric IHCA data. Hypothesis: ETCO2>20mmHg averaged during the first 10 min of recorded CPR is associated with 1) compliance with AHA CC depth quality targets, and 2) survival to hospital discharge. Methods: All pediatric 2015-2019 IHCA events reported by 4 pediRES-Q sites with simultaneous ETCO2 and CC metrics (ZOLL R-Series defibrillator) measured. Analysis included the first 10 min of CPR with CC data recorded using dual sensor accelerometers that compensate for mattress deflection. Compliance with 2015 AHA guidelines CC depth quality target defined as ∼1/3 estimated AP diameter: ≥3.4 cm for infants <1yr, ≥4.4cm for 1 to < 8yrs, and 4.5-6.6cm for 8 to ≤ 18yrs. Primary analysis for ETCO2>20mmHg cutoff association with CC depth and survival by modified Poisson regression models, accounting for age. Secondary analysis for mean ETCO2 (no a priori cutoff) association with CC depth and survival, adjusting for age. Results: Of 44 events (24 index): median 10-min averaged ETCO2 was 23 [IQR 13, 37] mmHg, CPR duration was 23 [IQR 10, 53] min, return of spontaneous circulation (ROSC) was 70% (31/44), and survival to hospital discharge was 33% (8/24). ETCO2>20 mmHg cutoff was associated with CC depth [RR 1.55 (95%CI: 1.20,2.00) p=0.0007], and age-specific AHA depth quality target compliance [RR 1.01 (95%CI: 1.00,1.02) p=0.02. However, ETCO2 > 20mmHg cutoff was not significantly associated with survival: ROSC [RR 1.08 (95%CI: 0.71, 1.65), p=0.72)] nor survival to hospital discharge [RR 1.10 (95%CI: 0.33, 3.65), p=0.87]. Mean 10-min averaged ETCO2 (no cutoff) was not significantly associated with CC depth (p=0.09), age-specific AHA depth quality target compliance (p=0.07), ROSC (p=0.57) , nor survival to hospital discharge (26 [IQR 14, 43] mmHg vs. 16 [IQR 13,34] mmHg non-survival to hospital discharge, p=0.28). Conclusions: In this multicenter pediatric In-hospital CPR cohort, ETCO2>20mmHg cutoff averaged during the first 10-min of recorded CPR was significantly associated with CC depth and age-specific AHA depth quality target compliance, but not with ROSC or survival to hospital discharge.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".