Abstract Sa803: Duration of cardiopulmonary resuscitation and survival for pediatric patients with out-of-hospital cardiac arrest
Bibliographic record
Abstract
Background: Prior studies have reported that a longer duration of prehospital cardiopulmonary resuscitation (CPR) before return of spontaneous circulation (ROSC) is associated with poor patient outcomes for adults with out-of-hospital cardiac arrest (OHCA). The association of CPR duration with survival has not been fully investigated for pediatric patients. Aim: To quantify the time-dependent probability of survival as a function of CPR duration among pediatric patients with OHCA. Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective multicenter OHCA registry at 10 sites in the US and Canada from 2011 through 2015. We included pediatric patients (<18 years) with emergency medical services (EMS)-treated OHCA. We estimated the time-dependent probability of subsequently surviving to hospital discharge if patients without prehospital ROSC at each minute of CPR duration received further CPR beyond the time point. The numerator was the number of patients without ROSC at each minute and subsequently survived to hospital discharge. The denominator was the number of patients without ROSC at each minute, excluding those who had termination of resuscitation before or at each minute. Results: Of 1,313 eligible pediatric patients (median [IQR] age, 1 [0-9] year; 773 [58.9%] were male), 236 (18.0%) achieved prehospital ROSC. The median interval from initiation of CPR by EMS clinicians to ROSC was 10 minutes (IQR 5-16 minutes). The time-dependent probabilities (95% CIs) of survival to hospital discharge among patients without ROSC were 7.9% (6.4%-9.4%) at 1 minute, 5.6% (4.3%-6.9%) at 5 minutes, 2.6% (1.6%-3.5%) at 10 minutes, 1.1% (0.4%-1.8%) at 15 minutes, and 0.6% (0.02%-1.3%) at 20 minutes of CPR duration. The point estimate of the probability became less than 1% at 17 minutes of CPR duration. Conclusions: In this analysis of a large multicenter OHCA registry, we quantified the time-dependent probability of survival to hospital discharge in each minute of CPR duration for pediatric OHCA. These findings provide EMS clinicians, patients, and their surrogates with insights into the likelihood of survival if pediatric patients without ROSC continue to receive further CPR.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".