Pediatric Cardiopulmonary Resuscitation Ventilation Rates and Outcomes

Shepard, LN; Friess, SH; Reeder, RW; Bender, D; Berg, RA; Graham, K; Meert, KL; Mourani, PM; Murray, R; Nadkarni, VM; Nataraj, C; Palmer, CA; Patterson, E; Srivastava, N; Wolfe, HA; Yates, AR; Morgan, RW; Sutton, RM; ICU-RESUS and Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) Investigator Groups

doi:10.1097/ccm.0000000000007381

Cardiac arrest & resuscitation

Pediatric Cardiopulmonary Resuscitation Ventilation Rates and Outcomes

Crit Care MedPublished 14 Oct 2026Multicenter prospective ancillary observational cohort study of the ICU-RESUS trial

Main finding · Survival to hospital dischargeResultARR for survival to hospital discharge 0.95 95% CI 0.75–1.21

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Authors' conclusion

CPR ventilation rates in the currently recommended range (20-30 bpm) were not associated with survival in children with in-hospital cardiac arrest. In exploratory analyses in children younger than 8 years, higher ventilation rates (≥ 26 bpm) were associated with improved survival and warrant confirmation in future studies.

Study context

Population: Hospitalized children (≤ 18 yr) with endotracheal or tracheostomy tubes and evaluable intra-arrest end-tidal carbon dioxide data to calculate ventilation rate, in 18 ICUs from 10 U.S. clinical sites, October 2016 to March 2021
Participants: 234 included events

Exposure: Guideline-recommended cardiopulmonary resuscitation (CPR) ventilation rate (20-30 bpm) and survival to hospital discharge
Guideline-recommended ventilation raten = 86
Outcome: Survival to hospital discharge

Main finding

As reported in the abstract

ARR for survival to hospital discharge

0.95

95% CI 0.75–1.21

P = 0.68

Guideline-recommended ventilation rate vs < 26 bpm (< 8 yr)

aRR for survival to hospital discharge 0.95 (95% CI 0.75–1.21); P = 0.68

Observational data: associations, not effects.

Further findings

Outcome		aRR for survival to hospital discharge (95% CI)	P value
Survival to hospital discharge, children younger than 8 years (exploratory)≥ 26 bpm (< 8 yr) vs < 26 bpm (< 8 yr) · associated with improved survival · exploratory	0.512	1.32 (1.00–1.73)	P = 0.048
	0.512ARR for survival to hospital discharge (log scale)

Novel age-stratified ventilation rate thresholds (exploratory)

Potential thresholds: < 8 yr, ≥ 26 bpm; ≥ 8 yr, < 26 bpm

Exploratory
Natural cubic splines, then evaluated in multivariable models

Reference

Authors: Shepard LN, Friess SH, Reeder RW, Bender D, Berg RA, Graham K, et al.
All 19 authors
Shepard LN, Friess SH, Reeder RW, Bender D, Berg RA, Graham K, Meert KL, Mourani PM, Murray R, Nadkarni VM, Nataraj C, Palmer CA, Patterson E, Srivastava N, Wolfe HA, Yates AR, Morgan RW, Sutton RM, ICU-RESUS and Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) Investigator Groups
Journal: Critical Care Medicine
Published: 14 Oct 2026
DOI: 10.1097/ccm.0000000000007381
PubMed: 42872941
Registration: NCT02837497

Topic: Cardiac arrest & resuscitation
Also indexed: Paediatric anaesthesia & critical care

Exposure definitions

Guideline-recommended ventilation rate: average ventilation rate during CPR 20-30 beats per min [bpm]
≥ 26 bpm (< 8 yr): children younger than 8 years with average CPR ventilation rate greater than or equal to 26 bpm
< 26 bpm (< 8 yr): children younger than 8 years with average CPR ventilation rate less than 26 bpm

Key notes

No association
Poisson regression using generalized estimating equations, controlling for a priori covariables (initial pulse status, immediate cause of arrest)

Original publication

Pediatric Cardiopulmonary Resuscitation Ventilation Rates and Outcomes. Crit Care Med. Published 14 October 2026. doi:10.1097/ccm.0000000000007381

Read the original article ↗

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