The impact of tracheal intubation attempts on chest compression fraction during pediatric CPR: a report from the Videography in Pediatric Resuscitation (VIPER) collaborative

AIM: To examine the association between tracheal intubation (TI) attempts and chest compression (CC) pauses on chest compression fraction (CCF) during pediatric CPR across a network of emergency departments. METHODS: Prospective observational cohort by the Videography in Pediatric Resuscitation (VIPER) Collaborative. Videorecorded CPR events were reviewed to measure CC pauses and characterize TI attempts. CCF was calculated as the proportion of time compressions were delivered during each event. Events were categorized based on whether TI-associated pauses occurred, and CCF was compared using Wilcoxon rank-sum testing. RESULTS: A total of 183 CPR events were included. The median event duration was 971 s (IQR 645-1432 s), and the median CCF was 92% (IQR 90-95%). TI was attempted in 73 events (40%), most commonly once per event, with a median laryngoscopy duration of 34 s (IQR 24-53 s). CC pauses occurred during TI attempts in 29 events, with a median pause duration of 20 s (IQR 10-33 s). TI success rates did not differ significantly between attempts with and without associated CC pauses. There was no significant difference in CCF between events with TI-associated CC pauses (median 92%, IQR 89-94%) and those without such pauses (median 93%, IQR 89-94%; p = 0.11). CONCLUSIONS: TI-associated CC pauses were often longer than recommended but did not reduce overall CCF. There were no significant differences in median pause duration or the frequency of prolonged pauses between events with and without pauses associated with TI. Further studies should explore respiratory parameters during pediatric CPR to clarify the optimal method for assisted ventilation.