Introduction: Interposed abdominal compression CPR (IAC-CPR) is an American Heart Association Class IIb recommended adjunct to standard CPR (S-CPR) that employs abdominal counter-pulsation during the "diastolic" (release) phase of thoracic compressions. Animal and adult studies have demonstrated IAC-CPR augmentation of venous return to the right heart with enhanced cardiac output, and increased diastolic blood pressure (DBP) with improved retrograde flow to the coronary arteries and brain. We hypothesized that IAC-CPR (compared with S-CPR) would result in higher DBP which has been associated with improved survival outcomes in pediatric cardiac intensive care unit (PCICU) patients.

Methods: As participants in a prospective, multicenter, quality assurance collaborative (PediRes-Q.org) from Dec 2020 - July 2024, three participating PCICU sites used IAC-CPR within usual care, and systematically collected hemodynamic data from 1-2 minute sequential epochs of S-CPR and IAC-CPR within the same patient. IAC-CPR training via video (https://youtu.be/cd3Gxu7Maqk), digital slide presentation, and in-person mannequin demonstration of technique competency at each participating center were required. Single rescuer resuscitation of children ≤3 years old proceeded with S-CPR for 1-2 min, followed by 1-2 min of IAC-CPR. Choice of CPR technique for the remainder of the cardiac arrest event was then left to the clinical care team. Hemodynamic waveforms from epochs of S-CPR and IAC-CPR were compared. Return of spontaneous circulation (ROSC), return of circulation (ROC) with ECMO, and survival to hospital discharge or to 30 days were recorded. Neurological outcome was assessed pre-arrest and at hospital discharge by the Pediatric Cerebral Performance Category (PCPC) score. Favorable neurologic outcome was considered PCPC category 1-2, or no change from pre-arrest baseline.

Results: Seventeen infants with complex congenital heart disease were included, the majority of which (14/17) were single ventricle patients who experienced arrest postoperatively. Intervention analyses demonstrated a DBP increase of 11.6 mmHg during IAC-CPR versus S-CPR (95% CI [2.2 - 21.1], p = 0.018, adjusted for non-stationarity and correlations in individual time series). Peak systolic blood pressure (SBP) increased by 15.4 mmHg during IAC-CPR versus S-CPR (95% CI [0.51 - 30.2], p = 0.044, adjusted for non-stationarity and correlations in individual time series). ROSC was achieved in 11/17 (65%), and ROC with ECMO in 5/17 (29%). Survival to hospital discharge or to 30 days occurred in 8/17 (47%), and all had a favorable neurologic outcome. No complications attributable to IAC-CPR were found.

Conclusions: IAC-CPR was associated with significant improvements in both DBP and SBP compared to S-CPR technique in pediatric ICU patients with complex congenital heart disease. This underscores the need for study of IAC-CPR hemodynamics and outcomes in a broader cohort of cardiac and non-cardiac pediatric patients.

Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.

介绍： 间插腹部加压心肺复苏（IAC-CPR）是美国心脏协会推荐的二级辅助标准心肺复苏（S-CPR），在胸部按压的“舒张”（释放）阶段使用腹部反搏。动物和成人研究表明，IAC-CPR可以增强静脉回流到右心室，并提高心脏输出量，同时增加舒张期血压（DBP），从而改善冠状动脉和大脑的逆向血液流动。我们假设在儿科心脏病重症监护病房（PCICU）患者中，与S-CPR相比，IAC-CPR将导致更高的DBP，这与患者的生存结果改善有关。

方法： 作为前瞻性、多中心质量保证协作项目（PediRes-Q.org）的参与者，在2020年12月至2024年7月期间，三个参与PCICU站点在其常规护理中使用了IAC-CPR，并从同一患者体内按顺序记录了一到两分钟标准心肺复苏和间插腹部加压心肺复苏（S-CPR 和 IAC-CPR）的时期内的血流动力学数据。IAC-CPR培训包括视频演示（https://youtu.be/cd3Gxu7Maqk）、数字幻灯片展示，以及每个参与中心的手动模型技术熟练度示范。对于1-3岁儿童的一人复苏程序，在进行了一到两分钟的标准心肺复苏后，接下来进行一到两分钟的间插腹部加压心肺复苏。随后的心脏骤停事件中使用哪种CPR技术，则由临床护理团队决定。S-CPR和IAC-CPR时期内的血流动力学波形进行了比较。记录了自主循环恢复（ROSC）、ECMO支持下的血液循环恢复（ROC）以及出院或30天后的生存情况。通过儿科脑功能分类评分（PCPC），在入院前和医院出院时对患者的神经状态进行评估。有利的神经系统结果被认为是PCPC 1-2类，或者没有从入院前基线变化。

结果： 包括了17名患有复杂先天性心脏病的婴儿，其中大部分（14/17）为单心室患者，并且这些患者的术后心脏骤停。干预分析显示，在IAC-CPR期间舒张压(DBP)比S-CPR增加11.6 mmHg (95% CI [2.2 - 21.1], p = 0.018，经非平稳性和个体时间序列的相关性调整)。收缩压(SBP)在IAC-CPR期间也增加了15.4 mmHg相比S-CPR（95% CI [0.51 - 30.2]，p = 0.044，经过非平稳性和个体时间序列相关性的校正）。ROSC在17名患者中的11人中实现(65%)。使用ECMO恢复循环在17名患者中有5人成功（29%）。8/17名患者生存至出院或30天，并且所有幸存者都有有利的神经学结果。未发现任何可归因于IAC-CPR的并发症。

结论： 在患有复杂先天性心脏病的儿科ICU患者中，与S-CPR相比，IAC-CPR显著改善了舒张压和收缩压。这强调了对更广泛的心脏病和非心脏儿科患者的IAC-CPR血流动力学和结果进行研究的需求。