Survival after delivery room cardiopulmonary resuscitation: A national registry study

Aims: Survival after delivery room cardiopulmonary resuscitation (DR-CPR) is not well characterized in full-term infants, and survival outcomes after DR-CPR have not been defined across the spectrum of gestation. The study objectives were to define gestational age (GA) specific survival following DR-CPR and to assess the association between GA and DR-CPR characteristics and survival outcomes. Methods: Retrospective cohort study of prospectively collected data in the American Heart Association Get With the Guidelines-Resuscitation registry. Newborn infants without congenital abnormalities who received greater than 1 min of chest compressions for DR-CPR were included. GA was stratified by categorical subgroups: ≥36 weeks; 33–35^6/7 weeks; 29–32^6/7 weeks; 25–28^6/7 weeks; 22–24^6/7 weeks. The primary outcome was survival to hospital discharge; the secondary outcome was return of circulation (ROC). Results: Among 1022 infants who received DR-CPR, 83% experienced ROC and 64% survived to hospital discharge. GA-stratified hospital survival rates were 83% (≥36 weeks), 66% (33–35 weeks), 60% (29–32 weeks), 52% (25–28 weeks), and 25% (22–24 weeks). Compared with GA ≥ 36 weeks, lower GA was independently associated with decreasing odds of survival (33–35 weeks: adjusted Odds Ratio [aOR] 0.46, 95% Confidence Interval [CI] 0.26–0.81; 29–32 weeks: aOR 0.40, 95% CI 0.23–0.69; 25–28 weeks: aOR 0.21, 95% CI 0.11–0.41; 22–24 weeks: aOR 0.06, 95% CI 0.03–0.10). Conclusions: In this national registry of infants who received delivery room cardiopulmonary resuscitation (DR-CPR), 83% survived the event and two-thirds survived to hospital discharge. These results contribute to defining survival outcomes following DR-CPR across the continuum of gestation.