Functional outcomes among survivors of pediatric in-hospital cardiac arrest are associated with baseline neurologic and functional status, but not with diastolic blood pressure during CPR

Heather A Wolfe; Robert M Sutton; Ron W Reeder; Kathleen L Meert; Murray M Pollack; Andrew R Yates; John T Berger; Christopher J Newth; Joseph A Carcillo; Patrick S McQuillen; Rick E Harrison; Frank W Moler; Todd C Carpenter; Daniel A Notterman; Richard Holubkov; J Michael Dean; Vinay M Nadkarni; Robert A Berg; Eunice Kennedy Shriver National Institute of Child Health; Human Development Collaborative Pediatric Critical Care Research Network; Pediatric Intensive Care Quality of Cardiopulmonary Resuscitation Investigators

doi:10.1016/j.resuscitation.2019.08.006

Functional outcomes among survivors of pediatric in-hospital cardiac arrest are associated with baseline neurologic and functional status, but not with diastolic blood pressure during CPR

Resuscitation. 2019 Oct:143:57-65. doi: 10.1016/j.resuscitation.2019.08.006. Epub 2019 Aug 9.

Authors

Heather A Wolfe¹, Robert M Sutton², Ron W Reeder³, Kathleen L Meert⁴, Murray M Pollack⁵, Andrew R Yates⁶, John T Berger⁷, Christopher J Newth⁸, Joseph A Carcillo⁹, Patrick S McQuillen¹⁰, Rick E Harrison¹¹, Frank W Moler¹², Todd C Carpenter¹³, Daniel A Notterman¹⁴, Richard Holubkov³, J Michael Dean³, Vinay M Nadkarni², Robert A Berg²; Eunice Kennedy Shriver National Institute of Child Health; Human Development Collaborative Pediatric Critical Care Research Network; Pediatric Intensive Care Quality of Cardiopulmonary Resuscitation Investigators

Collaborators

Athena F Zuppa², Katherine Graham², Carolann Twelves², Mary Ann Diliberto², Elyse Tomanio⁷, Jeni Kwok⁸, Michael J Bell¹⁵, Alan Abraham⁹, Anil Sapru¹⁶, Mustafa F Alkhouli¹⁰, Sabrina Heidemann⁴, Ann Pawluszka⁴, Mark W Hall⁶, Lisa Steele⁶, Thomas P Shanley¹⁷, Monica Weber¹², Heidi J Dalton¹⁸, Aimee La Bell¹³, Peter M Mourani¹³, Kathryn Malone¹³, Russell Telford³, Christopher Locandro³, Whitney Coleman³, Alecia Peterson³, Julie Thelen³, Allan Doctor¹⁹

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA United States. Electronic address: wolfeh@email.chop.edu.
² Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA United States.
³ Department of Pediatrics, University of Utah, Salt Lake City, UT United States.
⁴ Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI United States.
⁵ Department of Pediatrics, Children's National Medical Center, Washington, D.C. United States; Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ United States.
⁶ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH United States.
⁷ Department of Pediatrics, Children's National Medical Center, Washington, D.C. United States.
⁸ Department of Anesthesiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA United States.
⁹ Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA United States.
¹⁰ Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA United States.
¹¹ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA United States.
¹² Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, MI United States.
¹³ Department of Pediatrics, Denver Children's Hospital, University of Colorado, Denver, CO United States.
¹⁴ Department of Molecular Biology, Princeton University, Princeton, NJ United States.
¹⁵ Department of Pediatrics, Children's National Medical Center, Washington, D.C. United States; Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA United States.
¹⁶ Department of Anesthesiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA United States; Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA United States.
¹⁷ Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, MI United States; Department of Pediatrics, Lurie Children's Hospital, Northwestern University, Chicago, IL United States.
¹⁸ Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ United States.
¹⁹ Department of Pediatrics, Washington University School of Medicine, St. Louis, MO United States.

PMID: 31404636
PMCID: PMC7050270
DOI: 10.1016/j.resuscitation.2019.08.006

Abstract

Aim: Diastolic blood pressure (DBP) during cardiopulmonary resuscitation (CPR) is associated with survival following pediatric in-hospital cardiac arrest. The relationship between intra-arrest haemodynamics and neurological status among survivors of pediatric cardiac arrest is unknown.

Methods: This study represents analysis of data from the prospective multicenter Pediatric Intensive Care Quality of cardiopulmonary resuscitation (PICqCPR) Study. Primary predictor variables were median DBP and median systolic blood pressure (SBP) over the first 10min of CPR. The primary outcome measure was "new substantive morbidity" determined by Functional Status Scale (FSS) and defined as an increase in the FSS of at least 3 points or increase of 2 in a single FSS domain. Univariable analyses were completed to investigate the relationship between new substantive morbidity and BPs during CPR.

Results: 244 index CPR events occurred during the study period, 77 (32%) CPR events met all inclusion criteria as well as having both DBP and FSS data available. Among 77 survivors, 32 (42%) had new substantive morbidity as measured by the FSS score. No significant differences were identified in DBP (median 30.5mmHg vs. 30.9mmHg, p=0.5) or SBP (median 76.3mmHg vs. 63.0mmHg, p=0.2) between patients with and without new substantive morbidity. Children who developed new substantive morbidity were more likely to have lower pre-arrest FSS than those that did not (median [IQR]: 7.5 [6.0-9.0] versus 9.0 [7.0-13.0], p=0.01).

Conclusion: New substantive morbidity determined by FSS after a pediatric IHCA was associated with baseline functional status, but not DBP during CPR.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation (CPR); In-hospital; Outcomes; Pediatric; Survival.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Blood Pressure / physiology*
Cardiopulmonary Resuscitation / methods*
Child
Child, Preschool
Diastole
Female
Follow-Up Studies
Heart Arrest / mortality
Heart Arrest / physiopathology*
Hospital Mortality / trends
Hospitals, Pediatric*
Humans
Infant
Infant, Newborn
Male
Prognosis
Prospective Studies
Survival Rate / trends
United States / epidemiology
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding