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Diastolic Blood Pressure Threshold During Pediatric Cardiopulmonary Resuscitation and Survival Outcomes: A Multicenter Validation Study.
Berg, Robert A; Morgan, Ryan W; Reeder, Ron W; Ahmed, Tageldin; Bell, Michael J; Bishop, Robert; Bochkoris, Matthew; Burns, Candice; Carcillo, Joseph A; Carpenter, Todd C; Dean, J Michael; Diddle, J Wesley; Federman, Myke; Fernandez, Richard; Fink, Ericka L; Franzon, Deborah; Frazier, Aisha H; Friess, Stuart H; Graham, Kathryn; Hall, Mark; Hehir, David A; Horvat, Christopher M; Huard, Leanna L; Maa, Tensing; Manga, Arushi; McQuillen, Patrick S; Meert, Kathleen L; Mourani, Peter M; Nadkarni, Vinay M; Naim, Maryam Y; Notterman, Daniel; Palmer, Chella A; Pollack, Murray M; Sapru, Anil; Schneiter, Carleen; Sharron, Matthew P; Srivastava, Neeraj; Tabbutt, Sarah; Tilford, Bradley; Viteri, Shirley; Wessel, David; Wolfe, Heather A; Yates, Andrew R; Zuppa, Athena F; Sutton, Robert M.
Affiliation
  • Berg RA; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
  • Morgan RW; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
  • Reeder RW; Department of Pediatrics, University of Utah, Salt Lake City, UT.
  • Ahmed T; Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
  • Bell MJ; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
  • Bishop R; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
  • Bochkoris M; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
  • Burns C; Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI.
  • Carcillo JA; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
  • Carpenter TC; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
  • Dean JM; Department of Pediatrics, University of Utah, Salt Lake City, UT.
  • Diddle JW; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
  • Federman M; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
  • Fernandez R; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
  • Fink EL; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
  • Franzon D; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.
  • Frazier AH; Alfred I. duPont Hospital for Children, Wilmington, DE.
  • Friess SH; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
  • Graham K; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
  • Hall M; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
  • Hehir DA; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
  • Horvat CM; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
  • Huard LL; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
  • Maa T; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
  • Manga A; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
  • McQuillen PS; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
  • Meert KL; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.
  • Mourani PM; Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
  • Nadkarni VM; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
  • Naim MY; Department of Pediatrics, University of Arkansas for Medical Sciences, and Arkansas Children's Research Institute, Little Rock, AR.
  • Notterman D; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
  • Palmer CA; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
  • Pollack MM; Department of Molecular Biology, Princeton University, Princeton, NJ.
  • Sapru A; Department of Pediatrics, University of Utah, Salt Lake City, UT.
  • Schneiter C; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
  • Sharron MP; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
  • Srivastava N; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
  • Tabbutt S; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
  • Tilford B; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
  • Viteri S; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.
  • Wessel D; Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
  • Wolfe HA; Alfred I. duPont Hospital for Children, Wilmington, DE.
  • Yates AR; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
  • Zuppa AF; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
  • Sutton RM; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Crit Care Med ; 51(1): 91-102, 2023 01 01.
Article in En | MEDLINE | ID: mdl-36519983
ABSTRACT

OBJECTIVES:

Arterial diastolic blood pressure (DBP) greater than 25 mm Hg in infants and greater than 30 mm Hg in children greater than 1 year old during cardiopulmonary resuscitation (CPR) was associated with survival to hospital discharge in one prospective study. We sought to validate these potential hemodynamic targets in a larger multicenter cohort.

DESIGN:

Prospective observational study.

SETTING:

Eighteen PICUs in the ICU-RESUScitation prospective trial from October 2016 to March 2020. PATIENTS Children less than or equal to 18 years old with CPR greater than 30 seconds and invasive blood pressure (BP) monitoring during CPR.

INTERVENTIONS:

None. MEASUREMENTS AND MAIN

RESULTS:

Invasive BP waveform data and Utstein-style CPR data were collected, including prearrest patient characteristics, intra-arrest interventions, and outcomes. Primary outcome was survival to hospital discharge, and secondary outcomes were return of spontaneous circulation (ROSC) and survival to hospital discharge with favorable neurologic outcome. Multivariable Poisson regression models with robust error estimates evaluated the association of DBP greater than 25 mm Hg in infants and greater than 30 mm Hg in older children with these outcomes. Among 1,129 children with inhospital cardiac arrests, 413 had evaluable DBP data. Overall, 85.5% of the patients attained thresholds of mean DBP greater than or equal to 25 mm Hg in infants and greater than or equal to 30 mm Hg in older children. Initial return of circulation occurred in 91.5% and 25% by placement on extracorporeal membrane oxygenator. Survival to hospital discharge occurred in 58.6%, and survival with favorable neurologic outcome in 55.4% (i.e. 94.6% of survivors had favorable neurologic outcomes). Mean DBP greater than 25 mm Hg for infants and greater than 30 mm Hg for older children was significantly associated with survival to discharge (adjusted relative risk [aRR], 1.32; 1.01-1.74; p = 0.03) and ROSC (aRR, 1.49; 1.12-1.97; p = 0.002) but did not reach significance for survival to hospital discharge with favorable neurologic outcome (aRR, 1.30; 0.98-1.72; p = 0.051).

CONCLUSIONS:

These validation data demonstrate that achieving mean DBP during CPR greater than 25 mm Hg for infants and greater than 30 mm Hg for older children is associated with higher rates of survival to hospital discharge, providing potential targets for DBP during CPR.
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Full text: 1 Database: MEDLINE Main subject: Cardiopulmonary Resuscitation / Heart Arrest Type of study: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adolescent / Child / Humans / Infant Language: En Journal: Crit Care Med Year: 2023 Type: Article Affiliation country: Panama
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Full text: 1 Database: MEDLINE Main subject: Cardiopulmonary Resuscitation / Heart Arrest Type of study: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adolescent / Child / Humans / Infant Language: En Journal: Crit Care Med Year: 2023 Type: Article Affiliation country: Panama