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Outcomes and characteristics of cardiac arrest in children with pulmonary hypertension: A secondary analysis of the ICU-RESUS clinical trial.
Morgan, Ryan W; Reeder, Ron W; Ahmed, Tageldin; Bell, Michael J; Berger, John T; 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; Himebauch, Adam S; 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; Page, Kent; 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; Berg, Robert A; Sutton, Robert M.
Affiliation
  • Morgan RW; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: MorganR1@chop.edu.
  • Reeder RW; Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
  • Ahmed T; Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
  • Bell MJ; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
  • Berger JT; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
  • Bishop R; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
  • Bochkoris M; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
  • Burns C; Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA.
  • Carcillo JA; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
  • Carpenter TC; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
  • Dean JM; Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
  • Diddle JW; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
  • Federman M; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
  • Fernandez R; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Fink EL; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
  • Franzon D; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
  • Frazier AH; Nemours Cardiac Center, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE, USA; Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE, USA.
  • Friess SH; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
  • Graham K; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Hall M; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Hehir DA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Himebauch AS; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Horvat CM; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
  • Huard LL; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
  • Maa T; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Manga A; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
  • McQuillen PS; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
  • Meert KL; Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
  • Mourani PM; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
  • Nadkarni VM; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Naim MY; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Notterman D; Department of Molecular Biology, Princeton University, Princeton, NJ, USA.
  • Page K; Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
  • Pollack MM; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
  • Sapru A; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
  • Schneiter C; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
  • Sharron MP; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
  • Srivastava N; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
  • Tabbutt S; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
  • Tilford B; Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
  • Viteri S; Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE, USA.
  • Wessel D; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
  • Wolfe HA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Yates AR; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Zuppa AF; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Berg RA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Sutton RM; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
Resuscitation ; 190: 109897, 2023 09.
Article in En | MEDLINE | ID: mdl-37406760
ABSTRACT

BACKGROUND:

Previous studies have identified pulmonary hypertension (PH) as a relatively common diagnosis in children with in-hospital cardiac arrest (IHCA), and preclinical laboratory studies have found poor outcomes and low systemic blood pressures during CPR for PH-associated cardiac arrest. The objective of this study was to determine the prevalence of PH among children with IHCA and the association between PH diagnosis and intra-arrest physiology and survival outcomes.

METHODS:

This was a prospectively designed secondary analysis of patients enrolled in the ICU-RESUS clinical trial (NCT02837497). The primary exposure was a pre-arrest diagnosis of PH. The primary survival outcome was survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline). The primary physiologic outcome was event-level average diastolic blood pressure (DBP) during CPR.

RESULTS:

Of 1276 patients with IHCAs during the study period, 1129 index IHCAs were enrolled; 184 (16.3%) had PH and 101/184 (54.9%) were receiving inhaled nitric oxide at the time of IHCA. Survival with favorable neurologic outcome was similar between patients with and without PH on univariate (48.9% vs. 54.4%; p = 0.17) and multivariate analyses (aOR 0.82 [95%CI 0.56, 1.20]; p = 0.32). There were no significant differences in CPR event outcome or survival to hospital discharge. Average DBP, systolic BP, and end-tidal carbon dioxide during CPR were similar between groups.

CONCLUSIONS:

In this prospective study of pediatric IHCA, pre-existing PH was present in 16% of children. Pre-arrest PH diagnosis was not associated with statistically significant differences in survival outcomes or intra-arrest physiologic measures.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cardiopulmonary Resuscitation / Heart Arrest / Hypertension, Pulmonary Type of study: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Child / Humans Language: En Journal: Resuscitation Year: 2023 Document type: Article
Fulltext
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cardiopulmonary Resuscitation / Heart Arrest / Hypertension, Pulmonary Type of study: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Child / Humans Language: En Journal: Resuscitation Year: 2023 Document type: Article