Your browser doesn't support javascript.
loading
Identification of post-cardiac arrest blood pressure thresholds associated with outcomes in children: an ICU-Resuscitation study.
Gardner, Monique M; Hehir, David A; Reeder, Ron W; Ahmed, Tageldin; Bell, Michael J; Berg, Robert A; 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; Harding, Monica L; Horvat, Christopher M; Huard, Leanna L; Maa, Tensing; Manga, Arushi; McQuillen, Patrick S; Meert, Kathleen L; Morgan, Ryan W; Mourani, Peter M; Nadkarni, Vinay M; Naim, Maryam Y; Notterman, Daniel; Pollack, Murray M; Sapru, Anil; Schneiter, Carleen; Sharron, Matthew P; Srivastava, Neeraj; Tilford, Bradley; Viteri, Shirley; Wessel, David; Wolfe, Heather A; Yates, Andrew R; Zuppa, Athena F; Sutton, Robert M; Topjian, Alexis A.
Afiliação
  • Gardner MM; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA. gardnerm@chop.edu.
  • Hehir DA; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
  • 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.
  • Berg RA; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, 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 Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, 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 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, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
  • Hall M; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Harding ML; Department of Pediatrics, University of Utah, Salt Lake City, UT, 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.
  • Morgan RW; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
  • Mourani PM; 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, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
  • Naim MY; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
  • Notterman D; Department of Molecular Biology, Princeton University, Princeton, NJ, 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.
  • 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 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, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, 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, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
  • Sutton RM; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
  • Topjian AA; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Crit Care ; 27(1): 388, 2023 10 07.
Article em En | MEDLINE | ID: mdl-37805481
ABSTRACT

INTRODUCTION:

Though early hypotension after pediatric in-hospital cardiac arrest (IHCA) is associated with inferior outcomes, ideal post-arrest blood pressure (BP) targets have not been established. We aimed to leverage prospectively collected BP data to explore the association of post-arrest BP thresholds with outcomes. We hypothesized that post-arrest systolic and diastolic BP thresholds would be higher than the currently recommended post-cardiopulmonary resuscitation BP targets and would be associated with higher rates of survival to hospital discharge.

METHODS:

We performed a secondary analysis of prospectively collected BP data from the first 24 h following return of circulation from index IHCA events enrolled in the ICU-RESUScitation trial (NCT02837497). The lowest documented systolic BP (SBP) and diastolic BP (DBP) were percentile-adjusted for age, height and sex. Receiver operator characteristic curves and cubic spline analyses controlling for illness category and presence of pre-arrest hypotension were generated exploring the association of lowest post-arrest SBP and DBP with survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1-3 or no change from baseline). Optimal cutoffs for post-arrest BP thresholds were based on analysis of receiver operator characteristic curves and spline curves. Logistic regression models accounting for illness category and pre-arrest hypotension examined the associations of these thresholds with outcomes.

RESULTS:

Among 693 index events with 0-6 h post-arrest BP data, identified thresholds were SBP > 10th percentile and DBP > 50th percentile for age, sex and height. Fifty-one percent (n = 352) of subjects had lowest SBP above threshold and 50% (n = 346) had lowest DBP above threshold. SBP and DBP above thresholds were each associated with survival to hospital discharge (SBP aRR 1.21 [95% CI 1.10, 1.33]; DBP aRR 1.23 [1.12, 1.34]) and survival to hospital discharge with favorable neurologic outcome (SBP aRR 1.22 [1.10, 1.35]; DBP aRR 1.27 [1.15, 1.40]) (all p < 0.001).

CONCLUSIONS:

Following pediatric IHCA, subjects had higher rates of survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome when BP targets above a threshold of SBP > 10th percentile for age and DBP > 50th percentile for age during the first 6 h post-arrest.
Assuntos
Palavras-chave
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Reanimação Cardiopulmonar / Parada Cardíaca / Hipotensão Tipo de estudo: Diagnostic_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Reanimação Cardiopulmonar / Parada Cardíaca / Hipotensão Tipo de estudo: Diagnostic_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article