@article{3651,
  keywords = {Humans, Female, Male, Child, Child, Preschool, Prospective Studies, Infant, Heart Diseases, Adolescent, Infant, Newborn, Cardiopulmonary Resuscitation, Heart Arrest, Blood Pressure, Cardiac Catheterization, Cardiac Surgical Procedures, Hemodynamics},
  author = {Andrew Yates and Robert Sutton and Ron Reeder and Kathleen Meert and John Berger and Richard Fernandez and David Wessel and Christopher Newth and Joseph Carcillo and Patrick McQuillen and Rick Harrison and Frank Moler and Murray Pollack and Todd Carpenter and Daniel Notterman and J Michael Dean and Vinay Nadkarni and Robert Berg and Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network},
  title = {Survival and Cardiopulmonary Resuscitation Hemodynamics Following Cardiac Arrest in Children With Surgical Compared to Medical Heart Disease.},
  abstract = { <p><b>OBJECTIVES: </b>To assess the association of diastolic blood pressure cutoffs (>= 25 mm Hg in infants and >= 30 mm Hg in children) during cardiopulmonary resuscitation with return of spontaneous circulation and survival in surgical cardiac versus medical cardiac patients. Secondarily, we assessed whether these diastolic blood pressure targets were feasible to achieve and associated with outcome in physiology unique to congenital heart disease (single ventricle infants, open chest), and influenced outcomes when extracorporeal cardiopulmonary resuscitation was deployed.</p><p><b>DESIGN: </b>Multicenter, prospective, observational cohort analysis.</p><p><b>SETTING: </b>Tertiary PICU and cardiac ICUs within the Collaborative Pediatric Critical Care Research Network.</p><p><b>PATIENTS: </b>Patients with invasive arterial catheters during cardiopulmonary resuscitation and surgical cardiac or medical cardiac illness category.</p><p><b>INTERVENTIONS: </b>None.</p><p><b>MEASUREMENTS AND MAIN RESULTS: </b>Hemodynamic waveforms during cardiopulmonary resuscitation were analyzed on 113 patients, 88 surgical cardiac and 25 medical cardiac. A similar percent of surgical cardiac (51/88; 58\%) and medical cardiac (17/25; 68\%) patients reached the diastolic blood pressure targets (p = 0.488). Achievement of diastolic blood pressure target was associated with improved survival to hospital discharge in surgical cardiac patients (p = 0.018), but not medical cardiac patients (p = 0.359). Fifty-three percent (16/30) of patients with single ventricles attained the target diastolic blood pressure. In patients with an open chest at the start of chest compressions, 11 of 20 (55\%) attained the target diastolic blood pressure. In the 33 extracorporeal cardiopulmonary resuscitation patients, 16 patients (48\%) met the diastolic blood pressure target with no difference between survivors and nonsurvivors (p = 0.296).</p><p><b>CONCLUSIONS: </b>During resuscitation in an ICU, with invasive monitoring in place, diastolic blood pressure targets of greater than or equal to 25 mm Hg in infants and greater than or equal to 30 mm Hg in children can be achieved in patients with both surgical and medical heart disease. Achievement of diastolic blood pressure target was associated with improved survival to hospital discharge in surgical cardiac patients, but not medical cardiac patients. Diastolic blood pressure targets were feasible to achieve in 1) single ventricle patients, 2) open chest physiology, and 3) extracorporeal cardiopulmonary resuscitation patients.</p> },
  year = {2019},
  journal = {Pediatr Crit Care Med},
  volume = {20},
  pages = {1126-1136},
  month = {2019 Dec},
  issn = {1529-7535},
  doi = {10.1097/PCC.0000000000002088},
  language = {eng},
}