Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival.

TitleAssociation Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival.
Publication TypeJournal Article
Year of Publication2018
AuthorsBerg, RA, Sutton, RM, Reeder, RW, Berger, JT, Newth, CJ, Carcillo, JA, McQuillen, PS, Meert, KL, Yates, AR, Harrison, RE, Moler, FW, Pollack, MM, Carpenter, TC, Wessel, DL, Jenkins, TL, Notterman, DA, Holubkov, R, Tamburro, RF, J Dean, M, Nadkarni, VM
Corporate Authors
JournalCirculation
Volume137
Issue17
Pagination1784-1795
Date Published2018 04 24
ISSN1524-4539
KeywordsAdolescent, Adolescent Development, Age Factors, Arterial Pressure, Brain, Cardiopulmonary Resuscitation, Cerebrovascular Circulation, Child, Child Development, Child, Preschool, Diastole, Disability Evaluation, Female, Heart Arrest, Hospital Mortality, Humans, Infant, Infant, Newborn, Inpatients, Male, Patient Discharge, Prospective Studies, Recovery of Function, Risk Factors, Time Factors, Treatment Outcome, United States
Abstract

<p><b>BACKGROUND: </b>On the basis of laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data demonstrating that survival depends on attaining adequate arterial diastolic blood pressure (DBP) during CPR, the American Heart Association recommends using blood pressure to guide pediatric CPR. However, evidence-based blood pressure targets during pediatric CPR remain an important knowledge gap for CPR guidelines.</p><p><b>METHODS: </b>All children ≥37 weeks' gestation and <19 years old in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for ≥1 minute and invasive arterial blood pressure monitoring before and during CPR between July 1, 2013, and June 31, 2016, were included. Mean DBP during CPR and Utstein-style standardized cardiac arrest data were collected. The hypothesis was that DBP ≥25 mm Hg during CPR in infants and ≥30 mm Hg in children ≥1 year old would be associated with survival. Primary outcome was survival to hospital discharge. Secondary outcome was survival to hospital discharge with favorable neurological outcome, defined as Pediatric Cerebral Performance Categories 1 to 3 or no worse than prearrest baseline. Multivariable Poisson regression models with robust error estimates were used to estimate the relative risk of outcomes.</p><p><b>RESULTS: </b>Blinded investigators analyzed blood pressure waveforms during CPR from 164 children, including 60% <1 year old, 60% with congenital heart disease, and 54% after cardiac surgery. The immediate cause of arrest was hypotension in 67%, respiratory decompensation in 44%, and arrhythmia in 19%. Median duration of CPR was 8 minutes (quartiles, 3 and 27 minutes). Ninety percent survived the event, 68% with return of spontaneous circulation and 22% by extracorporeal life support. Forty-seven percent survived to hospital discharge, and 43% survived to discharge with favorable neurological outcome. Maintaining mean DBP ≥25 mm Hg in infants and ≥30 mm Hg in children ≥1 year old occurred in 101 of 164 children (62%) and was associated with survival (adjusted relative risk, 1.7; 95% confidence interval, 1.2-2.6; =0.007) and survival with favorable neurological outcome (adjusted relative risk, 1.6; 95% confidence interval, 1.1-2.5; =0.02).</p><p><b>CONCLUSIONS: </b>These data demonstrate that mean DBP ≥25 mm Hg during CPR in infants and ≥30 mm Hg in children ≥1 year old was associated with greater likelihood of survival to hospital discharge and survival with favorable neurological outcome.</p>

DOI10.1161/CIRCULATIONAHA.117.032270
Alternate JournalCirculation
PubMed ID29279413
PubMed Central IDPMC5916041
Grant ListU10 HD063108 / HD / NICHD NIH HHS / United States
U10 HD050012 / HD / NICHD NIH HHS / United States
UG1 HD050012 / HD / NICHD NIH HHS / United States
UG1 HD049983 / HD / NICHD NIH HHS / United States
UG1 HD050096 / HD / NICHD NIH HHS / United States
U10 HD049981 / HD / NICHD NIH HHS / United States
U10 HD050096 / HD / NICHD NIH HHS / United States
UG1 HD083170 / HD / NICHD NIH HHS / United States
UG1 HD083166 / HD / NICHD NIH HHS / United States
U10 HD049983 / HD / NICHD NIH HHS / United States
U10 HD063106 / HD / NICHD NIH HHS / United States
UG1 HD063108 / HD / NICHD NIH HHS / United States
UG1 HD063106 / HD / NICHD NIH HHS / United States
UG1 HD083171 / HD / NICHD NIH HHS / United States
U10 HD063114 / HD / NICHD NIH HHS / United States
U01 HD049934 / HD / NICHD NIH HHS / United States
UG1 HD049981 / HD / NICHD NIH HHS / United States