Title | The association of immediate post cardiac arrest diastolic hypertension and survival following pediatric cardiac arrest. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Topjian, AA, Sutton, RM, Reeder, RW, Telford, R, Meert, KL, Yates, AR, Morgan, RW, Berger, JT, Newth, CJ, Carcillo, JA, McQuillen, PS, Harrison, RE, Moler, FW, Pollack, MM, Carpenter, TC, Notterman, DA, Holubkov, R, J Dean, M, Nadkarni, VM, Berg, RA, Zuppa, AF, Graham, K, Twelves, C, Diliberto, MAnn, Landis, WP, Tomanio, E, Kwok, J, Bell, MJ, Abraham, A, Sapru, A, Alkhouli, MF, Heidemann, S, Pawluszka, A, Hall, MW, Steele, L, Shanley, TP, Weber, M, Dalton, HJ, La Bell, A, Mourani, PM, Malone, K, Locandro, C, Coleman, W, Peterson, A, Thelen, J, Doctor, A |
Corporate Authors | |
Journal | Resuscitation |
Volume | 141 |
Pagination | 88-95 |
Date Published | 2019 08 |
ISSN | 1873-1570 |
Keywords | Diastole, Female, Heart Arrest, Humans, Hypertension, Infant, Male, Prospective Studies, Survival Rate, Time Factors |
Abstract | <p><b>AIM: </b>In-hospital cardiac arrest occurs in >5000 children each year in the US and almost half will not survive to discharge. Animal data demonstrate that an immediate post-resuscitation burst of hypertension is associated with improved survival. We aimed to determine if systolic and diastolic invasive arterial blood pressures immediately (0-20 min) after return of spontaneous circulation (ROSC) are associated with survival and neurologic outcomes at hospital discharge.</p><p><b>METHODS: </b>This is a secondary analysis of the Pediatric Intensive Care Quality of CPR (PICqCPR) study of invasively measured blood pressures during intensive care unit CPR. Patients were eligible if they achieved ROSC and had at least one invasively measured blood pressure within the first 20 min following ROSC. Post-ROSC blood pressures were normalized for age, sex and height. "Immediate hypertension" was defined as at least one systolic or diastolic blood pressure >90th percentile. The primary outcome was survival to hospital discharge.</p><p><b>RESULTS: </b>Of 102 children, 70 (68.6%) had at least one episode of immediate post-CPR diastolic hypertension. After controlling for pre-existing hypotension, duration of CPR, calcium administration, and first documented rhythm, patients with immediate post-CPR diastolic hypertension were more likely to survive to hospital discharge (79.3% vs. 54.5%; adjusted OR = 2.93; 95%CI, 1.16-7.69).</p><p><b>CONCLUSIONS: </b>In this post hoc secondary analysis of the PICqCPR study, 68.6% of subjects had diastolic hypertension within 20 min of ROSC. Immediate post-ROSC hypertension was associated with increased odds of survival to discharge, even after adjusting for covariates of interest.</p> |
DOI | 10.1016/j.resuscitation.2019.05.033 |
Alternate Journal | Resuscitation |
PubMed ID | 31176666 |
PubMed Central ID | PMC6709525 |
Grant List | U10 HD050012 / HD / NICHD NIH HHS / United States UG1 HD049983 / HD / NICHD NIH HHS / United States UG1 HD050096 / HD / NICHD NIH HHS / United States U10 HD063106 / HD / NICHD NIH HHS / United States UG1 HD063108 / HD / NICHD NIH HHS / United States RL1 HD107773 / 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 UG1 HD083170 / HD / NICHD NIH HHS / United States K23 RR021921 / RR / NCRR NIH HHS / United States UG1 HD083166 / HD / NICHD NIH HHS / United States |