Ryan W. Morgan, Ron W. Reeder, Tageldin Ahmed, Michael J. Bell, John T. Berger, Robert Bishop, Matthew Bochkoris, Candice Burns, Joseph A. Carcillo, Todd C. Carpenter, J. Michael Dean, J. Wesley Diddle. Myke Federman, Richard Fernandez, Erika L. Fink, Deborah Franzon, Aisha H. Frazier, Stuart H. Friess, Kathryn Graham, Mark Hall, David A. Hehir, Adam S. Himebauch, Christopher M. Horvat, Leanna L. Huard, Tensing Maa, Arushi Manga, Patrick S. McQuillen, Kathleen L. Meert, Peter M. Mourani, Vinay M. Nadkarni, Maryam Y. Naim, Daniel Notterman, Kent Page, Murray . Pollack, Anil Sapru, Carleen Schneiter, Matthew P. Sharron, Neeraj Srivastava, Sarah Tabbutt, Bradley Tilford, Shirley Viteri, David Wessel, Heather A. Wolfe, Andrew R. Yates, Athena F. Zuppa, Robert A. Berg, Robert M. Sutton
Children’s Hospital of Philadelphia and University of Pennsylvania. University of Utah. Children’s Hospital of Michigan and Central Michigan University. Children’s National Hospital and George Washington University School of Medicine. University of Colorado School of Medicine and Children’s Hospital Colorado. UPMC Children’s Hospital of Pittsburgh and University of Pittsburgh. Michigan State University. Mattel Children’s Hospital and University of California Los Angeles. Nationwide Children’s Hospital and The Ohio State University. Benioff Children’s Hospital and University of California, San Francisco. Nemours Children’s Health and Delaware and Thomas Jefferson University. Washington University School of Medicine. University of Arkansas for Medical Sciences and Arkansas Children’s Hospital. Princeton University.
United States
Resuscitation
Resuscitation 2023;
DOI: 10.1016/j.resuscitation.2023.109897
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.
Category
Procedural Risk and Care for Individuals with Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: No