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.
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 D.; Wessel, David; Wolfe, Heather A; Yates, Andrew R; Zuppa, Athena F; Sutton, Robert M; and Topjian, Alexis A, "Identification of Post-cardiac Arrest Blood Pressure Thresholds Associated With Outcomes in Children: An ICU-Resuscitation Study" (2023). Department of Medicine Faculty Papers. Paper 425.
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