Heather A Wolfe1, Robert M Sutton2, Ron W Reeder3, Kathleen L Meert4, Murray M Pollack5, Andrew R Yates6, John T Berger7, Christopher J Newth8, Joseph A Carcillo9, Patrick S McQuillen10, Rick E Harrison11, Frank W Moler12, Todd C Carpenter13, Daniel A Notterman14, Richard Holubkov3, J Michael Dean3, Vinay M Nadkarni2, Robert A Berg2. 1. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA United States. Electronic address: wolfeh@email.chop.edu. 2. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA United States. 3. Department of Pediatrics, University of Utah, Salt Lake City, UT United States. 4. Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI United States. 5. Department of Pediatrics, Children's National Medical Center, Washington, D.C. United States; Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ United States. 6. Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH United States. 7. Department of Pediatrics, Children's National Medical Center, Washington, D.C. United States. 8. Department of Anesthesiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA United States. 9. Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA United States. 10. Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA United States. 11. Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA United States. 12. Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, MI United States. 13. Department of Pediatrics, Denver Children's Hospital, University of Colorado, Denver, CO United States. 14. Department of Molecular Biology, Princeton University, Princeton, NJ United States.
Abstract
AIM: Diastolic blood pressure (DBP) during cardiopulmonary resuscitation (CPR) is associated with survival following pediatric in-hospital cardiac arrest. The relationship between intra-arrest haemodynamics and neurological status among survivors of pediatric cardiac arrest is unknown. METHODS: This study represents analysis of data from the prospective multicenter Pediatric Intensive Care Quality of cardiopulmonary resuscitation (PICqCPR) Study. Primary predictor variables were median DBP and median systolic blood pressure (SBP) over the first 10min of CPR. The primary outcome measure was "new substantive morbidity" determined by Functional Status Scale (FSS) and defined as an increase in the FSS of at least 3 points or increase of 2 in a single FSS domain. Univariable analyses were completed to investigate the relationship between new substantive morbidity and BPs during CPR. RESULTS: 244 index CPR events occurred during the study period, 77 (32%) CPR events met all inclusion criteria as well as having both DBP and FSS data available. Among 77 survivors, 32 (42%) had new substantive morbidity as measured by the FSS score. No significant differences were identified in DBP (median 30.5mmHg vs. 30.9mmHg, p=0.5) or SBP (median 76.3mmHg vs. 63.0mmHg, p=0.2) between patients with and without new substantive morbidity. Children who developed new substantive morbidity were more likely to have lower pre-arrest FSS than those that did not (median [IQR]: 7.5 [6.0-9.0] versus 9.0 [7.0-13.0], p=0.01). CONCLUSION: New substantive morbidity determined by FSS after a pediatric IHCA was associated with baseline functional status, but not DBP during CPR.
AIM: Diastolic blood pressure (DBP) during cardiopulmonary resuscitation (CPR) is associated with survival following pediatric in-hospital cardiac arrest. The relationship between intra-arrest haemodynamics and neurological status among survivors of pediatric cardiac arrest is unknown. METHODS: This study represents analysis of data from the prospective multicenter Pediatric Intensive Care Quality of cardiopulmonary resuscitation (PICqCPR) Study. Primary predictor variables were median DBP and median systolic blood pressure (SBP) over the first 10min of CPR. The primary outcome measure was "new substantive morbidity" determined by Functional Status Scale (FSS) and defined as an increase in the FSS of at least 3 points or increase of 2 in a single FSS domain. Univariable analyses were completed to investigate the relationship between new substantive morbidity and BPs during CPR. RESULTS: 244 index CPR events occurred during the study period, 77 (32%) CPR events met all inclusion criteria as well as having both DBP and FSS data available. Among 77 survivors, 32 (42%) had new substantive morbidity as measured by the FSS score. No significant differences were identified in DBP (median 30.5mmHg vs. 30.9mmHg, p=0.5) or SBP (median 76.3mmHg vs. 63.0mmHg, p=0.2) between patients with and without new substantive morbidity. Children who developed new substantive morbidity were more likely to have lower pre-arrest FSS than those that did not (median [IQR]: 7.5 [6.0-9.0] versus 9.0 [7.0-13.0], p=0.01). CONCLUSION: New substantive morbidity determined by FSS after a pediatric IHCA was associated with baseline functional status, but not DBP during CPR.
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