@article{0db8b746698a471da47075f6967ceb46,
title = "Diastolic Blood Pressure Threshold during Pediatric Cardiopulmonary Resuscitation and Survival Outcomes: A Multicenter Validation Study∗",
abstract = "OBJECTIVES: Arterial diastolic blood pressure (DBP) greater than 25 mm Hg in infants and greater than 30 mm Hg in children greater than 1 year old during cardiopulmonary resuscitation (CPR) was associated with survival to hospital discharge in one prospective study. We sought to validate these potential hemodynamic targets in a larger multicenter cohort. DESIGN: Prospective observational study. SETTING: Eighteen PICUs in the ICU-RESUScitation prospective trial from October 2016 to March 2020. PATIENTS: Children less than or equal to 18 years old with CPR greater than 30 seconds and invasive blood pressure (BP) monitoring during CPR. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Invasive BP waveform data and Utstein-style CPR data were collected, including prearrest patient characteristics, intra-arrest interventions, and outcomes. Primary outcome was survival to hospital discharge, and secondary outcomes were return of spontaneous circulation (ROSC) and survival to hospital discharge with favorable neurologic outcome. Multivariable Poisson regression models with robust error estimates evaluated the association of DBP greater than 25 mm Hg in infants and greater than 30 mm Hg in older children with these outcomes. Among 1,129 children with inhospital cardiac arrests, 413 had evaluable DBP data. Overall, 85.5% of the patients attained thresholds of mean DBP greater than or equal to 25 mm Hg in infants and greater than or equal to 30 mm Hg in older children. Initial return of circulation occurred in 91.5% and 25% by placement on extracorporeal membrane oxygenator. Survival to hospital discharge occurred in 58.6%, and survival with favorable neurologic outcome in 55.4% (i.e. 94.6% of survivors had favorable neurologic outcomes). Mean DBP greater than 25 mm Hg for infants and greater than 30 mm Hg for older children was significantly associated with survival to discharge (adjusted relative risk [aRR], 1.32; 1.01-1.74; p = 0.03) and ROSC (aRR, 1.49; 1.12-1.97; p = 0.002) but did not reach significance for survival to hospital discharge with favorable neurologic outcome (aRR, 1.30; 0.98-1.72; p = 0.051). CONCLUSIONS: These validation data demonstrate that achieving mean DBP during CPR greater than 25 mm Hg for infants and greater than 30 mm Hg for older children is associated with higher rates of survival to hospital discharge, providing potential targets for DBP during CPR.",
keywords = "cardiopulmonary resuscitation, heart arrest, hemodynamics, outcomes, pediatric",
author = "Berg, {Robert A.} and Morgan, {Ryan W.} and Reeder, {Ron W.} and Tageldin Ahmed and Bell, {Michael J.} and Robert Bishop and Matthew Bochkoris and Candice Burns and Carcillo, {Joseph A.} and Carpenter, {Todd C.} and Dean, {J. Michael} and Diddle, {J. Wesley} and Myke Federman and Richard Fernandez and Fink, {Ericka L.} and Deborah Franzon and Frazier, {Aisha H.} and Friess, {Stuart H.} and Kathryn Graham and Mark Hall and Hehir, {David A.} and Horvat, {Christopher M.} and Huard, {Leanna L.} and Tensing Maa and Arushi Manga and McQuillen, {Patrick S.} and Meert, {Kathleen L.} and Mourani, {Peter M.} and Nadkarni, {Vinay M.} and Naim, {Maryam Y.} and Daniel Notterman and Palmer, {Chella A.} and Pollack, {Murray M.} and Anil Sapru and Carleen Schneiter and Sharron, {Matthew P.} and Neeraj Srivastava and Sarah Tabbutt and Bradley Tilford and Shirley Viteri and David Wessel and Wolfe, {Heather A.} and Yates, {Andrew R.} and Zuppa, {Athena F.} and Sutton, {Robert M.}",
note = "Funding Information: Drs. Berg, Morgan, Reeder, Bell, Carcillo, Carpenter, Dean, Fink, Hall, McQuillen, Meert, Mourani, Pollack, Sapru, Wessel, Wolfe, Yates, Zuppa, and Sutton received National Institutes of Health (NIH) grant funding to their institution related to this project. Drs. Berg{\textquoteright}s and Sutton{\textquoteright}s institutions received funding from the National Heart, Lung, and Blood Institute (NHLBI). Drs. Berg{\textquoteright}s, Horvat{\textquoteright}s, McQuillen{\textquoteright}s, Sapru{\textquoteright}s, Schneiter{\textquoteright}s, and Zuppa{\textquoteright}s institutions received funding from the National Institute of Child Health and Human Development (NICHD). Drs. Berg, Morgan, Reeder, Bell, Carcillo, Carpenter, Dean, Fink, Franzon, Frazier, Friess, Hall, Horvat, Manga, McQuillen, Meert, Mourani, Naim, Pollack, Sapru, Schneiter, Wessel, Wolfe, Yates, and Sutton received support for article research from the NIH. Dr. Morgan{\textquoteright}s institution received funding from the NHLBI (K23HL148541). Drs. Reeder{\textquoteright}s, Bell{\textquoteright}s, Carcillo{\textquoteright}s, Carpenter{\textquoteright}s, Dean{\textquoteright}s, Fink{\textquoteright}s, Frazier{\textquoteright}s, Friess{\textquoteright}s, Hall{\textquoteright}s, Manga{\textquoteright}s, Meert{\textquoteright}s, Mourani{\textquoteright}s, Nadkarni{\textquoteright}s, Naim{\textquoteright}s, Pollack{\textquoteright}s, Wessel{\textquoteright}s, Wolfe{\textquoteright}s, and Yates{\textquoteright} institutions received funding from the NIH. Dr. Fink{\textquoteright}s institution received funding from the Neurocritical Care Society; she received funding from the Child Neurology Society. Drs. Fink and Hall received funding from the American Board of Pediatrics. Dr. Hall received funding from Abbvie and Kiadis. Dr. Maa{\textquoteright}s institution received funding from the Children{\textquoteright}s Hospital of Philadelphia, the NHBLI (R01HL131544), and the NICHD (U01HD049934, UG1HD049981, UG1HD049983, UG1HD050096, UG1HD063108, UG1HD083166, UG1HD083170, and UG1HD083171). Dr. Nadkarni{\textquoteright}s institution received funding from Zoll Medical, the American Heart Association RQI Partners, and Nihon-Kohden; he disclosed that he is the Society of Critical Care Medicine President elect Citizen. CPR Foundation Board member volunteer, and an International Liaison Committee on Resuscitation board member volunteer. Dr. Notterman received funding from GenoTwin SAB. Dr. Sutton disclosed that he is the Chair of the Pediatric Research Task Force of the American Heart Association{\textquoteright}s Get with the Guidelines Resuscitation National Registry and a Pediatric Advanced Life Support author. The remaining authors have disclosed that they do not have any potential conflicts of interest. Funding Information: Supported, in part, by the following grants: R01HL131544, U01HD049934, UG1HD049981, UG1HD049983, UG1HD050096, UG1HD063108, UG1HD083166, UG1HD083170, and UG1HD083171. Publisher Copyright: {\textcopyright} 2023 Lippincott Williams and Wilkins. All rights reserved.",
year = "2023",
month = jan,
day = "1",
doi = "10.1097/CCM.0000000000005715",
language = "English (US)",
volume = "51",
pages = "91--102",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "1",
}