@article{9ce4b52912f6450495f52116c4693fe5,
title = "Survival and Cardiopulmonary Resuscitation Hemodynamics Following Cardiac Arrest in Children with Surgical Compared to Medical Heart Disease",
abstract = "Objectives: To assess the association of diastolic blood pressure cutoffs (≥ 25 mm Hg in infants and ≥ 30 mm Hg in children) during cardiopulmonary resuscitation with return of spontaneous circulation and survival in surgical cardiac versus medical cardiac patients. Secondarily, we assessed whether these diastolic blood pressure targets were feasible to achieve and associated with outcome in physiology unique to congenital heart disease (single ventricle infants, open chest), and influenced outcomes when extracorporeal cardiopulmonary resuscitation was deployed. Design: Multicenter, prospective, observational cohort analysis. Setting: Tertiary PICU and cardiac ICUs within the Collaborative Pediatric Critical Care Research Network. Patients: Patients with invasive arterial catheters during cardiopulmonary resuscitation and surgical cardiac or medical cardiac illness category. Interventions: None. Measurements and Main Results: Hemodynamic waveforms during cardiopulmonary resuscitation were analyzed on 113 patients, 88 surgical cardiac and 25 medical cardiac. A similar percent of surgical cardiac (51/88; 58%) and medical cardiac (17/25; 68%) patients reached the diastolic blood pressure targets (p = 0.488). Achievement of diastolic blood pressure target was associated with improved survival to hospital discharge in surgical cardiac patients (p = 0.018), but not medical cardiac patients (p = 0.359). Fifty-three percent (16/30) of patients with single ventricles attained the target diastolic blood pressure. In patients with an open chest at the start of chest compressions, 11 of 20 (55%) attained the target diastolic blood pressure. In the 33 extracorporeal cardiopulmonary resuscitation patients, 16 patients (48%) met the diastolic blood pressure target with no difference between survivors and nonsurvivors (p = 0.296). Conclusions: During resuscitation in an ICU, with invasive monitoring in place, diastolic blood pressure targets of greater than or equal to 25 mm Hg in infants and greater than or equal to 30 mm Hg in children can be achieved in patients with both surgical and medical heart disease. Achievement of diastolic blood pressure target was associated with improved survival to hospital discharge in surgical cardiac patients, but not medical cardiac patients. Diastolic blood pressure targets were feasible to achieve in 1) single ventricle patients, 2) open chest physiology, and 3) extracorporeal cardiopulmonary resuscitation patients.",
keywords = "cardiac, cardiopulmonary resuscitation, congenital heart disease, pediatric",
author = "Yates, {Andrew R.} and Sutton, {Robert M.} and Reeder, {Ron W.} and Meert, {Kathleen L.} and Berger, {John T.} and Richard Fernandez and David Wessel and Newth, {Christopher J.} and Carcillo, {Joseph A.} and McQuillen, {Patrick S.} and Harrison, {Rick E.} and Moler, {Frank W.} and Pollack, {Murray M.} and Carpenter, {Todd C.} and Notterman, {Daniel A.} and Dean, {J. Michael} and Nadkarni, {Vinay M.} and Berg, {Robert A.}",
note = "Funding Information: Human Services: UG1HD050096, UG1HD049981, UG1HD049983, UG1HD063108, UG1HD083171, UG1HD083166, UG1HD083170, U10HD050012, U10HD063106, U10HD063114, and U01HD049934. Drs. Yates{\textquoteright}s, Berger{\textquoteright}s, Newth{\textquoteright}s, and Carcillo{\textquoteright}s institutions received funding from the National Institutes of Child Health and Human Development. Drs. Yates, Reeder, Meert, Berger, Wessel, Newth, Carcillo, McQuillen, Harrison, Moler, Pollack, Carpenter, Dean, Nadkarni, and Berg received support for article research from the National Institutes of Health (NIH). Dr. Sutton{\textquoteright}s institution received funding from National Heart, Lung, and Blood Institute R01 to study cardiopulmonary resuscitation quality improvement bundle; he received funding from Zoll Medical (speaking honoraria); and he disclosed he is a volunteer for the American Heart Association (AHA), is the Chair for AHA{\textquoteright}s Get with the Guidelines Resuscitation Pediatric Research Task Force, and was an author for the 2015 and 2018 Pediatric Advanced Life Support Guidelines. Drs. Reeder{\textquoteright}s, Meert{\textquoteright}s, Wessel{\textquoteright}s, Harrison{\textquoteright}s, Moler{\textquoteright}s, Pollack{\textquoteright}s, Dean{\textquoteright}s, and Berg{\textquoteright}s institutions received funding from the NIH. Dr. Berger{\textquoteright}s institution received funding from Association for Pediatric Pulmonary Hypertension and Actelion Pharmaceutical. Dr. Newth received funding from Philips Research North America. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: Andrew.yates@nationwide-childrens.org Funding Information: Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Copyright {\textcopyright} 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Publisher Copyright: {\textcopyright} 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.",
year = "2019",
month = dec,
day = "1",
doi = "10.1097/PCC.0000000000002088",
language = "English (US)",
volume = "20",
pages = "1126--1136",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
publisher = "Lippincott Williams and Wilkins",
number = "12",
}