1. Outcomes and characteristics of cardiac arrest in children with pulmonary hypertension: A secondary analysis of the ICU-RESUS clinical trial.
- Author
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Morgan, Ryan, Reeder, Ron, Ahmed, Tageldin, Bell, Michael, Berger, John, Bishop, Robert, Bochkoris, Matthew, Burns, Candice, Carcillo, Joseph, Carpenter, Todd, Dean, J, Diddle, J, Federman, Myke, Fernandez, Richard, Fink, Ericka, Franzon, Deborah, Frazier, Aisha, Friess, Stuart, Graham, Kathryn, Hall, Mark, Hehir, David, Himebauch, Adam, Horvat, Christopher, Huard, Leanna, Maa, Tensing, Manga, Arushi, McQuillen, Patrick, Meert, Kathleen, Mourani, Peter, Nadkarni, Vinay, Naim, Maryam, Notterman, Daniel, Page, Kent, Pollack, Murray, Sapru, Anil, Schneiter, Carleen, Sharron, Matthew, Srivastava, Neeraj, Tabbutt, Sarah, Tilford, Bradley, Viteri, Shirley, Wessel, David, Wolfe, Heather, Yates, Andrew, Zuppa, Athena, Berg, Robert, and Sutton, Robert
- Subjects
Blood pressure ,Cardiac arrest ,Cardiopulmonary resuscitation ,Pediatrics ,Pulmonary hypertension ,Child ,Humans ,Cardiopulmonary Resuscitation ,Heart Arrest ,Hypertension ,Pulmonary ,Intensive Care Units ,Prospective Studies - 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.
- Published
- 2023