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2. Identification of post-cardiac arrest blood pressure thresholds associated with outcomes in children: an ICU-Resuscitation study.

Author

Gardner, Monique, Hehir, David, Reeder, Ron, Ahmed, Tageldin, Bell, Michael, Berg, Robert, 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, Harding, Monica, Horvat, Christopher, Huard, Leanna, Maa, Tensing, Manga, Arushi, McQuillen, Patrick, Meert, Kathleen, Morgan, Ryan, Mourani, Peter, Nadkarni, Vinay, Naim, Maryam, Notterman, Daniel, Pollack, Murray, Sapru, Anil, Schneiter, Carleen, Sharron, Matthew, Srivastava, Neeraj, Tilford, Bradley, Viteri, Shirley, Wessel, David, Wolfe, Heather, Yates, Andrew, Zuppa, Athena, Sutton, Robert, and Topjian, Alexis

Subjects
Blood pressure, Cardiopulmonary resuscitation, Hypotension, Infant, Neonatal, Outcomes, Pediatric, Post-cardiac arrest, Child, Humans, Blood Pressure, Heart Arrest, Cardiopulmonary Resuscitation, Hypotension, Hospital Mortality, Intensive Care Units
Abstract

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  10th percentile for age and DBP > 50th percentile for age during the first 6 h post-arrest.

Published
2023

3. Early bolus epinephrine administration during pediatric cardiopulmonary resuscitation for bradycardia with poor perfusion: an ICU-resuscitation study

Author

O’Halloran, Amanda J., Reeder, Ron W., Berg, Robert A., Ahmed, Tageldin, Bell, Michael J., 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, Hehir, David A., Horvat, Christopher M., Huard, Leanna L., Kienzle, Martha F., Kilbaugh, Todd J., Maa, Tensing, Manga, Arushi, McQuillen, Patrick S., Meert, Kathleen L., 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, Topjian, Alexis A., Viteri, Shirley, Wessel, David, Wolfe, Heather A., Yates, Andrew R., Zuppa, Athena F., Sutton, Robert M., and Morgan, Ryan W.

Published
2024
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4. Effect of dimethyl fumarate on mitochondrial metabolism in a pediatric porcine model of asphyxia-induced in-hospital cardiac arrest

Author

Piel, Sarah, McManus, Meagan J., Heye, Kristina N., Beaulieu, Forrest, Fazelinia, Hossein, Janowska, Joanna I., MacTurk, Bryce, Starr, Jonathan, Gaudio, Hunter, Patel, Nisha, Hefti, Marco M., Smalley, Martin E., Hook, Jordan N., Kohli, Neha V., Bruton, James, Hallowell, Thomas, Delso, Nile, Roberts, Anna, Lin, Yuxi, Ehinger, Johannes K., Karlsson, Michael, Berg, Robert A., Morgan, Ryan W., and Kilbaugh, Todd J.

Published
2024
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5. Calcium use during paediatric in-hospital cardiac arrest is associated with worse outcomes.

Author

Cashen, Katherine, Sutton, Robert, Reeder, Ron, Ahmed, Tageldin, Bell, Michael, Berg, Robert, Burns, Candice, Carcillo, Joseph, Carpenter, Todd, Michael Dean, J, Wesley Diddle, J, Federman, Myke, Fink, Ericka, Franzon, Deborah, Frazier, Aisha, Friess, Stuart, Graham, Kathryn, Hall, Mark, Hehir, David, Horvat, Christopher, Huard, Leanna, KirkpatrickN, Theresa, Maa, Tensing, Manga, Arushi, Morgan, Ryan, Mourani, Peter, Nadkarni, Vinay, Naim, Maryam, Notterman, Daniel, Page, Kent, Pollack, Murray, Qunibi, Danna, Sapru, Anil, Schneiter, Carleen, Sharron, Matthew, Srivastava, Neeraj, Viteri, Shirley, Wessel, David, Wolfe, Heather, Yates, Andrew, Zuppa, Athena, Meert, Kathleen, and Mcquillen, Patrick

Subjects
Calcium, Cardiac arrest, Cardiopulmonary resuscitation, Child, Infant, Neonate, Child, Infant, Newborn, Humans, Infant, Cardiopulmonary Resuscitation, Calcium, Heart Arrest, Patient Discharge, Hospitals, Pediatric, Retrospective Studies
Abstract

AIM: To evaluate associations between calcium administration and outcomes among children with in-hospital cardiac arrest and among specific subgroups in which calcium use is hypothesized to provide clinical benefit. METHODS: This is a secondary analysis of observational data collected prospectively as part of the ICU-RESUScitation project. Children 37 weeks post-conceptual age to 18 years who received chest compressions in one of 18 intensive care units from October 2016-March 2021 were eligible. Data included child and event characteristics, pre-arrest laboratory values, pre- and intra-arrest haemodynamics, and outcomes. Outcomes included sustained return of spontaneous circulation (ROSC), survival to hospital discharge, and survival to hospital discharge with favourable neurologic outcome. A propensity score weighted cohort was used to evaluate associations between calcium use and outcomes. Subgroups included neonates, and children with hyperkalaemia, sepsis, renal insufficiency, cardiac surgery with cardiopulmonary bypass, and calcium-avid cardiac diagnoses. RESULTS: Of 1,100 in-hospital cardiac arrests, median age was 0.63 years (IQR 0.19, 3.81); 450 (41%) received calcium. Among the weighted cohort, calcium use was not associated with sustained ROSC (aOR, 0.87; CI95 0.61-1.24; p = 0.445), but was associated with lower rates of both survival to hospital discharge (aOR, 0.68; CI95 0.52-0.89; p = 0.005) and survival with favourable neurologic outcome at hospital discharge (aOR, 0.75; CI95 0.57-0.98; p = 0.038). Among subgroups, calcium use was associated with lower rates of survival to hospital discharge in children with sepsis and renal insufficiency. CONCLUSIONS: Calcium use was common during paediatric in-hospital cardiac arrest and associated with worse outcomes at hospital discharge.

Published
2023

7. Diastolic Blood Pressure Threshold During Pediatric Cardiopulmonary Resuscitation and Survival Outcomes: A Multicenter Validation Study.

Author

Berg, Robert, Morgan, Ryan, Reeder, Ron, Ahmed, Tageldin, Bell, Michael, 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, Horvat, Christopher, Maa, Tensing, Manga, Arushi, McQuillen, Patrick, Meert, Kathleen, Mourani, Peter, Nadkarni, Vinay, Naim, Maryam, Notterman, Daniel, Palmer, Chella, Pollack, Murray, Sapru, Anil, Schneiter, Carleen, Sharron, Matthew, Srivastava, Neeraj, Tabbutt, Sarah, Tilford, Bradley, Viteri, Shirley, Wessel, David, Wolfe, Heather, Yates, Andrew, Zuppa, Athena, Sutton, Robert, and Huard, Leanna

Subjects
Infant, Child, Humans, Adolescent, Prospective Studies, Blood Pressure, Cardiopulmonary Resuscitation, Heart Arrest, Patient Discharge
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.

Published
2023

9. Epinephrine Dosing Intervals Are Associated With Pediatric In-Hospital Cardiac Arrest Outcomes: A Multicenter Study

Author

Kienzle, Martha F., Morgan, Ryan W., Reeder, Ron W., Ahmed, Tageldin, Berg, Robert A., Bishop, Robert, Bochkoris, Matthew, Carcillo, Joseph A., Carpenter, Todd C., Cooper, Kellimarie K., Diddle, J. Wesley, Federman, Myke, Fernandez, Richard, Franzon, Deborah, Frazier, Aisha H., Friess, Stuart H., Frizzola, Meg, Graham, Kathryn, Hall, Mark, Horvat, Christopher, Huard, Leanna L., Maa, Tensing, Manga, Arushi, McQuillen, Patrick S., Meert, Kathleen L., Mourani, Peter M., Nadkarni, Vinay M., Naim, Maryam Y., Pollack, Murray M., Sapru, Anil, Schneiter, Carleen, Sharron, Matthew P., Tabbutt, Sarah, Viteri, Shirley, Wolfe, Heather A., Sutton, Robert M., Bell, Michael J., Burns, Candice, Dean, J. Michael, Fink, Ericka L., Hehir, David, Landis, William P., Notterman, Daniel, Palmer, Chella A., Siems, Ashley, Srivastava, Neeraj, Tilford, Bradley, Wessel, David, Yates, Andrew R., and Zuppa, Athena F.

Published
2024
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11. The Temporal Association of the COVID-19 Pandemic and Pediatric Cardiopulmonary Resuscitation Quality and Outcomes.

Author

Morgan, Ryan W, Wolfe, Heather A, Reeder, Ron W, Alvey, Jessica S, Frazier, Aisha H, Friess, Stuart H, Maa, Tensing, McQuillen, Patrick S, Meert, Kathleen L, Nadkarni, Vinay M, Sharron, Matthew P, Siems, Ashley, Yates, Andrew R, Ahmed, Tageldin, Bell, Michael J, 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, Hall, Mark, Hehir, David, Horvat, Christopher M, Huard, Leanna L, Manga, Arushi, Mourani, Peter M, Naim, Maryam Y, Notterman, Daniel, Pollack, Murray M, Sapru, Anil, Schneiter, Carleen, Srivastava, Nerraj, Tabbutt, Sarah, Tilford, Bradley, Viteri, Shirley, Wessel, David, Zuppa, Athena F, Berg, Robert A, and Sutton, Robert M

Subjects
Humans, Heart Arrest, Cardiopulmonary Resuscitation, Retrospective Studies, Prospective Studies, Child, Pandemics, COVID-19, Cardiovascular, Clinical Research, Pediatric, Rehabilitation, Good Health and Well Being, cardiac arrest, cardiopulmonary resuscitation, pediatrics, Nursing, Paediatrics and Reproductive Medicine, Pediatrics
Abstract

ObjectivesThe COVID-19 pandemic resulted in adaptations to pediatric resuscitation systems of care. The objective of this study was to determine the temporal association between the pandemic and pediatric in-hospital cardiac arrest (IHCA) process of care metrics, cardiopulmonary resuscitation (cardiopulmonary resuscitation) quality, and patient outcomes.DesignMulticenter retrospective analysis of a dataset comprising observations of IHCA outcomes pre pandemic (March 1, 2019 to February 29, 2020) versus pandemic (March 1, 2020 to February 28, 2021).SettingData source was the ICU-RESUScitation Project ("ICU-RESUS;" NCT028374497), a prospective, multicenter, cluster randomized interventional trial.PatientsChildren (≤ 18 yr) who received cardiopulmonary resuscitation while admitted to the ICU and were enrolled in ICU-RESUS.InterventionsNone.Measurements and main resultsAmong 429 IHCAs meeting inclusion criteria, occurrence during the pandemic period was associated with higher frequency of hypotension as the immediate cause of arrest. Cardiac arrest physiology, cardiopulmonary resuscitation quality metrics, and postarrest physiologic and quality of care metrics were similar between the two periods. Survival with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline) occurred in 102 of 195 subjects (52%) during the pandemic compared with 140 of 234 (60%) pre pandemic ( p = 0.12). Among survivors, occurrence of IHCA during the pandemic period was associated with a greater increase in Functional Status Scale (FSS) (i.e., worsening) from baseline (1 [0-3] vs 0 [0-2]; p = 0.01). After adjustment for confounders, IHCA survival during the pandemic period was associated with a greater increase in FSS from baseline (+1.19 [95% CI, 0.35-2.04] FSS points; p = 0.006) and higher odds of a new FSS-defined morbidity (adjusted odds ratio, 1.88 [95% CI, 1.03-3.46]; p = 0.04).ConclusionsUsing the ICU-RESUS dataset, we found that relative to the year prior, pediatric IHCA during the first year of the COVID-19 pandemic was associated with greater worsening of functional status and higher odds of new functional morbidity among survivors.

Published
2022

12. Sodium Bicarbonate Use During Pediatric Cardiopulmonary Resuscitation: A Secondary Analysis of the ICU-RESUScitation Project Trial.

Author

Cashen, Katherine, Reeder, Ron, Ahmed, Tageldin, Bell, Michael, Berg, Robert, Burns, Candice, Carcillo, Joseph, Carpenter, Todd, Dean, J, Diddle, J, Maa, Tensing, Manga, Arushi, McQuillen, Patrick, Morgan, Ryan, Mourani, Peter, Nadkarni, Vinay, Naim, Maryam, Notterman, Daniel, Palmer, Chella, Pollack, Murray, Schneiter, Carleen, Sharron, Matthew, Srivastava, Neeraj, Wessel, David, Wolfe, Heather, Yates, Andrew, Zuppa, Athena, Sutton, Robert, Meert, Kathleen, Fink, Ericka, Frazier, Aisha, Friess, Stuart, Graham, Kathryn, Hall, Mark, Hehir, David, Horvat, Christopher, Huard, Leanna, and Federman, Myke

Subjects
Cardiopulmonary Resuscitation, Child, Cohort Studies, Heart Arrest, Humans, Infant, Intensive Care Units, Prospective Studies, Sodium Bicarbonate
Abstract

OBJECTIVES: To evaluate associations between sodium bicarbonate use and outcomes during pediatric in-hospital cardiac arrest (p-IHCA). DESIGN: Prespecified secondary analysis of a prospective, multicenter cluster randomized interventional trial. SETTING: Eighteen participating ICUs of the ICU-RESUScitation Project (NCT02837497). PATIENTS: Children less than or equal to 18 years old and greater than or equal to 37 weeks post conceptual age who received chest compressions of any duration from October 2016 to March 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Child and event characteristics, prearrest laboratory values (2-6 hr prior to p-IHCA), pre- and intraarrest hemodynamics, and outcomes were collected. In a propensity score weighted cohort, the relationships between sodium bicarbonate use and outcomes were assessed. The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and survival to hospital discharge with favorable neurologic outcome. Of 1,100 index cardiopulmonary resuscitation events, median age was 0.63 years (interquartile range, 0.19-3.81 yr); 528 (48.0%) received sodium bicarbonate; 773 (70.3%) achieved ROSC; 642 (58.4%) survived to hospital discharge; and 596 (54.2%) survived to hospital discharge with favorable neurologic outcome. Among the weighted cohort, sodium bicarbonate use was associated with lower survival to hospital discharge rate (adjusted odds ratio [aOR], 0.7; 95% CI, 0.54-0.92; p = 0.01) and lower survival to hospital discharge with favorable neurologic outcome rate (aOR, 0.69; 95% CI, 0.53-0.91; p = 0.007). Sodium bicarbonate use was not associated with ROSC (aOR, 0.91; 95% CI, 0.62-1.34; p = 0.621). CONCLUSIONS: In this propensity weighted multicenter cohort study of p-IHCA, sodium bicarbonate use was common and associated with lower rates of survival to hospital discharge.

Published
2022

13. The impact of pediatric post-cardiac arrest care on survival: A multicenter review from the AHA get with the Guidelines®-resuscitation post-cardiac arrest care registry

Author

Fowler, Jessica C., Morgan, Ryan W., O’Halloran, Amanda, Gardner, Monique M., Appel, Scott, Wolfe, Heather, Kienzle, Martha F., Raymond, Tia T., Scholefield, Barnaby R, Guerguerian, Anne-Marie, Bembea, Melania M., Nadkarni, Vinay, Berg, Robert A., Sutton, Robert, and Topjian, Alexis A.

Published
2024
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16. Early Cardiac Arrest Hemodynamics, End-Tidal CO2, and Outcome in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Secondary Analysis of the ICU-RESUScitation Project Dataset (2016–2021)*

Author

Yates, Andrew R., Naim, Maryam Y., Reeder, Ron W., Ahmed, Tageldin, Banks, Russell K., 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, Hehir, David A., Horvat, Christopher M., Huard, Leanna L., Maa, Tensing, Manga, Arushi, McQuillen, Patrick S., Morgan, Ryan W., Mourani, Peter M., Nadkarni, Vinay M., Notterman, Daniel, Pollack, Murray M., Sapru, Anil, Schneiter, Carleen, Sharron, Matthew P., Srivastava, Neeraj, Tilford, Bradley, Viteri, Shirley, Wessel, David, Wolfe, Heather A., Yeh, Justin, Zuppa, Athena F., Sutton, Robert M., and Meert, Kathleen L.

Published
2024
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20. Hyperferritinemic sepsis, macrophage activation syndrome, and mortality in a pediatric research network: a causal inference analysis

Author

Fan, Zhenziang, Kernan, Kate F., Qin, Yidi, Canna, Scott, Berg, Robert A., Wessel, David, Pollack, Murray M., Meert, Kathleen, Hall, Mark, Newth, Christopher, Lin, John C., Doctor, Allan, Shanley, Tom, Cornell, Tim, Harrison, Rick E., Zuppa, Athena F., Sward, Katherine, Dean, J. Michael, Park, H. J., and Carcillo, Joseph A.

Published
2023
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23. Chest compressions for pediatric organized rhythms: A hemodynamic and outcomes analysis

Author

Zinna, Shairbanu S., Morgan, Ryan W., Reeder, Ron W., Ahmed, Tageldin, Bell, Michael J., Bishop, Robert, Bochkoris, Matthew, Burns, Candice, Carcillo, Joseph A., Carpenter, Todd C., Cooper, Kellimarie K., Michael Dean, J., Wesley Diddle, J., Federman, Myke, Fernandez, Richard, Fink, Ericka L., Franzon, Deborah, Frazier, Aisha H., Friess, Stuart H., Graham, Kathryn, Hall, Mark, Harding, Monica L., Hehir, David A., Horvat, Christopher M., Huard, Leanna L., Landis, William P., Maa, Tensing, Manga, Arushi, McQuillen, Patrick S., Meert, Kathleen L., 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, Wessel, David, Wolfe, Heather A., Yates, Andrew R., Zuppa, Athena F., Berg, Robert A., and Sutton, Robert M.

Published
2024
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24. Associations Between End-Tidal Carbon Dioxide During Pediatric Cardiopulmonary Resuscitation, Cardiopulmonary Resuscitation Quality, and Survival

Author

Morgan, Ryan W., Reeder, Ron W., Bender, Dieter, Cooper, Kellimarie K., Friess, Stuart H., Graham, Kathryn, Meert, Kathleen L., Mourani, Peter M., Murray, Robert, Nadkarni, Vinay M., Nataraj, Chandrasekhar, Palmer, Chella A., Srivastava, Neeraj, Tilford, Bradley, Wolfe, Heather A., Yates, Andrew R., Berg, Robert A., Sutton, Robert M., Ahmed, Tageldin, Bell, Michael J., Bishop, Robert, Bochkoris, Matthew, Burns, Candice, Carpenter, Todd C., Carcillo, Joseph A., Dean, J. Michael, Diddle, J. Wesley, Federman, Myke, Fernandez, Richard, Fink, Ericka L, Franzon, Deborah, Frazier, Aisha H., Hall, Mark, Hehir, David A., Horvat, Christopher M., Huard, Leanna L., Maa, Tensing, Manga, Arushi, McQuillen, Patrick S., Naim, Maryam Y., Notterman, Daniel, Pollack, Murray M., Sapru, Anil, Schneiter, Carleen, Sharron, Matthew P., Tabbutt, Sarah, Viteri, Shirley, Wessel, David, and Zuppa, Athena F.

Published
2024
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26. Survival With Favorable Neurologic Outcome and Quality of Cardiopulmonary Resuscitation Following In-Hospital Cardiac Arrest in Children With Cardiac Disease Compared With Noncardiac Disease*

Author

Federman, Myke, Sutton, Robert M., 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, Fernandez, Richard, Fink, Ericka L., Franzon, Deborah, Frazier, Aisha H., Friess, Stuart H., Graham, Kathryn, Hall, Mark, Hehir, David A., Horvat, Christopher M., Huard, Leanna L., Kirkpatrick, Theresa, Maa, Tensing, Maitoza, Laura A., Manga, Arushi, McQuillen, Patrick S., Meert, Kathleen L., Morgan, Ryan W., Mourani, Peter M., Nadkarni, Vinay M., Notterman, Daniel, Palmer, Chella A., Pollack, Murray M., Sapru, Anil, Schneiter, Carleen, Sharron, Matthew P., Srivastava, Neeraj, Tilford, Bradley, Viteri, Shirley, Wessel, David, Wolfe, Heather A., Yates, Andrew R., Zuppa, Athena F., and Naim, Maryam Y.

Published
2024
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33. Outcomes and characteristics of cardiac arrest in children with pulmonary hypertension: A secondary analysis of the ICU-RESUS clinical trial

Author

Morgan, Ryan W, Reeder, Ron W, Ahmed, Tageldin, Bell, Michael J, Berger, John T, 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, Hehir, David A, Himebauch, Adam S, Horvat, Christopher M, Huard, Leanna L, Maa, Tensing, Manga, Arushi, McQuillen, Patrick S, Meert, Kathleen L, Mourani, Peter M, Nadkarni, Vinay M, Naim, Maryam Y, Notterman, Daniel, Page, Kent, Pollack, Murray M, Sapru, Anil, Schneiter, Carleen, Sharron, Matthew P, Srivastava, Neeraj, Tabbutt, Sarah, Tilford, Bradley, Viteri, Shirley, Wessel, David, Wolfe, Heather A, Yates, Andrew R, Zuppa, Athena F, Berg, Robert A, and Sutton, Robert M

Published
2023
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34. Early, Persistent Lymphopenia Is Associated With Prolonged Multiple Organ Failure and Mortality in Septic Children

Author

Podd, Bradley S., Banks, Russell K., Reeder, Ron, Telford, Russell, Holubkov, Richard, Carcillo, Joseph, Berg, Robert A., Wessel, David, Pollack, Murray M., Meert, Kathleen, Hall, Mark, Newth, Christopher, Lin, John C., Doctor, Allan, Shanley, Tom, Cornell, Tim, Harrison, Rick E., Zuppa, Athena F., Sward, Katherine, Dean, J. Michael, and Randolph, Adrienne G.

Published
2023
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41. Acute Disorders of Consciousness in Pediatric Severe Sepsis and Organ Failure: Secondary Analysis of the Multicenter Phenotyping Sepsis-Induced Multiple Organ Failure Study*

Author

Cheung, Christina, Kernan, Kate F., Berg, Robert A., Zuppa, Athena F., Notterman, Daniel A., Pollack, Murray M., Wessel, David, Meert, Kathleen L., Hall, Mark W., Newth, Christopher, Lin, John C., Doctor, Allan, Shanley, Tom, Cornell, Tim, Harrison, Rick E., Banks, Russell K., Reeder, Ron W., Holubkov, Richard, Carcillo, Joseph A., and Fink, Ericka L.

Published
2023
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42. Fluid Balance and Its Association With Mortality and Health-Related Quality of Life: A Nonprespecified Secondary Analysis of the Life After Pediatric Sepsis Evaluation

Author

Stenson, Erin K., Banks, Russell K., Reeder, Ron W., Maddux, Aline B., Zimmerman, Jerry, Meert, Kathleen L., Mourani, Peter M., Heidemann, Sabrina, Pawluszka, Ann, Lulic, Melanie, Berg, Robert A., Zuppa, Athena, Twelves, Carolann, DiLiberto, Mary Ann, Pollack, Murray, Wessel, David, Berger, John, Tomanio, Elyse, Hession, Diane, Wolfe, Ashley, Carpenter, Todd, Ladell, Diane, Sierra, Yamila, Rutebemberwa, Alle, Hall, Mark, Yates, Andy, Steele, Lisa, Flowers, Maggie, Hensley, Josey, Sapru, Anil, Harrison, Rick, Ashtari, Neda, Ratiu, Anna, Carcillo, Joe, Bell, Michael, Koch, Leighann, Abraham, Alan, McQuillen, Patrick, McKenzie, Anne, Zetino, Yensy, Newth, Christopher, Kwok, Jeni, Yamakawa, Amy, Quasney, Michael, Shanley, Thomas, Jayachandran, CJ, Chima, Ranjit, Wong, Hector, Krallman, Kelli, Stoneman, Erin, Benken, Laura, Yunger, Toni, Chen, Catherine, Sullivan, Erin, Merritt, Courtney, Rich, Deana, McGalliard, Julie, Haaland, Wren, Whitlock, Kathryn, Salud, Derek, Dean, J Michael, Holubkov, Richard, Coleman, Whit, Sorenson, Samuel, Webster, Angie, Burr, Jeri, Bisping, Stephanie, Liu, Teresa, Stock, Emily, Flick, Kristi, and Varni, James

Published
2023
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44. A Core Outcome Set for Pediatric Critical Care.

Author

Fink, Ericka L, Maddux, Aline B, Pinto, Neethi, Sorenson, Samuel, Notterman, Daniel, Dean, J Michael, Carcillo, Joseph A, Berg, Robert A, Zuppa, Athena, Pollack, Murray M, Meert, Kathleen L, Hall, Mark W, Sapru, Anil, McQuillen, Patrick S, Mourani, Peter M, Wessel, David, Amey, Deborah, Argent, Andrew, Brunow de Carvalho, Werther, Butt, Warwick, Choong, Karen, Curley, Martha AQ, Del Pilar Arias Lopez, Maria, Demirkol, Demet, Grosskreuz, Ruth, Houtrow, Amy J, Knoester, Hennie, Lee, Jan Hau, Long, Debbie, Manning, Joseph C, Morrow, Brenda, Sankar, Jhuma, Slomine, Beth S, Smith, McKenna, Olson, Lenora M, and Watson, R Scott

Subjects
Clinical Research, Behavioral and Social Science, Pediatric, Good Health and Well Being, Adult, Aged, Child, Child Health, Critical Care, Critical Illness, Delphi Technique, Female, Humans, Intensive Care Units, Pediatric, Male, Middle Aged, Stakeholder Participation, Treatment Outcome, Young Adult, child, critical care, family, outcome assessment, postintensive care syndrome, Pediatric Outcomes STudies after PICU (POST-PICU) Investigators of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network, Clinical Sciences, Nursing, Public Health and Health Services, Emergency & Critical Care Medicine
Abstract

ObjectivesMore children are surviving critical illness but are at risk of residual or new health conditions. An evidence-informed and stakeholder-recommended core outcome set is lacking for pediatric critical care outcomes. Our objective was to create a multinational, multistakeholder-recommended pediatric critical care core outcome set for inclusion in clinical and research programs.DesignA two-round modified Delphi electronic survey was conducted with 333 invited research, clinical, and family/advocate stakeholders. Stakeholders completing the first round were invited to participate in the second. Outcomes scoring greater than 69% "critical" and less than 15% "not important" advanced to round 2 with write-in outcomes considered. The Steering Committee held a virtual consensus conference to determine the final components.SettingMultinational survey.PatientsStakeholder participants from six continents representing clinicians, researchers, and family/advocates.Measurements and main resultsOverall response rates were 75% and 82% for each round. Participants voted on seven Global Domains and 45 Specific Outcomes in round 1, and six Global Domains and 30 Specific Outcomes in round 2. Using overall (three stakeholder groups combined) results, consensus was defined as outcomes scoring greater than 90% "critical" and less than 15% "not important" and were included in the final PICU core outcome set: four Global Domains (Cognitive, Emotional, Physical, and Overall Health) and four Specific Outcomes (Child Health-Related Quality of Life, Pain, Survival, and Communication). Families (n = 21) suggested additional critically important outcomes that did not meet consensus, which were included in the PICU core outcome set-extended.ConclusionsThe PICU core outcome set and PICU core outcome set-extended are multistakeholder-recommended resources for clinical and research programs that seek to improve outcomes for children with critical illness and their families.

Published
2020

47. Association between time of day and CPR quality as measured by CPR hemodynamics during pediatric in-hospital CPR

Author

Wolfe, Heather A, Morgan, Ryan W, Sutton, Robert M, Reeder, Ron W, Meert, Kathleen L, Pollack, Murray M, Yates, Andrew R, Berger, John T, Newth, Christopher J, Carcillo, Joseph A, McQuillen, Patrick S, Harrison, Rick E, Moler, Frank W, Carpenter, Todd C, Notterman, Daniel A, Dean, J Michael, Nadkarni, Vinay M, Berg, Robert A, investigators, for the Eunice Kennedy Shriver National Institute of Child Health Human Development Collaborative Pediatric Critical Care Research Network Pediatric Intensive Care Quality of Cardiopulmonary Resuscitation, Zuppa, Athena F, Graham, Katherine, Twelves, Carolann, Diliberto, Mary Ann, Holubkov, Richard, Telford, Russell, Locandro, Christopher, Coleman, Whitney, Peterson, Alecia, Thelen, Julie, Heidemann, Sabrina, Pawluszka, Ann, Tomanio, Elyse, Bell, Michael J, Hall, Mark W, Steele, Lisa, Kwok, Jeni, Sapru, Anil, Abraham, Alan, Alkhouli, Mustafa F, Shanley, Thomas P, Weber, Monica, Dalton, Heidi J, La Bell, Aimee, Mourani, Peter M, Malone, Kathryn, and Doctor, Allan

Subjects
Biomedical and Clinical Sciences, Health Services and Systems, Cardiovascular Medicine and Haematology, Clinical Sciences, Health Sciences, Clinical Research, Cardiovascular, Heart Disease, Pediatric, Blood Pressure, Cardiopulmonary Resuscitation, Child, Heart Arrest, Hemodynamics, Hospitals, Pediatric, Humans, Infant, Cardiopulmonary resuscitation, Cardiac arrest, In-Hospital, Survival, Outcomes, Eunice Kennedy Shriver National Institute of Child Health Human Development Collaborative Pediatric Critical Care Research Network Pediatric Intensive Care Quality of Cardiopulmonary Resuscitation (PICqCPR) investigators, Nursing, Public Health and Health Services, Emergency & Critical Care Medicine, Clinical sciences, Public health
Abstract

IntroductionPatients who suffer in-hospital cardiac arrest (IHCA) are less likely to survive if the arrest occurs during nighttime versus daytime. Diastolic blood pressure (DBP) as a measure of chest compression quality was associated with survival from pediatric IHCA. We hypothesized that DBP during CPR for IHCA is lower during nighttime versus daytime.MethodsThis is a secondary analysis of data collected from the Pediatric Intensive Care Quality of Cardiopulmonary Resuscitation Study. Pediatric or Pediatric Cardiac Intensive Care Unit patients who received chest compressions for ≥1 min and who had invasive arterial BP monitoring were enrolled. Nighttime was defined as 11:00PM to 6:59AM and daytime as 7:00AM until 10:59PM. Primary outcome was attainment of DBP ≥ 25 mmHg in infants

Published
2020

48. Development of a core outcome set for pediatric critical care outcomes research

Author

Fink, Ericka L, Jarvis, Jessica M, Maddux, Aline B, Pinto, Neethi, Galyean, Patrick, Olson, Lenora M, Zickmund, Susan, Ringwood, Melissa, Sorenson, Samuel, Dean, J Michael, Carcillo, Joseph A, Berg, Robert A, Zuppa, Athena, Pollack, Murray M, Meert, Kathleen L, Hall, Mark W, Sapru, Anil, McQuillen, Patrick S, Mourani, Peter M, Watson, R Scott, Investigators, and the Pediatric Acute Lung Injury and Sepsis Investigators Long-term Outcomes Subgroup, and Network, the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research

Subjects
Health Services and Systems, Health Sciences, Clinical Research, Pediatric, Generic health relevance, Adolescent, Child, Child, Preschool, Critical Illness, Delphi Technique, Endpoint Determination, Female, Guidelines as Topic, Humans, Infant, Intensive Care Units, Pediatric, Male, Outcome Assessment, Health Care, Research Design, Stakeholder Participation, Pediatrics, Core outcomes set, Clinical research, Critical illness, Morbidity, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Long-term Outcomes Subgroup Investigators, and, Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network, Medical and Health Sciences, General Clinical Medicine, Public Health, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundPediatric Intensive Care Unit (PICU) teams provide care for critically ill children with diverse and often complex medical and surgical conditions. Researchers often lack guidance on an approach to select the best outcomes when evaluating this critically ill population. Studies would be enhanced by incorporating multi-stakeholder preferences to better evaluate clinical care. This manuscript outlines the methodology currently being used to develop a PICU Core Outcome Set (COS). This PICU COS utilizes mixed methods, an inclusive stakeholder approach, and a modified Delphi consensus process that will serve as a resource for PICU research programs.MethodsA Scoping Review of the PICU literature evaluating outcomes after pediatric critical illness, a qualitative study interviewing PICU survivors and their parents, and other relevant literature will serve to inform a modified, international Delphi consensus process. The Delphi process will derive a set of minimum domains for evaluation of outcomes of critically ill children and their families. Delphi respondents include researchers, multidisciplinary clinicians, families and former patients, research funding agencies, payors, and advocates. Consensus meetings will refine and finalize the domains of the COS, outline a battery instruments for use in future studies, and prepare for extensive dissemination for broad implementation.DiscussionThe PICU COS will be a guideline resource for investigators to assure that outcomes most important to all stakeholders are considered in PICU clinical research in addition to those deemed most important to individual scientists.Trial registrationCOMET database (http://www.comet-initiative.org/, Record ID 1131, 01/01/18).

Published
2020

49. Variability in chest compression rate calculations during pediatric cardiopulmonary resuscitation.

Author

Landis, William P, Morgan, Ryan W, Reeder, Ron W, Graham, Kathryn, Siems, Ashley, Diddle, J Wesley, Pollack, Murray M, Maa, Tensing, Fernandez, Richard P, Yates, Andrew R, Tilford, Bradley, Ahmed, Tageldin, Meert, Kathleen L, Schneiter, Carleen, Bishop, Robert, Mourani, Peter M, Naim, Maryam Y, Friess, Stuart, Burns, Candice, Manga, Arushi, Franzon, Deborah, Tabbutt, Sarah, McQuillen, Patrick S, Horvat, Christopher M, Bochkoris, Matthew, Carcillo, Joseph A, Huard, Leanna, Federman, Myke, Sapru, Anil, Viteri, Shirley, Hehir, David A, Notterman, Daniel A, Holubkov, Richard, Dean, J Michael, Nadkarni, Vinay M, Berg, Robert A, Wolfe, Heather A, Sutton, Robert M, and Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) Investigators the National Heart Lung and Blood Institute ICU-RESUScitation Project Investigators

Subjects
Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) Investigators the National Heart Lung and Blood Institute ICU-RESUScitation Project Investigators, Humans, Heart Arrest, Cardiopulmonary Resuscitation, Pressure, Research Design, Child, American Heart Association, American Heart Association Guideline, Cardiopulmonary resuscitation, Chest compression rate, Cardiovascular, Clinical Sciences, Nursing, Public Health and Health Services, Emergency & Critical Care Medicine
Abstract

AimThe mathematical method used to calculate chest compression (CC) rate during cardiopulmonary resuscitation varies in the literature and across device manufacturers. The objective of this study was to determine the variability in calculated CC rates by applying four published methods to the same dataset.MethodsThis study was a secondary investigation of the first 200 pediatric cardiac arrest events with invasive arterial line waveform data in the ICU-RESUScitation Project (NCT02837497). Instantaneous CC rates were calculated during periods of uninterrupted CCs. The defined minimum interruption length affects rate calculation (e.g., if an interruption is defined as a break in CCs ≥ 2 s, the lowest possible calculated rate is 30 CCs/min). Average rates were calculated by four methods: 1) rate with an interruption defined as ≥ 1 s; 2) interruption ≥ 2 s; 3) interruption ≥ 3 s; 4) method #3 excluding top and bottom quartiles of calculated rates. American Heart Association Guideline-compliant rate was defined as 100-120 CCs/min. A clinically important change was defined as ±5 CCs/min. The percentage of events and epochs (30 s periods) that changed Guideline-compliant status was calculated.ResultsAcross calculation methods, mean CC rates (118.7-119.5/min) were similar. Comparing all methods, 14 events (7%) and 114 epochs (6%) changed Guideline-compliant status.ConclusionUsing four published methods for calculating CC rate, average rates were similar, but 7% of events changed Guideline-compliant status. These data suggest that a uniform calculation method (interruption ≥ 1 s) should be adopted to decrease variability in resuscitation science.

Published
2020

50. Ventilation Rates and Pediatric In-Hospital Cardiac Arrest Survival Outcomes.

Author

Sutton, Robert M, Reeder, Ron W, Landis, William P, Meert, Kathleen L, Yates, Andrew R, Morgan, Ryan W, Berger, John T, Newth, Christopher J, Carcillo, Joseph A, McQuillen, Patrick S, Harrison, Rick E, Moler, Frank W, Pollack, Murray M, Carpenter, Todd C, Notterman, Daniel A, Holubkov, Richard, Dean, J Michael, Nadkarni, Vinay M, and Berg, Robert A

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Health Sciences, Cardiovascular, Pediatric, Clinical Research, Arterial Pressure, Capnography, Cardiopulmonary Resuscitation, Female, Heart Arrest, Hospital Mortality, Humans, Hypotension, Infant, Intensive Care Units, Pediatric, Male, Patient Discharge, Prospective Studies, Pulmonary Ventilation, Respiratory Insufficiency, Systole, cardiac arrest, cardiopulmonary resuscitation, pediatric, ventilation, Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network, Clinical Sciences, Nursing, Public Health and Health Services, Emergency & Critical Care Medicine, Clinical sciences
Abstract

ObjectivesThe objective of this study was to associate ventilation rates during in-hospital cardiopulmonary resuscitation with 1) arterial blood pressure during cardiopulmonary resuscitation and 2) survival outcomes.DesignProspective, multicenter observational study.SettingPediatric and pediatric cardiac ICUs of the Collaborative Pediatric Critical Care Research Network.PatientsIntubated children (≥ 37 wk gestation and < 19 yr old) who received at least 1 minute of cardiopulmonary resuscitation.InterventionsNone.Measurements and main resultsArterial blood pressure and ventilation rate (breaths/min) were manually extracted from arterial line and capnogram waveforms. Guideline rate was defined as 10 ± 2 breaths/min; high ventilation rate as greater than or equal to 30 breaths/min in children less than 1 year old, and greater than or equal to 25 breaths/min in older children. The primary outcome was survival to hospital discharge. Regression models using Firth penalized likelihood assessed the association between ventilation rates and outcomes. Ventilation rates were available for 52 events (47 patients). More than half of patients (30/47; 64%) were less than 1 year old. Eighteen patients (38%) survived to discharge. Median event-level average ventilation rate was 29.8 breaths/min (interquartile range, 23.8-35.7). No event-level average ventilation rate was within guidelines; 30 events (58%) had high ventilation rates. The only significant association between ventilation rate and arterial blood pressure occurred in children 1 year old or older and was present for systolic blood pressure only (-17.8 mm Hg/10 breaths/min; 95% CI, -27.6 to -8.1; p < 0.01). High ventilation rates were associated with a higher odds of survival to discharge (odds ratio, 4.73; p = 0.029). This association was stable after individually controlling for location (adjusted odds ratio, 5.97; p = 0.022), initial rhythm (adjusted odds ratio, 3.87; p = 0.066), and time of day (adjusted odds ratio, 4.12; p = 0.049).ConclusionsIn this multicenter cohort, ventilation rates exceeding guidelines were common. Among the range of rates delivered, higher rates were associated with improved survival to hospital discharge.

Published
2019

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