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3. Brief report: incidence and outcomes of pediatric tracheal intubation-associated cardiac arrests in the ICU-RESUS clinical trial

Author

Nishisaki, Akira, Reeder, Ron W., McGovern, Elizabeth Laverriere, Ahmed, Tageldin, Bell, Michael J., Bishop, Robert, Bochkoris, Matthew, Burns, Candice, Carcillo, Joseph A., Carpenter, Todd C., Diddle, Wesley, Federman, Myke, 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, Meert, Kathleen L., Morgan, Ryan W., Mourani, Peter M., Nadkarni, Vinay M., Naim, Maryam Y., Notterman, Daniel, Palmer, Chella A., Sapru, Anil, Schneiter, Carleen, Sharron, Matthew P., Srivastava, Neeraj, Viteri, Shirley, Wessel, David, Wolfe, Heather A., Yates, Andrew R., Zuppa, Athena F., Sutton, Robert M., and Berg, Robert A.

Published
2024
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4. 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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6. 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

7. 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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8. Global PARITY: Study Design for a Multi-Centered, International Point Prevalence Study to Estimate the Burden of Pediatric Acute Critical Illness in Resource-Limited Settings

Author

Abbas, Qalab, Holloway, Adrian, Caporal, Paula, López-Barón, Eliana, Agulnik, Asya, Remy, Kenneth E, Appiah, John A, Attebery, Jonah, Fink, Ericka L, Lee, Jan Hau, Hooli, Shubhada, Kissoon, Niranjan, Miller, Erika, Murthy, Srinivas, Muttalib, Fiona, Nielsen, Katie, Puerto-Torres, Maria, Rodrigues, Karla, Sakaan, Firas, Rodrigues, Adriana Teixeira, Tabor, Erica A, von Saint Andre-von Arnim, Amelie, Wiens, Matthew O, Blackwelder, William, He, David, Kortz, Teresa B, and Bhutta, Adnan T

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Services, Clinical Research, Pediatric, Good Health and Well Being, pediatric critical illness, acute pediatric care, critical care, outcome, low-and lower-middle-income countries, resource utilization, low resource setting, Paediatrics and Reproductive Medicine, Other Medical and Health Sciences, Paediatrics
Abstract

BackgroundThe burden of pediatric critical illness and resource utilization by children with critical illness in resource limited settings (RLS) are largely unknown. Without specific data that captures key aspects of critical illness, disease presentation, and resource utilization for pediatric populations in RLS, development of a contextual framework for appropriate, evidence-based interventions to guide allocation of limited but available resources is challenging. We present this methods paper which describes our efforts to determine the prevalence, etiology, hospital outcomes, and resource utilization associated with pediatric acute, critical illness in RLS globally.MethodsWe will conduct a prospective, observational, multicenter, multinational point prevalence study in sixty-one participating RLS hospitals from North, Central and South America, Africa, Middle East and South Asia with four sampling time points over a 12-month period. Children aged 29 days to 14 years evaluated for acute illness or injury in an emergency department) or directly admitted to an inpatient unit will be enrolled and followed for hospital outcomes and resource utilization for the first seven days of hospitalization. The primary outcome will be prevalence of acute critical illness, which Global PARITY has defined as death within 48 hours of presentation to the hospital, including ED mortality; or admission/transfer to an HDU or ICU; or transfer to another institution for a higher level-of-care; or receiving critical care-level interventions (vasopressor infusion, invasive mechanical ventilation, non-invasive mechanical ventilation) regardless of location in the hospital, among children presenting to the hospital. Secondary outcomes include etiology of critical illness, in-hospital mortality, cause of death, resource utilization, length of hospital stay, and change in neurocognitive status. Data will be managed via REDCap, aggregated, and analyzed across sites.DiscussionThis study is expected to address the current gap in understanding of the burden, etiology, resource utilization and outcomes associated with pediatric acute and critical illness in RLS. These data are crucial to inform future research and clinical management decisions and to improve global pediatric hospital outcomes.

Published
2022

9. 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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10. Outcomes of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest Among Children With Noncardiac Illness Categories*

Author

Loaec, Morgann, Himebauch, Adam S., Reeder, Ron, Alvey, Jessica S., Race, Jonathan A., Su, Lillian, Lasa, Javier J., Slovis, Julia C., Raymond, Tia T., Coleman, Ryan, Barney, Bradley J., Kilbaugh, Todd J., Topjian, Alexis A., Sutton, Robert M., Morgan, Ryan W., Guerguerian, Anne-Marie, O’Brien, Caitlin E., Fink, Ericka L., Lasa, Javier J., Roberts, Joan S., Su, Lillian, Brown, Linda L., Dewan, Maya, Bembea, Melania M., Kleinman, Monica, Ali, Noorjahan, Gupta, Punkaj, Sutton, Robert M., Reeder, Ron, and Sweberg, Todd

Published
2024
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11. Higher Survival With the Use of Extracorporeal Cardiopulmonary Resuscitation Compared With Conventional Cardiopulmonary Resuscitation in Children Following Cardiac Surgery: Results of an Analysis of the Get With The Guidelines-Resuscitation Registry*

Author

Kobayashi, Ryan L., Gauvreau, Kimberlee, Alexander, Peta M. A., Teele, Sarah A., Fynn-Thompson, Francis, Lasa, Javier J., Bembea, Melania, Thiagarajan, Ravi R., Guerguerian, Anne-Marie, Fink, Ericka L., Lasa, Javier J., Roberts, Joan S., Su, Lillian, Brown, Linda L., Dewan, Maya, Bembea, Melania M., Kleinman, Monica, Gupta, Punkaj, Sutton, Robert M., Reeder, Ron, and Sweberg, Todd

Published
2024
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12. 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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13. Identification of post-cardiac arrest blood pressure thresholds associated with outcomes in children: an ICU-Resuscitation study

Author

Gardner, Monique M., Hehir, David A., 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, Federman, Myke, Fernandez, Richard, Fink, Ericka L., Franzon, Deborah, Frazier, Aisha H., Friess, Stuart H., Graham, Kathryn, Hall, Mark, Harding, Monica L., Horvat, Christopher M., Huard, Leanna L., Maa, Tensing, Manga, Arushi, McQuillen, Patrick S., Meert, Kathleen L., Morgan, Ryan W., 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., Sutton, Robert M., and Topjian, Alexis A.

Published
2023
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14. 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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15. 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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17. Higher Survival With the Use of Extracorporeal Cardiopulmonary Resuscitation Compared With Conventional Cardiopulmonary Resuscitation in Children Following Cardiac Surgery: Results of an Analysis of the Get With The Guidelines-Resuscitation Registry

Author

Kobayashi, Ryan L., Gauvreau, Kimberlee, Alexander, Peta M. A., Teele, Sarah A., Fynn-Thompson, Francis, Lasa, Javier J., Bembea, Melania, Thiagarajan, Ravi R., Guerguerian, Anne-Marie, Fink, Ericka L., Roberts, Joan S., Su, Lillian, Brown, Linda L., Dewan, Maya, Kleinman, Monica, Gupta, Punkaj, Sutton, Robert M., Reeder, Ron, and Sweberg, Todd

Published
2023
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19. 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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20. 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

21. 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

23. 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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24. Association of CPR simulation program characteristics with simulated and actual performance during paediatric in-hospital cardiac arrest

Author

Cashen, Katherine, 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., Wesley Diddle, J., Federman, Myke, 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., Naim, Maryam Y., Notterman, Daniel, Palmer, Chella A., Pollack, Murray M., Sapru, Anil, Schneiter, Carleen, Sharron, Matthew P., Srivastava, Neeraj, Viteri, Shirley, Wolfe, Heather A., Yates, Andrew R., Zuppa, Athena F., and Meert, Kathleen L.

Published
2023
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25. Proceedings of the Second Curing Coma Campaign NIH Symposium: Challenging the Future of Research for Coma and Disorders of Consciousness

Author

Mainali, Shraddha, Aiyagari, Venkatesh, Alexander, Sheila, Bodien, Yelena, Boerwinkle, Varina, Boly, Melanie, Brown, Emery, Brown, Jeremy, Claassen, Jan, Edlow, Brian L., Fink, Ericka L., Fins, Joseph J., Foreman, Brandon, Frontera, Jennifer, Geocadin, Romergryko G., Giacino, Joseph, Gilmore, Emily J., Gosseries, Olivia, Hammond, Flora, Helbok, Raimund, Claude Hemphill, J., Hirsch, Karen, Kim, Keri, Laureys, Steven, Lewis, Ariane, Ling, Geoffrey, Livesay, Sarah L., McCredie, Victoria, McNett, Molly, Menon, David, Molteni, Erika, Olson, DaiWai, O’Phelan, Kristine, Park, Soojin, Polizzotto, Len, Javier Provencio, Jose, Puybasset, Louis, Venkatasubba Rao, Chethan P., Robertson, Courtney, Rohaut, Benjamin, Rubin, Michael, Sharshar, Tarek, Shutter, Lori, Sampaio Silva, Gisele, Smith, Wade, Stevens, Robert D., Thibaut, Aurore, Vespa, Paul, Wagner, Amy K., Ziai, Wendy C., Zink, Elizabeth, and I Suarez, Jose

Published
2022
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26. The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest

Author

Topjian, Alexis A, Telford, Russell, Holubkov, Richard, Nadkarni, Vinay M, Berg, Robert A, Dean, J Michael, Moler, Frank W, Investigators, for the Therapeutic Hypothermia after Pediatric Cardiac Arrest Trial, Meert, Kathleen L, Hutchinson, Jamie S, Newth, Christopher JL, Bennett, Kimberly S, Berger, John T, Pineda, Jose A, Koch, Joshua D, Schleien, Charles L, Dalton, Heidi J, Ofori-Amanfo, George, Goodman, Denise M, Fink, Ericka L, McQuillen, Patrick, Zimmerman, Jerry J, Thomas, Neal J, van der Jagt, Elise W, Porter, Melissa B, Meyer, Michael T, Harrison, Rick, Pham, Nga, Schwarz, Adam J, Nowak, Jeffrey E, Alten, Jeffrey, Wheeler, Derek S, Bhalala, Utpal S, Lidsky, Karen, Lloyd, Eric, Mathur, Mudit, Shah, Samir, Theodore, Wu, Theodorou, Andreas A, Sanders, Ronald C, Silverstein, Faye S, Christensen, James R, Slomine, Beth S, Pemberton, Victoria L, and Browning, Brittan

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Physical Injury - Accidents and Adverse Effects, Clinical Research, Pediatric, Heart Disease, Cardiovascular, Clinical Trials and Supportive Activities, Child, Preschool, Extracorporeal Membrane Oxygenation, Female, Heart Arrest, Hospitalization, Humans, Hypotension, Hypothermia, Induced, Infant, Male, Patient Discharge, Survival Rate, Time Factors, Targeted temperature management, Cardiac arrest, Child, Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators, Nursing, Public Health and Health Services, Emergency & Critical Care Medicine, Clinical sciences, Public health
Abstract

AimApproximately 40% of children who have an in-hospital cardiac arrest (IHCA) in the US survive to discharge. We aimed to evaluate the impact of post-cardiac arrest hypotension during targeted temperature management following IHCA on survival to discharge.MethodsThis is a secondary analysis of the therapeutic hypothermia after pediatric cardiac arrest in-hospital (THAPCA-IH) trial. "Early hypotension" was defined as a systolic blood pressure less than the fifth percentile for age and sex for patients not treated with extracorporeal membrane oxygenation (ECMO) or a mean arterial pressure less than fifth percentile for age and sex for patients treated with ECMO during the first 6 h of temperature intervention. The primary outcome was survival to hospital discharge.ResultsOf 299 children, 142 (47%) patients did not receive ECMO and 157 (53%) received ECMO. Forty-two of 142 (29.6%) non-ECMO patients had systolic hypotension. Twenty-three of 157 (14.7%) ECMO patients had mean arterial hypotension. After controlling for confounders of interest, non-ECMO patients who had early systolic hypotension were less likely to survive to hospital discharge (40.5% vs. 72%; adjusted OR [aOR] 0.34; 95%CI, 0.12-0.93). There was no difference in survival to discharge by blood pressure groups for children treated with ECMO (30.4% vs. 49.3%; aOR = 0.60; 95%CI, 0.22-1.63).ConclusionsIn this secondary analysis of the THAPCA-IH trial, in patients not treated with ECMO, systolic hypotension within 6 h of temperature intervention was associated with lower odds of discharge survival. Blood pressure groups in patients treated with ECMO were not associated with survival to discharge.

Published
2019

31. P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in Children: An Advisory Statement From the International Liaison Committee on Resuscitation

Author

Topjian, Alexis A., Scholefield, Barnaby R., Pinto, Neethi P., Fink, Ericka L., Buysse, Corinne M.P., Haywood, Kirstie, Maconochie, Ian, Nadkarni, Vinay M., de Caen, Allan, Escalante-Kanashiro, Raffo, Ng, Kee-Chong, Nuthall, Gabrielle, Reis, Amelia G., Van de Voorde, Patrick, Suskauer, Stacy J., Schexnayder, Stephen M., Hazinski, Mary Fran, and Slomine, Beth S.

Published
2021
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32. Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children

Author

Moler, Frank W, Silverstein, Faye S, Holubkov, Richard, Slomine, Beth S, Christensen, James R, Nadkarni, Vinay M, Meert, Kathleen L, Browning, Brittan, Pemberton, Victoria L, Page, Kent, Gildea, Marianne R, Scholefield, Barnaby R, Shankaran, Seetha, Hutchison, Jamie S, Berger, John T, Ofori-Amanfo, George, Newth, Christopher JL, Topjian, Alexis, Bennett, Kimberly S, Koch, Joshua D, Pham, Nga, Chanani, Nikhil K, Pineda, Jose A, Harrison, Rick, Dalton, Heidi J, Alten, Jeffrey, Schleien, Charles L, Goodman, Denise M, Zimmerman, Jerry J, Bhalala, Utpal S, Schwarz, Adam J, Porter, Melissa B, Shah, Samir, Fink, Ericka L, McQuillen, Patrick, Wu, Theodore, Skellett, Sophie, Thomas, Neal J, Nowak, Jeffrey E, Baines, Paul B, Pappachan, John, Mathur, Mudit, Lloyd, Eric, van der Jagt, Elise W, Dobyns, Emily L, Meyer, Michael T, Sanders, Ronald C, Clark, Amy E, and Dean, J Michael

Subjects
Clinical Trials and Supportive Activities, Pediatric, Cardiovascular, Clinical Research, Heart Disease, Genetics, Adolescent, Body Temperature, Child, Child, Preschool, Coma, Female, Heart Arrest, Hospitalization, Hospitals, Pediatric, Humans, Hypothermia, Induced, Infant, Infant, Newborn, Male, Survival Analysis, Treatment Failure, THAPCA Trial Investigators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundTargeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited.MethodsIn a trial conducted at 37 children's hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest.ResultsThe trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse events, as well as 28-day mortality, did not differ significantly between groups.ConclusionsAmong comatose children who survived in-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute; THAPCA-IH ClinicalTrials.gov number, NCT00880087 .).

Published
2017

33. Challenges and Priorities for Pediatric Critical Care Clinician-Researchers in Low- and Middle-Income Countries

Author

von Saint André-von Arnim, Amelie O, Attebery, Jonah, Kortz, Teresa Bleakly, Kissoon, Niranjan, Molyneux, Elizabeth M, Musa, Ndidiamaka L, Nielsen, Katie R, Fink, Ericka L, and Network, The Pediatric Acute Lung Injury and Sepsis Investigators

Subjects
Paediatrics, Biomedical and Clinical Sciences, Prevention, Clinical Research, Pediatric, Health Services, Generic health relevance, Good Health and Well Being, low- and middle-income countries, low resource settings, researchers, pediatric critical care, support of research, surveys and questionnaires, intensive care unit, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, Paediatrics and Reproductive Medicine, Other Medical and Health Sciences
Abstract

IntroductionThere is need for more data on critical care outcomes and interventions from low- and middle-income countries (LMIC). Global research collaborations could help improve health-care delivery for critically ill children in LMIC where child mortality rates remain high.Materials and methodsTo inform the role of collaborative research in health-care delivery for critically ill children in LMIC, an anonymous online survey of pediatric critical care (PCC) physicians from LMIC was conducted to assess priorities, major challenges, and potential solutions to PCC research. A convenience sample of 56 clinician-researchers taking care of critically ill children in LMIC was targeted. In addition, the survey was made available on a Latin American PCC website. Descriptive statistics were used for data analysis.ResultsThe majority of the 47 survey respondents worked at urban, public teaching hospitals in LMIC. Respondents stated their primary PCC research motivations were to improve clinical care and establish guidelines to standardize care. Top challenges to conducting research were lack of funding, high clinical workload, and limited research support staff. Respondent-proposed solutions to these challenges included increasing research funding options for LMIC, better access to mentors from high-income countries, research training and networks, and higher quality medical record documentation.ConclusionLMIC clinician-researchers must be better empowered and resourced to lead and influence the local and global health research agenda for critically ill children. Increased funding options, access to training and mentorship in research methodology, and improved data collection systems for LMIC PCC researchers were recognized as key needs for success.

Published
2017

34. Abstract 317: Brain MRI And Spectroscopy Biomarkers Predict Outcome After Pediatric Cardiac Arrest In POCCA

Author

Fink, Ericka L, Kochanek, Patrick M, Bluml, Stefan, Wisnowski, Jessica, Narayanan, Srikala, subramanian, subramanian, Beers, Sue, Berger, Rachel, Bayir, Hulya, Wang, Chunyan, Pineda, Jose, Topjian, Alexis A, maddux, aline, Willyerd, Frederick, Hunt, Elizabeth A, Chung, Melissa G, Newth, Christopher, Smith, Lincoln, Doughty, Lesley, Diddle, J. Wesley, Piantino, Juan, Walson, Karen H, Balakrishnan, Binod, friess, stuart, Siems, Ashley, Press, Craig, Patregnani, Jason, Meyer, Michael T, Haller, Tamara, Treble-Barna, Amery, Clark, Robert, Fabio, Anthony, and Panigrahy, Ashok

Published
2022
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35. Abstract 265: Social Determinants Of Health Impact Phenotype-based Outcome Prediction After Pediatric Arrest

Author

Fink, Ericka L, Kochanek, Patrick M, Panigrahy, Ashok, Beers, Sue, Berger, Rachel, BAYIR, HULYA, Wang, Chunyan, Pineda, Jose, Topjian, Alexis A, maddux, aline, Willyerd, Frederick, Hunt, Elizabeth A, Chung, Melissa G, Newth, Christopher, Smith, Lincoln, Doughty, Lesley, Diddle, J Wesley, Piantino, Juan, Walson, Karen H, Balakrishnan, Binod, friess, stuart, Siems, Ashley, Press, Craig, Patregnani, Jason, Meyer, Michael T, Haller, Tamara, Treble-Barna, Amery, Clark, Robert, and Fabio, Anthony

Published
2022
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37. Correction to: Proceedings of the Second Curing Coma Campaign NIH Symposium: Challenging the Future of Research for Coma and Disorders of Consciousness

Author

Mainali, Shraddha, Aiyagari, Venkatesh, Alexander, Sheila, Bodien, Yelena, Boerwinkle, Varina, Boly, Melanie, Brown, Emery, Brown, Jeremy, Claassen, Jan, Edlow, Brian L., Fink, Ericka L., Fins, Joseph J., Foreman, Brandon, Frontera, Jennifer, Geocadin, Romergryko G., Giacino, Joseph, Gilmore, Emily J., Gosseries, Olivia, Hammond, Flora, Helbok, Raimund, Claude Hemphill, J., Hirsch, Karen, Kim, Keri, Laureys, Steven, Lewis, Ariane, Ling, Geoffrey, Livesay, Sarah L., McCredie, Victoria, McNett, Molly, Menon, David, Molteni, Erika, Olson, DaiWai, O’Phelan, Kristine, Park, Soojin, Polizzotto, Len, Javier Provencio, Jose, Puybasset, Louis, Venkatasubba Rao, Chethan P., Robertson, Courtney, Rohaut, Benjamin, Rubin, Michael, Sharshar, Tarek, Shutter, Lori, Sampaio Silva, Gisele, Smith, Wade, Stevens, Robert D., Thibaut, Aurore, Vespa, Paul, Wagner, Amy K., Ziai, Wendy C., Zink, Elizabeth, and Suarez, Jose I.

Published
2022
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38. Supporting families during pediatric critical illness: Opportunities identified in a multicenter, qualitative study.

Author

Jarvis, Jessica M, Huntington, Taylor, Perry, Grace, Zickmund, Susan, Yang, Serena, Galyean, Patrick, Pinto, Neethi, Watson, R. Scott, Olson, Lenora M, Fink, Ericka L, and Maddux, Aline B

Abstract

Critical illness resulting in a pediatric intensive care unit (PICU) admission is a profoundly stressful experience for a child and their family. Increasing evidence for emotional and behavioral sequelae post-PICU emphasizes a need to provide better support for families throughout this period of care and recovery. The aim of this qualitative investigation was to identify salient and modifiable aspects of a critical care experience that can be addressed to better support families of critically ill children. Individual semi-structured interviews were conducted with 26 caregivers of children who survived a PICU admission. Interviews were audio-recorded and transcribed verbatim; themes were identified via thematic analysis. Caregivers were enrolled using convenience sampling from seven tertiary care PICUs in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Themes from caregiver interviews were identified within two overarching categories containing three themes each. Advice for future PICU families: (1) Be intentional about caring for your own well-being, (2) speak up, ask questions, and challenge decisions you're not comfortable with, and (3) continue to engage with your child. Characteristics of a satisfactory PICU experience: (1) A caregiver–provider relationship of mutual trust established through clear communication and respectful collaboration, (2) hospital environments that provide physical and social supports to maintain humanity in healthcare, and (3) preparing families for care transitions. Targeted, interdisciplinary approaches to partner with families during critical care may improve their PICU experience and contribute to improved long-term outcomes for PICU survivors. [ABSTRACT FROM AUTHOR]

Published
2024
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39. 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, and Hall, Mark

Abstract

Background: Half of pediatric in-hospital cardiopulmonary resuscitation (CPR) events have an initial rhythm of non-pulseless bradycardia with poor perfusion. Our study objectives were to leverage granular data from the ICU-RESUScitation (ICU-RESUS) trial to: (1) determine the association of early epinephrine administration with survival outcomes in children receiving CPR for bradycardia with poor perfusion; and (2) describe the incidence and time course of the development of pulselessness. Methods: Prespecified secondary analysis of ICU-RESUS, a multicenter cluster randomized trial of children (< 19 years) receiving CPR in 18 intensive care units in the United States. Index events (October 2016–March 2021) lasting ≥ 2 min with a documented initial rhythm of bradycardia with poor perfusion were included. Associations between early epinephrine (first 2 min of CPR) and outcomes were evaluated with Poisson multivariable regression controlling for a priori pre-arrest characteristics. Among patients with arterial lines, intra-arrest blood pressure waveforms were reviewed to determine presence of a pulse during CPR interruptions. The temporal nature of progression to pulselessness was described and outcomes were compared between patients according to subsequent pulselessness status. Results: Of 452 eligible subjects, 322 (71%) received early epinephrine. The early epinephrine group had higher pre-arrest severity of illness and vasoactive-inotrope scores. Early epinephrine was not associated with survival to discharge (aRR 0.97, 95%CI 0.82, 1.14) or survival with favorable neurologic outcome (aRR 0.99, 95%CI 0.82, 1.18). Among 186 patients with invasive blood pressure waveforms, 118 (63%) had at least 1 period of pulselessness during the first 10 min of CPR; 86 (46%) by 2 min and 100 (54%) by 3 min. Sustained return of spontaneous circulation was highest after bradycardia with poor perfusion (84%) compared to bradycardia with poor perfusion progressing to pulselessness (43%) and bradycardia with poor perfusion progressing to pulselessness followed by return to bradycardia with poor perfusion (62%) (p < 0.001). Conclusions: In this cohort of pediatric CPR events with an initial rhythm of bradycardia with poor perfusion, we failed to identify an association between early bolus epinephrine and outcomes when controlling for illness severity. Most children receiving CPR for bradycardia with poor perfusion developed subsequent pulselessness, 46% within 2 min of CPR onset. [ABSTRACT FROM AUTHOR]

Published
2024
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47. The Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID): Development of Case Report Forms for Global Use

Author

McNett, Molly, Fink, Ericka L., Schober, Michelle, Mainali, Shraddha, Helbok, Raimund, Robertson, Courtney L., Mejia-Mantilla, Jorge, Kurtz, Pedro, Righy, Cássia, Roa, Juan D., Villamizar-Rosales, Carlos, Altamirano, Valeria, Frontera, Jennifer A., Maldonado, Nelson, Menon, David, Suarez, Jose, and Chou, Sherry H. Y.

Published
2020
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48. Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest in Children

Author

Moler, Frank W, Silverstein, Faye S, Holubkov, Richard, Slomine, Beth S, Christensen, James R, Nadkarni, Vinay M, Meert, Kathleen L, Clark, Amy E, Browning, Brittan, Pemberton, Victoria L, Page, Kent, Shankaran, Seetha, Hutchison, Jamie S, Newth, Christopher JL, Bennett, Kimberly S, Berger, John T, Topjian, Alexis, Pineda, Jose A, Koch, Joshua D, Schleien, Charles L, Dalton, Heidi J, Ofori-Amanfo, George, Goodman, Denise M, Fink, Ericka L, McQuillen, Patrick, Zimmerman, Jerry J, Thomas, Neal J, van der Jagt, Elise W, Porter, Melissa B, Meyer, Michael T, Harrison, Rick, Pham, Nga, Schwarz, Adam J, Nowak, Jeffrey E, Alten, Jeffrey, Wheeler, Derek S, Bhalala, Utpal S, Lidsky, Karen, Lloyd, Eric, Mathur, Mudit, Shah, Samir, Wu, Theodore, Theodorou, Andreas A, Sanders, Ronald C, and Dean, J Michael

Subjects
Cardiovascular, Clinical Research, Clinical Trials and Supportive Activities, Heart Disease, Adolescent, Child, Child, Preschool, Female, Humans, Hypothermia, Induced, Infant, Male, Out-of-Hospital Cardiac Arrest, Treatment Outcome, Unconsciousness, THAPCA Trial Investigators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundTherapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited.MethodsWe conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac arrest.ResultsA total of 295 patients underwent randomization. Among the 260 patients with data that could be evaluated and who had a VABS-II score of at least 70 before cardiac arrest, there was no significant difference in the primary outcome between the hypothermia group and the normothermia group (20% vs. 12%; relative likelihood, 1.54; 95% confidence interval [CI], 0.86 to 2.76; P=0.14). Among all the patients with data that could be evaluated, the change in the VABS-II score from baseline to 12 months was not significantly different (P=0.13) and 1-year survival was similar (38% in the hypothermia group vs. 29% in the normothermia group; relative likelihood, 1.29; 95% CI, 0.93 to 1.79; P=0.13). The groups had similar incidences of infection and serious arrhythmias, as well as similar use of blood products and 28-day mortality.ConclusionsIn comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute and others; THAPCA-OH ClinicalTrials.gov number, NCT00878644.).

Published
2015

49. The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest

Author

Moler, Frank W., Meert, Kathleen L., Hutchinson, Jamie S., Newth, Christopher J.L., Bennett, Kimberly S., Berger, John T., Topjian, Alexis A., Pineda, Jose A., Koch, Joshua D., Schleien, Charles L., Dalton, Heidi J., Ofori-Amanfo, George, Goodman, Denise M., Fink, Ericka L., McQuillen, Patrick, Zimmerman, Jerry J., Thomas, Neal J., van der Jagt, Elise W., Porter, Melissa B., Meyer, Michael T., Harrison, Rick, Pham, Nga, Schwarz, Adam J., Nowak, Jeffrey E., Alten, Jeffrey, Wheeler, Derek S., Bhalala, Utpal S., Lidsky, Karen, Lloyd, Eric, Mathur, Mudit, Shah, Samir, Theodore, Wu, Theodorou, Andreas A., Sanders, Ronald C., Jr., Silverstein, Faye S., Christensen, James R., Slomine, Beth S., Pemberton, Victoria L., Browning, Brittan, Holubkov, Richard, Michael Dean, J., Telford, Russell, Nadkarni, Vinay M., Berg, Robert A., and Dean, J. Michael

Published
2019
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