Early Postresuscitation Hypotension is Associated with Increased Mortality Following Pediatric Cardiac Arrest

Overview

Journal Crit Care Med

Specialties Critical Care
Emergency Medicine

Date 2014 Feb 25

PMID 24561563

Citations 56

Authors

Alexis A Topjian

Benjamin French

Robert M Sutton

Thomas Conlon

Vinay M Nadkarni

Frank W Moler

J Michael Dean

Robert A Berg

Affiliations

Soon will be listed here.

Abstract

Objective: To describe the association of systolic hypotension during the first 6 hours after successful resuscitation from pediatric cardiopulmonary arrest with in-hospital mortality.

Design: Retrospective cohort study.

Setting: Fifteen children's hospitals associated with the Pediatric Emergency Care Applied Research Network.

Patients: Patients between 1 day and 18 years old who had a cardiopulmonary arrest, received chest compressions more than 1 minute, had a return of spontaneous circulation more than 20 minutes, and had a systolic blood pressure documented within 6 hours of arrest.

Interventions: None.

Measurements And Main Results: Three hundred eighty-three patients had complete data for analysis. Patients with a documented minimum systolic blood pressure less than fifth percentile for age and sex within the first 6 hours following return of spontaneous circulation were considered to have early postresuscitation hypotension. Two hundred fourteen patients (56%) had early postresuscitation hypotension. One hundred eighty-four patients (48%) died prior to hospital discharge. After controlling for patient and cardiopulmonary arrest characteristics, hypotension in the first 6 hours following return of spontaneous circulation was associated with a significantly increased odds of in-hospital mortality (adjusted odds ratio = 1.71; 95% CI, 1.02-2.89; p = 0.042) and odds of unfavorable outcome (adjusted odds ratio = 1.83; 95% CI, 1.06-3.19; p = 0.032).

Conclusions: In the first 6 hours following successful resuscitation from pediatric cardiac arrest, systolic hypotension was documented in 56% and was associated with a higher rate of in-hospital mortality and worse hospital discharge neurologic outcomes.

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References

Neumar R, Nolan J, Adrie C, Aibiki M, Berg R, Bottiger B . Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on.... Circulation. 2008; 118(23):2452-83. DOI: 10.1161/CIRCULATIONAHA.108.190652. View

Rosner B, Cook N, Portman R, Daniels S, Falkner B . Determination of blood pressure percentiles in normal-weight children: some methodological issues. Am J Epidemiol. 2008; 167(6):653-66. DOI: 10.1093/aje/kwm348. View

Moler F, Meert K, Donaldson A, Nadkarni V, Brilli R, Dalton H . In-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study. Crit Care Med. 2009; 37(7):2259-67. PMC: 2711020. DOI: 10.1097/CCM.0b013e3181a00a6a. View

Bernard S, Gray T, Buist M, Jones B, Silvester W, Gutteridge G . Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; 346(8):557-63. DOI: 10.1056/NEJMoa003289. View

Trzeciak S, Jones A, Kilgannon J, Milcarek B, Hunter K, Shapiro N . Significance of arterial hypotension after resuscitation from cardiac arrest. Crit Care Med. 2009; 37(11):2895-903. DOI: 10.1097/ccm.0b013e3181b01d8c. View

Nadkarni V, Larkin G, Peberdy M, Carey S, Kaye W, Mancini M . First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006; 295(1):50-7. DOI: 10.1001/jama.295.1.50. View

Kilgannon J, Roberts B, Reihl L, Chansky M, Jones A, Dellinger R . Early arterial hypotension is common in the post-cardiac arrest syndrome and associated with increased in-hospital mortality. Resuscitation. 2008; 79(3):410-6. PMC: 2746417. DOI: 10.1016/j.resuscitation.2008.07.019. View

Gaieski D, Band R, Abella B, Neumar R, Fuchs B, Kolansky D . Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest. Resuscitation. 2009; 80(4):418-24. DOI: 10.1016/j.resuscitation.2008.12.015. View

Moler F, Donaldson A, Meert K, Brilli R, Nadkarni V, Shaffner D . Multicenter cohort study of out-of-hospital pediatric cardiac arrest. Crit Care Med. 2010; 39(1):141-9. PMC: 3297020. DOI: 10.1097/CCM.0b013e3181fa3c17. View

10.

Kern K, Hilwig R, Rhee K, Berg R . Myocardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning. J Am Coll Cardiol. 1996; 28(1):232-40. DOI: 10.1016/0735-1097(96)00130-1. View

11.

Girotra S, Nallamothu B, Spertus J, Li Y, Krumholz H, Chan P . Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012; 367(20):1912-20. PMC: 3517894. DOI: 10.1056/NEJMoa1109148. View

12.

Girotra S, Spertus J, Li Y, Berg R, Nadkarni V, Chan P . Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With the Guidelines-Resuscitation. Circ Cardiovasc Qual Outcomes. 2012; 6(1):42-9. PMC: 3555689. DOI: 10.1161/CIRCOUTCOMES.112.967968. View

13.

Peberdy M, Ornato J, Larkin G, Braithwaite R, Kashner T, Carey S . Survival from in-hospital cardiac arrest during nights and weekends. JAMA. 2008; 299(7):785-92. DOI: 10.1001/jama.299.7.785. View

14.

Meert K, Donaldson A, Nadkarni V, Tieves K, Schleien C, Brilli R . Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med. 2009; 10(5):544-53. PMC: 2741542. DOI: 10.1097/PCC.0b013e3181a7045c. View

15.

Laurent I, Monchi M, Chiche J, Joly L, Spaulding C, Bourgeois B . Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol. 2002; 40(12):2110-6. DOI: 10.1016/s0735-1097(02)02594-9. View

16.

Fiser D, Long N, Roberson P, Hefley G, Zolten K . Relationship of pediatric overall performance category and pediatric cerebral performance category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments. Crit Care Med. 2000; 28(7):2616-20. DOI: 10.1097/00003246-200007000-00072. View

17.

Adrie C, Adib-Conquy M, Laurent I, Monchi M, Vinsonneau C, Fitting C . Successful cardiopulmonary resuscitation after cardiac arrest as a "sepsis-like" syndrome. Circulation. 2002; 106(5):562-8. DOI: 10.1161/01.cir.0000023891.80661.ad. View

18.

Sunde K, Pytte M, Jacobsen D, Mangschau A, Jensen L, Smedsrud C . Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation. 2007; 73(1):29-39. DOI: 10.1016/j.resuscitation.2006.08.016. View

19.

Merchant R, Yang L, Becker L, Berg R, Nadkarni V, Nichol G . Incidence of treated cardiac arrest in hospitalized patients in the United States. Crit Care Med. 2011; 39(11):2401-6. PMC: 3196742. DOI: 10.1097/CCM.0b013e3182257459. View

20.

Jacobs I, Nadkarni V, Bahr J, Berg R, Billi J, Bossaert L . Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on.... Circulation. 2004; 110(21):3385-97. DOI: 10.1161/01.CIR.0000147236.85306.15. View