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Early postresuscitation hypotension is associated with increased mortality following pediatric cardiac arrest
Alexis A Topjian1, Benjamin French, Robert M Sutton
11Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 3Division of Critical Care Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI. 4Department of Pediatrics, University of Utah, Salt Lake City, UT.
Insights
Systolic hypotension after pediatric cardiac arrest is common, affecting 56% of survivors. This early post-resuscitation hypotension significantly increases the risk of in-hospital mortality and poor neurologic outcomes.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular physiology
- Emergency medicine
Background:
- Pediatric cardiopulmonary arrest (CPA) is a critical event with significant mortality.
- Understanding post-resuscitation complications is vital for improving outcomes.
- Systolic hypotension is a common finding after successful resuscitation.
Purpose of the Study:
- To determine the association between systolic hypotension within 6 hours of pediatric CPA resuscitation and in-hospital mortality.
- To evaluate the impact of early post-resuscitation hypotension on neurologic outcomes.
Main Methods:
- Retrospective cohort study involving 383 pediatric patients from 15 children's hospitals.
- Defined early post-resuscitation hypotension as systolic blood pressure below the fifth percentile for age and sex within 6 hours of return of spontaneous circulation.
- Analyzed the association between hypotension and in-hospital mortality, controlling for patient and CPA characteristics.
Main Results:
- 56% of patients experienced early post-resuscitation hypotension.
- 184 patients (48%) died before hospital discharge.
- Hypotension was significantly associated with increased odds of in-hospital mortality (aOR=1.71) and unfavorable outcomes (aOR=1.83).
Conclusions:
- Systolic hypotension in the first 6 hours post-resuscitation is prevalent in pediatric CPA survivors.
- Early post-resuscitation hypotension is a significant predictor of increased in-hospital mortality.
- This finding highlights the importance of vigilant hemodynamic monitoring and management in pediatric CPA resuscitation.
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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