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Association of Duration of Hypotension With Survival After Pediatric Cardiac Arrest
Elizabeth K Laverriere1, Marcia Polansky1,2, Benjamin French3
1Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
Insights
A higher burden of hypotension after pediatric cardiac arrest significantly reduces survival to hospital discharge. This finding highlights the importance of managing post-resuscitation blood pressure in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular physiology
- Resuscitation science
Background:
- Pediatric cardiac arrest (PCA) survivors often experience post-resuscitation hypotension.
- The impact of hypotension burden on survival after PCA requires further investigation.
Purpose of the Study:
- To evaluate the association between hypotension episodes and burden with survival to hospital discharge following pediatric cardiac arrest resuscitation.
Main Methods:
- Retrospective cohort study of 116 pediatric patients (1 day to 18 years) resuscitated from cardiac arrest.
- Hypotension defined as systolic blood pressure < 5th percentile for age/sex.
- Assessed single episode and burden (percentage of measurements < 5th percentile) of hypotension within 72 hours post-ICU admission.
Main Results:
- Hypotension occurred in 55% of patients within 72 hours post-resuscitation.
- No significant difference in discharge survival for a single hypotension episode.
- Increased burden of hypotension within 72 hours was associated with decreased discharge survival (aOR 0.67; p=0.006).
Conclusions:
- Systolic hypotension is common after pediatric cardiac arrest resuscitation.
- Higher burden of post-resuscitation hypotension is a significant predictor of decreased survival to discharge.
- Careful monitoring and management of blood pressure are crucial for PCA survivors.
Objectives:
To evaluate the association of a single episode of hypotension and burden of hypotension with survival to hospital discharge following resuscitation from pediatric cardiac arrest.
Design:
Retrospective cohort study.
Setting:
Single-center PICU.
Patients:
Patients between 1 day and 18 years old who had a cardiac arrest, received chest compressions for more than 2 minutes, had return of spontaneous circulation for more than 20 minutes, and survived to receive postresuscitation care in the ICU.
Interventions:
None.
Measurement And Main Results:
One-hundred sixteen patients were evaluable. Hypotension, defined as systolic blood pressure less than the fifth percentile for age and sex, occurred in 37 patients (32%) within the first 6 hours and 64 (55%) within 72 hours of postresuscitation ICU care. There was no significant difference in survival to discharge for patients who had a single episode of hypotension within 6 hours (51% vs 69%; p = 0.06) or within 72 hours (56% vs 73%; p = 0.06). Burden of hypotension was defined as the percentage of hypotension measurements that were below the fifth percentile. After controlling for patient and cardiac arrest event characteristics, a higher burden of hypotension within the first 72 hours of ICU postresuscitation care was associated with decreased discharge survival (adjusted odds ratio = 0.67 per 10% increase in hypotension burden; 95% CI, 0.48-0.86; p = 0.006).
Conclusions:
After successful resuscitation from pediatric cardiac arrest, systolic hypotension was common (55%). A higher burden of postresuscitation hypotension within the first 72 hours of ICU postresuscitation care was associated with significantly decreased discharge survival, after accounting for potential confounders including number of doses of epinephrine, arrest location, and arrest etiology due to airway obstruction or trauma.
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