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Diastolic Blood Pressure Threshold During Pediatric Cardiopulmonary Resuscitation and Survival Outcomes: A
Robert A Berg1, Ryan W Morgan1, Ron W Reeder2
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Insights
Maintaining arterial diastolic blood pressure (DBP) above 25 mm Hg in infants and 30 mm Hg in children during cardiopulmonary resuscitation (CPR) is linked to better survival rates. These findings validate DBP targets for pediatric CPR.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular physiology
- Resuscitation science
Background:
- Previous research suggested diastolic blood pressure (DBP) targets during cardiopulmonary resuscitation (CPR) in children.
- These targets included >25 mm Hg for infants and >30 mm Hg for children over 1 year old.
- Validation in a larger cohort was needed.
Purpose of the Study:
- To validate previously suggested diastolic blood pressure (DBP) targets during cardiopulmonary resuscitation (CPR) in a large, multicenter pediatric cohort.
- To assess the association of achieving these DBP targets with survival to hospital discharge and favorable neurologic outcomes.
Main Methods:
- A prospective observational study was conducted across 18 pediatric intensive care units (PICUs).
- Data from 1,129 children (≤18 years) undergoing CPR with invasive blood pressure monitoring were analyzed.
- Multivariable Poisson regression models assessed the association between DBP thresholds and outcomes like survival and return of spontaneous circulation (ROSC).
Main Results:
- 85.5% of patients achieved the DBP targets (infants ≥25 mm Hg, older children ≥30 mm Hg).
- Achieving DBP targets was significantly associated with survival to hospital discharge (aRR 1.32) and ROSC (aRR 1.49).
- The association with survival and favorable neurologic outcome did not reach statistical significance (aRR 1.30).
Conclusions:
- Achieving mean diastolic blood pressure (DBP) >25 mm Hg in infants and >30 mm Hg in older children during CPR is associated with increased survival to hospital discharge.
- These findings support the use of these DBP values as potential targets during pediatric CPR.
- Further research may explore the link between these DBP targets and favorable neurologic outcomes.
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.
Related Concept Videos
01:21Cardiopulmonary Resuscitation I: Adult
01:17Measurement of Blood Pressure
01:24Blood Pressure
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.