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Evaluating post-cardiac arrest blood pressure thresholds associated with neurologic outcome in children: Insights
A Ushpol1, S Je2, A Christoff3
1Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA.
Insights
Maintaining higher blood pressure percentiles after pediatric cardiac arrest (CA) is linked to better neurologic outcomes. Targeting mean arterial pressure (MAP) above the 25th percentile and systolic blood pressure (SBP) above the 5th percentile shows significant improvements.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Physiology
- Neurology
Background:
- Current Pediatric Advanced Life Support guidelines suggest maintaining blood pressure (BP) above the 5th percentile for age post-ROSC.
- Emerging evidence indicates higher BP thresholds may enhance neurologic outcomes after pediatric cardiac arrest (CA).
Purpose of the Study:
- To investigate the association between post-ROSC BP thresholds and neurologic outcomes in pediatric patients.
- To determine if maintaining mean arterial pressure (MAP) and systolic blood pressure (SBP) above specific percentiles improves outcomes.
Main Methods:
- Retrospective analysis of the Pediatric Resuscitation Quality Collaborative (pediRES-Q) database.
- Inclusion of children (<18 years) who achieved ROSC and survived at least 6 hours post-CA.
- Multivariable logistic regression to analyze BP thresholds (5th, 10th, 25th percentiles) and neurologic outcome, controlling for covariates.
Main Results:
- Higher MAP above the 5th, 10th, and 25th percentiles was significantly associated with improved odds of favorable neurologic outcome.
- Maintaining SBP above the 5th percentile also correlated with greater odds of favorable neurologic outcome.
- No statistically significant association was found between SBP above the 10th or 25th percentiles and favorable outcomes.
Conclusions:
- Maintaining MAP above the 5th, 10th, and 25th percentiles post-ROSC is linked to better neurologic outcomes in pediatric CA survivors.
- Maintaining SBP above the 5th percentile is also associated with improved neurologic outcomes.
- These findings suggest potential adjustments to post-ROSC BP management strategies in pediatric critical care.
Background:
Current Pediatric Advanced Life Support Guidelines recommend maintaining blood pressure (BP) above the 5th percentile for age following return of spontaneous circulation (ROSC) after cardiac arrest (CA). Emerging evidence suggests that targeting higher thresholds, such as the 10th or 25th percentiles, may improve neurologic outcomes. We aimed to evaluate the association between post-ROSC BP thresholds and neurologic outcome, hypothesizing that maintaining mean arterial pressure (MAP) and systolic blood pressure (SBP) above these thresholds would be associated with improved outcomes at hospital discharge.
Methods:
This retrospective, multi-center, observational study analyzed data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q). Children (<18 years) who achieved ROSC following index in-hospital or out-of-hospital cardiac arrest and survived ≥ 6 h were included. Multivariable logistic regression was preformed to analyze the association between the pre-defined BP thresholds (5th, 10th, and 25th percentiles) and favorable neurologic outcome, controlling for illness category (surgical-cardiac), initial rhythm (shockable), arrest time (weekend or night), age, CPR duration, and clustering by site.
Results:
There were 787 patients with evaluable MAP data and 711 patients with evaluable SBP data. Fifty-four percent (N = 424) of subjects with MAP data and 53 % (N = 380) with SBP data survived to hospital discharge with favorable neurologic outcome. MAP above the 5th, 10th, and 25th percentile thresholds was associated with significantly greater odds of favorable outcome compared to patients with MAP below target (aOR, 1.81 [95 % CI, 1.32, 2.50]; 1.50 [95 % CI, 1.10, 2.05]; 1.40 [95 % CI, 1.01, 1.94], respectively). Subjects with lowest SBP above the 5th percentile also had greater odds of favorable outcome (aOR, 1.44 [95 % CI, 1.04, 2.01]). Associations between lowest SBP above the 10th percentile and 25th percentile did not reach statistical significance (aOR 1.33 [95 % CI, 0.96, 1.86]; 1.23 [95 % CI, 0.87, 1.75], respectively).
Conclusion:
After pediatric CA, maintaining MAP above the 5th, 10th, and 25th percentiles and SBP above the 5th percentile during the first 6 h following ROSC was significantly associated with improved neurologic outcomes.
