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Cardiopulmonary Resuscitation I: Adult01:21

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Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
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Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
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Cardiac Output
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Updated: Feb 27, 2026

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Heart Rate Variability Discriminates Outcomes After Pediatric Cardiac Arrest.

Duncan B Mackie1, Craig M Smith1,2, L Nelson Sanchez-Pinto1,2

  • 1Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|February 26, 2026
PubMed
Summary

Lower heart rate variability (HRV) in the first 12 hours after pediatric cardiac arrest indicates a higher risk of death and poor neurologic outcomes. This finding suggests HRV can aid in prognostication for critically ill children.

Keywords:
cardiac arrestcritical care outcomesheart rate variabilityin-hospital mortalityneurologic outcomes

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Area of Science:

  • Pediatric critical care medicine
  • Cardiovascular physiology
  • Neurology

Background:

  • Cardiac arrest in children is associated with significant mortality and long-term neurologic deficits.
  • Accurate prognostication is crucial for guiding treatment decisions and resource allocation in pediatric intensive care units (PICUs).
  • Heart rate variability (HRV) reflects autonomic nervous system function and has shown potential as a prognostic marker in various critical illnesses.

Purpose of the Study:

  • To evaluate the effectiveness of heart rate variability (HRV) in predicting mortality and functional neurologic outcomes in pediatric patients following cardiac arrest.
  • To determine if HRV measurements within the initial 12 hours of PICU admission can discriminate between survivors and non-survivors, and between good and poor neurologic recovery.

Main Methods:

  • A retrospective review of physiologic and clinical data was conducted in a 46-bed PICU.
  • Seventy-five pediatric patients (older than 28 days and younger than 18 years) admitted after cardiac arrest between 2013 and 2019 were included.
  • Median integer HRV (mHRVi) was calculated from the first 12 hours of PICU admission and analyzed for its association with mortality and neurologic outcomes (Pediatric Cerebral Performance Category scores).

Main Results:

  • The 1-week in-hospital mortality rate was 23% (17 patients).
  • Lower mHRVi in the first 12 hours was significantly associated with 1-week mortality (p < 0.01) and poor neurologic outcomes (odds ratio 0.26; p = 0.01).
  • The 12-hour mHRVi demonstrated moderate discrimination for mortality (area under the ROC curve: 0.74) and remained significant after multivariable adjustment.

Conclusions:

  • Reduced mHRVi within the first 12 hours post-cardiac arrest in children is a significant predictor of both 1-week mortality and adverse neurologic outcomes.
  • mHRVi shows potential as an adjunctive tool in multimodal prognostication frameworks for pediatric cardiac arrest survivors.
  • Further validation in larger, diverse patient cohorts is necessary to establish clinical utility.