Diastolic Blood Pressure During Pediatric In-Hospital Cardiac Arrest: Trends and Associations With Outcomes

Area of Science:

• Pediatric Critical Care Medicine
• Cardiovascular Physiology during Resuscitation
• Emergency Medicine Research

Background:

• Current pediatric resuscitation guidelines use diastolic blood pressure (DBP) to assess cardiopulmonary resuscitation (CPR) quality.
• Established DBP thresholds (≥25 mm Hg infants, ≥30 mm Hg children) were based on limited data from the initial 10 minutes of CPR.
• The utility of these thresholds in prolonged in-hospital cardiac arrest (IHCA) remains unclear.

Purpose of the Study:

• To analyze DBP trends throughout pediatric IHCA.
• To investigate the association between DBP thresholds and return of spontaneous circulation (ROSC) during prolonged CPR (≥10 minutes).

Main Methods:

• Retrospective cohort study of pediatric IHCA patients with invasive arterial blood pressure monitoring (2017-2023).
• Analysis of DBP trajectories and regression modeling to assess trends and associations with ROSC.
• Evaluation of DBP thresholds in both early and prolonged CPR phases.

Main Results:

• DBP generally increased early and plateaued above guideline thresholds in pediatric IHCA.
• Higher average DBP and steeper early DBP rise were associated with early ROSC.
• In prolonged CPR (≥10 min), an upward DBP trend correlated with ROSC (p < 0.001).
• Achieving higher DBP thresholds (≥30 mm Hg infants, ≥35 mm Hg children) later in CPR was significantly associated with ROSC (OR 7.14, p = 0.009).

Conclusions:

• DBP can be maintained above current guideline thresholds during prolonged pediatric CPR.
• Current DBP thresholds may not be sufficient for predicting ROSC in prolonged CPR.
• Further research is needed to establish optimal, time-dependent DBP targets for prolonged pediatric resuscitation.