Outcomes and characteristics of cardiac arrest in children with pulmonary hypertension: A secondary analysis of the ICU-RESUS clinical trial - PubMed (original) (raw)

Clinical Trial

doi: 10.1016/j.resuscitation.2023.109897. Epub 2023 Jul 3.

Ron W Reeder 2, Tageldin Ahmed 3, Michael J Bell 4, John T Berger 4, Robert Bishop 5, Matthew Bochkoris 6, Candice Burns 7, Joseph A Carcillo 6, Todd C Carpenter 5, J Michael Dean 2, J Wesley Diddle 4, Myke Federman 8, Richard Fernandez 9, Ericka L Fink 6, Deborah Franzon 10, Aisha H Frazier 11, Stuart H Friess 12, Kathryn Graham 13, Mark Hall 9, David A Hehir 13, Adam S Himebauch 13, Christopher M Horvat 6, Leanna L Huard 8, Tensing Maa 9, Arushi Manga 12, Patrick S McQuillen 10, Kathleen L Meert 3, Peter M Mourani 14, Vinay M Nadkarni 13, Maryam Y Naim 13, Daniel Notterman 15, Kent Page 2, Murray M Pollack 4, Anil Sapru 8, Carleen Schneiter 5, Matthew P Sharron 4, Neeraj Srivastava 8, Sarah Tabbutt 10, Bradley Tilford 3, Shirley Viteri 16, David Wessel 4, Heather A Wolfe 13, Andrew R Yates 9, Athena F Zuppa 13, Robert A Berg 13, Robert M Sutton 13

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Clinical Trial

Outcomes and characteristics of cardiac arrest in children with pulmonary hypertension: A secondary analysis of the ICU-RESUS clinical trial

Ryan W Morgan et al. Resuscitation. 2023 Sep.

Abstract

Background: Previous studies have identified pulmonary hypertension (PH) as a relatively common diagnosis in children with in-hospital cardiac arrest (IHCA), and preclinical laboratory studies have found poor outcomes and low systemic blood pressures during CPR for PH-associated cardiac arrest. The objective of this study was to determine the prevalence of PH among children with IHCA and the association between PH diagnosis and intra-arrest physiology and survival outcomes.

Methods: This was a prospectively designed secondary analysis of patients enrolled in the ICU-RESUS clinical trial (NCT02837497). The primary exposure was a pre-arrest diagnosis of PH. The primary survival outcome was survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline). The primary physiologic outcome was event-level average diastolic blood pressure (DBP) during CPR.

Results: Of 1276 patients with IHCAs during the study period, 1129 index IHCAs were enrolled; 184 (16.3%) had PH and 101/184 (54.9%) were receiving inhaled nitric oxide at the time of IHCA. Survival with favorable neurologic outcome was similar between patients with and without PH on univariate (48.9% vs. 54.4%; p = 0.17) and multivariate analyses (aOR 0.82 [95%CI: 0.56, 1.20]; p = 0.32). There were no significant differences in CPR event outcome or survival to hospital discharge. Average DBP, systolic BP, and end-tidal carbon dioxide during CPR were similar between groups.

Conclusions: In this prospective study of pediatric IHCA, pre-existing PH was present in 16% of children. Pre-arrest PH diagnosis was not associated with statistically significant differences in survival outcomes or intra-arrest physiologic measures.

Keywords: Blood pressure; Cardiac arrest; Cardiopulmonary resuscitation; Pediatrics; Pulmonary hypertension.

Copyright © 2023 Elsevier B.V. All rights reserved.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Financial support for this project was provided through the National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development (U01HD049934, UG1HD049981, UG1HD049983, UG1HD050096, UG1HD063108, UG1HD083166, UG1HD083170, and UG1HD083171) and National Heart, Lung, and Blood Institute (R01HL131544, R01HL147616, K23HL148541, and K23HL153759) and by the Children’s Hospital of Philadelphia Resuscitation Science Center and Department of Anesthesiology and Critical Care Medicine.

Figures

Figure 1.

Figure 1.. Blood Pressures During Cardiopulmonary Resuscitation in Patients with and without Pulmonary Hypertension.

Systolic (Panel A) and diastolic (Panel B) blood pressures during the first ten minutes of CPR depicted between patients with pulmonary hypertension (red dashed line) and patients without pulmonary hypertension (blue solid line). Values represent the mean blood pressure for each 30-second epoch of CPR and error bars represent one standard error above and below the mean. The number of patients with contributing data in each group at each time point is noted. There were no statistically significant differences between groups at any given time point.

Comment in

References

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