The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest. (August 2019)

• Record Type: Journal Article
• Authors: Topjian, Alexis A.; Telford, Russell; Holubkov, Richard; Nadkarni, Vinay M.; Berg, Robert A.; Dean, J. Michael; Moler, Frank W.; Moler, Frank W.; Meert, Kathleen L.; Hutchinson, Jamie S.; Newth, Christopher J.L.; Bennett, Kimberly S.; Berger, John T.; Topjian, Alexis A.; Pineda, Jose A.; Koch, Joshua D.; Schleien, Charles L.; Dalton, Heidi J.; Ofori-Amanfo, George; Goodman, Denise M.; Fink, Ericka L.; McQuillen, Patrick; Zimmerman, Jerry J.; Thomas, Neal J.; van der Jagt, Elise W.; Porter, Melissa B.; Meyer, Michael T.; Harrison, Rick; Pham, Nga; Schwarz, Adam J.; Nowak, Jeffrey E.; Alten, Jeffrey; Wheeler, Derek S.; Bhalala, Utpal S.; Lidsky, Karen; Lloyd, Eric; Mathur, Mudit; Shah, Samir; Theodore, Wu; Theodorou, Andreas A.; Sanders, Ronald C.; Silverstein, Faye S.; Christensen, James R.; Slomine, Beth S.; Pemberton, Victoria L.; Browning, Brittan; Holubkov, Richard; Michael Dean, J.;
• Is Part Of: Resuscitation. Volume 141(2019)
• Page Start: 24
• Page End: 34
• Publication Date: 2019-08
• Subjects: Targeted temperature management -- Hypotension -- Cardiac arrest -- Child; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2019.05.032
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim: Approximately 40% of children who have an in-hospital cardiac arrest (IHCA) in the US survive to discharge. We aimed to evaluate the impact of post-cardiac arrest hypotension during targeted temperature management following IHCA on survival to discharge. Methods: This is a secondary analysis of the therapeutic hypothermia after pediatric cardiac arrest in-hospital (THAPCA-IH) trial. "Early hypotension" was defined as a systolic blood pressure less than the fifth percentile for age and sex for patients not treated with extracorporeal membrane oxygenation (ECMO) or a mean arterial pressure less than fifth percentile for age and sex for patients treated with ECMO during the first 6 h of temperature intervention. The primary outcome was survival to hospital discharge. Results: Of 299 children, 142 (47%) patients did not receive ECMO and 157 (53%) received ECMO. Forty-two of 142 (29.6%) non-ECMO patients had systolic hypotension. Twenty-three of 157 (14.7%) ECMO patients had mean arterial hypotension. After controlling for confounders of interest, non-ECMO patients who had early systolic hypotension were less likely to survive to hospital discharge (40.5% vs. 72%; adjusted OR [aOR] 0.34; 95%CI, 0.12–0.93). There was no difference in survival to discharge by blood pressure groups for children treated with ECMO (30.4% vs. 49.3%; aOR = 0.60; 95%CI, 0.22–1.63). Conclusions: In this secondary analysis of the THAPCA-IH trial, in patients not treated with ECMO, systolic hypotension within 6 h of temperature intervention was associated with lower odds of discharge survival. Blood pressure groups in patients treated with ECMO were not associated with survival to discharge.