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Resuscitation. 2019 Aug;141:88-95. doi: 10.1016/j.resuscitation.2019.05.033. Epub 2019 Jun 6.

The association of immediate post cardiac arrest diastolic hypertension and survival following pediatric cardiac arrest.

Author information

1
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: topjian@email.chop.edu.
2
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.
3
Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States.
4
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, United States.
5
Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States.
6
Department of Pediatrics, Children's National Medical Center, Washington D.C., United States.
7
Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States.
8
Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States.
9
Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States.
10
Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, United States.
11
Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, MI, United States.
12
Department of Pediatrics, Children's National Medical Center, Washington D.C., United States; Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, United States.
13
Department of Pediatrics, Denver Children's Hospital, University of Colorado, Denver, CO, United States.
14
Department of Molecular Biology, Princeton University, Princeton, New Jersey, United States.
15
Department of Pediatrics, Children's National Medical Center, Washington D.C., United States; Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States.
16
Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States; Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States.
17
Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, MI, United States; Department of Pediatrics, Lurie Children's Hospital, Northwestern University, Chicago, IL, United States.
18
Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, United States.
19
Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.

Abstract

AIM:

In-hospital cardiac arrest occurs in >5000 children each year in the US and almost half will not survive to discharge. Animal data demonstrate that an immediate post-resuscitation burst of hypertension is associated with improved survival. We aimed to determine if systolic and diastolic invasive arterial blood pressures immediately (0-20 min) after return of spontaneous circulation (ROSC) are associated with survival and neurologic outcomes at hospital discharge.

METHODS:

This is a secondary analysis of the Pediatric Intensive Care Quality of CPR (PICqCPR) study of invasively measured blood pressures during intensive care unit CPR. Patients were eligible if they achieved ROSC and had at least one invasively measured blood pressure within the first 20 min following ROSC. Post-ROSC blood pressures were normalized for age, sex and height. "Immediate hypertension" was defined as at least one systolic or diastolic blood pressure >90th percentile. The primary outcome was survival to hospital discharge.

RESULTS:

Of 102 children, 70 (68.6%) had at least one episode of immediate post-CPR diastolic hypertension. After controlling for pre-existing hypotension, duration of CPR, calcium administration, and first documented rhythm, patients with immediate post-CPR diastolic hypertension were more likely to survive to hospital discharge (79.3% vs. 54.5%; adjusted OR = 2.93; 95%CI, 1.16-7.69).

CONCLUSIONS:

In this post hoc secondary analysis of the PICqCPR study, 68.6% of subjects had diastolic hypertension within 20 min of ROSC. Immediate post-ROSC hypertension was associated with increased odds of survival to discharge, even after adjusting for covariates of interest.

KEYWORDS:

Cardiac arrest; Child; Hemodynamics; Hypertension; Hypotension; Post cardiac arrest care

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