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Critical Care Medicine:
doi: 10.1097/CCM.0000000000000216
Pediatric Critical Care

Early Postresuscitation Hypotension Is Associated With Increased Mortality Following Pediatric Cardiac Arrest*

Topjian, Alexis A. MD, MSCE1; French, Benjamin PhD2; Sutton, Robert M. MD, MSCE1; Conlon, Thomas MD1; Nadkarni, Vinay M. MD, MS1; Moler, Frank W. MD, MS3; Dean, J. Michael MD, MBA4; Berg, Robert A. MD1

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Abstract

Objective:

To describe the association of systolic hypotension during the first 6 hours after successful resuscitation from pediatric cardiopulmonary arrest with in-hospital mortality.

Design:

Retrospective cohort study.

Setting:

Fifteen children’s hospitals associated with the Pediatric Emergency Care Applied Research Network.

Patients:

Patients between 1 day and 18 years old who had a cardiopulmonary arrest, received chest compressions more than 1 minute, had a return of spontaneous circulation more than 20 minutes, and had a systolic blood pressure documented within 6 hours of arrest.

Interventions:

None.

Measurements and Main Results:

Three hundred eighty-three patients had complete data for analysis. Patients with a documented minimum systolic blood pressure less than fifth percentile for age and sex within the first 6 hours following return of spontaneous circulation were considered to have early postresuscitation hypotension. Two hundred fourteen patients (56%) had early postresuscitation hypotension. One hundred eighty-four patients (48%) died prior to hospital discharge. After controlling for patient and cardiopulmonary arrest characteristics, hypotension in the first 6 hours following return of spontaneous circulation was associated with a significantly increased odds of in-hospital mortality (adjusted odds ratio = 1.71; 95% CI, 1.02–2.89; p = 0.042) and odds of unfavorable outcome (adjusted odds ratio = 1.83; 95% CI, 1.06–3.19; p = 0.032).

Conclusions:

In the first 6 hours following successful resuscitation from pediatric cardiac arrest, systolic hypotension was documented in 56% and was associated with a higher rate of in-hospital mortality and worse hospital discharge neurologic outcomes.

Copyright © 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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