Institutional members access full text with Ovid®

Share this article on:

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

doi: 10.1097/CCM.0000000000000216
Pediatric Critical Care

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.

1Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

2Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

3Division of Critical Care Medicine, Department of Pediatrics, CS Mott Children’s Hospital, University of Michigan, Ann Arbor, MI.

4Department of Pediatrics, University of Utah, Salt Lake City, UT.

* See also p. 1571.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Topjian received support for article research from the National Institutes of Health (NIH), is employed by the University of Pennsylvania, and also received NIH career development award (K23NS075363 and U01HL094345). Her institution received grant support from NIH. Dr. French served as a statistical editor for JAMA Pediatrics and a Resuscitation Pediatric Research Task Force Member for the National Get with the Guidelines and received support for article research from NIH. Dr. Sutton received grant support from the NIH (NICHD Career Development Award) and is funded by a career development award from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (K23HD062629). Dr. Nadkarni received NIH award (U01 HL107681, U01 HL094345, RO1 HL114484, R01 HL058669, AHRQ R18 HS022469, AHRQ R18 HS022464, and CIHR 2009-09-15). Dr. Moler received support for article research from NIH (U01HL094345, R01HL112745, U10 HD063106, and R34HD072101). His institution received grant support from NIH. Dr. Dean received support for article research from NIH and is employed by the University of Utah. He is funded by NIH awards K12HD047349, U01HD049934, U01HL094339, HRSA award U03MC00008, and the HA and Edna Benning Presidential Endowment. His institution received grant support from NIH. Dr. Berg received grant support from NICHD (principal investigator of Collaborative Pediatric Clinical Critical Care Research Network at CHOP) and is funded by NIH award U10 HD063108. Dr. Conlon has disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: topjian@email.chop.edu

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