Journal article
Association of cumulative oxygen and carbon dioxide levels with neurologic outcome after pediatric cardiac arrest resuscitation: A multicenter cohort study
Resuscitation plus, Vol.20, 100804
12/2024
DOI: 10.1016/j.resplu.2024.100804
PMCID: PMC11541810
PMID: 39512524
Abstract
We aimed to (1) determine the association between cumulative PaO2 and PaCO2 exposure 24 h post-return of circulation and survival with favorable neurologic outcome. And (2) to assess adherence to American Heart Association post-cardiac arrest care treatment goals (PaO2 75–100 mmHg and PaCO2 35–45 mmHg).
Prospectively collected data were analysed from five Pediatric Resuscitation Quality collaborative sites supplemented with retrospective PaO2 and PaCO2 data.
Children aged 1 day–17 years with return of circulation after cardiac arrest, admitted 2019–2022, with ≥ 4 arterial blood gasses spanning at least 12 h within 24 h post-return of ciculation, were eligible. Congenital cyanotic heart disease events were excluded.
Area under the curve calculation provided hourly cumulative PaO2 and PaCO2 exposures per child and similarly guideline recommended cumulative ranges. The primary outcome was survival to hospital discharge with favorable neurologic outcome defined as a Pediatric Cerebral Performance Category 1–3, or no pre-arrest baseline difference.
Among 292 included children (median age 2.6 years (IQR 0.4–10.9)), 57 % survived to discharge and 48 % had favorable neurologic outcome (88 % of survivors). Cumulative PaO2 and PaCO2 exposure 0–24 h post-return of circulation were not significantly associated with favorable neurologic outcome in multivariable analysis (OR 1.0, 95 %CI 0.98–1.02 and OR 0.97, 95 %CI 0.87–1.09 respectively). Cumulative PaO2 and PaCO2 remained within guideline recommended ranges for 24 % and 58 % of children respectively with median areas under the curve over 0 – 24 h of 2664 mmHg (2151 – 3249 mmHg) for PaO2 and 948 mmHg (853 – 1051 mmHg) for PaCO2. AHA post-cardiac arrest care guideline recommendations for PaO2 (1800–2400 mmHg) and PaCO2 (840–1080 mmHg) were recalculated as area under the curve ranges. Achieving both normoxia and normocapnia was observed in 12 % of children.
Cumulative PaO2 and PaCO2 exposure in the first 24 h post-return of circulation was not associated with survival with favorable neurologic outcome. Pediatric AHA post-cardiac arrest care guideline normoxia and normocapnia goals were often not met. Larger cohort studies are necessary to improve the accuracy of cumulative exposure calculations, assess the long-term effects of PaO2 and PaCO2 exposure, and explore the influence of other post-cardiac arrest care therapeutic strategies.
Details
- Title: Subtitle
- Association of cumulative oxygen and carbon dioxide levels with neurologic outcome after pediatric cardiac arrest resuscitation: A multicenter cohort study
- Creators
- Marijn Albrecht - Erasmus MC - Sophia Children’s HospitalRogier C.J. de Jonge - Erasmus MC - Sophia Children’s HospitalJimena Del Castillo - Hospital General Universitario Gregorio MarañónAndrea Christoff - Children's Hospital at WestmeadMatthijs De Hoog - Erasmus MC - Sophia Children’s HospitalSangmo Je - Children's Hospital of PhiladelphiaVinay M. Nadkarni - Children's Hospital of PhiladelphiaDana E. Niles - Children's Hospital of PhiladelphiaOliver Tegg - Children's Hospital at WestmeadKari Wellnitz - University of IowaCorinne M.P. Buysse - Erasmus MC - Sophia Children’s HospitalPediatric Resuscitation Quality (pediRES-Q) Collaborative Investigators
- Resource Type
- Journal article
- Publication Details
- Resuscitation plus, Vol.20, 100804
- DOI
- 10.1016/j.resplu.2024.100804
- PMID
- 39512524
- PMCID
- PMC11541810
- NLM abbreviation
- Resusc Plus
- ISSN
- 2666-5204
- eISSN
- 2666-5204
- Publisher
- Elsevier B.V; AMSTERDAM
- Language
- English
- Date published
- 12/2024
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics
- Record Identifier
- 9984738165402771
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