Journal article
Evaluating post-cardiac arrest blood pressure thresholds associated with neurologic outcome in children: Insights from the pediRES-Q database
Resuscitation, Vol.207, 110468
02/2025
DOI: 10.1016/j.resuscitation.2024.110468
PMID: 39706470
Abstract
Current Pediatric Advanced Life Support Guidelines recommend maintaining blood pressure (BP) above the 5th percentile for age following return of spontaneous circulation (ROSC) after cardiac arrest (CA). Emerging evidence suggests that targeting higher thresholds, such as the 10th or 25th percentiles, may improve neurologic outcomes. We aimed to evaluate the association between post-ROSC BP thresholds and neurologic outcome, hypothesizing that maintaining mean arterial pressure (MAP) and systolic blood pressure (SBP) above these thresholds would be associated with improved outcomes at hospital discharge.
This retrospective, multi-center, observational study analyzed data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q). Children (<18 years) who achieved ROSC following index in-hospital or out-of-hospital cardiac arrest and survived ≥ 6 h were included. Multivariable logistic regression was preformed to analyze the association between the pre-defined BP thresholds (5th, 10th, and 25th percentiles) and favorable neurologic outcome, controlling for illness category (surgical-cardiac), initial rhythm (shockable), arrest time (weekend or night), age, CPR duration, and clustering by site.
There were 787 patients with evaluable MAP data and 711 patients with evaluable SBP data. Fifty-four percent (N = 424) of subjects with MAP data and 53 % (N = 380) with SBP data survived to hospital discharge with favorable neurologic outcome. MAP above the 5th, 10th, and 25th percentile thresholds was associated with significantly greater odds of favorable outcome compared to patients with MAP below target (aOR, 1.81 [95 % CI, 1.32, 2.50]; 1.50 [95 % CI, 1.10, 2.05]; 1.40 [95 % CI, 1.01, 1.94], respectively). Subjects with lowest SBP above the 5th percentile also had greater odds of favorable outcome (aOR, 1.44 [95 % CI, 1.04, 2.01]). Associations between lowest SBP above the 10th percentile and 25th percentile did not reach statistical significance (aOR 1.33 [95 % CI, 0.96, 1.86]; 1.23 [95 % CI, 0.87, 1.75], respectively).
After pediatric CA, maintaining MAP above the 5th, 10th, and 25th percentiles and SBP above the 5th percentile during the first 6 h following ROSC was significantly associated with improved neurologic outcomes.
Details
- Title: Subtitle
- Evaluating post-cardiac arrest blood pressure thresholds associated with neurologic outcome in children: Insights from the pediRES-Q database
- Creators
- A. Ushpol - Icahn School of Medicine at Mount SinaiS. Je - Children's Hospital of PhiladelphiaA. Christoff - Children's Hospital at WestmeadG. Nuthall - Starship Children's HealthB. Scholefield - Hospital for Sick ChildrenR.W. Morgan - Children's Hospital of PhiladelphiaV. Nadkarni - Children's Hospital of PhiladelphiaS. Gangadharan - Icahn School of Medicine at Mount SinaiKamal Abulebda - Riley Hospital for ChildrenDiane Atkins - University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USAShilpa Balikai - University of IowaMarc Berg - Lucile Packard Children's HospitalRobert Berg - Children's Hospital of PhiladelphiaMatthew S. Braga - Dartmouth–Hitchcock Medical CenterCorinne Buysse - Erasmus MC - Sophia Children’s HospitalAdam Cheng - Alberta Children's HospitalKelly Corbett - Dartmouth–Hitchcock Medical CenterAllan DeCaen - Stollery Children's HospitalDestiny LaShoto - Children's Healthcare of AtlantaGabry deJong - Erasmus MC - Sophia Children’s HospitalJimena del Castillo - Hospital General Universitario Gregorio MarañónMaya Dewan - Cincinnati Children's Hospital Medical CenterAaron Donoghue - Children's Hospital of PhiladelphiaIvie Esangbedo - Seattle Children's HospitalStuart Friess - St. Louis Children's HospitalOrsola Gawronski - Bambino Gesù Children's HospitalJonathan Gilleland - Alberta Children's HospitalHeather Griffis - Children's Hospital of PhiladelphiaJames Gray - Cincinnati Children's Hospital Medical CenterHelen Harvey - Rady Children's Hospital-San DiegoIlana Harwayne-Gidansky - Albany Medical Center HospitalSarah Haskell - University of IowaJennifer Hayes - Children's Hospital of Orange CountyKiran Heber - Children's Healthcare of AtlantaBetsy Hunt - Johns Hopkins University School of MedicineTakanari Ikeyama - Aichi Medical University Medical CenterPriti Jani - University of ChicagoMonica Kleinman - Boston Children's HospitalLynda Knight - Lucile Packard Children's HospitalHiroshi Kurosawa - Kobe Children's HospitalKasper Glerup Lauridsen - Children's Hospital of PhiladelphiaTara Lemoine - Children's Hospital Central CaliforniaTensing Maa - Nationwide Children's HospitalElizabeth Masse - Seattle Children's HospitalLuz Marina Mejia - Theodore Roosevelt High SchoolYee Hui Mok - KK Women's and Children's HospitalRyan Morgan - University of PennsylvaniaVinay Nadkarni - Children's Hospital of PhiladelphiaSholeen Nett - Dartmouth–Hitchcock Medical CenterAbhay Ranganathan - Children's Hospital of PhiladelphiaAmanda O’Halloran - Children's Hospital of PhiladelphiaMichelle Olson - Children's Hospital of Richmond at VCUGene Ong - KK Women's and Children's HospitalAndrea Maxwell - Children's Hospital of WisconsinTia Raymond - Medical City Children's HospitalJoan Roberts - Seattle Children's HospitalAnita Sen - Morgan Stanley Children's HospitalSophie Skellet - Great Ormond Street HospitalDaniel Stromberg - Dell Children's Medical Center of Central TexasRobert Sutton - Children's Hospital of PhiladelphiaFelice Su - Lucile Packard Children's HospitalTodd Sweberg - Cohen Children's Medical CenterOscar Tegg - Children's Hospital at WestmeadKen Tegtmeyer - Cincinnati Children's Hospital Medical CenterAlexis Topjian - Children's Hospital of PhiladelphiaClaire Hanson - Akron Children's HospitalJavier Urbano Villaescusa - Hospital Materno-InfantilIchiro Watanabe - Tokyo Metropolitan Children's Medical CenterDenise Welsby - Great Ormond Street HospitalJesse Wenger - Seattle Children's HospitalHeather Wolfe - Children's Hospital of PhiladelphiaAndrea Yeo - National University of SingaporePricilla Yu - The University of Texas Southwestern Medical CenterRhea Vidrine - University of KentuckyGim Tan - Los Angeles Medical CenterAfsaneh Pirzadeh - University of North Carolina HospitalsAngela Wratney - Golisano Children's HospitalKimberly DiMaria - Children's Hospital ColoradoPediatric Resuscitation Quality (pediRES-Q) Investigators
- Resource Type
- Journal article
- Publication Details
- Resuscitation, Vol.207, 110468
- DOI
- 10.1016/j.resuscitation.2024.110468
- PMID
- 39706470
- NLM abbreviation
- Resuscitation
- ISSN
- 0300-9572
- eISSN
- 1873-1570
- Publisher
- Elsevier B.V
- Grant note
- ZOLL Medical
The pediRES-Q is supported by an unrestricted research grant to the Children's Hospital of Philadelphia from ZOLL Medical. The sponsorhad no role in the design, interpretation, writing, editing, or submis-sion of the manuscript.
- Language
- English
- Electronic publication date
- 12/18/2024
- Date published
- 02/2025
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics
- Record Identifier
- 9984759114902771
Metrics
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