Diastolic Blood Pressure Threshold During Pediatric CPR and Outcomes: A Multicenter Validation Study
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Resuscitation, Cardiovascular, Pediatrics, 2022
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INTRODUCTION:  A prior Collaborative Pediatric Critical Care Network (CPCCRN) derivation study of 164 patients with ICU cardiac arrests (7/2013-6/2016) established that invasive arterial diastolic BP >25mmHg in infants and >30mmHg in children >1yo was associated with survival to hospital discharge with favorable neurologic outcome (aRR 1.6; 1.1-2.5, p=0.02) and survival to discharge (aRR 1.7; 1.2-2.6, p=0.007). We attempted to validate these findings. METHODS:  Children ≤18 years old and ≥37 weeks gestation who received chest compressions >1-min duration with invasive BP monitoring before and during CPR (same as derivation set) in 18 ICUs from NHLBI-funded ICU-RESUScitation (NCT028374497) prospective trial (10/2016-3/2020). Standardized CPR data collection included pre-arrest patient characteristics, arterial BPs during first 10 minutes of CPR, intra-arrest interventions and outcomes. Exposure was mean DBP >25mmHg for infants and >30mmHg for older children during the first 10 minutes of CPR. Primary outcome was survival to hospital discharge with favorable neurologic outcome (PCPC 1-3). Multivariable Poisson regression models with robust error estimates evaluated the association of attaining exposure DBP with Return of Spontaneous Circulation (ROSC), survival to hospital discharge, and survival to hospital discharge with favorable neurologic outcome RESULTS:  Among 1129 ICU-RESUS children with IHCAs, 357 met inclusion criteria. 65% were infants, 8% had initial shockable rhythm, median duration of CPR was 7 [3, 23] minutes, 86% received >1 dose of epinephrine, 85% attained DBP targets >25mmHg in infants or >30mmHg when >1yo. 63% had ROSC, 56% survived to hospital discharge, and 54% survived with favorable neurologic outcome. Adjusting for age, initial rhythm, location (PICU or CICU), and institution, attaining exposure DBP was significantly associated with ROSC (aRR 1.49; 1.13-1.98, P=0.002) and survival to discharge with favorable neurologic outcome (aRR 1.31; 1.00-1.72, P=0.035), but did not reach significance for survival to hospital discharge (aRR 1.29; 0.97-1.70, P=0.056) CONCLUSIONS: These data validate that achieving mean DBP during CPR >25mmHg for infants or >30mmHg for children >1yo is associated with higher rates of successful ROSC and survival to hospital discharge with favorable neurologic outcome.
Meta Tag
Content Type Presentation
Knowledge Area Resuscitation
Knowledge Area Cardiovascular
Knowledge Area Pediatrics
Knowledge Level Advanced
Membership Level Select
Tag Cardiopulmonary Resuscitation CPR
Tag Hemodynamic Monitoring
Tag Pediatrics
Tag Cardiothoracic Critical Care
Year 2022
Bob Berg
multicenter validation study
diastolic blood pressure thresholds
pediatric CPR
survival outcomes


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