The Temporal Association of the COVID-19 Pandemic and Pediatric Cardiopulmonary Resuscitation Quality and Outcomes

Ryan W. Morgan, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.
Heather A. Wolfe, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.
Ron W. Reeder, Department of Pediatrics, University of Utah, Salt Lake City, UT.
Jessica S. Alvey, Department of Pediatrics, University of Utah, Salt Lake City, UT.
Aisha H. Frazier, Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
Stuart H. Friess, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
Tensing Maa, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
Patrick S. McQuillen, Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA.
Kathleen L. Meert, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
Vinay M. Nadkarni, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.
Matthew P. Sharron, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
Ashley Siems, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
Andrew R. Yates, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
Tageldin Ahmed, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
Michael J. Bell, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
Robert Bishop, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Matthew Bochkoris, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
Candice Burns, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
Joseph A. Carcillo, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
Todd C. Carpenter, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
J Michael Dean, Department of Pediatrics, University of Utah, Salt Lake City, UT.
J Wesley Diddle, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
Myke Federman, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
Richard Fernandez, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
Ericka L. Fink, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
Deborah Franzon, Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA.
Mark Hall, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
David Hehir, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.
Christopher M. Horvat, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
Leanna L. Huard, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
Arushi Manga, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
Peter M. Mourani, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.

Document Type

Journal Article

Publication Date

9-2-2022

Journal

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

DOI

10.1097/PCC.0000000000003073

Abstract

OBJECTIVES: The COVID-19 pandemic resulted in adaptations to pediatric resuscitation systems of care. The objective of this study was to determine the temporal association between the pandemic and pediatric in-hospital cardiac arrest (IHCA) process of care metrics, cardiopulmonary resuscitation (cardiopulmonary resuscitation) quality, and patient outcomes. DESIGN: Multicenter retrospective analysis of a dataset comprising observations of IHCA outcomes pre pandemic (March 1, 2019 to February 29, 2020) versus pandemic (March 1, 2020 to February 28, 2021). SETTING: Data source was the ICU-RESUScitation Project ("ICU-RESUS;" NCT028374497), a prospective, multicenter, cluster randomized interventional trial. PATIENTS: Children (≤ 18 yr) who received cardiopulmonary resuscitation while admitted to the ICU and were enrolled in ICU-RESUS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 429 IHCAs meeting inclusion criteria, occurrence during the pandemic period was associated with higher frequency of hypotension as the immediate cause of arrest. Cardiac arrest physiology, cardiopulmonary resuscitation quality metrics, and postarrest physiologic and quality of care metrics were similar between the two periods. Survival with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline) occurred in 102 of 195 subjects (52%) during the pandemic compared with 140 of 234 (60%) pre pandemic (p = 0.12). Among survivors, occurrence of IHCA during the pandemic period was associated with a greater increase in Functional Status Scale (FSS) (i.e., worsening) from baseline (1 [0-3] vs 0 [0-2]; p = 0.01). After adjustment for confounders, IHCA survival during the pandemic period was associated with a greater increase in FSS from baseline (+1.19 [95% CI, 0.35-2.04] FSS points; p = 0.006) and higher odds of a new FSS-defined morbidity (adjusted odds ratio, 1.88 [95% CI, 1.03-3.46]; p = 0.04). CONCLUSIONS: Using the ICU-RESUS dataset, we found that relative to the year prior, pediatric IHCA during the first year of the COVID-19 pandemic was associated with greater worsening of functional status and higher odds of new functional morbidity among survivors.

Department

Pediatrics

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