Outcomes and characteristics of cardiac arrest in children with pulmonary hypertension: A secondary analysis of the ICU-RESUS clinical trial

Authors

• Ryan W. Morgan, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: MorganR1@chop.edu.
• Ron W. Reeder, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
• Tageldin Ahmed, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
• Michael J. Bell, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
• John T. Berger, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
• Robert Bishop, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
• Matthew Bochkoris, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
• Candice Burns, Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA.
• Joseph A. Carcillo, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
• Todd C. Carpenter, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
• J Michael Dean, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
• J Wesley Diddle, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
• Myke Federman, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
• Richard Fernandez, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
• Ericka L. Fink, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
• Deborah Franzon, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
• Aisha H. Frazier, Nemours Cardiac Center, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE, USA; Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE, USA.
• Stuart H. Friess, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
• Kathryn Graham, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
• Mark Hall, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
• David A. Hehir, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
• Adam S. Himebauch, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
• Christopher M. Horvat, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
• Leanna L. Huard, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
• Tensing Maa, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
• Arushi Manga, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
• Patrick S. McQuillen, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
• Kathleen L. Meert, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
• Peter M. Mourani, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
• Vinay M. Nadkarni, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
• Maryam Y. Naim, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
• Daniel Notterman, Department of Molecular Biology, Princeton University, Princeton, NJ, USA.

Document Type

Journal Article

Publication Date

7-3-2023

Journal

Resuscitation

DOI

10.1016/j.resuscitation.2023.109897

Keywords

Blood pressure; Cardiac arrest; Cardiopulmonary resuscitation; Pediatrics; Pulmonary hypertension

Abstract

BACKGROUND: Previous studies have identified pulmonary hypertension (PH) as a relatively common diagnosis in children with in-hospital cardiac arrest (IHCA), and preclinical laboratory studies have found poor outcomes and low systemic blood pressures during CPR for PH-associated cardiac arrest. The objective of this study was to determine the prevalence of PH among children with IHCA and the association between PH diagnosis and intra-arrest physiology and survival outcomes. METHODS: This was a prospectively designed secondary analysis of patients enrolled in the ICU-RESUS clinical trial (NCT02837497). The primary exposure was a pre-arrest diagnosis of PH. The primary survival outcome was survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline). The primary physiologic outcome was event-level average diastolic blood pressure (DBP) during CPR. RESULTS: Of 1276 patients with IHCAs during the study period, 1129 index IHCAs were enrolled; 184 (16.3%) had PH and 101/184 (54.9%) were receiving inhaled nitric oxide at the time of IHCA. Survival with favorable neurologic outcome was similar between patients with and without PH on univariate (48.9% vs. 54.4%; p = 0.17) and multivariate analyses (aOR 0.82 [95%CI: 0.56, 1.20]; p = 0.32). There were no significant differences in CPR event outcome or survival to hospital discharge. Average DBP, systolic BP, and end-tidal carbon dioxide during CPR were similar between groups. CONCLUSIONS: In this prospective study of pediatric IHCA, pre-existing PH was present in 16% of children. Pre-arrest PH diagnosis was not associated with statistically significant differences in survival outcomes or intra-arrest physiologic measures.

APA Citation

Morgan, Ryan W.; Reeder, Ron W.; Ahmed, Tageldin; Bell, Michael J.; Berger, John T.; Bishop, Robert; Bochkoris, Matthew; Burns, Candice; Carcillo, Joseph A.; Carpenter, Todd C.; Dean, J Michael; Diddle, J Wesley; Federman, Myke; Fernandez, Richard; Fink, Ericka L.; Franzon, Deborah; Frazier, Aisha H.; Friess, Stuart H.; Graham, Kathryn; Hall, Mark; Hehir, David A.; Himebauch, Adam S.; Horvat, Christopher M.; Huard, Leanna L.; Maa, Tensing; Manga, Arushi; McQuillen, Patrick S.; Meert, Kathleen L.; Mourani, Peter M.; Nadkarni, Vinay M.; Naim, Maryam Y.; and Notterman, Daniel, "Outcomes and characteristics of cardiac arrest in children with pulmonary hypertension: A secondary analysis of the ICU-RESUS clinical trial" (2023). GW Authored Works. Paper 3124.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3124

Department

Pediatrics