Association of Pediatric Post-Cardiac Arrest Ventilation and Oxygenation with Survival Outcomes

Authors

• Aisha H. Frazier, Nemours Children's Hospital Delaware, 25401, Cardiac Center, Wilmington, Delaware, United States.
• Alexis A. Topjian, University of Pennsylvania Perelman School of Medicine, 14640, Philadelphia, Pennsylvania, United States.
• Ron W. Reeder, University of Utah, Department of Pediatrics, Salt Lake City, Utah, United States.
• Ryan W. Morgan, The Children's Hospital of Philadelphia, 6567, Department of Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States.
• Ericka L. Fink, Children's Hospital of Pittsburgh of UPMC, 6619, Department of Critical Care Medicine, Pittsburgh, Pennsylvania, United States.
• Deborah Franzon, UCSF Benioff Children's Hospital, 21642, Department of Pediatrics, San Francisco, California, United States.
• Kathryn Graham, The Children's Hospital of Philadelphia, 6567, Department of Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States.
• Monica L. Harding, University of Utah, Department of Pediatrics, Salt Lake City, Utah, United States.
• Peter M. Mourani, University of Arkansas for Medical Sciences, 12215, Pediatrics, Critical Care Medicine, Little Rock, Arkansas, United States.
• Vinay M. Nadkarni, The Children's Hospital of Philadelphia, 6567, Department of Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States.
• Heather A. Wolfe, The Children's Hospital of Philadelphia, 6567, Department of Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States.
• Tageldin Ahmed, Children's Hospital of Michigan, 2969, Department of Pediatrics , Detroit, Michigan, United States.
• Michael J. Bell, Children's National Hospital, 8404, Department of Pediatrics, Washington, District of Columbia, United States.
• Candice Burns, Washington University School of Medicine in Saint Louis, 12275, Department of Pediatrics, St Louis, Missouri, United States.
• Joseph A. Carcillo, Children's Hospital of Pittsburgh of UPMC Department of Pediatric Critical Care Medicine, 549368, Pittsburgh, Pennsylvania, United States.
• Todd C. Carpenter, University of Colorado School of Medicine, 12225, Aurora, Colorado, United States.
• J Wesley Diddle, The Children's Hospital of Philadelphia, 6567, Department of Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States.
• Myke Federman, University of California Los Angeles, 8783, Los Angeles, California, United States.
• Stuart H. Friess, Washington University School of Medicine in Saint Louis, 12275, Department of Pediatrics, St Louis, Missouri, United States.
• Mark Hall, Nationwide Children's Hospital, 2650, Department of Pediatrics, Columbus, Ohio, United States.
• David A. Hehir, The Children's Hospital of Philadelphia, 6567, Department of Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States.
• Christopher M. Horvat, Children's Hospital of Pittsburgh of UPMC, 6619, Department of Critical Care Medicine, Pittsburgh, Pennsylvania, United States.
• Leanna L. Huard, University of California Los Angeles, 8783, Los Angeles, California, United States.
• Tensing Maa, Nationwide Children's Hospital, 2650, Department of Pediatrics , Columbus, Ohio, United States.
• Kathleen L. Meert, Children's Hospital of Michigan, 2969, Department of Pediatrics, Detroit, Michigan, United States.
• Maryam Y. Naim, The Children's Hospital of Philadelphia, 6567, Department of Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States.
• Daniel Notterman, Princeton University, 6740, Department of Molecular Biology, Princeton, New Jersey, United States.
• Murray M. Pollack, Children's National Hospital, 8404, Department of Pediatrics, Washington, District of Columbia, United States.
• Carleen Schneiter, University of Colorado School of Medicine, 12225, Aurora, Colorado, United States.
• Matthew P. Sharron, Children's National Medical Center, 8404, Department of Pediatrics, Washington, District of Columbia, United States.
• Neeraj Srivastava, UCLA Mattel Children's Hospital, 21785, Department of Pediatrics, Los Angeles, California, United States.
• Shirley Viteri, Nemours Children's Hospital Delaware, 25401, Department of Pediatrics, Wilmington, Delaware, United States.

Document Type

Journal Article

Publication Date

3-20-2024

Journal

Annals of the American Thoracic Society

DOI

10.1513/AnnalsATS.202311-948OC

Abstract

RATIONALE: Adult and pediatric studies provide conflicting data whether post-cardiac arrest hypoxemia, hyperoxemia, hypercapnia and/or hypocapnia are associated with worse outcomes. OBJECTIVES: Determine if post-arrest hypoxemia or post-arrest hyperoxemia are associated with lower rates of survival to hospital discharge compared to post-arrest normoxemia, and if post-arrest hypocapnia or hypercapnia are associated with lower rates of survival compared to post-arrest normocapnia. METHODS: Embedded prospective observational study during a multi-center interventional cardiopulmonary resuscitation trial from 2016-2021. Patients ≤18 years and ≥37 weeks corrected gestational age who received chest compressions for cardiac arrest in one of 18 ICUs were included. Exposures during the first 24 hours post-arrest were hypoxemia, hyperoxemia, or normoxemia defined as lowest PaO2 <60mmHg, highest PaO2 ≥200mmHg, or every PaO2 60-199mmHg, respectively, and hypocapnia, hypercapnia, or normocapnia defined as lowest PaCO2 <30mmHg, highest PaCO2 ≥50mmHg, or every PaCO2 30-49mmHg, respectively. Associations of oxygenation and carbon dioxide group with survival to hospital discharge were assessed using Poisson regression with robust error estimates. MEASUREMENTS AND MAIN RESULTS: The hypoxemia group was less likely to survive to hospital discharge compared with the normoxemia group (aRR 0.71, 0.58-0.87), whereas the hyperoxemia group survival did not differ from the normoxemia group (aRR 1.0, 0.87-1.15). The hypercapnia group was less likely to survive to hospital discharge compared with the normocapnia group (aRR 0.74, 0.64-0.84), whereas the hypocapnia group survival did not differ from the normocapnia group (aRR 0.91, 0.74-1.12). CONCLUSIONS: Post-arrest hypoxemia and hypercapnia were each associated with lower rates of survival to hospital discharge.

APA Citation

Frazier, Aisha H.; Topjian, Alexis A.; Reeder, Ron W.; Morgan, Ryan W.; Fink, Ericka L.; Franzon, Deborah; Graham, Kathryn; Harding, Monica L.; Mourani, Peter M.; Nadkarni, Vinay M.; Wolfe, Heather A.; Ahmed, Tageldin; Bell, Michael J.; Burns, Candice; Carcillo, Joseph A.; Carpenter, Todd C.; Diddle, J Wesley; Federman, Myke; Friess, Stuart H.; Hall, Mark; Hehir, David A.; Horvat, Christopher M.; Huard, Leanna L.; Maa, Tensing; Meert, Kathleen L.; Naim, Maryam Y.; Notterman, Daniel; Pollack, Murray M.; Schneiter, Carleen; Sharron, Matthew P.; Srivastava, Neeraj; and Viteri, Shirley, "Association of Pediatric Post-Cardiac Arrest Ventilation and Oxygenation with Survival Outcomes" (2024). GW Authored Works. Paper 4499.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4499

Department

Pediatrics