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

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.

Department

Pediatrics

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