Practice patterns for acquiring neuroimaging after pediatric in-hospital cardiac arrest

Matthew P. Kirschen, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA USA; Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA USA. Electronic address: kirschenm@chop.edu.
Natalie L. Ullman, Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA USA.
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.
Robert A. Berg, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia 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 Wesley Diddle, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA USA.
Myke Federman, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles Los Angeles CA USA.
Ericka L. Fink, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh University of Pittsburgh Pittsburgh PA USA.
Aisha H. Frazier, Department of Pediatrics, Nemours Children's Hospital, Delaware 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, The 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.
Todd J. Kilbaugh, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA 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.
Ryan W. Morgan, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA USA.
Peter M. Mourani, 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, The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA USA.
Maryam Y. Naim, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA USA.
Daniel Notterman, Department of Molecular Biology Princeton University Princeton NJ USA.
Chella A. Palmer, Department of Pediatrics, University of Utah Salt Lake City UT USA.
Murray M. Pollack, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine Washington DC USA.
Anil Sapru, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles Los Angeles CA USA.
Matthew P. Sharron, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine Washington DC USA.
Neeraj Srivastava, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles Los Angeles CA USA.

Document Type

Journal Article

Publication Date

2-1-2025

Journal

Resuscitation

Volume

207

DOI

10.1016/j.resuscitation.2025.110506

Keywords

CT; Cardiac arrest; MRI; Neuroimaging; Pediatric ICU; Ultrasound

Abstract

AIMS: To determine which patient and cardiac arrest factors were associated with obtaining neuroimaging after in-hospital cardiac arrest, and among those patients who had neuroimaging, factors associated with which neuroimaging modality was obtained. METHODS: Retrospective cohort study of patients who survived in-hospital cardiac arrest (IHCA) and were enrolled in the ICU-RESUS trial (NCT02837497). RESULTS: We tabulated ultrasound (US), CT, and MRI frequency within 7 days following IHCA and identified patient and cardiac arrest factors associated with neuroimaging modalities utilized. Multivariable models determined which factors were associated with obtaining neuroimaging. Of 1000 patients, 44% had ≥ 1 neuroimaging study (US in 31%, CT in 18%, and MRI in 6% of patients). Initial USs were performed a median of 0.3 [0.1,0.5], CTs 1.4 [0.4,2.8], and MRIs 4.1 [2.2,5.1] days post-arrest. Neuroimaging timing and frequency varied by site. Factors associated with greater odds of neuroimaging were cardiac arrest in CICU (versus PICU), longer duration CPR, receiving ECMO post-arrest, and post-arrest care with targeted temperature management or EEG monitoring. US performance was associated with congenital heart disease. CT was associated with age ≥ 1-month, greater pre-arrest disability, and receiving CPR for ≥ 16 min. MRI utilization increased with pre-existing respiratory insufficiency and respiratory decompensation as arrest cause, and medical cardiac and surgical non-cardiac or trauma illness category. Overall, if neuroimaging was obtained, US was more common in CICU while CT/MRI were utilized more in PICU. CONCLUSIONS: Practice patterns for acquiring neuroimaging after IHCA are variable and influenced by patient, cardiac arrest, and site factors.

Department

Pediatrics

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