Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis

Ryan W. Morgan, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Ron W. Reeder, Department of Pediatrics, University of Utah, Salt Lake City, UT.
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.
Julie C. Fitzgerald, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Kathryn Graham, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Todd J. Kilbaugh, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
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, Philadelphia, PA.
Chella A. Palmer, Department of Pediatrics, University of Utah, Salt Lake City, UT.
Matthew P. Sharron, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
Scott L. Weiss, Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE.
Heather A. Wolfe, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
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.
Candice Burns, Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI.
J Wesley Diddle, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
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.
Aisha H. Frazier, Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE.
Stuart H. Friess, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
David A. Hehir, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, 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.
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.
Peter M. Mourani, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR.
Maryam Y. Naim, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Murray M. Pollack, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
Anil Sapru, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
Neeraj Srivastava, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.

Document Type

Journal Article

Publication Date

6-25-2025

Journal

Critical care medicine

DOI

10.1097/CCM.0000000000006739

Keywords

cardiac arrest; cardiopulmonary resuscitation; intensive care unit; pediatrics; sepsis; septic shock

Abstract

OBJECTIVES: Prearrest sepsis has been associated with particularly poor outcomes among children who suffer in-hospital cardiac arrest (IHCA), but there is a paucity of dedicated studies on the topic. In this study of children receiving cardiopulmonary resuscitation (CPR) in the ICU, our objective was to determine the associations of sepsis with IHCA outcomes and intraarrest physiology. DESIGN: Prospectively designed secondary analysis of the ICU Resuscitation Project clinical trial (NCT02837497). SETTING: The 18 pediatric and pediatric cardiac ICUs at ten children's hospitals in the United States. PATIENTS: Children (≤ 18 yr) with an index IHCA event. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary exposure was a prearrest diagnosis of sepsis. 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 average diastolic blood pressure (DBP) during CPR. Multivariable regression models controlling for a priori covariates assessed the relationship between sepsis and outcomes. Of 1129 children with index IHCAs, 184 (16.3%) had prearrest sepsis. Patients with sepsis had greater prearrest comorbidities, higher prearrest severity of illness, and higher Vasoactive-Inotropic Scores than patients without sepsis. They more frequently had hypotension as the cause of IHCA, had longer durations of CPR, and more frequently received epinephrine and sodium bicarbonate during CPR. They less frequently achieved survival with favorable neurologic outcome (52/184 [28.3%] vs. 552/945 [58.4%]; p < 0.001; adjusted relative risk, 0.54; 95% CI, 0.43-0.68; p < 0.001). Intraarrest DBPs did not differ between patients with vs. without sepsis. Following IHCA, event survivors with sepsis had higher vasoactive requirements, more frequently experienced hypotension, and continued to have greater mortality rates through 48 hours postarrest. CONCLUSIONS: Children with prearrest sepsis had worse survival outcomes, similar intraarrest DBPs, and greater pre and postarrest severity of illness than children without sepsis.

Department

Pediatrics

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