Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival
Background—Based on laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data demonstrating that survival depends on attaining adequate arterial diastolic blood pressure (DBP) during CPR, American Heart Association recommends using BP to guide pediatric CPR. However, evidence-based BP targets during pediatric CPR remain an important knowledge gap for CPR guidelines.
Methods—All children ≥37 weeks gestation and <19 years old in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for ≥1 minute and invasive arterial blood pressure monitoring prior to and during CPR between July 1, 2013 and June 31, 2016 were included. Mean DBP during CPR and Utstein-style standardized cardiac arrest data were collected. The hypothesis was that DBP ≥25 mmHg during CPR in infants and ≥30 mmHg in children ≥1 year old would be associated with survival. Primary outcome was survival to hospital discharge. Secondary outcome was survival to hospital discharge with favorable neurologic outcome, defined as Pediatric Cerebral Performance Categories 1-3 or no worse than pre-arrest baseline. Multivariable Poisson regression models with robust error estimates were used to estimate the relative risk of outcomes.
Results—Blinded investigators analyzed BP waveforms during CPR from 164 children, including 60% <1 year old, 60% with congenital heart disease, and 54% post-cardiac surgery. Immediate cause of arrest was hypotension in 67%, respiratory decompensation in 44%, and arrhythmia in 19%. Median duration of CPR was 8 minutes [quartiles: 3 minutes, 27 minutes]. Ninety percent survived the event, 68% with return of spontaneous circulation and 22% by extracorporeal life support. Forty-seven percent survived to hospital discharge and 43% survived to discharge with favorable neurologic outcome. Maintaining mean DBP ≥25 mmHg in infants and ≥30 mmHg in children ≥1 year old occurred in 101/164 children (62%) and was associated with survival (adjusted Relative Risk [aRR] 1.7; 95% CI, 1.2-2.6; P=0.007) and survival with favorable neurologic outcome (aRR 1.6; 95% CI, 1.1-2.5; P=0.02).
Conclusions—These data demonstrate that mean DBP ≥25 mmHg during CPR in infants and ≥30 mmHg in children ≥1 year old was associated with greater likelihood of survival to hospital discharge and survival with favorable neurologic outcome.
- Received October 19, 2017.
- Revision received November 27, 2017.
- Accepted December 7, 2017.