Early postresuscitation hypotension is associated with increased mortality following pediatric cardiac arrest

Alexis A Topjian, Benjamin French, Robert M Sutton, Thomas Conlon, Vinay M Nadkarni, Frank W Moler, J Michael Dean, Robert A Berg
Critical Care Medicine 2014, 42 (6): 1518-23

OBJECTIVE: To describe the association of systolic hypotension during the first 6 hours after successful resuscitation from pediatric cardiopulmonary arrest with in-hospital mortality.

DESIGN: Retrospective cohort study.

SETTING: Fifteen children's hospitals associated with the Pediatric Emergency Care Applied Research Network.

PATIENTS: Patients between 1 day and 18 years old who had a cardiopulmonary arrest, received chest compressions more than 1 minute, had a return of spontaneous circulation more than 20 minutes, and had a systolic blood pressure documented within 6 hours of arrest.


MEASUREMENTS AND MAIN RESULTS: Three hundred eighty-three patients had complete data for analysis. Patients with a documented minimum systolic blood pressure less than fifth percentile for age and sex within the first 6 hours following return of spontaneous circulation were considered to have early postresuscitation hypotension. Two hundred fourteen patients (56%) had early postresuscitation hypotension. One hundred eighty-four patients (48%) died prior to hospital discharge. After controlling for patient and cardiopulmonary arrest characteristics, hypotension in the first 6 hours following return of spontaneous circulation was associated with a significantly increased odds of in-hospital mortality (adjusted odds ratio = 1.71; 95% CI, 1.02-2.89; p = 0.042) and odds of unfavorable outcome (adjusted odds ratio = 1.83; 95% CI, 1.06-3.19; p = 0.032).

CONCLUSIONS: In the first 6 hours following successful resuscitation from pediatric cardiac arrest, systolic hypotension was documented in 56% and was associated with a higher rate of in-hospital mortality and worse hospital discharge neurologic outcomes.

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