Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival

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Abstract

On the basis of laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data demonstrating that survival depends on attaining adequate arterial diastolic blood pressure (DBP) during CPR, the American Heart Association recommends using blood pressure to guide pediatric CPR. However, evidence-based blood pressure targets during pediatric CPR remain an important knowledge gap for CPR guidelines.

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Most cited references 26

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First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults.

Vinay Nadkarni, Gregory Luke Larkin, Mary Ann Peberdy … (2006)

Cardiac arrests in adults are often due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), which are associated with better outcomes than asystole or pulseless electrical activity (PEA). Cardiac arrests in children are typically asystole or PEA. To test the hypothesis that children have relatively fewer in-hospital cardiac arrests associated with VF or pulseless VT compared with adults and, therefore, worse survival outcomes. A prospective observational study from a multicenter registry (National Registry of Cardiopulmonary Resuscitation) of cardiac arrests in 253 US and Canadian hospitals between January 1, 2000, and March 30, 2004. A total of 36,902 adults (> or =18 years) and 880 children (<18 years) with pulseless cardiac arrests requiring chest compressions, defibrillation, or both were assessed. Cardiac arrests occurring in the delivery department, neonatal intensive care unit, and in the out-of-hospital setting were excluded. Survival to hospital discharge. The rate of survival to hospital discharge following pulseless cardiac arrest was higher in children than adults (27% [236/880] vs 18% [6485/36,902]; adjusted odds ratio [OR], 2.29; 95% confidence interval [CI], 1.95-2.68). Of these survivors, 65% (154/236) of children and 73% (4737/6485) of adults had good neurological outcome. The prevalence of VF or pulseless VT as the first documented pulseless rhythm was 14% (120/880) in children and 23% (8361/36,902) in adults (OR, 0.54; 95% CI, 0.44-0.65; P<.001). The prevalence of asystole was 40% (350) in children and 35% (13 024) in adults (OR, 1.20; 95% CI, 1.10-1.40; P = .006), whereas the prevalence of PEA was 24% (213) in children and 32% (11,963) in adults (OR, 0.67; 95% CI, 0.57-0.78; P<.001). After adjustment for differences in preexisting conditions, interventions in place at time of arrest, witnessed and/or monitored status, time to defibrillation of VF or pulseless VT, intensive care unit location of arrest, and duration of cardiopulmonary resuscitation, only first documented pulseless arrest rhythm remained significantly associated with differential survival to discharge (24% [135/563] in children vs 11% [2719/24,987] in adults with asystole and PEA; adjusted OR, 2.73; 95% CI, 2.23-3.32). In this multicenter registry of in-hospital cardiac arrest, the first documented pulseless arrest rhythm was typically asystole or PEA in both children and adults. Because of better survival after asystole and PEA, children had better outcomes than adults despite fewer cardiac arrests due to VF or pulseless VT.

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Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies.

Sander Greenland (2004)

Some recent articles have discussed biased methods for estimating risk ratios from adjusted odds ratios when the outcome is common, and the problem of setting confidence limits for risk ratios. These articles have overlooked the extensive literature on valid estimation of risks, risk ratios, and risk differences from logistic and other models, including methods that remain valid when the outcome is common, and methods for risk and rate estimation from case-control studies. The present article describes how most of these methods can be subsumed under a general formulation that also encompasses traditional standardization methods and methods for projecting the impact of partially successful interventions. Approximate variance formulas for the resulting estimates allow interval estimation; these intervals can be closely approximated by rapid simulation procedures that require only standard software functions.

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Incidence of treated cardiac arrest in hospitalized patients in the United States.

Raina M Merchant, Lin Yang, Lance B. Becker … (2011)

The incidence and incidence over time of cardiac arrest in hospitalized patients is unknown. We sought to estimate the event rate and temporal trends of adult inhospital cardiac arrest treated with a resuscitation response. Three approaches were used to estimate the inhospital cardiac arrest event rate. First approach: calculate the inhospital cardiac arrest event rate at hospitals (n = 433) in the Get With The Guidelines-Resuscitation registry, years 2003-2007, and multiply this by U.S. annual bed days. Second approach: use the Get With The Guidelines-Resuscitation inhospital cardiac arrest event rate to develop a regression model (including hospital demographic, geographic, and organizational factors), and use the model coefficients to calculate predicted event rates for acute care hospitals (n = 5445) responding to the American Hospital Association survey. Third approach: classify acute care hospitals into groups based on academic, urban, and bed size characteristics, and determine the average event rate for Get With The Guidelines-Resuscitation hospitals in each group, and use weighted averages to calculate the national inhospital cardiac arrest rate. Annual event rates were calculated to estimate temporal trends. Get With The Guidelines-Resuscitation registry. Adult inhospital cardiac arrest with a resuscitation response. The mean adult treated inhospital cardiac arrest event rate at Get With The Guidelines-Resuscitation hospitals was 0.92/1000 bed days (interquartile range 0.58 to 1.2/1000). In hospitals (n = 150) contributing data for all years of the study period, the event rate increased from 2003 to 2007. With 2.09 million annual U.S. bed days, we estimated 192,000 inhospital cardiac arrests throughout the United States annually. Based on the regression model, extrapolating Get With The Guidelines-Resuscitation hospitals to hospitals participating in the American Hospital Association survey projected 211,000 annual inhospital cardiac arrests. Using weighted averages projected 209,000 annual U.S. inhospital cardiac arrests. There are approximately 200,000 treated cardiac arrests among U.S. hospitalized patients annually, and this rate may be increasing. This is important for understanding the burden of inhospital cardiac arrest and developing strategies to improve care for hospitalized patients.

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Author and article information

Journal

Title: Circulation

Abbreviated Title: Circulation

Publisher: Ovid Technologies (Wolters Kluwer Health)

ISSN (Print): 0009-7322

ISSN (Electronic): 1524-4539

Publication date Created: April 24 2018

Publication date (Print): April 24 2018

Volume: 137

Issue: 17

Pages: 1784-1795

Affiliations

[1 ]Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania (R.A.B., R.M.S., V.M.N).

[2 ]Department of Pediatrics, University of Utah, Salt Lake City (R.W.R., R.H., J.M.D.).

[3 ]Department of Pediatrics, Children’s National Medical Center, Washington, DC (J.T.B., M.M.P., D.L.W.).

[4 ]Department of Anesthesiology, Children’s Hospital of Los Angeles, University of Southern California Keck College of Medicine (C.J.N.).

[5 ]Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh, PA (J.A.C.).

[6 ]Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco (P.S.M.).

[7 ]Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit (K.L.M.).

[8 ]Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus (A.R.Y.).

[9 ]Department of Pediatrics, Mattel Children’s Hospital, University of California, Los Angeles (R.E.H.).

[10 ]Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor (F.W.M.).

[11 ]Department of Pediatrics, Phoenix Children’s Hospital, AZ (M.M.P.).

[12 ]Department of Pediatrics, Denver Children’s Hospital, University of Colorado, Aurora (T.C.C.).

[13 ]Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (T.L.J., R.F.T.).

[14 ]Department of Molecular Biology, Princeton University, NJ (D.A.N).

Article

DOI: 10.1161/CIRCULATIONAHA.117.032270

PMC ID: 5916041

PubMed ID: 29279413

SO-VID: 0fc4cf65-bfcb-42e7-9c19-4d9596536228

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Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival

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Most cited references 26

First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults.

Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies.

Incidence of treated cardiac arrest in hospitalized patients in the United States.

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