The association of immediate post cardiac arrest diastolic hypertension and survival following pediatric cardiac arrest

Alexis A. Topjian*, Robert M. Sutton, Ron W. Reeder, Russell Telford, Kathleen L. Meert, Andrew R. Yates, Ryan W. Morgan, John T. Berger, Christopher J. Newth, Joseph A. Carcillo, Patrick S. McQuillen, Rick E. Harrison, Frank W. Moler, Murray M. Pollack, Todd C. Carpenter, Daniel A. Notterman, Richard Holubkov, J. Michael Dean, Vinay M. Nadkarni, Robert A. Berg & 26 others Athena F. Zuppa, Katherine Graham, Carolann Twelves, Mary Ann Diliberto, William P. Landis, Elyse Tomanio, Jeni Kwok, Michael J. Bell, Alan Abraham, Anil Sapru, Mustafa F. Alkhouli, Sabrina Heidemann, Ann Pawluszka, Mark W. Hall, Lisa Steele, Thomas Patrick Shanley, Monica Weber, Heidi J. Dalton, Aimee La Bell, Peter M. Mourani, Kathryn Malone, Christopher Locandro, Whitney Coleman, Alecia Peterson, Julie Thelen, Allan Doctor

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Aim: In-hospital cardiac arrest occurs in >5000 children each year in the US and almost half will not survive to discharge. Animal data demonstrate that an immediate post-resuscitation burst of hypertension is associated with improved survival. We aimed to determine if systolic and diastolic invasive arterial blood pressures immediately (0–20 min) after return of spontaneous circulation (ROSC) are associated with survival and neurologic outcomes at hospital discharge. Methods: This is a secondary analysis of the Pediatric Intensive Care Quality of CPR (PICqCPR) study of invasively measured blood pressures during intensive care unit CPR. Patients were eligible if they achieved ROSC and had at least one invasively measured blood pressure within the first 20 min following ROSC. Post-ROSC blood pressures were normalized for age, sex and height. “Immediate hypertension” was defined as at least one systolic or diastolic blood pressure >90th percentile. The primary outcome was survival to hospital discharge. Results: Of 102 children, 70 (68.6%) had at least one episode of immediate post-CPR diastolic hypertension. After controlling for pre-existing hypotension, duration of CPR, calcium administration, and first documented rhythm, patients with immediate post-CPR diastolic hypertension were more likely to survive to hospital discharge (79.3% vs. 54.5%; adjusted OR = 2.93; 95%CI, 1.16–7.69). Conclusions: In this post hoc secondary analysis of the PICqCPR study, 68.6% of subjects had diastolic hypertension within 20 min of ROSC. Immediate post-ROSC hypertension was associated with increased odds of survival to discharge, even after adjusting for covariates of interest.

Original languageEnglish (US)
Pages (from-to)88-95
Number of pages8
JournalResuscitation
Volume141
DOIs
StatePublished - Aug 1 2019

Fingerprint

Cardiopulmonary Resuscitation
Heart Arrest
Pediatrics
Hypertension
Survival
Blood Pressure
Critical Care
Resuscitation
Hypotension
Nervous System
Intensive Care Units
Arterial Pressure
Calcium

Keywords

  • Cardiac arrest
  • Child
  • Hemodynamics
  • Hypertension
  • Hypotension
  • Post cardiac arrest care

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Topjian, A. A., Sutton, R. M., Reeder, R. W., Telford, R., Meert, K. L., Yates, A. R., ... Doctor, A. (2019). The association of immediate post cardiac arrest diastolic hypertension and survival following pediatric cardiac arrest. Resuscitation, 141, 88-95. https://doi.org/10.1016/j.resuscitation.2019.05.033
Topjian, Alexis A. ; Sutton, Robert M. ; Reeder, Ron W. ; Telford, Russell ; Meert, Kathleen L. ; Yates, Andrew R. ; Morgan, Ryan W. ; Berger, John T. ; Newth, Christopher J. ; Carcillo, Joseph A. ; McQuillen, Patrick S. ; Harrison, Rick E. ; Moler, Frank W. ; Pollack, Murray M. ; Carpenter, Todd C. ; Notterman, Daniel A. ; Holubkov, Richard ; Dean, J. Michael ; Nadkarni, Vinay M. ; Berg, Robert A. ; Zuppa, Athena F. ; Graham, Katherine ; Twelves, Carolann ; Diliberto, Mary Ann ; Landis, William P. ; Tomanio, Elyse ; Kwok, Jeni ; Bell, Michael J. ; Abraham, Alan ; Sapru, Anil ; Alkhouli, Mustafa F. ; Heidemann, Sabrina ; Pawluszka, Ann ; Hall, Mark W. ; Steele, Lisa ; Shanley, Thomas Patrick ; Weber, Monica ; Dalton, Heidi J. ; Bell, Aimee La ; Mourani, Peter M. ; Malone, Kathryn ; Locandro, Christopher ; Coleman, Whitney ; Peterson, Alecia ; Thelen, Julie ; Doctor, Allan. / The association of immediate post cardiac arrest diastolic hypertension and survival following pediatric cardiac arrest. In: Resuscitation. 2019 ; Vol. 141. pp. 88-95.
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title = "The association of immediate post cardiac arrest diastolic hypertension and survival following pediatric cardiac arrest",
abstract = "Aim: In-hospital cardiac arrest occurs in >5000 children each year in the US and almost half will not survive to discharge. Animal data demonstrate that an immediate post-resuscitation burst of hypertension is associated with improved survival. We aimed to determine if systolic and diastolic invasive arterial blood pressures immediately (0–20 min) after return of spontaneous circulation (ROSC) are associated with survival and neurologic outcomes at hospital discharge. Methods: This is a secondary analysis of the Pediatric Intensive Care Quality of CPR (PICqCPR) study of invasively measured blood pressures during intensive care unit CPR. Patients were eligible if they achieved ROSC and had at least one invasively measured blood pressure within the first 20 min following ROSC. Post-ROSC blood pressures were normalized for age, sex and height. “Immediate hypertension” was defined as at least one systolic or diastolic blood pressure >90th percentile. The primary outcome was survival to hospital discharge. Results: Of 102 children, 70 (68.6{\%}) had at least one episode of immediate post-CPR diastolic hypertension. After controlling for pre-existing hypotension, duration of CPR, calcium administration, and first documented rhythm, patients with immediate post-CPR diastolic hypertension were more likely to survive to hospital discharge (79.3{\%} vs. 54.5{\%}; adjusted OR = 2.93; 95{\%}CI, 1.16–7.69). Conclusions: In this post hoc secondary analysis of the PICqCPR study, 68.6{\%} of subjects had diastolic hypertension within 20 min of ROSC. Immediate post-ROSC hypertension was associated with increased odds of survival to discharge, even after adjusting for covariates of interest.",
keywords = "Cardiac arrest, Child, Hemodynamics, Hypertension, Hypotension, Post cardiac arrest care",
author = "Topjian, {Alexis A.} and Sutton, {Robert M.} and Reeder, {Ron W.} and Russell Telford and Meert, {Kathleen L.} and Yates, {Andrew R.} and Morgan, {Ryan W.} and Berger, {John T.} and Newth, {Christopher J.} and Carcillo, {Joseph A.} and McQuillen, {Patrick S.} and Harrison, {Rick E.} and Moler, {Frank W.} and Pollack, {Murray M.} and Carpenter, {Todd C.} and Notterman, {Daniel A.} and Richard Holubkov and Dean, {J. Michael} and Nadkarni, {Vinay M.} and Berg, {Robert A.} and Zuppa, {Athena F.} and Katherine Graham and Carolann Twelves and Diliberto, {Mary Ann} and Landis, {William P.} and Elyse Tomanio and Jeni Kwok and Bell, {Michael J.} and Alan Abraham and Anil Sapru and Alkhouli, {Mustafa F.} and Sabrina Heidemann and Ann Pawluszka and Hall, {Mark W.} and Lisa Steele and Shanley, {Thomas Patrick} and Monica Weber and Dalton, {Heidi J.} and Bell, {Aimee La} and Mourani, {Peter M.} and Kathryn Malone and Christopher Locandro and Whitney Coleman and Alecia Peterson and Julie Thelen and Allan Doctor",
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Topjian, AA, Sutton, RM, Reeder, RW, Telford, R, Meert, KL, Yates, AR, Morgan, RW, Berger, JT, Newth, CJ, Carcillo, JA, McQuillen, PS, Harrison, RE, Moler, FW, Pollack, MM, Carpenter, TC, Notterman, DA, Holubkov, R, Dean, JM, Nadkarni, VM, Berg, RA, Zuppa, AF, Graham, K, Twelves, C, Diliberto, MA, Landis, WP, Tomanio, E, Kwok, J, Bell, MJ, Abraham, A, Sapru, A, Alkhouli, MF, Heidemann, S, Pawluszka, A, Hall, MW, Steele, L, Shanley, TP, Weber, M, Dalton, HJ, Bell, AL, Mourani, PM, Malone, K, Locandro, C, Coleman, W, Peterson, A, Thelen, J & Doctor, A 2019, 'The association of immediate post cardiac arrest diastolic hypertension and survival following pediatric cardiac arrest', Resuscitation, vol. 141, pp. 88-95. https://doi.org/10.1016/j.resuscitation.2019.05.033

The association of immediate post cardiac arrest diastolic hypertension and survival following pediatric cardiac arrest. / Topjian, Alexis A.; Sutton, Robert M.; Reeder, Ron W.; Telford, Russell; Meert, Kathleen L.; Yates, Andrew R.; Morgan, Ryan W.; Berger, John T.; Newth, Christopher J.; Carcillo, Joseph A.; McQuillen, Patrick S.; Harrison, Rick E.; Moler, Frank W.; Pollack, Murray M.; Carpenter, Todd C.; Notterman, Daniel A.; Holubkov, Richard; Dean, J. Michael; Nadkarni, Vinay M.; Berg, Robert A.; Zuppa, Athena F.; Graham, Katherine; Twelves, Carolann; Diliberto, Mary Ann; Landis, William P.; Tomanio, Elyse; Kwok, Jeni; Bell, Michael J.; Abraham, Alan; Sapru, Anil; Alkhouli, Mustafa F.; Heidemann, Sabrina; Pawluszka, Ann; Hall, Mark W.; Steele, Lisa; Shanley, Thomas Patrick; Weber, Monica; Dalton, Heidi J.; Bell, Aimee La; Mourani, Peter M.; Malone, Kathryn; Locandro, Christopher; Coleman, Whitney; Peterson, Alecia; Thelen, Julie; Doctor, Allan.

In: Resuscitation, Vol. 141, 01.08.2019, p. 88-95.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The association of immediate post cardiac arrest diastolic hypertension and survival following pediatric cardiac arrest

AU - Topjian, Alexis A.

AU - Sutton, Robert M.

AU - Reeder, Ron W.

AU - Telford, Russell

AU - Meert, Kathleen L.

AU - Yates, Andrew R.

AU - Morgan, Ryan W.

AU - Berger, John T.

AU - Newth, Christopher J.

AU - Carcillo, Joseph A.

AU - McQuillen, Patrick S.

AU - Harrison, Rick E.

AU - Moler, Frank W.

AU - Pollack, Murray M.

AU - Carpenter, Todd C.

AU - Notterman, Daniel A.

AU - Holubkov, Richard

AU - Dean, J. Michael

AU - Nadkarni, Vinay M.

AU - Berg, Robert A.

AU - Zuppa, Athena F.

AU - Graham, Katherine

AU - Twelves, Carolann

AU - Diliberto, Mary Ann

AU - Landis, William P.

AU - Tomanio, Elyse

AU - Kwok, Jeni

AU - Bell, Michael J.

AU - Abraham, Alan

AU - Sapru, Anil

AU - Alkhouli, Mustafa F.

AU - Heidemann, Sabrina

AU - Pawluszka, Ann

AU - Hall, Mark W.

AU - Steele, Lisa

AU - Shanley, Thomas Patrick

AU - Weber, Monica

AU - Dalton, Heidi J.

AU - Bell, Aimee La

AU - Mourani, Peter M.

AU - Malone, Kathryn

AU - Locandro, Christopher

AU - Coleman, Whitney

AU - Peterson, Alecia

AU - Thelen, Julie

AU - Doctor, Allan

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Aim: In-hospital cardiac arrest occurs in >5000 children each year in the US and almost half will not survive to discharge. Animal data demonstrate that an immediate post-resuscitation burst of hypertension is associated with improved survival. We aimed to determine if systolic and diastolic invasive arterial blood pressures immediately (0–20 min) after return of spontaneous circulation (ROSC) are associated with survival and neurologic outcomes at hospital discharge. Methods: This is a secondary analysis of the Pediatric Intensive Care Quality of CPR (PICqCPR) study of invasively measured blood pressures during intensive care unit CPR. Patients were eligible if they achieved ROSC and had at least one invasively measured blood pressure within the first 20 min following ROSC. Post-ROSC blood pressures were normalized for age, sex and height. “Immediate hypertension” was defined as at least one systolic or diastolic blood pressure >90th percentile. The primary outcome was survival to hospital discharge. Results: Of 102 children, 70 (68.6%) had at least one episode of immediate post-CPR diastolic hypertension. After controlling for pre-existing hypotension, duration of CPR, calcium administration, and first documented rhythm, patients with immediate post-CPR diastolic hypertension were more likely to survive to hospital discharge (79.3% vs. 54.5%; adjusted OR = 2.93; 95%CI, 1.16–7.69). Conclusions: In this post hoc secondary analysis of the PICqCPR study, 68.6% of subjects had diastolic hypertension within 20 min of ROSC. Immediate post-ROSC hypertension was associated with increased odds of survival to discharge, even after adjusting for covariates of interest.

AB - Aim: In-hospital cardiac arrest occurs in >5000 children each year in the US and almost half will not survive to discharge. Animal data demonstrate that an immediate post-resuscitation burst of hypertension is associated with improved survival. We aimed to determine if systolic and diastolic invasive arterial blood pressures immediately (0–20 min) after return of spontaneous circulation (ROSC) are associated with survival and neurologic outcomes at hospital discharge. Methods: This is a secondary analysis of the Pediatric Intensive Care Quality of CPR (PICqCPR) study of invasively measured blood pressures during intensive care unit CPR. Patients were eligible if they achieved ROSC and had at least one invasively measured blood pressure within the first 20 min following ROSC. Post-ROSC blood pressures were normalized for age, sex and height. “Immediate hypertension” was defined as at least one systolic or diastolic blood pressure >90th percentile. The primary outcome was survival to hospital discharge. Results: Of 102 children, 70 (68.6%) had at least one episode of immediate post-CPR diastolic hypertension. After controlling for pre-existing hypotension, duration of CPR, calcium administration, and first documented rhythm, patients with immediate post-CPR diastolic hypertension were more likely to survive to hospital discharge (79.3% vs. 54.5%; adjusted OR = 2.93; 95%CI, 1.16–7.69). Conclusions: In this post hoc secondary analysis of the PICqCPR study, 68.6% of subjects had diastolic hypertension within 20 min of ROSC. Immediate post-ROSC hypertension was associated with increased odds of survival to discharge, even after adjusting for covariates of interest.

KW - Cardiac arrest

KW - Child

KW - Hemodynamics

KW - Hypertension

KW - Hypotension

KW - Post cardiac arrest care

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DO - 10.1016/j.resuscitation.2019.05.033

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JF - Resuscitation

SN - 0300-9572

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