Outcomes and characteristics of cardiac arrest in children with pulmonary hypertension: A secondary analysis of the ICU-RESUS clinical trial

Ryan W Morgan; Ron W Reeder; Tageldin Ahmed; Michael J Bell; John T Berger; Robert Bishop; Matthew Bochkoris; Candice Burns; Joseph A Carcillo; Todd C Carpenter; J Michael Dean; J Wesley Diddle; Myke Federman; Richard Fernandez; Ericka L Fink; Deborah Franzon; Aisha H Frazier; Stuart H Friess; Kathryn Graham; Mark Hall; David A Hehir; Adam S Himebauch; Christopher M Horvat; Leanna L Huard; Tensing Maa; Arushi Manga; Patrick S McQuillen; Kathleen L Meert; Peter M Mourani; Vinay M Nadkarni; Maryam Y Naim; Daniel Notterman; Kent Page; Murray M Pollack; Anil Sapru; Carleen Schneiter; Matthew P Sharron; Neeraj Srivastava; Sarah Tabbutt; Bradley Tilford; Shirley Viteri; David Wessel; Heather A Wolfe; Andrew R Yates; Athena F Zuppa; Robert A Berg; Robert M Sutton

doi:10.1016/j.resuscitation.2023.109897

Outcomes and characteristics of cardiac arrest in children with pulmonary hypertension: A secondary analysis of the ICU-RESUS clinical trial

Resuscitation. 2023 Sep:190:109897. doi: 10.1016/j.resuscitation.2023.109897. Epub 2023 Jul 3.

Authors

Ryan W Morgan¹, Ron W Reeder², Tageldin Ahmed³, Michael J Bell⁴, John T Berger⁴, Robert Bishop⁵, Matthew Bochkoris⁶, Candice Burns⁷, Joseph A Carcillo⁶, Todd C Carpenter⁵, J Michael Dean², J Wesley Diddle⁴, Myke Federman⁸, Richard Fernandez⁹, Ericka L Fink⁶, Deborah Franzon¹⁰, Aisha H Frazier¹¹, Stuart H Friess¹², Kathryn Graham¹³, Mark Hall⁹, David A Hehir¹³, Adam S Himebauch¹³, Christopher M Horvat⁶, Leanna L Huard⁸, Tensing Maa⁹, Arushi Manga¹², Patrick S McQuillen¹⁰, Kathleen L Meert³, Peter M Mourani¹⁴, Vinay M Nadkarni¹³, Maryam Y Naim¹³, Daniel Notterman¹⁵, Kent Page², Murray M Pollack⁴, Anil Sapru⁸, Carleen Schneiter⁵, Matthew P Sharron⁴, Neeraj Srivastava⁸, Sarah Tabbutt¹⁰, Bradley Tilford³, Shirley Viteri¹⁶, David Wessel⁴, Heather A Wolfe¹³, Andrew R Yates⁹, Athena F Zuppa¹³, Robert A Berg¹³, Robert M Sutton¹³

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: MorganR1@chop.edu.
² Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
³ Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
⁴ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
⁵ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
⁶ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
⁷ Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA.
⁸ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
⁹ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
¹⁰ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
¹¹ Nemours Cardiac Center, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE, USA; Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE, USA.
¹² Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
¹³ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
¹⁴ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
¹⁵ Department of Molecular Biology, Princeton University, Princeton, NJ, USA.
¹⁶ Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE, USA.

PMID: 37406760
PMCID: PMC10530491 (available on 2024-09-01)
DOI: 10.1016/j.resuscitation.2023.109897

Abstract

Background: Previous studies have identified pulmonary hypertension (PH) as a relatively common diagnosis in children with in-hospital cardiac arrest (IHCA), and preclinical laboratory studies have found poor outcomes and low systemic blood pressures during CPR for PH-associated cardiac arrest. The objective of this study was to determine the prevalence of PH among children with IHCA and the association between PH diagnosis and intra-arrest physiology and survival outcomes.

Methods: This was a prospectively designed secondary analysis of patients enrolled in the ICU-RESUS clinical trial (NCT02837497). The primary exposure was a pre-arrest diagnosis of PH. 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 event-level average diastolic blood pressure (DBP) during CPR.

Results: Of 1276 patients with IHCAs during the study period, 1129 index IHCAs were enrolled; 184 (16.3%) had PH and 101/184 (54.9%) were receiving inhaled nitric oxide at the time of IHCA. Survival with favorable neurologic outcome was similar between patients with and without PH on univariate (48.9% vs. 54.4%; p = 0.17) and multivariate analyses (aOR 0.82 [95%CI: 0.56, 1.20]; p = 0.32). There were no significant differences in CPR event outcome or survival to hospital discharge. Average DBP, systolic BP, and end-tidal carbon dioxide during CPR were similar between groups.

Conclusions: In this prospective study of pediatric IHCA, pre-existing PH was present in 16% of children. Pre-arrest PH diagnosis was not associated with statistically significant differences in survival outcomes or intra-arrest physiologic measures.

Keywords: Blood pressure; Cardiac arrest; Cardiopulmonary resuscitation; Pediatrics; Pulmonary hypertension.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Cardiopulmonary Resuscitation*
Child
Heart Arrest*
Humans
Hypertension, Pulmonary* / diagnosis
Hypertension, Pulmonary* / epidemiology
Intensive Care Units
Prospective Studies

Associated data

ClinicalTrials.gov/NCT02837497

Abstract

Publication types

MeSH terms

Associated data

Grants and funding