The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest.
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AIM: Approximately 40% of children who have an in-hospital cardiac arrest (IHCA) in the US survive to discharge. We aimed to evaluate the impact of post-cardiac arrest hypotension during targeted temperature management following IHCA on survival to discharge. METHODS: This is a secondary analysis of the therapeutic hypothermia after pediatric cardiac arrest in-hospital (THAPCA-IH) trial. "Early hypotension" was defined as a systolic blood pressure less than the fifth percentile for age and sex for patients not treated with extracorporeal membrane oxygenation (ECMO) or a mean arterial pressure less than fifth percentile for age and sex for patients treated with ECMO during the first 6h of temperature intervention. The primary outcome was survival to hospital discharge. RESULTS: Of 299 children, 142 (47%) patients did not receive ECMO and 157 (53%) received ECMO. Forty-two of 142 (29.6%) non-ECMO patients had systolic hypotension. Twenty-three of 157 (14.7%) ECMO patients had mean arterial hypotension. After controlling for confounders of interest, non-ECMO patients who had early systolic hypotension were less likely to survive to hospital discharge (40.5% vs. 72%; adjusted OR [aOR] 0.34; 95%CI, 0.12-0.93). There was no difference in survival to discharge by blood pressure groups for children treated with ECMO (30.4% vs. 49.3%; aOR=0.60; 95%CI, 0.22-1.63). CONCLUSIONS: In this secondary analysis of the THAPCA-IH trial, in patients not treated with ECMO, systolic hypotension within 6h of temperature intervention was associated with lower odds of discharge survival. Blood pressure groups in patients treated with ECMO were not associated with survival to discharge.
Topjian, A. A., Telford, R., Holubkov, R., Nadkarni, V. M., Berg, R. A., Dean, J. M., Moler, F. W., & Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators.
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Topjian, Alexis A||Telford, Russell||Holubkov, Richard||Nadkarni, Vinay M||Berg, Robert A||Dean, J Michael||Moler, Frank W
