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

Berg, RA; Sutton, RM; Reeder, RW; Berger, JT; Newth, CJ; Carcillo, JA; McQuillen, PS; Meert, KL; Yates, AR; Harrison, RE; Moler, FW; Pollack, MM; Carpenter, TC; Wessel, DL; Jenkins, TL; Notterman, DA; Holubkov, R; Tamburro, RF; Dean, JM; Nadkarni, VM; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) PICqCPR (Pediatric Intensive Care Quality of Cardio-Pulmonary Resuscitation) Investigators

doi:10.1161/circulationaha.117.032270

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

CirculationPublished 26 Dec 2017Prospective observational cohort study

Main finding · Survival to hospital dischargeResultAdjusted RR for survival to hospital discharge 1.7 95% CI 1.2–2.6

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Authors' conclusion

These data demonstrate that mean DBP ≥25 mm Hg during CPR in infants and ≥30 mm Hg in children ≥1 year old was associated with greater likelihood of survival to hospital discharge and survival with favorable neurological outcome.

Study context

Population: Children ≥37 weeks' gestation and <19 years old in ICUs with chest compressions ≥1 minute and invasive arterial BP monitoring before and during cardiopulmonary resuscitation (CPR), 2013–201660% <1 year old
Participants: 164 children

Exposure: Mean diastolic blood pressure (DBP) ≥25 mm Hg / ≥30 mm Hg during CPR vs lower DBP
Mean DBP ≥25 mm Hg in infants and ≥30 mm Hg in children ≥1 year oldn = 101
Outcome: Survival to hospital discharge
Follow-up: Hospital discharge

Methodological detailsmulticentre, blinded waveform analysis, Median CPR duration 8 minutes (quartiles, 3 and 27 minutes)

Multicentre
Blinded waveform analysis
Median CPR duration 8 minutes (quartiles, 3 and 27 minutes)

Main finding

As reported in the abstract

Adjusted RR for survival to hospital discharge

1.7

95% CI 1.2–2.6

P = 0.007

Mean DBP ≥25 mm Hg (infants) / ≥30 mm Hg (children ≥1 year) during CPR vs lower DBP

adjusted RR for survival to hospital discharge 1.7 (95% CI 1.2–2.6); P = 0.007

Observational data: associations, not effects.

Secondary outcomes

Survival to discharge with favorable neurological outcome (PCPC 1–3 or no worse than prearrest baseline)

Comparison	← Lower ←→ Higher →	Adjusted RR for survival with favorable neurological outcome (95% CI)	P value
Mean DBP ≥25 mm Hg in infants and ≥30 mm Hg in children ≥1 year oldvs lower DBP	0.512	1.6 (1.1–2.5)	P = 0.02
	0.512Adjusted RR for survival with favorable neurological outcome (log scale)

Reference

Authors: Berg RA, Sutton RM, Reeder RW, Berger JT, Newth CJ, Carcillo JA, et al.
All 21 authors
Berg RA, Sutton RM, Reeder RW, Berger JT, Newth CJ, Carcillo JA, McQuillen PS, Meert KL, Yates AR, Harrison RE, Moler FW, Pollack MM, Carpenter TC, Wessel DL, Jenkins TL, Notterman DA, Holubkov R, Tamburro RF, Dean JM, Nadkarni VM, Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) PICqCPR (Pediatric Intensive Care Quality of Cardio-Pulmonary Resuscitation) Investigators
Journal: Circulation
Published: 26 Dec 2017
DOI: 10.1161/circulationaha.117.032270
PubMed: 29279413

Country: United States

Exposure definitions

mean DBP ≥25 mm Hg in infants and ≥30 mm Hg in children ≥1 year old: mean DBP during CPR maintained ≥25 mm Hg in infants and ≥30 mm Hg in children ≥1 year old

Key notes

vs lower DBP; multivariable Poisson regression
101 of 164 children (62%) attained target DBP

Original publication

Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival. Circulation. Published 26 December 2017. doi:10.1161/circulationaha.117.032270

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Summarised from the published abstract; every number is checked against it