Association of Postarrest Hypotension Burden With Unfavorable Neurologic Outcome After Pediatric Cardiac Arrest

Liu, R; Majumdar, T; Gardner, MM; Burnett, R; Graham, K; Beaulieu, F; Sutton, RM; Nadkarni, VM; Berg, RA; Morgan, RW; Topjian, AA; Kirschen, MP

doi:10.1097/ccm.0000000000006339

Pediatric anesthesia & critical care

Association of Postarrest Hypotension Burden With Unfavorable Neurologic Outcome After Pediatric Cardiac Arrest

Crit Care MedPublished 4 Jun 2024Retrospective observational study

Main finding · Hypotension burden below 5th percentile MAP for ageResultAdjusted odds ratio 14.8 95% CI 1.1–200

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Authors' conclusion

The burden, duration, and magnitude of hypotension are associated with unfavorable neurologic outcomes.

Study context

Population: Children ≤18 years admitted to an academic PICU after in-hospital or OHCA with invasive arterial BP monitoring during postarrest care63% unfavorable outcomes
Participants: 140 children

Exposure: Unfavorable vs Favorable
Outcome: Unfavorable neurologic status (pediatric cerebral performance category ≥ 3 with change from baseline)
Follow-up: Hospital discharge

Methodological detailssingle-centre, academic PICU, high-resolution continuous arterial blood pressure (ABP), Continuous ABP analysed up to 24 hours after ROC; monitoring duration 21 (7-24) hours

Single-centre
Academic PICU
High-resolution continuous ABP
Continuous ABP analysed up to 24 hours after ROC; monitoring duration 21 (7-24) hours

Main finding

As reported in the abstract

Hypotension burden below 5th percentile MAP for age

Adjusted odds ratio

14.8

95% CI 1.1–200

P = 0.040

By group

Unfavorable0.02median · IQR 0–0.27 · mm Hg-hr per hour

Favorable0median · IQR 0–0.02 · mm Hg-hr per hour

A 1-point increase in hypotension burden below the fifth percentile for age

aOR 14.8 (95% CI 1.1–200); P = 0.040

Per hour of recording, as printed

Observational data: associations, not effects.

Further findings

Hypotension duration below 5th percentile MAP

P = 0.003

Unfavorable0.71 %range 0–5.01

Favorable0.03 %range 0–0.77

Hypotension magnitude below 5th percentile MAP

P = 0.001

Unfavorable2 mm Hgrange 0–4.02

Favorable0.16 mm Hgrange 0–1.99

Mean arterial pressure (MAP) burden at thresholds of 10th-50th percentiles for age

Greater in unfavorable vs favorable patients in a dose-dependent manner

Original publication

Association of Postarrest Hypotension Burden With Unfavorable Neurologic Outcome After Pediatric Cardiac Arrest. Crit Care Med. Published 4 June 2024. doi:10.1097/ccm.0000000000006339

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