The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest

for the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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 6 h 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 6 h 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.

Original languageEnglish (US)
Pages (from-to)24-34
Number of pages11
JournalResuscitation
Volume141
DOIs
StatePublished - Aug 1 2019

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Extracorporeal Membrane Oxygenation
Pediatric Hospitals
Heart Arrest
Resuscitation
Hypotension
Temperature
Survival
Blood Pressure
Induced Hypothermia
Blood Group Antigens
Pediatrics
Membranes
Arterial Pressure

Keywords

  • Cardiac arrest
  • Child
  • Hypotension
  • Targeted temperature management

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest. / for the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators.

In: Resuscitation, Vol. 141, 01.08.2019, p. 24-34.

Research output: Contribution to journalArticle

for the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators. / The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest. In: Resuscitation. 2019 ; Vol. 141. pp. 24-34.
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abstract = "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 6 h 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 6 h 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.",
keywords = "Cardiac arrest, Child, Hypotension, Targeted temperature management",
author = "{for the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators} and Topjian, {Alexis A.} and Russell Telford and Richard Holubkov and Nadkarni, {Vinay M.} and Berg, {Robert A.} and Dean, {J. Michael} and Moler, {Frank W.} and Meert, {Kathleen L.} and Hutchinson, {Jamie S.} and Newth, {Christopher J.L.} and Bennett, {Kimberly S.} and Berger, {John T.} and Pineda, {Jose A.} and Koch, {Joshua D.} and Schleien, {Charles L.} and Dalton, {Heidi J.} and George Ofori-Amanfo and Goodman, {Denise M.} and Fink, {Ericka L.} and Patrick McQuillen and Zimmerman, {Jerry J.} and Thomas, {Neal J.} and {van der Jagt}, {Elise W.} and Porter, {Melissa B.} and Meyer, {Michael T.} and Rick Harrison and Nga Pham and Schwarz, {Adam J.} and Nowak, {Jeffrey E.} and Jeffrey Alten and Wheeler, {Derek S.} and Bhalala, {Utpal S.} and Karen Lidsky and Eric Lloyd and Mudit Mathur and Samir Shah and Theodore Wu and Theodorou, {Andreas A.} and Sanders, {Ronald C.} and Silverstein, {Faye S.} and Christensen, {James R.} and Slomine, {Beth S.} and Pemberton, {Victoria L.} and Brittan Browning and {Michael Dean}, J.",
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T1 - The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest

AU - for the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators

AU - Topjian, Alexis A.

AU - Telford, Russell

AU - Holubkov, Richard

AU - Nadkarni, Vinay M.

AU - Berg, Robert A.

AU - Dean, J. Michael

AU - Moler, Frank W.

AU - Meert, Kathleen L.

AU - Hutchinson, Jamie S.

AU - Newth, Christopher J.L.

AU - Bennett, Kimberly S.

AU - Berger, John T.

AU - Pineda, Jose A.

AU - Koch, Joshua D.

AU - Schleien, Charles L.

AU - Dalton, Heidi J.

AU - Ofori-Amanfo, George

AU - Goodman, Denise M.

AU - Fink, Ericka L.

AU - McQuillen, Patrick

AU - Zimmerman, Jerry J.

AU - Thomas, Neal J.

AU - van der Jagt, Elise W.

AU - Porter, Melissa B.

AU - Meyer, Michael T.

AU - Harrison, Rick

AU - Pham, Nga

AU - Schwarz, Adam J.

AU - Nowak, Jeffrey E.

AU - Alten, Jeffrey

AU - Wheeler, Derek S.

AU - Bhalala, Utpal S.

AU - Lidsky, Karen

AU - Lloyd, Eric

AU - Mathur, Mudit

AU - Shah, Samir

AU - Wu, Theodore

AU - Theodorou, Andreas A.

AU - Sanders, Ronald C.

AU - Silverstein, Faye S.

AU - Christensen, James R.

AU - Slomine, Beth S.

AU - Pemberton, Victoria L.

AU - Browning, Brittan

AU - Michael Dean, J.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - 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 6 h 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 6 h 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.

AB - 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 6 h 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 6 h 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.

KW - Cardiac arrest

KW - Child

KW - Hypotension

KW - Targeted temperature management

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DO - 10.1016/j.resuscitation.2019.05.032

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