@article{914e555a88354ad89a24fd877bed7da2,
title = "The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest",
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.",
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 Wu Theodore 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.",
note = "Funding Information: Supported by grants from the National Heart, Lung, and Blood Institute ( HL094345 , to Dr. Moler; and HL094339 , to Dr. Dean), federal planning grants for the planning of the THAPCA trials ( HD044955 and HD050531 , both to Dr. Moler), cooperative agreements from the Pediatric Emergency Care Applied Research Network ( U03MC00001 , U03MC00003 , U03MC00006 , U03MC00007 , and U03MC00008 ) and the Collaborative Pediatric Critical Care Research Network ( U10HD500009 , U10HD050096 , U10HD049981 , U10HD049945 , U10HD049983 , U10HD050012 and U01HD049934 ), and a National Emergency Medical Services for Children Data Analysis Resource Center Demonstration grant ( U07MC09174 ). Publisher Copyright: {\textcopyright} 2019 Elsevier B.V.",
year = "2019",
month = aug,
doi = "10.1016/j.resuscitation.2019.05.032",
language = "English (US)",
volume = "141",
pages = "24--34",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",
}