Evidence map›Paper›PMID 37805481›Full record

ArticleCritical care (London, England)2023

Identification of post-cardiac arrest blood pressure thresholds associated with outcomes in children: an ICU-Resuscitation study.

Monique M Gardner, David A Hehir, Ron W Reeder, Tageldin Ahmed, Michael J Bell, Robert A Berg, Robert Bishop, Matthew Bochkoris, Candice Burns, Joseph A Carcillo and 36 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02837497 (Improving Outcomes After Pediatric Cardiac Arrest), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02837497 nacompletednot on this map

Improving Outcomes After Pediatric Cardiac Arrest

TypeinterventionalSponsorChildren's Hospital of PhiladelphiaRan2016 to 2021Enrolled1,127ConditionsCardiac ArrestArmsICU-RESUS CPR Improvement Bundle
3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Article
  3. Review
  4. Article
  5. Article
  6. Article
  7. Article
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

46 authors.

Monique M GardnerDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA. gardnerm@chop.edu.
David A HehirDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Ron W ReederDepartment of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Tageldin AhmedDepartment of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
Michael J BellDepartment of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
Robert A BergDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Robert BishopDepartment of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
Matthew BochkorisDepartment of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Candice BurnsDepartment of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA.
Joseph A CarcilloDepartment of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Todd C CarpenterDepartment of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
J Michael DeanDepartment of Pediatrics, University of Utah, Salt Lake City, UT, USA.
J Wesley DiddleDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Myke FedermanDepartment of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
Richard FernandezDepartment of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Ericka L FinkDepartment of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Deborah FranzonDepartment of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
Aisha H FrazierNemours Cardiac Center, Nemours Children's Health and Thomas Jefferson University, Wilmington, DE, USA.
Stuart H FriessDepartment of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
Kathryn GrahamDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Mark HallDepartment of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Monica L HardingDepartment of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Christopher M HorvatDepartment of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Leanna L HuardDepartment of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
Tensing MaaDepartment of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Arushi MangaDepartment of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
Patrick S McQuillenDepartment of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
Kathleen L MeertDepartment of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
Ryan W MorganDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Peter M MouraniDepartment of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
Vinay M NadkarniDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Maryam Y NaimDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Daniel NottermanDepartment of Molecular Biology, Princeton University, Princeton, NJ, USA.
Murray M PollackDepartment of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
Anil SapruDepartment of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
Carleen SchneiterDepartment of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
Matthew P SharronDepartment of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
Neeraj SrivastavaDepartment of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
Bradley TilfordDepartment of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
Shirley ViteriDepartment of Pediatrics, Nemours Children's Health and Thomas Jefferson University, Wilmington, DE, USA.
David WesselDepartment of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
Heather A WolfeDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Andrew R YatesDepartment of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Athena F ZuppaDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Robert M SuttonDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Alexis A TopjianDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.

Funding

CPCCRN PRECISE SupplementPL1HD105462 · NICHD · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · PI Jonathan Michael Dean · 2021 to 2026
$17.5M
Pulmonary Hypertension-Associated Pediatric Cardiac ArrestK23HL148541 · NHLBI · CHILDREN'S HOSP OF PHILADELPHIA · PI MORGAN, RYAN WILLIAM · 2020 to 2024
$791k
Assessment of Myocardial Dysfunction and Inflammation after Pediatric Cardiac ArrestK23HL175123 · NHLBI · NEMOURS CHILDREN'S HOSPITAL, DELAWARE · PI Monique-Anne Gardner · 2024 to 2026
$444k
NHLBI NIH HHS K23 HL148541NHLBI NIH HHS K23 HL175123NICHD NIH HHS PL1 HD105462
6 · The paper itself

Abstract

introductionThough early hypotension after pediatric in-hospital cardiac arrest (IHCA) is associated with inferior outcomes, ideal post-arrest blood pressure (BP) targets have not been established. We aimed to leverage prospectively collected BP data to explore the association of post-arrest BP thresholds with outcomes. We hypothesized that post-arrest systolic and diastolic BP thresholds would be higher than the currently recommended post-cardiopulmonary resuscitation BP targets and would be associated with higher rates of survival to hospital discharge.

methodsWe performed a secondary analysis of prospectively collected BP data from the first 24 h following return of circulation from index IHCA events enrolled in the ICU-RESUScitation trial (NCT02837497). The lowest documented systolic BP (SBP) and diastolic BP (DBP) were percentile-adjusted for age, height and sex. Receiver operator characteristic curves and cubic spline analyses controlling for illness category and presence of pre-arrest hypotension were generated exploring the association of lowest post-arrest SBP and DBP with survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1-3 or no change from baseline). Optimal cutoffs for post-arrest BP thresholds were based on analysis of receiver operator characteristic curves and spline curves. Logistic regression models accounting for illness category and pre-arrest hypotension examined the associations of these thresholds with outcomes.

resultsAmong 693 index events with 0-6 h post-arrest BP data, identified thresholds were: SBP > 10th percentile and DBP > 50th percentile for age, sex and height. Fifty-one percent (n = 352) of subjects had lowest SBP above threshold and 50% (n = 346) had lowest DBP above threshold. SBP and DBP above thresholds were each associated with survival to hospital discharge (SBP: aRR 1.21 [95% CI 1.10, 1.33]; DBP: aRR 1.23 [1.12, 1.34]) and survival to hospital discharge with favorable neurologic outcome (SBP: aRR 1.22 [1.10, 1.35]; DBP: aRR 1.27 [1.15, 1.40]) (all p < 0.001).

conclusionsFollowing pediatric IHCA, subjects had higher rates of survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome when BP targets above a threshold of SBP > 10th percentile for age and DBP > 50th percentile for age during the first 6 h post-arrest.

Indexed as

Cardiopulmonary ResuscitationHeart ArrestHypotensionBlood PressureChildHospital MortalityHumansIntensive Care UnitsBlood pressureCardiopulmonary resuscitationHypotensionInfantNeonatalOutcomesPediatricPost-cardiac arrest

Identifiers

PMID37805481
PMCPMC10559632

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.