Ushpol A, Je S, Christoff A, Nuthall G, Scholefield B, Morgan R W, Nadkarni V, Gangadharan S
Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA.
Departments of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
Resuscitation. 2025 Feb;207:110468. doi: 10.1016/j.resuscitation.2024.110468. Epub 2024 Dec 18.
Current Pediatric Advanced Life Support Guidelines recommend maintaining blood pressure (BP) above the 5th percentile for age following return of spontaneous circulation (ROSC) after cardiac arrest (CA). Emerging evidence suggests that targeting higher thresholds, such as the 10th or 25th percentiles, may improve neurologic outcomes. We aimed to evaluate the association between post-ROSC BP thresholds and neurologic outcome, hypothesizing that maintaining mean arterial pressure (MAP) and systolic blood pressure (SBP) above these thresholds would be associated with improved outcomes at hospital discharge.
This retrospective, multi-center, observational study analyzed data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q). Children (<18 years) who achieved ROSC following index in-hospital or out-of-hospital cardiac arrest and survived ≥ 6 h were included. Multivariable logistic regression was preformed to analyze the association between the pre-defined BP thresholds (5th, 10th, and 25th percentiles) and favorable neurologic outcome, controlling for illness category (surgical-cardiac), initial rhythm (shockable), arrest time (weekend or night), age, CPR duration, and clustering by site.
There were 787 patients with evaluable MAP data and 711 patients with evaluable SBP data. Fifty-four percent (N = 424) of subjects with MAP data and 53 % (N = 380) with SBP data survived to hospital discharge with favorable neurologic outcome. MAP above the 5th, 10th, and 25th percentile thresholds was associated with significantly greater odds of favorable outcome compared to patients with MAP below target (aOR, 1.81 [95 % CI, 1.32, 2.50]; 1.50 [95 % CI, 1.10, 2.05]; 1.40 [95 % CI, 1.01, 1.94], respectively). Subjects with lowest SBP above the 5th percentile also had greater odds of favorable outcome (aOR, 1.44 [95 % CI, 1.04, 2.01]). Associations between lowest SBP above the 10th percentile and 25th percentile did not reach statistical significance (aOR 1.33 [95 % CI, 0.96, 1.86]; 1.23 [95 % CI, 0.87, 1.75], respectively).
After pediatric CA, maintaining MAP above the 5th, 10th, and 25th percentiles and SBP above the 5th percentile during the first 6 h following ROSC was significantly associated with improved neurologic outcomes.
当前的《儿科高级生命支持指南》建议，心脏骤停（CA）后自主循环恢复（ROSC），应将血压（BP）维持在高于相应年龄第5百分位数。新出现的证据表明，设定更高的血压阈值，如第10或第25百分位数，可能会改善神经学预后。我们旨在评估ROSC后血压阈值与神经学预后之间的关联，假设将平均动脉压（MAP）和收缩压（SBP）维持在这些阈值以上，将与出院时更好的预后相关。
这项回顾性、多中心、观察性研究分析了儿科复苏质量协作组（pediRES-Q）的数据。纳入在院内或院外发生心脏骤停后实现ROSC且存活≥6小时的18岁以下儿童。进行多变量逻辑回归分析，以分析预先定义的血压阈值（第5、第10和第25百分位数）与良好神经学预后之间的关联，并对疾病类别（外科心脏疾病）、初始心律（可电击心律）、骤停时间（周末或夜间）、年龄、心肺复苏持续时间以及按地点聚类进行控制。
有787例患者有可评估的MAP数据，711例患者有可评估的SBP数据。有MAP数据的受试者中54%（N = 424）和有SBP数据的受试者中53%（N = 380）存活至出院且神经学预后良好。与MAP低于目标值的患者相比，MAP高于第5、第10和第25百分位数阈值与良好预后的显著更高几率相关（调整后比值比分别为1.81 [95%置信区间，1.32, 2.50]；1.50 [95%置信区间，1.10, 2.05]；1.40 [95%置信区间，1.01, 1.94]）。SBP高于第5百分位数的最低值的受试者也有更高的良好预后几率（调整后比值比，1.44 [95%置信区间，1.04, 2.01]）。SBP高于第10百分位数和第25百分位数的最低值之间的关联未达到统计学显著性（调整后比值比分别为1.33 [95%置信区间，0.96, 1.86]；1.23 [95%置信区间，0.87, 1.75]）。
儿科CA后，在ROSC后的前6小时内，将MAP维持在第5、第10和第25百分位数以上以及将SBP维持在第5百分位数以上与改善神经学预后显著相关。
