Fowler Jessica C, Morgan Ryan W, O'Halloran Amanda, Gardner Monique M, Appel Scott, Wolfe Heather, Kienzle Martha F, Raymond Tia T, Scholefield Barnaby R, Guerguerian Anne-Marie, Bembea Melania M, Nadkarni Vinay, Berg Robert A, Sutton Robert, Topjian Alexis A
Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia 3401 Civic Center Blvd., Philadelphia, PA 19104, USA.
Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia 3401 Civic Center Blvd., Philadelphia, PA 19104, USA.
Resuscitation. 2024 Sep;202:110301. doi: 10.1016/j.resuscitation.2024.110301. Epub 2024 Jul 23.
Adherence to post-cardiac arrest care (PCAC) recommendations is associated with improved outcomes for adults. We aimed to describe the survival impact of meeting American Heart Association (AHA) PCAC guidelines in children after cardiac arrest.
We conducted a retrospective study using Get With The Guidelines® Resuscitation's (GWTG®-R) registry to describe the PCAC of patients ≤ 18 years old who suffered an in-hospital or out-of-hospital cardiac arrest (IHCA or OHCA). We evaluated the association between the absence of hypotension and fever in the initial 24 h following return of circulation (ROC) with survival to hospital discharge. We reviewed the utilization of monitoring/evaluation tools recommended in pediatric PCAC guidelines: electrocardiogram (ECG), electroencephalogram (EEG), and neuro-imaging.
We found 385 pediatric patients who suffered an IHCA or OHCA from 2015 through 2019 and survived at least 6 h post-ROC. Sixty-six percent of patients survived to hospital discharge. Following ROC, 56% of patients had EEG monitoring, 80% had an ECG performed, 47% had a head CT, and 26% had a cerebral MRI. In the initial 24 h post-ROC, 92% of patients did not have hypotension and 79% were afebrile. Patients without hypotension in the initial 24 h post-ROC had higher odds of survival to hospital discharge than those with hypotension (aOR 4.96; 95% CI 2.07, 11.90; p = 0.0003), adjusting for age and cardiac arrest location. Patients without hypotension and without fever in the initial 24 h post-ROC had higher odds of survival to hospital discharge compared to patients who had either hypotension or fever or both (aOR 1.98; 95% CI 1.06,3.71; p = 0.034).
In this retrospective multicenter registry study, absence of both post-cardiac arrest hypotension and fever were associated with increased odds of survival to hospital discharge. Further research is needed to understand the full impact of PCAC recommendation compliance on survival outcomes.
坚持心脏骤停后护理（PCAC）建议与改善成人预后相关。我们旨在描述儿童心脏骤停后符合美国心脏协会（AHA）PCAC指南对生存的影响。
我们使用“遵循指南®复苏”（GWTG®-R）登记系统进行了一项回顾性研究，以描述18岁及以下在院内心脏骤停（IHCA）或院外心脏骤停（OHCA）患者的PCAC情况。我们评估了恢复自主循环（ROC）后最初24小时内无低血压和发热与存活至出院之间的关联。我们审查了儿科PCAC指南中推荐的监测/评估工具的使用情况：心电图（ECG）、脑电图（EEG）和神经影像学检查。
我们发现了385例在2015年至2019年期间发生IHCA或OHCA且在ROC后至少存活6小时的儿科患者。66%的患者存活至出院。在ROC后，56%的患者进行了EEG监测，80%的患者进行了ECG检查，47%的患者进行了头部CT检查，26%的患者进行了脑部MRI检查。在ROC后的最初24小时内�，92%的患者没有低血压，79%的患者没有发热。在ROC后最初24小时内没有低血压的患者存活至出院的几率高于有低血压的患者（调整年龄和心脏骤停位置后，校正比值比[aOR]为4.96；95%置信区间[CI]为2.07,11.90；P = 0.0003）。与有低血压或发热或两者皆有的患者相比，在ROC后最初24小时内没有低血压且没有发热的患者存活至出院的几率更高（aOR为1.98；95%CI为1.06,3.71；P = 0.034）。
在这项回顾性多中心登记研究中，心脏骤停后无低血压和发热与存活至出院的几率增加相关。需要进一步研究以了解遵循PCAC建议对生存结局的全面影响。
