The following is a summary of “Identification of post-cardiac arrest blood pressure thresholds associated with outcomes in children: an ICU-Resuscitation study,” published in the October 2023 issue of Critical Care by Gardner et al.

Hypotension after pediatric in-hospital cardiac arrest (IHCA) is associated with inferior outcomes, but ideal post-arrest blood pressure (BP) targets are unknown. Researchers started a retrospective study to identify post-arrest systolic and diastolic BP thresholds associated with higher survival rates to hospital discharge in children.

They conducted a secondary analysis that collected BP data from the first 24 hours following the return of circulation after index IHCA events enrolled in the ICU-RESUScitation trial. The lowest recorded systolic BP (SBP) and diastolic BP (DBP) were adjusted for age, height, and sex percentiles. Receiver operator characteristic and cubic spline analyses explored the association of the lowest post-arrest SBP and DBP with survival and neurologic outcome, adjusting for illness category and pre-arrest hypotension. (Pediatric Cerebral Performance Category of 1–3 or no change from baseline). Receiver operator characteristics and spline curves identified optimal post-arrest BP thresholds. Post-arrest blood pressure thresholds impacted outcomes after adjusting for illness category and pre-arrest hypotension.

The results showed 693 index events with 0–6 hours post-arrest BP data. The identified thresholds were SBP > 10th percentile and DBP > 50th percentile for age, sex, and height. Among the subjects, 51% (n = 352) had their lowest SBP above the threshold, and 50% (n = 346) had their lowest DBP above the threshold. Both SBP and DBP above these thresholds were 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 outcomes (SBP: aRR 1.22 [1.10, 1.35]; DBP: aRR 1.27 [1.15, 1.40]) (P<0.001).

They concluded that higher blood pressure targets during the first 6 hours after pediatric IHCA are associated with improved survival and neurologic outcomes.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04662-9