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Accepted (AM)Open Access (License Unspecified), Open
Journal article
Deviations from NIRS-derived optimal blood pressure are associated with worse outcomes after pediatric cardiac arrest
Resuscitation, v 168, pp 110-118
01 Nov 2021
PMID: 34600027
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Evaluate cerebrovascular autoregulation (CAR) using near-infrared spectroscopy (NIRS) after pediatric cardiac arrest and determine if deviations from CAR-derived optimal mean arterial pressure (MAPopt) are associated with outcomes.
CAR was quantified by a moving, linear correlation between time-synchronized mean arterial pressure (MAP) and regional cerebral oxygenation, called cerebral oximetry index (COx). MAPopt was calculated using a multi-window weighted algorithm. We calculated burden (magnitude and duration) of MAP less than 5 mmHg below MAPopt (MAPopt - 5), as the area between MAP and MAPopt - 5 curves using numerical integration and normalized as percentage of monitoring duration. Unfavorable outcome was defined as death or pediatric cerebral performance category (PCPC) at hospital discharge ≥3 with ≥1 change from baseline. Univariate logistic regression tested association between burden of MAP less than MAPopt - 5 and outcome.
Thirty-four children (median age 2.9 [IQR 1.5,13.4] years) were evaluated. Median COx in the first 24 h post-cardiac arrest was 0.06 [0,0.20]; patients spent 27% [19,43] of monitored time with COx ≥ 0.3. Patients with an unfavorable outcome (n = 24) had a greater difference between MAP and MAPopt - 5 (13 [11,19] vs. 9 [8,10] mmHg, p = 0.01) and spent more time with MAP below MAPopt - 5 (38% [26,61] vs. 24% [14,28], p = 0.03). Patients with unfavorable outcome had a higher burden of MAP less than MAPopt - 5 than patients with favorable outcome in the first 24 h post-arrest (187 [107,316] vs. 62 [43,102] mmHg × Min/Hr; OR 4.93 [95% CI 1.16–51.78]).
Greater burden of MAP below NIRS-derived MAPopt - 5 during the first 24 h after cardiac arrest was associated with unfavorable outcomes.
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Details
- Title
- Deviations from NIRS-derived optimal blood pressure are associated with worse outcomes after pediatric cardiac arrest
- Creators
- Matthew P. Kirschen - Children's Hospital of PhiladelphiaTanmay Majmudar - Drexel University, College of MedicineForrest Beaulieu - Children's Hospital of PhiladelphiaRyan Burnett - Children's Hospital of PhiladelphiaMohammed Shaik - Children's Hospital of PhiladelphiaRyan W. Morgan - Children's Hospital of PhiladelphiaWesley Baker - University of PennsylvaniaTiffany Ko - Children's Hospital of PhiladelphiaRamani Balu - Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, United StatesKenya Agarwal - Children's Hospital of PhiladelphiaKristen Lourie - Children's Hospital of PhiladelphiaRobert Sutton - Children's Hospital of PhiladelphiaTodd Kilbaugh - Children's Hospital of PhiladelphiaRamon Diaz-Arrastia - Drexel UniversityRobert Berg - Children's Hospital of PhiladelphiaAlexis Topjian - Children's Hospital of Philadelphia
- Publication Details
- Resuscitation, v 168, pp 110-118
- Publisher
- Elsevier
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine; Drexel University
- Web of Science ID
- WOS:000708091700009
- Scopus ID
- 2-s2.0-85116607186
- Other Identifier
- 991021860654804721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine
- Emergency Medicine