Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis.
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Morgan Ryan W, Reeder Ron W, Carcillo Joseph A, Carpenter Todd C, Fitzgerald Julie C, Graham Kathryn, Kilbaugh Todd J, Meert Kathleen L, Nadkarni Vinay M, Palmer Chella A, Sharron Matthew P, Weiss Scott L, Wolfe Heather A, Ahmed Tageldin, Bell Michael J, Bishop Robert, Burns Candice, Diddle J Wesley, Fink Ericka L, Franzon Deborah, Frazier Aisha H, Friess Stuart H, Hehir David A, Horvat Christopher M, Huard Leanna L, Maa Tensing, McQuillen Patrick S, Mourani Peter M, Naim Maryam Y, Pollack Murray M, Sapru Anil, Srivastava Neeraj, Yates Andrew R, Berg Robert A, Sutton Robert M, for the ICU-Resuscitation Project (ICU-RESUS) Investigators and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigators
Аннотация
DESIGN: Prospectively designed secondary analysis of the ICU Resuscitation Project clinical trial (NCT02837497).
SETTING: The 18 pediatric and pediatric cardiac ICUs at ten children's hospitals in the United States.
PATIENTS: Children (≤ 18 yr) with an index IHCA event.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The primary exposure was a prearrest diagnosis of sepsis. The primary survival outcome was survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline). The primary physiologic outcome was average diastolic blood pressure (DBP) during CPR. Multivariable regression models controlling for a priori covariates assessed the relationship between sepsis and outcomes. Of 1129 children with index IHCAs, 184 (16.3%) had prearrest sepsis. Patients with sepsis had greater prearrest comorbidities, higher prearrest severity of illness, and higher Vasoactive-Inotropic Scores than patients without sepsis. They more frequently had hypotension as the cause of IHCA, had longer durations of CPR, and more frequently received epinephrine and sodium bicarbonate during CPR. They less frequently achieved survival with favorable neurologic outcome (52/184 [28.3%] vs. 552/945 [58.4%]; p < 0.001; adjusted relative risk, 0.54; 95% CI, 0.43-0.68; p < 0.001). Intraarrest DBPs did not differ between patients with vs. without sepsis. Following IHCA, event survivors with sepsis had higher vasoactive requirements, more frequently experienced hypotension, and continued to have greater mortality rates through 48 hours postarrest.
CONCLUSIONS: Children with prearrest sepsis had worse survival outcomes, similar intraarrest DBPs, and greater pre and postarrest severity of illness than children without sepsis.