Practice patterns for acquiring neuroimaging after pediatric in-hospital cardiac arrest.
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Kirschen Matthew P, Ullman Natalie L, Reeder Ron W, Ahmed Tageldin, Bell Michael J, Berg Robert A, Burns Candice, Carcillo Joseph A, Carpenter Todd C, Wesley Diddle J, Federman Myke, Fink Ericka L, Frazier Aisha H, Friess Stuart H, Graham Kathryn, Horvat Christopher M, Huard Leanna L, Kilbaugh Todd J, Maa Tensing, Manga Arushi, McQuillen Patrick S, Meert Kathleen L, Morgan Ryan W, Mourani Peter M, Nadkarni Vinay M, Naim Maryam Y, Notterman Daniel, Palmer Chella A, Pollack Murray M, Sapru Anil, Sharron Matthew P, Srivastava Neeraj, Tilford Bradley, Viteri Shirley, Wolfe Heather A, Yates Andrew R, Topjian Alexis, Sutton Robert M, Press Craig A
Аннотация
METHODS: Retrospective cohort study of patients who survived in-hospital cardiac arrest (IHCA) and were enrolled in the ICU-RESUS trial (NCT02837497).
RESULTS: We tabulated ultrasound (US), CT, and MRI frequency within 7 days following IHCA and identified patient and cardiac arrest factors associated with neuroimaging modalities utilized. Multivariable models determined which factors were associated with obtaining neuroimaging. Of 1000 patients, 44% had ≥ 1 neuroimaging study (US in 31%, CT in 18%, and MRI in 6% of patients). Initial USs were performed a median of 0.3 [0.1,0.5], CTs 1.4 [0.4,2.8], and MRIs 4.1 [2.2,5.1] days post-arrest. Neuroimaging timing and frequency varied by site. Factors associated with greater odds of neuroimaging were cardiac arrest in CICU (versus PICU), longer duration CPR, receiving ECMO post-arrest, and post-arrest care with targeted temperature management or EEG monitoring. US performance was associated with congenital heart disease. CT was associated with age ≥ 1-month, greater pre-arrest disability, and receiving CPR for ≥ 16 min. MRI utilization increased with pre-existing respiratory insufficiency and respiratory decompensation as arrest cause, and medical cardiac and surgical non-cardiac or trauma illness category. Overall, if neuroimaging was obtained, US was more common in CICU while CT/MRI were utilized more in PICU.
CONCLUSIONS: Practice patterns for acquiring neuroimaging after IHCA are variable and influenced by patient, cardiac arrest, and site factors.