Association of diastolic blood pressure with survival during paediatric cardiopulmonary resuscitation

Caitlin E. O'Brien, Polan T. Santos, Michael Reyes, Shawn Adams, C. Danielle Hopkins, Ewa Kulikowicz, Jennifer L. Hamrick, Justin T. Hamrick, Jennifer K. Lee, Sapna R. Kudchadkar, Elizabeth A. Hunt, Raymond C. Koehler, Donald H. Shaffner

Research output: Contribution to journalArticle

Abstract

Aim: To examine the relationship between survival and diastolic blood pressure (DBP) throughout resuscitation from paediatric asphyxial cardiac arrest. Methods: Retrospective, secondary analysis of 200 swine resuscitations. Swine underwent asphyxial cardiac arrest and were resuscitated with predefined periods of basic and advanced life support (BLS and ALS, respectively). DBP was recorded every 30 s. Survival was defined as 20-min sustained return of spontaneous circulation (ROSC). Results: During BLS, DBP peaked between 1–3 min and was greater in survivors (20.0 [11.3, 33.3] mmHg) than in non-survivors (5.0 [1.0, 10.0] mmHg; p < 0.001). After this transient increase, the DBP in survivors progressively decreased but remained greater than that of non-survivors after 10 min of resuscitation (9.0 [6.0, 13.8] versus 3.0 [1.0, 6.8] mmHg; p < 0.001). During ALS, the magnitude of DBP change after the first adrenaline (epinephrine) administration was greater in survivors (22.0 [16.5, 36.5] mmHg) than in non-survivors (6.0 [2.0, 11.0] mmHg; p < 0.001). Survival rate was greater when DBP improved by ≥26 mmHg after the first dose of adrenaline (20/21; 95%) than when DBP improved by ≤10 mmHg (1/99; 1%). The magnitude of DBP change after the first adrenaline administration correlated with the timetoROSC (r = −0.54; p < 0.001). Conclusions: Survival after asphyxial cardiac arrest is associated with a higher DBP throughout resuscitation, but the difference between survivors and non-survivors was reduced after prolonged BLS. During ALS, response to adrenaline administration correlates with survival and time to ROSC. If confirmed clinically, these findings may be useful for titrating adrenaline during resuscitation and prognosticating likelihood of ROSC. Institutional Protocol Numbers: SW14M223 and SW17M101

Original languageEnglish (US)
Pages (from-to)50-56
Number of pages7
JournalResuscitation
Volume143
DOIs
StatePublished - Oct 1 2019

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Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Diastolic blood pressure
  • Pediatrics
  • Survival
  • Swine

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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