Lindsay Shepard, MD (she/her/hers)
Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Amanda O'Halloran, MD
Assistant Professor of Anesthesiology and Critical Care
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Kathryn Graham, BA, MLAS
Research Coordinator
The Children's Hospital of Philadelphia, United States
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Martha Kienzle, MD
Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Julia Slovis, MD
MD
Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Alexis Topjian, MD, MSCE, FCCM
Associate Professor of Anesthesiology, Critical Care, and Pediatrics
Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Robert Sutton, MD, FCCM
Professor of Anesthesia, Critical Care, & Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Nadir Yehya, MD, MSCE
Children's Hospital of Philadelphia
Cherry Hill, NJ
Disclosure information not submitted.
Ryan Morgan, MD, MTR
Assistant Professor of Anesthesia, Critical Care, & Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Title: Pre-Arrest Invasive Ventilation Characteristics of Pediatric In-Hospital Cardiac Arrest Patients
Introduction: Most children with in-hospital cardiac arrest (IHCA) have respiratory failure prior to arrest, but cardiopulmonary resuscitation (CPR) guidelines do not consider pre-existing respiratory failure characteristics in their recommendations. Respiratory failure and invasive mechanical ventilation (MV) characteristics prior to pediatric IHCA have not been reported. We aimed to describe these characteristics among children requiring invasive MV at the time of IHCA.
Methods: This is a single-center, retrospective pilot study within a prospective cohort of children ( < 18 years) in the PICU and pediatric cardiac ICU (CICU) who received CPR for ≥1 minute while invasively ventilated. We examined patient and MV data in the 0-2 hours before CPR. Exploratory analyses compared those with primary respiratory failure vs. other MV indications and those in the PICU vs. CICU (Chi-square and Wilcoxon rank-sum tests).
Results: Of 30 index IHCAs, 16 (53%) were in the PICU and 14 (47%) in the CICU. Median [IQR] age was 0.7 [0, 4.6] years. Primary MV indication was respiratory in 12 (40%), peri-procedural in 12 (40%), cardiovascular in 3 (10%), and neurologic in 3 (10%). Median pre-arrest peak pressure was 28.5 [22, 35] cmH2O; positive end-expiratory pressure (PEEP) was 6.5 [5, 8] cmH2O; mean airway pressure (MAP) was 12.6 [8.6, 17] cmH2O; and FiO2 was 0.3 [0.25, 0.5]. Median CPR duration was 10.5 [3, 45] minutes, with 18 subjects (60%) with return of spontaneous circulation, 8 (27%) requiring extracorporeal-CPR, and 4 (13%) dying during CPR; 17 (57%) survived to hospital discharge. Patients with primary respiratory indications for MV had higher pre-arrest PEEP (8 [7, 14] vs. 5 [3.5, 8] cmH2O; p=0.02); 5/11 (45%) with available data met Berlin oxygenation criteria for Acute Respiratory Distress Syndrome. Compared to CICU patients, more PICU patients had a primary respiratory indication for MV (63% vs. 14%; p< 0.01). PICU patients had higher pre-arrest PEEP (9 [8, 14] cmH2O vs. 5 [3, 5] cmH2O; p< 0.01) and higher MAP (17 [12.8, 22] cm H2O vs. 9.75 [7.1, 12.5] cmH2O; p=0.03).
Conclusions: This study provides insight into pre-arrest MV characteristics in children with respiratory failure and IHCA. Further work will explore the relationship between these characteristics and outcomes to inform ventilation strategies during CPR.