Ryan Morgan, MD, MTR
Assistant Professor of Anesthesia, Critical Care, & Pediatrics
Childrens Hospital of Philadelphia, United States
Disclosure information not submitted.
Adam Himebauch, MD
Assistant Professor of Anesthesiology and Critical Care Medicine
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
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Heather Griffis, PhD
Director of Data Science and Biostatistics
Children's Hospital of Philadelphia, United States
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Willam Quarshie, MS
Biostatistician, Data Science and Biostatistics Unit
Children's Hospital of Philadelphia, United States
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Timothy Yeung, BA
Medical Student
Lewis Katz School of Medicine, United States
Disclosure information not submitted.
Todd Kilbaugh, MD
Associate Professor of Anesthesia, Critical Care, & Pediatrics
Childrens Hospital of Philadelphia, 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
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Danielle Traynor, MSN, RN, CCRN
Department of Anesthesiology and Critical Care Medicine
Children's Hospital of Philadelphia, United States
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.jpg "Vinay Nadkarni, MD, MS, FCCM (he/him/his) photo")
Vinay Nadkarni, MD, MS, FCCM (he/him/his)
Professor, Anesthesiology, Critical Care and Pediatrics
University of Pennsylvania Perelman School of Medicine, CHOP
Media, Pennsylvania, United States
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Robert Berg, MD, MCCM (he/him/his)
Division Chief, Pediatric Critical Care Medicine
Children's Hospital of Philadelphia
Merion Station, Pennsylvania, United States
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Akira Nishisaki, MD, MSCE
Associate Professor of Anesthesia and Critical Care Medicine
The Children's Hospital of Philadelphia, United States
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Robert Sutton, MD, FCCM
Professor of Anesthesia, Critical Care, & Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
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Title: Pulmonary Hypertension Among Children with In-hospital Cardiac Arrest: A Multicenter Study
Introduction: Pulmonary hypertension (PH) was common in children with in-hospital cardiac arrest (IHCA) in a single-center study and is associated with poor outcomes in adult IHCA. The objectives of this study were to determine the prevalence of PH among children with IHCA and the association of PH with survival following pediatric IHCA in a multicenter registry. We hypothesized that PH would be associated with lower rates of survival to hospital discharge.
Methods: Children (< 18 years) admitted to ICUs participating in the Virtual Pediatric Systems (VPS) national multicenter registry between January 1, 2011 and December 31, 2017 who had an IHCA during their hospitalization were included. Children were classified according to whether or not they had a documented diagnosis of PH at the time of IHCA. Clinical characteristics were compared between patients with and without PH. After propensity score matching between patients with and without PH, logistic regression determined the association between PH and survival to hospital discharge.
Results: Of 18,575 children with IHCA during the study period, 1,590 (8.6%) had a pre-arrest diagnosis of PH. Patients with PH were more likely to be 30 days to 2 years of age, female, Black/African American, or American Indian/Alaskan Native, and to be treated in a cardiac ICU or mixed pediatric ICU/cardiac ICU. At the time of ICU admission, children with PH had higher probability of death as determined by the Pediatric Index of Mortality 2 (PIM-2) score. The PH group had more ICU interventions in place at the time of IHCA, including inhaled nitric oxide (13.0% vs. 2.1%; p< 0.001). Propensity score matching successfully matched 1,302 patients with PH with 3,604 patients without PH. In conditional multivariable logistic regression analysis of the matched cohort, patients with PH were less likely to survive to hospital discharge (aOR 0.83; 95% CI: 0.72-0.95; p=0.01) than non-PH patients.
Conclusions: In this large multicenter study, 8.6% of children with IHCA had PH and these children were less likely to survive to hospital discharge than those without PH.