Association of Left Ventricular Systolic Function and Vasopressor Support With Survival Following Pediatric Out-of-Hospital Cardiac Arrest*

Abstract

Objective To characterize the association of hospital discharge survival with left ventricular (LV) systolic function evaluated by transthoracic echocardiography (TTE) and vasoactive infusion support following return of spontaneous circulation (ROSC) after pediatric out-of-hospital cardiac arrest (OHCA). Design Retrospective case series Setting Single center tertiary care pediatric cardiac arrest and critical care referral center Patients Consecutive OHCA patients <18 years surviving to Pediatric Intensive Care Unit (ICU) admission who had a TTE obtained by the clinical team within 24 hours of admission from January 2006 to May 2012. Interventions None Measurements and Main Results Fifty-eight patients had a post-ROSC TTE performed within 24 hours of admission. The median time from ROSC to echo was 6.5 [IQR 4.7, 15.0] hours. LV systolic function was decreased in 24/58 (41%) patients. The mortality rate was 67% (39/58). Thirty-six patients (62%) received vasoactive infusions at the time of TTE and increased vasopressor inotropic score (VIS) was associated with increased mortality on univariate analysis (p<0.001). After controlling for defibrillation, VIS and interaction between VIS and LV systolic function, decreased LV systolic function was associated with increased mortality (OR 13.7 [95% CI: 1.54, 122]). Conclusions In patients receiving TTE within the first 24 hours following ROSC after pediatric OHCA, decreased LV systolic function and vasopressor use were common. Decreased LV systolic function was associated with increased mortality.

Part 12: Pediatric Advanced Life Support

“…Myocardial dysfunction and vascular instability are common after resuscitation from cardiac arrest 84 – 90 …”

Interrater Agreement of EEG Interpretation After Pediatric Cardiac Arrest Using Standardized Critical Care EEG Terminology

“…(1–9) However, biomarkers of brain injury severity early after cardiac arrest are lacking. Clinical and resuscitation characteristics are only moderately predictive of long-term outcomes,(10–14) In contrast, electroencephalographic (EEG) monitoring provides a robust method of assessing brain activity, and EEG data are commonly acquired at bedside early after cardiac arrest to identify non-convulsive seizures. (15, 16) Further, single center data establish that specific early post cardiac arrest EEG features are associated with short-term gross neurologic outcomes, supporting the concept that EEG features could serve as early, reliable, and clinically available brain injury severity biomarkers.…”

An Update on Cardiopulmonary Resuscitation in Children

“…Myocardial dysfunction and hypotension are common findings in survivors after pediatric IHCA [92,93]. Hypotension after ROSC is associated with poorer rates of survival to discharge and survival with favorable neurologic outcome [94,95].…”