title: Early postresuscitation hypotension is associated with increased mortality following pediatric cardiac arrest.
abstract: OBJECTIVE
  To describe the association of systolic hypotension during the first 6 hours after successful resuscitation from pediatric cardiopulmonary arrest with in-hospital mortality.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Fifteen children's hospitals associated with the Pediatric Emergency Care Applied Research Network.
  
  
  METHODS
  Patients between 1 day and 18 years old who had a cardiopulmonary arrest, received chest compressions more than 1 minute, had a return of spontaneous circulation more than 20 minutes, and had a systolic blood pressure documented within 6 hours of arrest.
  
  
  METHODS
  None.
  
  
  RESULTS
  Three hundred eighty-three patients had complete data for analysis. Patients with a documented minimum systolic blood pressure less than fifth percentile for age and sex within the first 6 hours following return of spontaneous circulation were considered to have early postresuscitation hypotension. Two hundred fourteen patients (56%) had early postresuscitation hypotension. One hundred eighty-four patients (48%) died prior to hospital discharge. After controlling for patient and cardiopulmonary arrest characteristics, hypotension in the first 6 hours following return of spontaneous circulation was associated with a significantly increased odds of in-hospital mortality (adjusted odds ratio = 1.71; 95% CI, 1.02-2.89; p = 0.042) and odds of unfavorable outcome (adjusted odds ratio = 1.83; 95% CI, 1.06-3.19; p = 0.032).
  
  
  CONCLUSIONS
  In the first 6 hours following successful resuscitation from pediatric cardiac arrest, systolic hypotension was documented in 56% and was associated with a higher rate of in-hospital mortality and worse hospital discharge neurologic outcomes.
authors.affiliation: 1Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 3Division of Critical Care Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI. 4Department of Pediatrics, University of Utah, Salt Lake City, UT.
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Topjian
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.forename: Thomas
authors.initials: T
authors.lastname: Conlon
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Frank W
authors.initials: FW
authors.lastname: Moler
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D012151:Resuscitation; D012189:Retrospective Studies; D016896:Treatment Outcome