Topjian AA, et al. - Researchers strived to examine if hypotension exhibited a correlation with survival to discharge in children and adolescents after resuscitation from out-of-hospital cardiac arrest (OHCA). Hypotension was reported within 6 hours after temperature intervention in 26.7% of the enrollees. A link was brought to light between the early post–cardiac arrest hypotension with lower odds of discharge survival, even after adjusting for covariates of interest.

Methods

• The scheme of this research was a post hoc secondary analysis of the Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA) trial.
• The authors examined 292 pediatric patients older than 48 hours and younger than 18 years, who were treated in 36 pediatric intensive care units from September 1, 2009, through December 31, 2012.
• Participants underwent therapeutic hypothermia (33.0°C) vs therapeutic normothermia (36.8°C) for 48 hours.
• Documentation was undertaken of hourly systolic blood pressure measurements for all participants during the initial 6 hours of temperature intervention.
• Hourly blood pressures beginning at the time of temperature intervention (time 0) were normalized for age, sex, and height.
• Early hypotension was defined as a systolic blood pressure less than the fifth percentile during the first 6 hours after temperature intervention.
• Utilizing the forward stepwise logistic regression, covariates of interest (age, sex, initial cardiac rhythm, any preexisting condition, estimated duration of cardiopulmonary resuscitation [CPR], primary cause of cardiac arrest, temperature intervention group, night or weekend cardiac arrest, witnessed status, and bystander CPR) were scrutinized in the final model.
• Data analysis was conducted from February 5, 2016, through June 13, 2017.
• Hypotension was included as a part of the exposure.
• The main outome was survival to hospital discharge.

Results

• Among 292 children (194 boys [66.4%] and 98 girls [33.6%]; median age, 23.0 months [interquartile range, 5.0-105.0 months]), 78 (26.7%) presented with at least 1 episode of early hypotension.
• Findings did not disclose any variation between the therapeutic hypothermia and therapeutic normothermia groups in the prevalence of hypotension during induction and maintenance (73 of 153 [47.7%] vs 72 of 139 [51.8%]; P=.50) or rewarming (35 of 118 [29.7%] vs 19 of 95 [20.0%]; P=.10) during the first 72 hours.
• Those candidates who had early hypotension exhibited a lesser tendency to survive hospital discharge (20 of 78 [25.6%] vs 93 of 214 [43.5%]; adjusted odds ratio, 0.39; 95% CI, 0.20-0.74).