Khera R, et al. - Researchers determined the prevalence as well as factors predictive of survival for pediatric patients (aged >30 days and <18 years) who progressed from bradycardia to pulseless in-hospital cardiac arrest even with cardiopulmonary resuscitation (CPR). Overall, 5,592 pediatric patients were treated with CPR, of whom 2,799 (50.1%) received CPR for bradycardia with poor perfusion and 2,793 (49.9%) for initial pulseless cardiac arrest. Among those with bradycardia, 869 (31.0%, or 15.5% of cohort) became pulseless after a median of 3 minutes of CPR. Bradycardia with poor perfusion at the start of chest compressions was seen in half of the overall hospitalized children in whom CPR was initiated, with approximately one-third of these progressing to pulselessness even with CPR. Significantly lower survival was experienced by children who progressed to pulselessness even with CPR vs those who were initially pulseless. A high-risk, as well as a need for a renewed focus on post-resuscitation care, were especially highlighted in pediatric patients who lost their pulse despite resuscitation attempts.