The association between early hypotension and neurologic outcome after pediatric cardiac ECPR in children with cardiac disease
Objective: Explore the relationship between early hypotension after ECPR and survival to hospital discharge (SHD) with favorable neurologic outcome (FNO) in children with cardiac disease. Methods: Retrospective cohort study of patients undergoing ECPR at a single center pediatric cardiac intensive c...
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Elsevier
2024-12-01
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| Series: | Resuscitation Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520424002595 |
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| author | Priscilla Yu Sierra Foster Xilong Li Priya Bhaskar Michael Morriss Sumit Singh Tyler Burr Deepa Sirsi Lakshmi Raman Javier J. Lasa |
| author_facet | Priscilla Yu Sierra Foster Xilong Li Priya Bhaskar Michael Morriss Sumit Singh Tyler Burr Deepa Sirsi Lakshmi Raman Javier J. Lasa |
| author_sort | Priscilla Yu |
| collection | DOAJ |
| description | Objective: Explore the relationship between early hypotension after ECPR and survival to hospital discharge (SHD) with favorable neurologic outcome (FNO) in children with cardiac disease. Methods: Retrospective cohort study of patients undergoing ECPR at a single center pediatric cardiac intensive care unit. Hypotension was defined as MAP < 5th percentile for age. Primary and secondary exposure variables were presence and burden of hypotension respectively, during the first 6 h after ECPR. Our primary outcome was SHD with FNO defined by Pediatric Cerebral Performance Category score of 1–3 or no change from baseline. Secondary outcomes included acute central nervous system (CNS) injury via neuroimaging and EEG. Univariate and multivariable logistic regression analyses were performed. Results: We analyzed 82 index ECPR events from 2010 to 2022. Hypotension was observed for at least one MAP value in 36/82 (43.9%) of the cohort. The median [IQR] burden of hypotension was 0 [0,14.3]%. Patients with SHD with FNO had shorter CPR duration, lower number of epinephrine and calcium doses, and lower maximum lactate levels when compared to patients who died or had SHD without FNO. After controlling for potential confounders, there was no association between presence of hypotension or burden of hypotension and SHD, SHD with FNO, or acute CNS injury via neuroimaging and EEG. Conclusion: In children with cardiac disease, there was no association between early hypotension after ECPR and SHD with FNO. Multicenter studies are needed to better understand how early hypotension after ECPR affects neurologic outcomes in children with cardiac disease. |
| format | Article |
| id | doaj-art-5d0cb97d4bd2443583cb970a86c5d4ca |
| institution | OA Journals |
| issn | 2666-5204 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj-art-5d0cb97d4bd2443583cb970a86c5d4ca2025-08-20T01:57:04ZengElsevierResuscitation Plus2666-52042024-12-012010080810.1016/j.resplu.2024.100808The association between early hypotension and neurologic outcome after pediatric cardiac ECPR in children with cardiac diseasePriscilla Yu0Sierra Foster1Xilong Li2Priya Bhaskar3Michael Morriss4Sumit Singh5Tyler Burr6Deepa Sirsi7Lakshmi Raman8Javier J. Lasa9University of Texas Southwestern Medical Center, Dept of Pediatrics, Divisions of Cardiology, Dallas, TX, United States; University of Texas Southwestern Medical Center, Dept of Pediatrics, Division of Critical Care Medicine, Dallas, TX, United States; Corresponding author at: Chlidren’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235, USA.University of Texas Southwestern Medical Center, Dept of Pediatrics, Division of Critical Care Medicine, Dallas, TX, United StatesUniversity of Texas Southwestern Medical Center, DPeter O'Donnell Jr. School of Public Health, Dallas, TX, United StatesUniversity of Texas Southwestern Medical Center, Dept of Pediatrics, Divisions of Cardiology, Dallas, TX, United States; University of Texas Southwestern Medical Center, Dept of Pediatrics, Division of Critical Care Medicine, Dallas, TX, United StatesUniversity of Texas Southwestern Medical Center, Department of Radiology, Division of Pediatric Radiology, Dallas, TX, United StatesUniversity of Texas Southwestern Medical Center, Department of Radiology, Division of Pediatric Radiology, Dallas, TX, United StatesMcLane Children’s Hospital, Department of Pediatrics, Temple, TX, United StatesUniversity of Texas Southwestern Medical Center, Dept of Pediatrics and Neurology, Dallas, TX, United StatesUniversity of Texas Southwestern Medical Center, Dept of Pediatrics, Division of Critical Care Medicine, Dallas, TX, United StatesUniversity of Texas Southwestern Medical Center, Dept of Pediatrics, Divisions of Cardiology, Dallas, TX, United States; University of Texas Southwestern Medical Center, Dept of Pediatrics, Division of Critical Care Medicine, Dallas, TX, United StatesObjective: Explore the relationship between early hypotension after ECPR and survival to hospital discharge (SHD) with favorable neurologic outcome (FNO) in children with cardiac disease. Methods: Retrospective cohort study of patients undergoing ECPR at a single center pediatric cardiac intensive care unit. Hypotension was defined as MAP < 5th percentile for age. Primary and secondary exposure variables were presence and burden of hypotension respectively, during the first 6 h after ECPR. Our primary outcome was SHD with FNO defined by Pediatric Cerebral Performance Category score of 1–3 or no change from baseline. Secondary outcomes included acute central nervous system (CNS) injury via neuroimaging and EEG. Univariate and multivariable logistic regression analyses were performed. Results: We analyzed 82 index ECPR events from 2010 to 2022. Hypotension was observed for at least one MAP value in 36/82 (43.9%) of the cohort. The median [IQR] burden of hypotension was 0 [0,14.3]%. Patients with SHD with FNO had shorter CPR duration, lower number of epinephrine and calcium doses, and lower maximum lactate levels when compared to patients who died or had SHD without FNO. After controlling for potential confounders, there was no association between presence of hypotension or burden of hypotension and SHD, SHD with FNO, or acute CNS injury via neuroimaging and EEG. Conclusion: In children with cardiac disease, there was no association between early hypotension after ECPR and SHD with FNO. Multicenter studies are needed to better understand how early hypotension after ECPR affects neurologic outcomes in children with cardiac disease.http://www.sciencedirect.com/science/article/pii/S2666520424002595Extracorporeal cardiopulmonary resuscitationHypotensionPediatricCardiac arrestCongenital heart diseaseOutcome |
| spellingShingle | Priscilla Yu Sierra Foster Xilong Li Priya Bhaskar Michael Morriss Sumit Singh Tyler Burr Deepa Sirsi Lakshmi Raman Javier J. Lasa The association between early hypotension and neurologic outcome after pediatric cardiac ECPR in children with cardiac disease Resuscitation Plus Extracorporeal cardiopulmonary resuscitation Hypotension Pediatric Cardiac arrest Congenital heart disease Outcome |
| title | The association between early hypotension and neurologic outcome after pediatric cardiac ECPR in children with cardiac disease |
| title_full | The association between early hypotension and neurologic outcome after pediatric cardiac ECPR in children with cardiac disease |
| title_fullStr | The association between early hypotension and neurologic outcome after pediatric cardiac ECPR in children with cardiac disease |
| title_full_unstemmed | The association between early hypotension and neurologic outcome after pediatric cardiac ECPR in children with cardiac disease |
| title_short | The association between early hypotension and neurologic outcome after pediatric cardiac ECPR in children with cardiac disease |
| title_sort | association between early hypotension and neurologic outcome after pediatric cardiac ecpr in children with cardiac disease |
| topic | Extracorporeal cardiopulmonary resuscitation Hypotension Pediatric Cardiac arrest Congenital heart disease Outcome |
| url | http://www.sciencedirect.com/science/article/pii/S2666520424002595 |
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