Abstract 152: Cerebral Oximetry During Pediatric In-hospital Cardiac Arrest

• Published in: Circulation (New York, N.Y.) N.Y.), 2020-11, Vol.142 (Suppl_4)
• Main Authors: Esangbedo, Ivie D, Rajapreyar, Prakadeshwari, Kirschen, Matthew, Hanna, Richard, Niles, Dana E, Zhang, Xuemei, Griffis, Heather M, Francoeur, Conall, Wakeham, Martin K, Petersen, Tara, Topjian, Alexis A, Nadkarni, Vinay M, Raymond, Tia T
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.142.suppl_4.152

Abstract only Introduction: Cerebral near-infrared spectroscopy (NIRS) measuring regional oxygen saturation (rSO 2 ) during cardiopulmonary resuscitation (CPR) is associated with return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD) in adults, with limited data in children. We hypothesized mean cerebral rSO 2 during pediatric in-hospital cardiac arrest (IHCA) would be associated with return of spontaneous circulation (ROSC). Methods: Consecutive case series of pediatric IHCA events with rSO 2 data reported between 2016-2020 by 3 sites to the Pediatric Resuscitation Quality (pediRES-Q) collaborative. We excluded patients with CPR duration ≤2 minutes or who had return of circulation via extracorporeal membrane oxygenation. We calculated mean rSO 2 for duration of CPR and the primary outcome measure was ROSC. Exploratory sensitivity analyses were performed for cutoffs of mean rSO 2 >25, >30, >35, >40 and >50%. Analysis was done using independent samples t test, Exact logistic regression and Fisher’s exact test. Results: Of 36 events (26 index), median age was 3 [IQR 1,7.8] months; 29 (80.5%) had congenital heart disease and 15 (41.7%) had single ventricle (SV) physiology. Median CPR duration was 7.5 [IQR 3.8, 32.2] minutes and 28/36 (77.8%) had ROSC. Mean intra-arrest cerebral rSO 2 was 44.2% (±19.5) for ROSC vs. 37.4% (±15) for non-ROSC group ( p =0.267). Using Exact logistic regression, there was no association found between rSO 2 and ROSC, even after controlling for age, presence of congenital heart disease, and SV physiology. Using mean rSO 2 cutoffs >25, >30, >35, >40, and >50%, we found no significant association with ROSC. We found same result in the SV subgroup. Conclusion: In this small pediatric cohort of predominantly cardiac patients, there was no significant association between cerebral rSO 2 during pediatric cardiac arrest and ROSC, even after controlling for important confounders of age and SV physiology. More extensive studies using larger populations, and evaluating intra-arrest change in cerebral rSO 2 from baseline, are warranted to provide more insight into the possibilities of using rSO 2 to guide CPR.