Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis

Ryan W Morgan; Ron W Reeder; Joseph A Carcillo; Todd C Carpenter; Julie C Fitzgerald; Kathryn Graham; Todd J Kilbaugh; Kathleen L Meert; Vinay M Nadkarni; Chella A Palmer; Matthew P Sharron; Scott L Weiss; Heather A Wolfe; Tageldin Ahmed; Michael J Bell; Robert Bishop; Candice Burns; J Wesley Diddle; Ericka L Fink; Deborah Franzon; Aisha H Frazier; Stuart H Friess; David A Hehir; Christopher M Horvat; Leanna L Huard; Tensing Maa; Patrick S McQuillen; Peter M Mourani; Maryam Y Naim; Murray M Pollack; Anil Sapru; Neeraj Srivastava; Andrew R Yates; Robert A Berg; Robert M Sutton; for the ICU-Resuscitation Project (ICU-RESUS) Investigators and the 
                                Eunice Kennedy Shriver
                                 National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigators

doi:10.1097/CCM.0000000000006739

Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis

Crit Care Med. 2025 Jun 25. doi: 10.1097/CCM.0000000000006739. Online ahead of print.

Authors

Ryan W Morgan¹, Ron W Reeder², Joseph A Carcillo³, Todd C Carpenter⁴, Julie C Fitzgerald¹, Kathryn Graham¹, Todd J Kilbaugh¹, Kathleen L Meert⁵, Vinay M Nadkarni¹, Chella A Palmer², Matthew P Sharron⁶, Scott L Weiss⁷, Heather A Wolfe¹, Tageldin Ahmed⁵, Michael J Bell⁶, Robert Bishop⁴, Candice Burns⁸, J Wesley Diddle^{1

6}, Ericka L Fink³, Deborah Franzon⁹, Aisha H Frazier^{7

10}, Stuart H Friess¹¹, David A Hehir^{1

7

10}, Christopher M Horvat³, Leanna L Huard¹², Tensing Maa¹³, Patrick S McQuillen⁹, Peter M Mourani¹⁴, Maryam Y Naim¹, Murray M Pollack⁶, Anil Sapru¹², Neeraj Srivastava¹², Andrew R Yates¹³, Robert A Berg¹, Robert M Sutton¹; for the ICU-Resuscitation Project (ICU-RESUS) Investigators and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigators

Collaborators

for the ICU-Resuscitation Project (ICU-RESUS) Investigators and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigators:
Matthew Bochkoris³, J Michael Dean², Myke Federman¹⁵, Richard Fernandez¹³, Mark Hall¹³, Arushi Manga¹¹, Daniel Notterman¹⁶, Carleen Schneiter⁴, Bradley Tilford⁵, Shirley Viteri¹⁰, David Wessel⁶, Athena F Zuppa¹

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
² Department of Pediatrics, University of Utah, Salt Lake City, UT.
³ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
⁴ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
⁵ Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
⁶ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
⁷ Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE.
⁸ Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI.
⁹ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.
¹⁰ Nemours Cardiac Center, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE.
¹¹ Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
¹² Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
¹³ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
¹⁴ Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR.
¹⁵ Department of Pediatrics, Mattel Children's Hospital, ULCA, Los Angeles, CA.
¹⁶ Department of Molecular Biology, Princeton University, Princeton, NJ.

PMID: 40558671
DOI: 10.1097/CCM.0000000000006739

Abstract

Objectives: Prearrest sepsis has been associated with particularly poor outcomes among children who suffer in-hospital cardiac arrest (IHCA), but there is a paucity of dedicated studies on the topic. In this study of children receiving cardiopulmonary resuscitation (CPR) in the ICU, our objective was to determine the associations of sepsis with IHCA outcomes and intraarrest physiology.

Design: Prospectively designed secondary analysis of the ICU Resuscitation Project clinical trial (NCT02837497).

Setting: The 18 pediatric and pediatric cardiac ICUs at ten children's hospitals in the United States.

Patients: Children (≤ 18 yr) with an index IHCA event.

Interventions: None.

Measurements and main results: The primary exposure was a prearrest diagnosis of sepsis. The primary survival outcome was survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline). The primary physiologic outcome was average diastolic blood pressure (DBP) during CPR. Multivariable regression models controlling for a priori covariates assessed the relationship between sepsis and outcomes. Of 1129 children with index IHCAs, 184 (16.3%) had prearrest sepsis. Patients with sepsis had greater prearrest comorbidities, higher prearrest severity of illness, and higher Vasoactive-Inotropic Scores than patients without sepsis. They more frequently had hypotension as the cause of IHCA, had longer durations of CPR, and more frequently received epinephrine and sodium bicarbonate during CPR. They less frequently achieved survival with favorable neurologic outcome (52/184 [28.3%] vs. 552/945 [58.4%]; p < 0.001; adjusted relative risk, 0.54; 95% CI, 0.43-0.68; p < 0.001). Intraarrest DBPs did not differ between patients with vs. without sepsis. Following IHCA, event survivors with sepsis had higher vasoactive requirements, more frequently experienced hypotension, and continued to have greater mortality rates through 48 hours postarrest.

Conclusions: Children with prearrest sepsis had worse survival outcomes, similar intraarrest DBPs, and greater pre and postarrest severity of illness than children without sepsis.

Keywords: cardiac arrest; cardiopulmonary resuscitation; intensive care unit; pediatrics; sepsis; septic shock.

Associated data

ClinicalTrials.gov/NCT02837497