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February 2018

Importance of Hypotension and Its Definition After Cardiac Arrest

Author Affiliations
  • 1Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta, Stollery Children’s Hospital, Edmonton, Alberta, Canada
JAMA Pediatr. 2018;172(2):120-122. doi:10.1001/jamapediatrics.2017.4099

Out-of-hospital cardiac arrest (OHCA) in children continues to have a poor prognosis. In a recent study of 12 877 OHCAs in children,1 30-day survival was 9.1%, and survival with favorable neurologic outcome (cerebral performance category of 1 or 2) was 2.5%. After 20 and 30 minutes of emergency medical services–initiated cardiopulmonary resuscitation (CPR), survival was 2.4% and 0.66%, respectively, and survival with favorable neurologic outcome was 0.43% and 0.10%, respectively.1 In the multicenter randomized Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA) study of OHCA,2 1-year survival was 33%, and 1-year survival with favorable neurologic outcome (a Vineland Adaptive Behavior Scale score ≥70) was 16%. The THAPCA randomized clinical trial tested hypothermia vs normothermia treatment after return of spontaneous circulation and found no difference in outcome. Hypothermia can be added to the hundreds of neuroprotective interventions found to be beneficial in nonhuman animal experiments that have not translated to improved outcomes for human adults or children, suggesting that different paradigms of resuscitation research are necessary.3,4

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