Higher DBP In Arrest Impacts Survival

February 8, 2018

Spoon Feed
Maintaining a diastolic blood pressure (DBP) of >/=25mm Hg in infants and >/= 30mm Hg in children over age 1 during CPR was associated with improved survival to discharge and improved neurologically intact survival.  This is possible only if a child arrests and has invasive BP monitoring in place but is a good reminder that high quality CPR in all patients positively impacts survival.

Why does this matter?
In order to perfuse the coronary arteries during CPR, compressions must result in a measurable DBP.  There is no way to know the DBP unless invasive BP monitoring is in place when the child arrests.  Many arrests occur in the PICU or ED, places in which this could be measured.  But even if not, measures to improve CPR quality raise DBP, which appears to improve survival.

High quality CPR matters
This was a retrospective study of 164 infants and young children with invasive BP monitoring who arrested and had CPR.  They found that for children with invasive BP monitoring, a DBP >/=25mm Hg in infants and >/= 30mm Hg in children over age 1 during CPR was associated with a 60% greater likelihood of neurologically intact survival.  But what if there is no invasive BP monitor in place?  The way to generate a higher DBP in arrest is high quality CPR, minimizing pauses in compressions, possibly adding vasopressors, and addressing reversible causes.  So even if you don’t have invasive BP measurement, this is a helpful reminder that all these factors really matter and are associated with improved DBP and survival.

Source
Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival. Circulation. 2017 Dec 26. pii: CIRCULATIONAHA.117.032270. doi: 10.1161/CIRCULATIONAHA.117.032270. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.