(904) Pre-Arrest Vital Sign Abnormalities Associated With Lower Survival in Pediatric IHCA

Introduction: The impact of pre-arrest vital sign abnormalities on pediatric in-hospital cardiac arrest (IHCA) outcomes is not well characterized. Defining pre-arrest abnormalities can inform detection, planning, and early CPR management. We hypothesized that over 50% of pediatric IHCAs would have abnormal vital signs prior to IHCA and that more abnormalities would correlate with lower odds of survival.

Methods: We conducted a retrospective cohort study using the American Heart Association Get with The Guidelines-Resuscitation® registry. We included children who received >= 1 minute of CPR in an ICU from 2007 to 2022. We excluded cases missing complete pre-arrest vitals (heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP)), outcome data, or were from sites reporting vitals for < 50% of IHCAs. We classified HR or RR >95th and SBP or DBP < 5th percentile for age as abnormal; >99th or < 1st percentile as severely abnormal. We assessed vital signs most proximate to CPR within the 0.5-4-hour pre-arrest period. The primary outcome was survival to hospital discharge; secondary outcome was sustained return of spontaneous circulation (ROSC). We performed multivariable regression clustering by site and adjusted for age, illness category, pre-existing conditions, and pre-arrest interventions.

Results: Of 6,781 children screened, 3,382 (49.9%) had a complete set of vitals, and 2,919 were in the final cohort. Most (1800; 62%) had ≥ 1 abnormal vital (HR (33%), RR (18%), SBP (35%), DBP (20%)). Children with abnormal vitals were younger, had more medical-non-cardiac illness, had more pre-existing conditions, longer CPR duration, and were more often pulseless at CPR start. In adjusted models, presence of an additional abnormal vital sign was associated with decreased survival (OR 0.6; 95%CI 0.6 -0.7; p< 0.01) and ROSC (OR 0.7; 95%CI 0.6-0.8; p< 0.01). Severely abnormal vital signs were similarly associated with decreased survival (OR 0.6; 95%CI 0.5-0.7; p< 0.01) and ROSC (OR 0.7; 95%CI 0.6-0.8; p< 0.01).

Conclusions: Pre-arrest vital sign abnormalities are prevalent and significantly associated with pediatric IHCA outcomes. Further characterization of pre-arrest physiology and trajectories could provide actionable insights for clinicians.