(1512) Association of Post-Arrest Oxygenation With Neurologic Outcomes in Children With Cardiac Disease

Introduction: Post-arrest oxygenation guidelines for children with cardiac disease are limited. In children with cardiac disease who had an in-hospital cardiac arrest (IHCA) with return of spontaneous circulation (ROSC), hypoxemia, hyperoxia, and greater changes in PaO2 in the first 24 hours are linked to reduced survival to hospital discharge (SHD) with favorable neurologic outcomes (FNO).

Methods: We conducted a retrospective cohort study of patients ≤ 18 years old who experienced an IHCA at a single-center cardiac ICU from 2010 to 2024. Only index events were included; extracorporeal cardiopulmonary resuscitation (ECPR) cases were excluded. Exposure variables included hypoxemia (min PaO2 < 60), hyperoxia (max PaO2 >200), delta min PaO2 (min PaO2-baseline PaO2), and delta max PaO2 (max PaO2-baseline PaO2). Our primary outcome was SHD with FNO, defined by a Pediatric Cerebral Performance Category (PCPC) score of 1,2, or 3, or no change from admission. Our secondary outcomes were SHD and SHD with favorable functional outcomes (FFO), defined as a change in overall Functional Status Score (FSS) ≤ 3 or any individual domain ≤ 2. Wilcoxon Rank Sum and Chi square evaluated differences between continuous and categorical variables between groups.

Results: We analyzed 66 events. SHD with FNO occurred in 16 events (24.2%). Compared to those who died or had SHD without FNO, patients with SHD with FNO had shorter CPR duration (4[3,29.5] vs. 17.5[9,31] min, p=0.04) but no differences in age, surgical vs medical illness category, or single ventricle physiology. No significant differences in SHD with FNO rates were seen between patients with or without hypoxemia (31.9 vs. 0%, p=0.24) or hyperoxia (27.2 vs. 30.8%, p=0.82). Compared to patients who died or had SHD without FNO, those with SHD with FNO had similar delta min PaO2 (-28[-40,-2] vs. -16.5[-46.5,-6.9], p=0.78) and delta max PaO2 (9[-11,140] vs. 21[-8.1,67], p=1.00]. Secondary outcomes were also similar.

Conclusions: In this single-center study of children with cardiac disease undergoing IHCA, no association was found between hypoxemia, hyperoxia, delta min PaO2, or delta max PaO2 and outcomes of SHD with FNO, SHD with FFO, or SHD. Future research should investigate optimal oxygenation thresholds for this population.