(838) Association Between Lung Injury and Functional Outcomes After Cardiac Arrest in Children

Introduction: Sustained lung injury after cardiac arrest may worsen neurologic outcomes due to hypoxemia and higher ventilation pressures which can negatively impact cerebral perfusion pressure. Impaired oxygenation after arrest worsens outcomes, however, less is known about sustained lung injury. We tested for an association between sustained lung injury and functional outcomes in pediatric cardiac arrest and hypothesized that patients with sustained lung injury would have worse functional outcomes.

Methods: We conducted a retrospective analysis of the prospective, multicenter study, Personalizing Outcomes after Child Cardiac Arrest. We analyzed children who were mechanically ventilated after cardiac arrest, excluding patients admitted to the cardiac intensive care unit and those who died within 48 hours. Sustained lung injury was defined as an oxygenation index (OI) >4 during at least 2 of 3 initial post-arrest days. We used univariate multinomial logistic regression to evaluate for an association between sustained lung injury and our primary outcome of hospital discharge status: death, severe new morbidity (Functional Status Scale score increase > 3 or > 2 in a specific domain relative to pre-arrest baseline), or survival without new severe morbidity.

Results: We evaluated 118 patients: 20 (17%) had sustained lung injury, 46 (39%) did not, and 52 (44%) had insufficient data to determine. Among patients with sustained lung injury, 6 (30%) had a severe new morbidity and 6 (30%) died. Among patients without sustained lung injury, 10 (22%) had a severe new morbidity and 12 (26%) died. In univariate analyses comparing patients with and without sustained lung injury, sustained lung injury was not associated with having a new severe morbidity relative to survival without new severe morbidity (relative risk ratio [RRR] 1.8 [0.5, 6.5]) or death relative to survival without new severe morbidity (RRR 1.5 [0.4, 5.3]).

Conclusions: In this prospective cohort of children who survived at least 48 hours post-arrest, sustained lung injury was uncommon and not associated with increased risk of poor functional outcome or death. We were unable to determine lung injury status in many patients. Larger studies are needed to effectively assess the association between lung injury and outcomes after pediatric cardiac arrest.