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. 2021 Dec:169:11-19.
doi: 10.1016/j.resuscitation.2021.10.004. Epub 2021 Oct 11.

Post-cardiac arrest physiology and management in the neonatal intensive care unit

Sarah A Coggins  1 , Mary Haggerty  2 , Heidi M Herrick  3
Affiliations

Post-cardiac arrest physiology and management in the neonatal intensive care unit

Sarah A Coggins et al. Resuscitation. 2021 Dec.

Abstract

Aim: The importance of high-quality post-cardiac arrest care is well-described in adult and paediatric populations, but data are lacking to inform post-cardiac arrest care in the neonatal intensive care unit (NICU). The objective of this study was to describe post-cardiac arrest physiology and management in a quaternary NICU.

Methods: Retrospective descriptive study of post-cardiac arrest physiology and management. Data were abstracted from electronic medical records and an institutional resuscitation database. A cardiac arrest was defined as ≥1 minute of chest compressions. Only index arrests were analysed. Descriptive statistics were used to report patient, intra-arrest, and post-arrest characteristics.

Results: There were 110 index cardiac arrests during the 5-year study period from 1/2017-2/2021. The majority (69%) were acute respiratory compromise leading to cardiopulmonary arrest (ARC-CPA) and 26% were primary cardiopulmonary arrests (CPA). Vital sign monitoring within 24 hours post-arrest was variable, especially non-invasive blood pressure frequency (median 5, range 1-44 measurements). There was a high prevalence of hypothermia (73% of arrest survivors). There was substantial variability in laboratory frequency within 24 hours post-arrest. Patients with primary CPA received significantly more lab testing and had a higher prevalence of acidosis (pH < 7.2) than those with ARC-CPA.

Conclusions: We identified significant variation in post-arrest management and a high prevalence of hypothermia. These data highlight the need for post-arrest management guidelines specific to neonatal physiology, as well as opportunities for quality improvement initiatives. Further research is needed to ascertain the impact of neonatal post-arrest management on long-term outcomes and survival.

Keywords: Neonatology; Post-cardiac arrest.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1:
Figure 1:
Flow diagram of outcomes among patients experiencing cardiac arrest N/IICU= Newborn/Infant Intensive Care Unit
Figure 2:
Figure 2:
Dot plot demonstrating frequency and distribution of laboratory testing in the 24 hours post-arrest. Each dot represents a unique patient. Black horizontal lines denote the median testing frequency for each laboratory test. CBC= Complete blood cell count; BMP= Basic metabolic panel
See this image and copyright information in PMC

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