Multicenter Study

. 2025 Aug 1;53(8):e1529-e1541.

doi: 10.1097/CCM.0000000000006739. Epub 2025 Jun 25.

Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis

Ryan W Morgan¹, Ron W Reeder², Joseph A Carcillo³, Todd C Carpenter⁴, Julie C Fitzgerald¹, Kathryn Graham¹, Todd J Kilbaugh¹, Kathleen L Meert⁵, Vinay M Nadkarni¹, Chella A Palmer², Matthew P Sharron⁶, Scott L Weiss⁷, Heather A Wolfe¹, Tageldin Ahmed⁵, Michael J Bell⁶, Robert Bishop⁴, Candice Burns⁸, J Wesley Diddle^{1

6}, Ericka L Fink³, Deborah Franzon⁹, Aisha H Frazier^{7

10}, Stuart H Friess¹¹, David A Hehir^{1

7

10}, Christopher M Horvat³, Leanna L Huard¹², Tensing Maa¹³, Patrick S McQuillen⁹, Peter M Mourani¹⁴, Maryam Y Naim¹, Murray M Pollack⁶, Anil Sapru¹², Neeraj Srivastava¹², Andrew R Yates¹³, Robert A Berg¹, Robert M Sutton¹; for the ICU-Resuscitation Project (ICU-RESUS) Investigators and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigators

Collaborators, Affiliations

Collaborators

for the ICU-Resuscitation Project (ICU-RESUS) Investigators and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigators:
Matthew Bochkoris³, J Michael Dean², Myke Federman¹⁵, Richard Fernandez¹³, Mark Hall¹³, Arushi Manga¹¹, Daniel Notterman¹⁶, Carleen Schneiter⁴, Bradley Tilford⁵, Shirley Viteri¹⁰, David Wessel⁶, Athena F Zuppa¹

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
² Department of Pediatrics, University of Utah, Salt Lake City, UT.
³ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
⁴ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
⁵ Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
⁶ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
⁷ Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE.
⁸ Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI.
⁹ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.
¹⁰ Nemours Cardiac Center, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE.
¹¹ Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
¹² Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
¹³ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
¹⁴ Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR.
¹⁵ Department of Pediatrics, Mattel Children's Hospital, ULCA, Los Angeles, CA.
¹⁶ Department of Molecular Biology, Princeton University, Princeton, NJ.

PMID: 40558671
PMCID: PMC12286578 (available on 2026-06-25)
DOI: 10.1097/CCM.0000000000006739

Multicenter Study

Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis

Ryan W Morgan et al. Crit Care Med. 2025.

. 2025 Aug 1;53(8):e1529-e1541.

doi: 10.1097/CCM.0000000000006739. Epub 2025 Jun 25.

Authors

Collaborators

for the ICU-Resuscitation Project (ICU-RESUS) Investigators and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigators:
Matthew Bochkoris³, J Michael Dean², Myke Federman¹⁵, Richard Fernandez¹³, Mark Hall¹³, Arushi Manga¹¹, Daniel Notterman¹⁶, Carleen Schneiter⁴, Bradley Tilford⁵, Shirley Viteri¹⁰, David Wessel⁶, Athena F Zuppa¹

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
² Department of Pediatrics, University of Utah, Salt Lake City, UT.
³ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
⁴ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
⁵ Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
⁶ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
⁷ Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE.
⁸ Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI.
⁹ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.
¹⁰ Nemours Cardiac Center, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE.
¹¹ Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
¹² Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
¹³ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
¹⁴ Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR.
¹⁵ Department of Pediatrics, Mattel Children's Hospital, ULCA, Los Angeles, CA.
¹⁶ Department of Molecular Biology, Princeton University, Princeton, NJ.

PMID: 40558671
PMCID: PMC12286578 (available on 2026-06-25)
DOI: 10.1097/CCM.0000000000006739

Abstract

Objectives: Prearrest sepsis has been associated with particularly poor outcomes among children who suffer in-hospital cardiac arrest (IHCA), but there is a paucity of dedicated studies on the topic. In this study of children receiving cardiopulmonary resuscitation (CPR) in the ICU, our objective was to determine the associations of sepsis with IHCA outcomes and intraarrest physiology.

Design: Prospectively designed secondary analysis of the ICU Resuscitation Project clinical trial (NCT02837497).

Setting: The 18 pediatric and pediatric cardiac ICUs at ten children's hospitals in the United States.

Patients: Children (≤ 18 yr) with an index IHCA event.

Interventions: None.

Measurements and main results: The primary exposure was a prearrest diagnosis of sepsis. The primary survival outcome was survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline). The primary physiologic outcome was average diastolic blood pressure (DBP) during CPR. Multivariable regression models controlling for a priori covariates assessed the relationship between sepsis and outcomes. Of 1129 children with index IHCAs, 184 (16.3%) had prearrest sepsis. Patients with sepsis had greater prearrest comorbidities, higher prearrest severity of illness, and higher Vasoactive-Inotropic Scores than patients without sepsis. They more frequently had hypotension as the cause of IHCA, had longer durations of CPR, and more frequently received epinephrine and sodium bicarbonate during CPR. They less frequently achieved survival with favorable neurologic outcome (52/184 [28.3%] vs. 552/945 [58.4%]; p < 0.001; adjusted relative risk, 0.54; 95% CI, 0.43-0.68; p < 0.001). Intraarrest DBPs did not differ between patients with vs. without sepsis. Following IHCA, event survivors with sepsis had higher vasoactive requirements, more frequently experienced hypotension, and continued to have greater mortality rates through 48 hours postarrest.

Conclusions: Children with prearrest sepsis had worse survival outcomes, similar intraarrest DBPs, and greater pre and postarrest severity of illness than children without sepsis.

Keywords: cardiac arrest; cardiopulmonary resuscitation; intensive care unit; pediatrics; sepsis; septic shock.

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Conflict of interest statement

Dr. Morgan’s institution received funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute; he received funding from the Children’s Hospital of Philadelphia. Drs. Morgan, Reeder, Carcillo, Carpenter, Fitzgerland, Graham, Kilbaugh, Meert, Nadkarni, Palmer, Wolfe, Bell, Diddle, Fink, Franzon, Horvat, Maa, McQuillen, Mourani, Naim, Pollack, Sapru, Yates, Berg, and Sutton received support for article research from the National Institutes of Health (NIH). Drs. Reeder’s, Fitzgerald’s, Meert’s, Nadkarni’s, Palmer’s, Weiss’, Wolfe’s, Bell’s, Fink’s, Franzon’s, Maa’s, Mourani’s, Naim’s, Pollack’s, Yates’, Berg’s, and Sutton’s institutions received funding from the NIH. Drs. Carcillo’s and Carpenter’s institutions received funding from the NHLBI. Dr. Weiss’ institution received funding from the Centers for Disease Control and Prevention. Dr. Diddle’s institution received funding from Mallinckrodt Pharmaceuticals; he received funding from Mallinckrodt Pharmaceuticals. Dr. Fink received funding from the Health Navigator Foundation. Dr. Franzon received funding from the American Board of Pediatrics. Drs. Horvat’s, McQuillen’s, and Sapru’s institutions received funding from the NICHD. Dr. Huard received funding from Doyle Schafer McMahon LLP. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

1. Holmberg MJ, Ross CE, Fitzmaurice GM, et al. ; American Heart Association’s Get With the Guidelines–Resuscitation Investigators: Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes 2019; 12:e005580. - PMC - PubMed
1. Niles DE, Duval-Arnould J, Skellett S, et al. ; Pediatric Resuscitation Quality (pediRES-Q) Collaborative Investigators: Characterization of pediatric in-hospital cardiopulmonary resuscitation quality metrics across an international resuscitation collaborative. Pediatr Crit Care Med 2018; 19:421–432 - PubMed
1. Topjian AA, Raymond TT, Atkins D, et al. ; Pediatric Basic and Advanced Life Support Collaborators: Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2020; 142(16 Suppl 2):S469–S523 - PubMed
1. Holmberg MJ, Wiberg S, Ross CE, et al. : Trends in survival after pediatric in-hospital cardiac arrest in the United States. Circulation 2019; 140:1398–1408 - PMC - PubMed
1. Morgan RW, Kirschen MP, Kilbaugh TJ, et al. : Pediatric in-hospital cardiac arrest and cardiopulmonary resuscitation in the United States: A review. JAMA Pediatr 2021; 175:293–302 - PMC - PubMed

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Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis

Collaborators

Affiliations

Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

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