Abstract 304: Cerebral Near-infrared Spectroscopy During Pediatric In-hospital Cardiac Arrest: A Multicenter, Observational Study

Abstract

Introduction: Cerebral regional oxygen saturation (crS0 2 ) measured by near-infrared spectroscopy (NIRS) during CPR is associated with outcomes in adults, but there is limited pediatric data. Hypothesis: Median crSO 2 during pediatric in-hospital cardiac arrest (IHCA) is associated with return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD). Methods: Pediatric IHCA events from 2015-2022 with ≥ 1min CPR and intra-arrest crS0 2 reported by 3 sites in the pediRES-Q registry were included. ROSC was defined as return of spontaneous circulation for ≥ 20 mins without ECMO. We analyzed the association of ROSC for all events and SHD for index events only with median crS0 2 and percent crS0 2 measurements above a priori thresholds during 1) the entire event, 2) the first 5 mins, and 3) the final 5 mins by Fisher’s exact test, Wilcoxon rank sum test, and multivariable logistic regression with Firth bias correction. Results: There were 106 IHCA events in 81 patients. Median age was 0.3 yrs [0.06,0.85], 43% had cyanotic heart disease, and SHD in 61% (49/81). For all events, median CPR duration was 8 mins [3.25, 32] and ROSC was achieved in 62% (66/106). Higher median crSO 2 for the entire event, the first 5 mins, and the last 5 mins was significantly associated with ROSC and SHD (Table). Events with ROSC had significantly higher percent crS0 2 measurements ≥ 30% and 40% for the entire event. Patients with SHD had significantly higher percent crSO 2 measurements ≥ 30%, 40%, 50%, and 60% for the entire event (Table). Multivariable analysis controlling for age (aOR 1.02 [CI 1.01,1.05] p=0.012) and cyanotic heart disease (aOR 1.03 [CI 1.01,1.05] p=0.008) showed median crS0 2 was independently associated with ROSC. Conclusions: Higher median crSO 2 (measured by cerebral NIRS) during pediatric IHCA was significantly associated with increased rate of ROSC and SHD. Studies evaluating intra-arrest cerebral rSO 2 may provide insight and possibly serve as a predictor of ROSC and SHD.