Resuscitation arterial waveform quantification and outcomes in pediatric bidirectional Glenn and Fontan patients

Andrew R Yates; David A Hehir; Ron W Reeder; John T Berger; Richard Fernandez; Aisha H Frazier; Kathryn Graham; Patrick S McQuillen; Ryan W Morgan; Vinay M Nadkarni; Maryam Y Naim; Chella A Palmer; Heather A Wolfe; Robert A Berg; Robert M Sutton; ICU-RESUS; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigator Groups

doi:10.1038/s41390-024-03564-y

Resuscitation arterial waveform quantification and outcomes in pediatric bidirectional Glenn and Fontan patients

Pediatr Res. 2024 Sep 16. doi: 10.1038/s41390-024-03564-y. Online ahead of print.

Authors

Andrew R Yates¹, David A Hehir², Ron W Reeder³, John T Berger⁴, Richard Fernandez⁵, Aisha H Frazier⁶, Kathryn Graham², Patrick S McQuillen⁷, Ryan W Morgan², Vinay M Nadkarni², Maryam Y Naim², Chella A Palmer³, Heather A Wolfe², Robert A Berg², Robert M Sutton²; ICU-RESUS; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigator Groups

Affiliations

¹ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA. [email protected].
² Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
³ Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
⁴ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
⁵ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
⁶ Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE, USA.
⁷ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.

PMID: 39284966
DOI: 10.1038/s41390-024-03564-y

Abstract

Background: Resuscitation with chest compressions and positive pressure ventilation in Bidirectional Glenn (BDG) or Fontan physiology may compromise passive venous return and accentuate neurologic injury. We hypothesized that arterial pressure and survival would be better in BDG than Fontan patients.

Methods: Secondary analyses of the Pediatric Intensive Care Quality of CPR and Improving Outcomes from Pediatric Cardiac Arrest databases. P-values were considered significant if < 0.05.

Results: In total, 64 patients had either BDG (42/64, 66%) or Fontan (22/64, 34%) anatomy. Return of spontaneous circulation was achieved in 76% of BDG patients versus 59% of Fontan patients and survival with favorable neurologic outcome in 22/42 (52%) BDG versus 6/22 (27%) Fontan patients, p = 0.067. Twelve of 24 (50%) BDG and 2/7 (29%) Fontan patients who survived to discharge suffered new morbidity as defined by worsening Functional Status Score. More BDG patients achieved adequate DBP (≥25 mmHg for neonates and infants; ≥ 30 mmHg for children) than Fontan patients (21/23 (91%) vs. 5/11 (46%), p = 0.007).

Conclusions: Only 27% of Fontan patients survived to hospital discharge with favorable neurologic outcome after CPR, likely driven by inadequate diastolic blood pressure during resuscitation. One half of the BDG patients who survived to hospital discharge had new neurologic morbidity.

Impact statement: Hemodynamic waveforms from 2 large prospective observational studies now allow for exploration of physiology during cardiopulmonary resuscitation for unique anatomy associated with single ventricle congenital heart disease. Fewer patients with Fontan physiology (46%) achieved an adequate diastolic blood pressure (defined as ≥ 25 mmHg for neonates and infants and ≥ 30 mmHg for children) than bidirectional Glenn patients during cardiopulmonary resuscitation (91%, p = 0.007). Only 27% of Fontan patients survived to hospital discharge with favorable neurologic outcome after cardiopulmonary resuscitation. Of the bidirectional Glenn patients who survived, 50% developed a new morbidity as quantified by the Functional Status Score.