Practice patterns for acquiring neuroimaging after pediatric in-hospital cardiac arrest

Matthew P Kirschen; Natalie L Ullman; Ron W Reeder; Tageldin Ahmed; Michael J Bell; Robert A Berg; Candice Burns; Joseph A Carcillo; Todd C Carpenter; JWesley Diddle; Myke Federman; Ericka L Fink; Aisha H Frazier; Stuart H Friess; Kathryn Graham; Christopher M Horvat; Leanna L Huard; Todd J Kilbaugh; Tensing Maa; Arushi Manga; Patrick S McQuillen; Kathleen L Meert; Ryan W Morgan; Peter M Mourani; Vinay M Nadkarni; Maryam Y Naim; Daniel Notterman; Chella A Palmer; Murray M Pollack; Anil Sapru; Matthew P Sharron; Neeraj Srivastava; Bradley Tilford; Shirley Viteri; Heather A Wolfe; Andrew R Yates; Alexis Topjian; Robert M Sutton; Craig A Press

doi:10.1016/j.resuscitation.2025.110506

Practice patterns for acquiring neuroimaging after pediatric in-hospital cardiac arrest

Resuscitation. 2025 Jan 21:110506. doi: 10.1016/j.resuscitation.2025.110506. Online ahead of print.

Authors

Matthew P Kirschen¹, Natalie L Ullman², Ron W Reeder³, Tageldin Ahmed⁴, Michael J Bell⁵, Robert A Berg⁶, Candice Burns⁷, Joseph A Carcillo⁸, Todd C Carpenter⁹, JWesley Diddle⁶, Myke Federman¹⁰, Ericka L Fink⁸, Aisha H Frazier¹¹, Stuart H Friess¹², Kathryn Graham⁶, Christopher M Horvat⁸, Leanna L Huard¹⁰, Todd J Kilbaugh⁶, Tensing Maa¹³, Arushi Manga¹², Patrick S McQuillen¹⁴, Kathleen L Meert⁴, Ryan W Morgan⁶, Peter M Mourani¹⁵, Vinay M Nadkarni⁶, Maryam Y Naim⁶, Daniel Notterman¹⁶, Chella A Palmer³, Murray M Pollack⁵, Anil Sapru¹⁰, Matthew P Sharron⁵, Neeraj Srivastava¹⁰, Bradley Tilford⁴, Shirley Viteri¹¹, Heather A Wolfe⁶, Andrew R Yates¹³, Alexis Topjian⁶, Robert M Sutton⁶, Craig A Press²

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA; Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: [email protected].
² Division of Neurology, Department of Pediatrics, 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 Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
⁵ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
⁶ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
⁷ Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA.
⁸ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
⁹ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
¹⁰ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
¹¹ Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, DE, USA.
¹² Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
¹³ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
¹⁴ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
¹⁵ Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
¹⁶ Department of Molecular Biology, Princeton University, Princeton, NJ, USA.

PMID: 39848427
DOI: 10.1016/j.resuscitation.2025.110506

Abstract

Aims: To determine which patient and cardiac arrest factors were associated with obtaining neuroimaging after in-hospital cardiac arrest, and among those patients who had neuroimaging, factors associated with which neuroimaging modality was obtained.

Methods: Retrospective cohort study of patients who survived in-hospital cardiac arrest (IHCA) and were enrolled in the ICU-RESUS trial (NCT02837497).

Results: We tabulated ultrasound (US), CT, and MRI frequency within 7 days following IHCA and identified patient and cardiac arrest factors associated with neuroimaging modalities utilized. Multivariable models determined which factors were associated with obtaining neuroimaging. Of 1000 patients, 44% had ≥1 neuroimaging study (US in 31%, CT in 18%, and MRI in 6% of patients). Initial USs were performed a median of 0.3 [0.1,0.5], CTs 1.4 [0.4,2.8], and MRIs 4.1 [2.2,5.1] days post-arrest. Neuroimaging timing and frequency varied by site. Factors associated with greater odds of neuroimaging were cardiac arrest in CICU (versus PICU), longer duration CPR, receiving ECMO post-arrest, and post-arrest care with targeted temperature management or EEG monitoring. US performance was associated with congenital heart disease. CT was associated with age ≥1-month, greater pre-arrest disability, and receiving CPR for ≥16 minutes. MRI utilization increased with pre-existing respiratory insufficiency and respiratory decompensation as arrest cause, and medical cardiac and surgical non-cardiac or trauma illness category. Overall, if neuroimaging was obtained, US was more common in CICU while CT/MRI were utilized more in PICU.

Conclusions: Practice patterns for acquiring neuroimaging after IHCA are variable and influenced by patient, cardiac arrest, and site factors.

Keywords: CT; MRI; cardiac arrest; neuroimaging; pediatric ICU; ultrasound.

Associated data

ClinicalTrials.gov/NCT02837497