Key result
Target intra-arrest DBP linked to improved pediatric CPR survival and favorable neurological outcomes.
Why the study?
The utility of intra-arrest blood pressure monitoring and the association between specific blood pressure thresholds and outcomes in infants and children during in-hospital cardiac arrest required systematic evaluation.
Does achieving intra-arrest blood pressure thresholds (such as DBP ≥25 mmHg in infants or ≥30 mmHg in children) improve ROSC, survival to hospital discharge, and survival with favourable neurological outcome in infants and children during in-hospital cardiac arrest?
Meta-Analysis (n=577)
Does achieving intra-arrest blood pressure thresholds (such as DBP ≥25 mmHg in infants or ≥30 mmHg in children) improve ROSC, survival to hospital discharge, and survival with favourable neurological outcome in infants and children during in-hospital cardiac arrest?
Answers are grounded in this paper and cite their sources.
In paediatric in-hospital cardiac arrest with invasive arterial monitoring, maintaining an average diastolic blood pressure ≥25 mmHg in infants or ≥30 mmHg in children during the first 10 minutes of CPR is associated with improved ROSC, survival to discharge, and favourable neurological outcomes, although certainty of evidence is very low.
Aim To evaluate the use of intra-arrest blood pressure monitoring and association between blood pressure thresholds and outcomes in infants and children. Methods A systematic review was performed, registered with PROSPERO (CRD42024590080). We executed the search strategy on MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials all years until April 1, 2026. We used GRADE and the Newcastle Ottawa Scale to assess the evidence found. Critically important outcomes included return of spontaneous circulation (ROSC), survival to hospital discharge, survival with favourable neurological outcome, as defined in the Paediatric Core Outcome Set for Cardiac Arrest. Results Six studies were included in the final analysis. Two studies (577 events) were pooled. A diastolic blood pressure (DBP) of ≥25 mmHg for infants <1 year and ≥30 mmHg for children 1 to ≤18 years, averaged over the first ten minutes of CPR, was associated with improved rates of ROSC, survival to hospital discharge, and survival with favourable neurological outcome, with very low certainty of evidence. The analysis did not find a statistically significant association for intra-arrest systolic blood pressure (SBP) thresholds and the described outcomes. Conclusion In infants and children with invasive arterial monitoring in place during IHCA, a DBP of ≥25 mmHg (infants) or ≥30 mmHg (children) during the first 10 minutes of CPR was associated with improved survival and neurological outcome. The evidence is observational and of very low certainty, and does not establish that titrating resuscitation to these thresholds improves outcomes. The protocol for this systematic review was registered as PROSPERO ID CRD42024590080
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Gray et al. (2026) conducted a meta-analysis in Paediatric in-hospital cardiac arrest (n=577). Intra-arrest diastolic blood pressure ≥25 mmHg (infants <1 year) and ≥30 mmHg (children 1 to ≤18 years) averaged over the first 10 minutes of CPR vs. Lower intra-arrest diastolic blood pressure or systolic blood pressure thresholds was evaluated on Return of spontaneous circulation (ROSC), survival to hospital discharge, and survival with favourable neurological outcome. Intra-arrest DBP ≥25 mmHg (infants) or ≥30 mmHg (children) over 10 min of CPR (577 pooled events) was associated with improved ROSC, survival to discharge, and favourable neurological outcome.
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