Aim

The importance of high-quality post-cardiac arrest care is well-described in adult and paediatric populations, but data are lacking to inform post-cardiac arrest care in the neonatal intensive care unit (NICU). The objective of this study was to describe post-cardiac arrest physiology and management in a quaternary NICU.

Methods

Retrospective descriptive study of post-cardiac arrest physiology and management. Data were abstracted from electronic medical records and an institutional resuscitation database. A cardiac arrest was defined as ≥1 minute of chest compressions. Only index arrests were analysed. Descriptive statistics were used to report patient, intra-arrest, and post-arrest characteristics.

Results

There were 110 index cardiac arrests during the 5-year study period from 1/2017–2/2021. The majority (69%) were acute respiratory compromise leading to cardiopulmonary arrest (ARC-CPA) and 26% were primary cardiopulmonary arrests (CPA). Vital sign monitoring within 24 hours post-arrest was variable, especially non-invasive blood pressure frequency (median 5, range 1–44 measurements). There was a high prevalence of hypothermia (73% of arrest survivors). There was substantial variability in laboratory frequency within 24 hours post-arrest. Patients with primary CPA received significantly more lab testing and had a higher prevalence of acidosis (pH < 7.2) than those with ARC-CPA.

Conclusions

We identified significant variation in post-arrest management and a high prevalence of hypothermia. These data highlight the need for post-arrest management guidelines specific to neonatal physiology, as well as opportunities for quality improvement initiatives. Further research is needed to ascertain the impact of neonatal post-arrest management on long-term outcomes and survival.

中文翻译：

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新生儿重症监护病房心脏骤停后生理学和管理

目标

高质量心脏骤停后护理的重要性在成人和儿童人群中得到了很好的描述，但缺乏数据来为新生儿重症监护病房 (NICU) 中的心脏骤停后护理提供信息。本研究的目的是描述第四纪 NICU 中心脏骤停后的生理学和管理。

方法

心脏骤停后生理学和管理的回顾性描述性研究。数据是从电子病历和机构复苏数据库中提取的。心脏骤停定义为胸外按压≥1 分钟。仅分析指数逮捕。描述性统计用于报告患者、逮捕期间和逮捕后的特征。

结果

在 1/2017–2/2021 的 5 年研究期间，有 110 次指数心脏骤停。大多数 (69%) 是导致心肺骤停 (ARC-CPA) 的急性呼吸损害，26% 是原发性心肺骤停 (CPA)。逮捕后 24 小时内的生命体征监测是可变的，尤其是无创血压频率（中位数 5，范围 1-44 次测量）。体温过低的发生率很高（73% 的逮捕幸存者）。逮捕后 24 小时内实验室频率有很大差异。与 ARC-CPA 患者相比，原发性 CPA 患者接受了更多的实验室检测，并且酸中毒 (pH < 7.2) 的患病率更高。

结论

我们发现逮捕后管理存在显着差异，并且体温过低的发生率很高。这些数据强调了针对新生儿生理学的逮捕后管理指南的必要性，以及质量改进计划的机会。需要进一步研究以确定新生儿逮捕后管理对长期结果和生存的影响。