Abstract
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.
Keywords
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Article info
Publication history
Published online: October 11, 2021
Accepted:
October 1,
2021
Received in revised form:
September 28,
2021
Received:
September 1,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
