Prearrest Vital Sign Abnormalities are Associated with Adverse Outcomes in Pediatric ICU Cardiac Arrest: A Get with the Guidelines-Resuscitation Analysis.

Aim: We aimed to quantitatively describe vital sign abnormalities prior to pediatric IHCA and evaluate whether the severity of abnormalities was independently associated with survival.

Methods: In a retrospective cohort study using the American Heart Association's Get with The Guidelines-Resuscitation® registry, children with ≥ 1 minute of cardiopulmonary resuscitation (CPR) in an Intensive Care Unit (ICU) from 2007 to 2022 with prearrest vital signs were included. Vital signs most proximate to CPR (10-120 minutes prior) were classified as abnormal (HR or RR >95^th, SBP or DBP <5^th percentile for age). Multivariable regression adjusted for age, illness category, prearrest conditions, and prearrest interventions assessed the associations between vital sign abnormalities and outcomes (primary: survival to hospital discharge, secondary: return of spontaneous circulation [ROSC]).

Results: Of 2,875 IHCA patients meeting inclusion criteria, 1,790 (62.3%) had at least one abnormal vital sign. Patients with vital sign abnormalities were older, had non-surgical illness categories, and higher prevalence of prearrest illnesses and interventions. Low SBP (<5%) was the vital sign with the lowest odds of survival to hospital discharge (aOR 0.56 [95%CI 0.46-0.68], p<0.01) and ROSC (aOR 0.63 [95%CI 0.54-0.73], p<0.01). There was a stepwise decrease in the adjusted odds of survival for each additional abnormal vital sign (1 vs 0: aOR 0.62 [95%CI 0.51-0.76], p<0.01; 2 vs 1: 0.72 [95%CI 0.53-0.97] p=0.03; 3 vs 2: 0.53 [95%CI 0.33-0.86] p<0.01).

Conclusions: Prearrest vital sign abnormalities are common in pediatric ICU IHCA and independently associated with worse outcomes, emphasizing the need for prompt detection and intervention to improve outcomes.