Resuscitation arterial waveform quantification and outcomes in pediatric bidirectional Glenn and Fontan patients
Authors: Yates Andrew R. , Hehir David A. , Reeder Ron W. , Berger John T. , Fernandez Richard , Frazier Aisha H. , Graham Kathryn , McQuillen Patrick S. , Morgan Ryan W. , Nadkarni Vinay M. , Naim Maryam Y. , Palmer Chella A. , Wolfe Heather A. , Berg Robert A. , Sutton Robert M. ,   ICU-RESUS, Ahmed Tageldin , Bell Michael J. , Bishop Robert , Bochkoris Matthew , Burns Candice , Carcillo Joseph A. , Carpenter Todd C. , Dean J. Michael , Diddle J. Wesley , Federman Myke , Fink Ericka L. , Franzon Deborah , Friess Stuart H. , Hall Mark , Horvat Christopher M. , Huard Leanna L. , Maa Tensing , Manga Arushi , Meert Kathleen L. , Mourani Peter M. , Notterman Daniel , Pollack Murray M. , Sapru Anil , Schneiter Carleen , Sharron Matthew P. , Srivastava Neeraj , Tabbutt Sarah , Tilford Bradley , Viteri Shirley , Wessel David , Zuppa Athena F. ,   the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigator Groups
Published: September 2024

Abstract
Background
Resuscitation with chest compressions and positive pressure ventilation in Bidirectional Glenn (BDG) or Fontan physiology may compromise passive venous return and accentuate neurologic injury. We hypothesized that arterial pressure and survival would be better in BDG than Fontan patients.

Methods
Secondary analyses of the Pediatric Intensive Care Quality of CPR and Improving Outcomes from Pediatric Cardiac Arrest databases. P-values were considered significant if < 0.05.

Results
In total, 64 patients had either BDG (42/64, 66%) or Fontan (22/64, 34%) anatomy. Return of spontaneous circulation was achieved in 76% of BDG patients versus 59% of Fontan patients and survival with favorable neurologic outcome in 22/42 (52%) BDG versus 6/22 (27%) Fontan patients, p = 0.067. Twelve of 24 (50%) BDG and 2/7 (29%) Fontan patients who survived to discharge suffered new morbidity as defined by worsening Functional Status Score. More BDG patients achieved adequate DBP (≥25 mmHg for neonates and infants; ≥ 30 mmHg for children) than Fontan patients (21/23 (91%) vs. 5/11 (46%), p = 0.007).

Conclusions
Only 27% of Fontan patients survived to hospital discharge with favorable neurologic outcome after CPR, likely driven by inadequate diastolic blood pressure during resuscitation. One half of the BDG patients who survived to hospital discharge had new neurologic morbidity.

Impact statement

Hemodynamic waveforms from 2 large prospective observational studies now allow for exploration of physiology during cardiopulmonary resuscitation for unique anatomy associated with single ventricle congenital heart disease.

Fewer patients with Fontan physiology (46%) achieved an adequate diastolic blood pressure (defined as ≥ 25 mmHg for neonates and infants and ≥ 30 mmHg for children) than bidirectional Glenn patients during cardiopulmonary resuscitation (91%, p = 0.007).

Only 27% of Fontan patients survived to hospital discharge with favorable neurologic outcome after cardiopulmonary resuscitation.

Of the bidirectional Glenn patients who survived, 50% developed a new morbidity as quantified by the Functional Status Score.