Letter by Guo et al Regarding Article, “Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival”

HomeCirculationVol. 138, No. 22Letter by Guo et al Regarding Article, “Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Guo et al Regarding Article, “Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival” Junjie Guo, MD, Yonghong Li, MD and Haichu Yu, MD Junjie GuoJunjie Guo Department of Cardiology, Affiliated Hospital of Qingdao University, Shandong, China. Search for more papers by this author , Yonghong LiYonghong Li Department of Cardiology, Affiliated Hospital of Qingdao University, Shandong, China. Search for more papers by this author and Haichu YuHaichu Yu Department of Cardiology, Affiliated Hospital of Qingdao University, Shandong, China. Search for more papers by this author Originally published26 Nov 2018https://doi.org/10.1161/CIRCULATIONAHA.118.035691Circulation. 2018;138:2586–2587To the Editor:We congratulate Berg et al1 for their significant work recently published in Circulation about the association between diastolic blood pressure during pediatric in-hospital cardiopulmonary resuscitation and survival. The findings of this multicenter clinical study indicate that diastolic blood pressure ≥25 mm Hg during cardiopulmonary resuscitation in infants and ≥30 mm Hg in children ≥1 year of age was associated with a greater likelihood of survival to hospital discharge and survival with a favorable neurological outcome. However, detailed information about some pivotal therapeutic interventions after pediatric in-hospital cardiopulmonary resuscitation was not specifically reported in the present study. The use of the hypnotic drug propofol may interfere with or even abrogate the reduction of reperfusion injury effect by therapeutic hypothermia, and using intravenous propofol anesthesia appears to increase mortality after cardiac surgery compared with halogenated agents.2,3 A preclinical study has shown that propofol may result in impaired brain metabolism during hypothermic circulatory arrest.3 Moreover, the opioid-induced organ protection against ischemia reperfusion injury has been reported for decades. Recently, opioids were shown to provide cardioprotection against ischemia/reperfusion injury in patients undergoing cardiopulmonary bypass grafting.4 Therefore, we wonder whether the dose and timing of opioids or propofol in the intensive care unit affect patient outcomes. It would be interesting to reanalyze the data to address this issue. The present trial performed by Berg et al1 was well designed and performed; however, the lack of detailed information about drug therapy in this study makes it confusing to understand whether the positive outcomes are attributable to the benefit of elevated diastolic blood pressure or the disturbance from different therapeutic interventions.Sources of FundingThis work was supported by the National Natural Science Foundation of China (No. 81800238), and Shandong Provincial Natural Science Foundation, (ZR201702200205).DisclosuresNone.Footnoteshttps://www.ahajournals.org/journal/circReferences1. Berg RA, Sutton RM, Reeder RW, Berger JT, Newth CJ, Carcillo JA, McQuillen PS, Meert KL, Yates AR, Harrison RE, Moler FW, Pollack MM, Carpenter TC, Wessel DL, Jenkins TL, Notterman DA, Holubkov R, Tamburro RF, Dean JM, Nadkarni VM; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) PICqCPR (Pediatric Intensive Care Quality of Cardio-Pulmonary Resuscitation) Investigators. Association between diastolic blood pressure during pediatric in-hospital cardiopulmonary resuscitation and survival.Circulation. 2018; 137:1784–1795. doi: 10.1161/CIRCULATIONAHA.117.032270LinkGoogle Scholar2. Kottenberg E, Thielmann M, Bergmann L, Heine T, Jakob H, Heusch G, Peters J. Protection by remote ischemic preconditioning during coronary artery bypass graft surgery with isoflurane but not propofol: a clinical trial.Acta Anaesthesiol Scand. 2012; 56:30–38. doi: 10.1111/j.1399-6576.2011.02585.xCrossrefMedlineGoogle Scholar3. Dahlbacka S, Mäkelä J, Kaakinen T, Alaoja H, Heikkinen J, Laurila P, Kiviluoma K, Salomäki T, Tuominen H, Ohtonen P, Lepola P, Biancari F, Juvonen T. Propofol is associated with impaired brain metabolism during hypothermic circulatory arrest: an experimental microdialysis study.Heart Surg Forum. 2006; 9:E710–E718.doi: 10.1532/HSF98.20061022CrossrefMedlineGoogle Scholar4. Zhang R, Shen L, Xie Y, Gen L, Li X, Ji Q. Effect of morphine-induced postconditioning in corrections of tetralogy of fallot.J Cardiothorac Surg. 2013; 8:76. doi: 10.1186/1749-8090-8-76CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails November 27, 2018Vol 138, Issue 22 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.118.035691PMID: 30571352 Originally publishedNovember 26, 2018 PDF download Advertisement SubjectsCardiopulmonary Resuscitation and Emergency Cardiac Care