Post-ROSC Blood Pressure Targets After Pediatric Cardiac Arrest
Red Cross Guidelines
- For infants and children with return of circulation following an in-hospital or out-of-hospital cardiac arrest, it is reasonable to target a systolic or mean arterial blood pressure greater than the 10th percentile for age and sex. UPDATED
Insights
Hypotension in infants and children after return of circulation (ROC) can contribute to secondary cerebral and myocardial injury and is associated with poor outcomes. Determining the optimal blood pressure target has been the focus of recent research and systematic reviews. Previous Red Cross guidelines recommended targeting a systolic blood pressure above the 10th percentile for age following ROC. An updated systematic review found that, in addition to systolic blood pressure, exposure to a mean arterial blood pressure (MAP) above the 10th percentile within the first 6 hours after ROC was associated with more favorable neurological outcome at hospital discharge, compared with a MAP at or below the 10th percentile. Based on this evidence, the Red Cross guidelines now suggest targeting either a systolic blood pressure or MAP greater than the 10th percentile for age in infants and children after ROC, whether from in- or out-of-hospital cardiac arrest.