Abstract Body: Background: Myocardial function and systemic inflammation and their impact on outcomes after pediatric cardiac arrest is understudied. We aimed to prospectively evaluate the association of early myocardial dysfunction and systemic inflammation with hospital mortality. We also sought to identify correlations between arrest characteristics and outcomes with echocardiographic myocardial function and circulating inflammatory biomarkers to inform future study design. We hypothesized that worse myocardial function and higher levels of inflammation would be associated with hospital mortality.

Methods: We prospectively enrolled children <18 who received CPR >1 minute after in- or out-of-hospital cardiac arrest and were admitted to an intensive care unit. We excluded subjects on extracorporeal life support, or within 7 days of bypass. We obtained echocardiograms for global longitudinal and circumferential strain (GLS, GCS) and blood samples for measure of 15 biomarkers within 36 hours of arrest. Clinical data, GLS and GCS, and log-transformed biomarker levels were compared between non-survivors and survivors. Correlations between variables was made with Spearman rho coefficients (ρ). Univariate logistic regression tested the associations between exposures and hospital mortality. In this pilot, p<0.1 was deemed significant for future study.

Results: We included 38 subjects with echocardiography; 20 of which had blood samples. Median age was 2.5 years (IQR 0.8-7.1); 57% (n=23) had out-of-hospital arrests and median CPR duration was 10 minutes (IQR 3.5-16.1). Ten subjects (26%) died prior to hospital discharge. GLS (OR 0.98, p=0.72) and GCS (OR 0.92, p=0.22) were not associated with mortality, while MMP-1 (OR 1.67, p=0.09) and IL-8 (OR 2.7, p=0.08) suggested association with mortality. CPR duration was not associated with GLS and GCS but was moderately correlated with MMP-1 (ρ=0.41) and ST2 (ρ=0.51). CXCL10 and TNFa (ρ=0.74), IL-10 and TNFa (ρ=0.70), IL-10 and CXCL10 (ρ=0.83), sRAGE and IL-6 (ρ=0.72) were strongly correlated. MMP-1 and IL-8 (ρ=0.75) and MMP-9 and ST2 were strongly inversely correlated (ρ=-0.72).

Conclusion: This pilot study found preliminary associations between inflammatory biomarkers, including including MMP-1 and IL-18, and hospital mortality, but not between echocardiographic function and morality. Larger studies will further investigate the association of myocardial dysfunction and inflammation with pediatric post-cardiac arrest outcomes.