Current practice in pediatric post-cardiac arrest care: a national survey among Italian pediatric intensivists

Background and aims: Pediatric post-cardiac arrest care (PCAC) is an evolving science with many uncertainties leading to many variations in practice. This study aimed to investigate the current practice in PCAC care across Italian paediatric intensive care units (PICUs), interviewing a cohort of pediatric intensivists. Methods: An electronic survey with 69 questions was distributed to 54 physicians from 23 PICUs in Italy. The survey covered various domains of PCAC care, including hemodynamics, oxygenation and ventilation, sedation, seizure and temperature control, infection treatment, glycemic control, transfusion practice, neuroprognostication, post-CA recovery and rehabilitation, organisation and local protocols. Results: Twenty-eight out of 54 invited physicians (51%) completed the survey, accounting for 82% of the participating PICUs. Up to 80% reported no specific PCAC protocol in their PICU. Half of the respondents suggested specific recommendations for patients of lower ages, particularly infants. Significant variability was observed in hemodynamic monitoring and support; 45% did not have a specific hemodynamic target, while 41% aimed for a systolic arterial pressure above the 50th age-specific percentile. Seventy-one percent lacked a protocol for target temperature management (TTM), with significant variability in practice. Sixty-four percent did not have a scheduled follow-up program for survivors after hospital discharge. A rehabilitation program for survivors and psychological support for patients and their families were available in half of the instances. Neuroprotective strategies, prognostication, and hemodynamic management were the top PCAC research priorities reported. Conclusion: The study revealed significant variability in PCAC care practices among pediatric intensivists. The majority of surveyed practitioners evidenced the limits of current PCAC evidence, potentially advocating the need for further research. The top three areas recognised as PCAC research priorities include hemodynamic optimisation, neuroprotective therapies and neuroprognostication.