Objective: Less than half of the thousands of children who suffer in-hospital cardiac arrests annually survive and neurologic injury is common among survivors. Hemodynamic-directed cardiopulmonary resuscitation (HD-CPR) improves short-term survival but its impact on longer term survival and mitochondrial respiration -a potential neurotherapeutic target -remains unknown. The primary objectives of this study were to compare rates of 24-hour survival with favorable neurologic outcome after cardiac arrest treated with HD-CPR versus standard depthguided CPR (DG-CPR) and to compare brain and heart mitochondrial respiration between groups 24 hours after resuscitation.

Objectives To determine whether peak blood PCT measured within 48 hours of pediatric intensive care unit (PICU) admission can differentiate severe bacterial infections from sterile inflammation and viral infection and identify potential subgroups of PICU patients for whom PCT may not have clinical utility. Study design This was a retrospective, observational study of 646 critically ill children who had PCT measured within 48 hours of admission to an urban, academic PICU. Patients were stratified into 6 categories by infection status. We compared test characteristics for peak PCT, C-reactive protein (CRP), white blood cell count (WBC), absolute neutrophil count (ANC), and percentage immature neutrophils (% Imm). The area under the receiver operating characteristic curve (AUROC) was determined for each biomarker to discriminate bacterial infection. Results The AUROC was similar for PCT (0.73, 95% CI 0.69, 0.77) and CRP (0.75, 95% CI 0.71, 0.79; p=0.36), but both outperformed WBC, ANC, and % immature neutrophils (p<0.01 for all pairwise comparisons). The combination of PCT and CRP was no better than either PCT or CRP alone. Diagnostic patterns prone to false-positive and false-negative PCT values were identified. Conclusions Peak blood PCT measured close to PICU admission was not superior to CRP in differentiating severe bacterial infection from viral illness and sterile inflammation; both PCT and CRP outperformed WBC, ANC, and % immature neutrophils. PCT appeared especially prone to inaccuracies in detecting localized bacterial central nervous system infections or bacterial co-infection in acute viral illness causing respiratory failure.