Robert M. Sutton
VerifiedUniversity of Pennsylvania · Rehabilitation Medicine
Active 1988–2025
About
Robert M. Sutton, MD, MSCE, is a Professor of Anesthesiology and Critical Care at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia. He serves as an Attending Physician in Pediatric Critical Care Medicine at the Children's Hospital of Philadelphia and is a Faculty Member in the Department of Emergency Medicine at the University of Pennsylvania, where he is also the Director of the Children's Hospital of Philadelphia Research Institute Resuscitation Science Center of Emphasis. Additionally, he holds the position of Division Chief in the Division of Critical Care Medicine at the Children's Hospital of Philadelphia and is a Secretary on the Children's Anesthesia Associates (CAA) Board at CHOP. His research expertise focuses on pediatric CPR quality, with an emphasis on evaluating novel educational and technological interventions aimed at improving care during pediatric resuscitation attempts.
Research topics
- Medicine
- Internal medicine
- Emergency medicine
- Cardiology
- Intensive care medicine
- Political Science
- Anesthesia
- Medical emergency
- Humanities
- Biology
- Law
- Art
- Gerontology
Selected publications
UNC Libraries · 2025-04-17
articleOpen accessThe American Heart Association, along with its collaborating organizations American Academy of Pediatrics, American Association for Respiratory Care, American Society of Anesthesiologists, and the Society of Critical Care Anesthesiologists, is committed to providing the most up-to-date evidence-based guidelines on resuscitation and supporting the health care providers that provide these interventions. At times, there is a need for an interim statement based on new data or, in the case of this pandemic, a rapidly changing environment. Interim guidance may arise from a scientific review of a single topic, or the need for a best-practice statement because of new or urgent public health initiatives. Based on evolving epidemiological reports, emergence of new and more transmissible strains of the coronavirus, declining vaccine effectiveness, as well as recent feedback from the health care provider community, it became clear that the guidance developed in the spring of 2021 and published in October 2021 needed to be updated to emphasize fully protecting health care providers who perform resuscitation. Our overall guiding principles and goals in providing this interim guidance are to achieve the best possible resuscitation outcomes and simultaneously ensure optimal protection for health care providers. Language has been clarified in this updated interim guidance to adhere to this guiding principle. Interim guidance will continue to evolve as the pandemic continues to ensure our guidance reflects the best, most up-to-date science and available evidence to guide best practices.
Critical Care Medicine · 2025-01-01
articleResuscitation · 2025-09-25
articleOpen accessAIM: We aimed to quantitatively describe vital sign abnormalities prior to pediatric IHCA and evaluate whether the severity of abnormalities was independently associated with survival. METHODS: In a retrospective cohort study using the American Heart Association's Get with The Guidelines-Resuscitation® registry, children with ≥1 min of cardiopulmonary resuscitation (CPR) in an Intensive Care Unit (ICU) from 2007 to 2022 with prearrest vital signs were included. Vital signs most proximate to CPR (10-120 min prior) were classified as abnormal (HR or RR >95th, SBP or DBP <5th percentile for age). Multivariable regression adjusted for age, illness category, prearrest conditions, and prearrest interventions assessed the associations between vital sign abnormalities and outcomes (primary: survival to hospital discharge, secondary: return of spontaneous circulation [ROSC]). RESULTS: Of 2875 IHCA patients meeting inclusion criteria, 1790 (62.3 %) had at least one abnormal vital sign. Patients with vital sign abnormalities were older, had non-surgical illness categories, and higher prevalence of prearrest illnesses and interventions. Low SBP (<5%) was the vital sign with the lowest odds of survival to hospital discharge (aOR 0.56 [95 %CI 0.46-0.68], p < 0.01) and ROSC (aOR 0.63 [95 %CI 0.54-0.73], p < 0.01). There was a stepwise decrease in the adjusted odds of survival for each additional abnormal vital sign (1 vs 0: aOR 0.62 [95 %CI 0.51-0.76], p < 0.01; 2 vs 1: 0.72 [95 %CI 0.53-0.97] p = 0.03; 3 vs 2: 0.53 [95 %CI 0.33-0.86] p < 0.01). CONCLUSIONS: Prearrest vital sign abnormalities are common in pediatric ICU IHCA and independently associated with worse outcomes, emphasizing the need for prompt detection and intervention to improve outcomes.
Circulation · 2025-11-03
articleBackground: Animal and recent clinical studies have identified differences in the hemodynamic response to epinephrine between survivors and non-survivors. We aimed to evaluate how sequential epinephrine responses during CPR relate to survival outcomes in an animal model of cardiac arrest with standard chest compression depth. Hypothesis: Hemodynamic responses to sequential epinephrine doses during CPR change over time and are associated with ROSC. Methods: We retrospectively analyzed hemodynamic data acquired in pediatric swine models ( Sus scrofa , 9-13kg) of asphyxia-associated cardiac arrest treated with CPR (n=69). Epinephrine (0.02mg/kg) was administered every 3-4min starting 2 minutes into CPR. Defibrillation was attempted after 10 or 15min of CPR based off the cohort. Manual or mechanical chest compressions were performed at a set depth and rate throughout CPR. Median and interquartile ranges were calculated for diastolic blood pressure (DBP), systolic blood pressure (SBP), end-tidal CO 2 (ETCO 2 ), pulse pressure (SBP-DBP), and right atrium pressure (RaP) for each 15-second epoch and the change between pre-epinephrine values and each 15-second value for the 3m post-epinephrine were determined. Wilcoxon rank-sum tests were used for sequential Epi dose to compare survivors and non-survivors at each epoch. Trends across Epi doses within both groups were compared using Kruskal-Wallis test with Bonferroni correction. Results: Sixty-nine animals (survivor 42, non-survivor 27) were included. Baseline characteristics were similar between groups. Comparisons between survivors and non-survivors for the first 3 Epi doses are show in in Figure 1. During the evaluation period, non-survivors had progressively diminished responses to Epi as noted by lower delta DBP and SBP. RaP showed no significant change. Non-survivors exhibited progressive decline in median pulse pressure with each subsequent dose (Figure 2), whereas survivors maintained stable pulse pressure with no significant change between the first and the third doses. Discussion: In an animal model of asphyxia-associated cardiac arrest, the response to successive epinephrine administration diverge between survivors and non-survivors. Although the two groups have comparable responses to the first Epi dose, non-survivors have lower blood pressures and a decreased response to subsequent Epi doses. Future studies should explore alternative resuscitation strategies for animals based off Epi responsiveness.
Phytomedicine · 2025-02-05 · 4 citations
articleOpen accessBACKGROUND: Whether circulating histones in gut lymph contribute to organ failure and impact of chaiqin chengqi decoction (CQCQD) on histones in severe acute pancreatitis (SAP) remain elusive. PURPOSE: To verify the role of histones in gut lymph of SAP and evaluate the effect of the CQCQD on them. METHODS: Sodium taurocholate was retrogradely infused into pancreatobiliary duct to induce SAP in rodents. Various regimens of CQCQD were administered intragastrically or via duodenum followed by dynamic gut lymph collection in rats. The impact of gut lymph and histones on endothelial cell viability and lymphocytes was determined. Components of CQCQD in gut lymph were identified by UHPLC-MS and their binding activities with histones were quantified by biolayer interferometry followed by validation in vitro and in vivo in mice. RESULTS: The histone level was significantly increased in gut lymph of SAP at various time points assessed, closely correlating with multiple organ injury (MOI) indices and contemporary cell viability. Inhibition of histones reduced cytotoxicity induced by SAP-conditioned gut lymph. CQCQD reduced apoptotic cell death in mesenteric lymph nodes, histone level, and cytotoxicity of gut lymph, alleviating MOI parameters. Baicalin and baicalein were amongst top 13 identified CQCQD components absorbed into gut lymph to actively bind histones, block membrane disruption and calcium influx of lymphocytes, and inhibit their cytotoxicity. Both baicalin and baicalein mitigated histone- and SAP-induced MOI indices in mice. CONCLUSION: Histones are key toxic factors in the gut lymph of SAP and their antagonism by baicalin and baicalein offers a novel therapeutic strategy.
Resuscitation · 2025-11-08 · 1 citations
articleOpen accessCritical Care Medicine · 2025-01-01
articleEpinephrine Before Defibrillation in Children With Initially Shockable In-Hospital Cardiac Arrest
Critical Care Medicine · 2025-07-30 · 2 citations
articleOpen accessOBJECTIVE: Assess prevalence of epinephrine before or during the same minute as defibrillation and association with clinical outcomes in pediatric in-hospital cardiac arrest (IHCA). DESIGN: Retrospective cohort study. SETTING: We used 2000-2020 data from the American Heart Association's Get With the Guidelines-Resuscitation Registry. PATIENTS: Children (< 18 yr) with index IHCA with an initial shockable rhythm of ventricular fibrillation or pulseless ventricular tachycardia and at least one defibrillation attempt. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary exposure was epinephrine administration before or during the same minute as defibrillation. Study outcomes were survival to hospital discharge (primary outcome), return of spontaneous circulation (ROSC) for greater than or equal to 20 min, and survival with favorable neurologic outcome. Propensity-score matching was used for confounding adjustment. Among 492 pediatric IHCA index events with an initial shockable rhythm, median age was 7 years and 351 (71%) were in the ICU. Overall, 232 (47%) children received either epinephrine before defibrillation (29%) or during the same minute as defibrillation (18%). In unadjusted analyses, proportions of survival to hospital discharge (37.1% vs. 51.2%), ROSC (74.6% vs. 84.6%), and survival with favorable neurologic outcome (22.1% vs. 40.4%) were lower in the epinephrine before or during the same minute as defibrillation group. However, in adjusted analyses using propensity score matching with exact matching on time to defibrillation category, epinephrine before or during the same minute as defibrillation was not associated with hospital survival (odds ratio [OR] 0.84, 0.46-1.56), ROSC (OR 0.97, 0.48-1.96), or favorable neurologic outcome (OR 0.52, 0.27-1.00). CONCLUSIONS: Contrary to current guidelines, nearly 50% of pediatric IHCA due to an initial shockable rhythm receive epinephrine before, or during the same minute, as first defibrillation. Although survival outcomes were numerically lower in epinephrine before defibrillation group, the association was not statistically significant.
Resuscitation Plus · 2025-03-14 · 1 citations
articleOpen accessMeasurement of coronary perfusion pressure (CoPP) and diastolic blood pressure (DBP) during cardiopulmonary resuscitation (CPR) is important for titration of physiologic-directed CPR. However, agreement between different calculation methods and their relative performance as outcome discriminators are not well established. Four calculation methods, differentiated by sampling technique, were retrospectively applied to pressure waveforms from piglet CPR: late diastole (CoPP 65 , DBP 65 ), mid-diastole (CoPP 50 , DBP 50 ), diastolic minimum (CoPP min , DBP min ), and diastolic mean (CoPP mean , DBP mean ). Intermethod agreement was assessed by Bland-Altman analysis and Cohen’s kappa statistic. Logistic regression was used to evaluate performance in discriminating return of spontaneous circulation (ROSC) and to identify optimal thresholds. Relative to CoPP 65 , measurements by CoPP 50 , CoPP min , and CoPP mean were within 5 mmHg limits of agreement (LOA) in 97%, 64%, and 99% of instances with kappa 0.88, 0.76, and 0.91, respectively. Relative to DBP 65 , measurements by DBP 50 , DBP min , and DBP mean were within 5 mmHg LOA in 98%, 71%, and 99% of instances with kappa 0.90, 0.80, and 0.91, respectively. The areas under the ROC curves (AUC) for CoPP 65 , CoPP 50 , CoPP min , and CoPP mean were 0.777, 0.792, 0.787, and 0.788, and optimal thresholds to discriminate ROSC were 15.3, 15.8, 12.3, and 14.7 mmHg, respectively. The AUCs for DBP 65 , DBP 50 , DBP min , and DBP mean were 0.813, 0.827, 0.833, and 0.826, and optimal thresholds to discriminate ROSC were 28.6, 27.3, 26.2, and 29.7 mmHg, respectively. During piglet CPR, measurements by late diastole, mid-diastole, and diastolic mean strongly agreed, whereas those at diastolic minimum were more discrepant. All methods performed similarly in discrimination of ROSC.
Annals of the American Thoracic Society · 2025-06-04 · 1 citations
articleOpen accessSenior authorAbstract Rationale Delayed (&gt;5 minutes) epinephrine during pediatric in-hospital cardiac arrest (IHCA) is associated with worse outcomes. Epinephrine is nearly always given earlier, limiting 5 minutes as a quality target. Objectives To assess early epinephrine administration (⩽2 minutes) on outcomes and hemodynamics during cardiopulmonary resuscitation (CPR) in pediatric IHCA from pulseless, nonshockable rhythms. Methods This study leveraged the database of the ICU-RESUS (Intensive Care Unit Resuscitation) project (clinicaltrials.gov identifier NCT 02837497). Primary exposure was the time to epinephrine bolus: early versus &gt;2 minutes. Primary outcome was survival to discharge. Secondary outcomes included the return of spontaneous circulation (ROSC), survival with favorable neurologic outcome, change from baseline to discharge Functional Status Scale (FSS) score, total FSS score at discharge, new morbidity among survivors, and invasively measured blood pressure during the first 10 minutes of CPR. Results Among 352 CPR events, median age was 1.0 (interquartile range [IQR], 0.3–8.0) year, 186 (53%) were male, and 185 (52.6%) had cardiac disease. Early epinephrine was administered in 273 (78%), and median time to administration was 1.0 (0.0–2.0) minute. Survival to discharge was similar between patients who received early epinephrine and those who did not. Early epinephrine administration was associated with higher ROSC, a change from baseline to discharge in FSS, lower total FSS scores at discharge, and lower rates of new morbidity compared with epinephrine administration at &gt;2 minutes. The probability of ROSC and survival to discharge with favorable neurologic outcome decreased for each minute of delay in epinephrine administration. There was no difference in the invasive blood pressure targets during the first 10 minutes of CPR. Conclusions Early epinephrine administration was common and was associated with higher ROSC and improved functional outcomes compared with epinephrine administration at &gt;2 minutes in pediatric IHCA.
Recent grants
Improving Outcomes after Pediatric Cardiac Arrest
NIH · $3.1M · 2016–2023
Validation of Physiologic CPR Quality Using NOn-inVasive Waveform Analytics (CPR-NOVA)
NIH · $846k · 2019–2022
NIH · $604k · 2016
Frequent coauthors
- 617 shared
Vinay Nadkarni
Children's Hospital of Philadelphia
- 568 shared
Robert A. Berg
University of Pennsylvania
- 445 shared
Ryan W. Morgan
University of Pennsylvania
- 286 shared
Heather Wolfe
Children's Hospital of Philadelphia
- 212 shared
Maryam Y. Naim
- 170 shared
Alexis A. Topjian
- 162 shared
Kathryn Graham
Children's Hospital of Philadelphia
- 154 shared
Todd C. Carpenter
University of Colorado Denver
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