About

Alexis A. Topjian, 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 the Department of Anesthesiology and Critical Care Medicine at the Children's Hospital of Philadelphia and is a member of the Medical Staff at the Hospital of the University of Pennsylvania. Additionally, he is a faculty member at the Center for Resuscitation Science within the Department of Emergency Medicine at the University of Pennsylvania and holds the position of Associate Chair for Faculty Affairs at the Children's Hospital of Philadelphia.

Research topics

• Medicine
• Medical emergency
• Emergency medicine
• Intensive care medicine
• Internal medicine
• Political Science
• Humanities
• Anesthesia
• Cardiology
• Art
• Pediatrics
• Gerontology
• Law

Selected publications

• Quality of Bag-Mask Ventilation for Children Before Intubation: Single-Center PICU Pilot Observational Study, 2019–2022

  Pediatric Critical Care Medicine · 2026-03-23 · 1 citations

  articleOpen access

  OBJECTIVES: To characterize the quality of bag-mask ventilation (BMV) before tracheal intubation in children in the PICU and to evaluate the association between poor BMV quality and adverse airway outcomes. DESIGN: Single-center, pilot observational study, 2019-2022. SETTING: Large, urban quaternary care PICU. PATIENTS: Pediatric patients requiring BMV before tracheal intubation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using a respiratory function monitor, we collected flow and pressure data from 8446 BMV breaths before tracheal intubation in 85 children in the PICU (median age, 3.3 yr [interquartile range, 1.4-8.3 yr]). Adverse airway outcomes (i.e., tracheal intubation-associated event and/or pulse oximetry desaturation < 80%) occurred in 14 of 85 patients (16.5%). Low-quality BMV breaths were defined as: 1) inadequate or excessive exhaled tidal volume (VTe < 4 or > 12 mL/kg); 2) excessive peak inspiratory pressure (PIP) and excessive VTe; 3) excessive facemask leak (> 40%); or 4) failure to relieve upper airway obstruction. Overall, 78.0% of BMV breaths met at least one low-quality criterion; most frequently inadequate or excessive VTe (55.5%), followed by excessive leak (46.2%). Infants (< 1 yr) and young children (1-7 yr), compared with older children (8-17 yr), had a higher proportion of low-quality BMV breaths overall (86.0%, 85.5% vs. 57.9%; p < 0.001 for both), with inadequate or excessive VTe (57.7%, 61.1% vs. 43.7%; p < 0.001 for both), excessive leak (50.6%, 49.2% vs. 37.0%; p < 0.001 for both), and excessive PIP with excessive VTe (17.5%, 19.4% vs. 6.4%; p < 0.001). After controlling for respiratory pathology, low-quality BMV was associated with 2.8-times greater odds of adverse airway outcome (adjusted odds ratio, 2.8 [95% CI, 1.2-6.2]; p = 0.01). CONCLUSIONS: The majority of BMV breaths delivered to children before tracheal intubation in the PICU were of low-quality. And, such breaths, were more frequent in younger children and were associated with greater odds of adverse airway outcomes.

  PublisherOA PDFDOI

• Prediction of neurological outcome after pediatric cardiac arrest using heart rate variability and machine learning

  Resuscitation · 2026-01-06

  articleOpen access
  PublisherOA PDFDOI

• Epinephrine Before Defibrillation in Children With Initially Shockable In-Hospital Cardiac Arrest

  Critical Care Medicine · 2025-07-30 · 2 citations

  articleOpen access

  OBJECTIVE: 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.

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• Pediatric cardiac arrest outcome prediction using data-driven machine learning of early quantitative electroencephalogram (qEEG) features

  Resuscitation · 2025-10-08 · 3 citations

  articleOpen access
  PublisherOA PDFDOI

• Part 8: Pediatric Advanced Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

  PEDIATRICS · 2025-10-22 · 4 citations

  articleOpen accessSenior author

  The American Heart Association and the American Academy of Pediatrics provide these pediatric advanced life support guidelines focusing on resuscitation during cardiopulmonary resuscitation and emergency cardiovascular care. These guidelines are intended to be a resource for health care professionals to identify and treat infants and children up to 18 years of age (excluding newborn infants) in the prearrest, intra-arrest, and post-cardiac arrest states as well as select other emergency care situations. These guidelines apply to infants and children in various settings, including the community, prehospital environments, and hospital environments. Topics presented include ventilation and advanced airway strategies during cardiopulmonary resuscitation; drug administration and weight-based dosing of medications during cardiopulmonary resuscitation; energy doses for defibrillation; measuring cardiopulmonary resuscitation physiology and quality; extracorporeal cardiopulmonary resuscitation; post-cardiac arrest care related to management of core temperature, blood pressure, oxygenation/ventilation, neurologic monitoring, and seizures; neurological prognostication post-cardiac arrest; post-cardiac arrest survivorship; family presence during cardiopulmonary resuscitation; evaluation of sudden unexplained cardiac arrest; management of shock types; airway/intubation management; arrhythmia management including bradycardia and tachycardia (narrow and wide complex); treatment of myocarditis/cardiomyopathies; resuscitation of patients with single ventricle congenital heart disease; management of pulmonary hypertension; and management of traumatic cardiac arrest. Lastly, important gaps in resuscitation science knowledge are identified, aiming to encourage further scientific inquiry and provide additional evidence for future pediatric advanced life support guidelines. Key Words: AHA Scientific Statements • cardiopulmonary resuscitation • child • epinephrine • heart arrest • pediatric • prognosis.

  PublisherOA PDFDOI

• Pediatric Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations

  PEDIATRICS · 2025-10-22 · 1 citations

  articleOpen access

  The International Liaison Committee on Resuscitation conducts continuous review of new peer-reviewed published cardiopulmonary resuscitation science and publishes annual summaries. More comprehensive reviews are published every 5 years. The Pediatric Life Support Task Force chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations addresses all published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Pediatric Life Support Task Force members in the past year, as well as brief summaries of topics reviewed since 2020, to provide a more comprehensive update. In total, 39 questions related to pre-arrest, intra-arrest, and postarrest resuscitation phases of pediatric cardiac arrest are included, including systematic reviews, scoping reviews, and evidence updates. Members of the task force assessed, discussed, and debated the quality of evidence, based on Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. The task force has also listed priority knowledge gaps for further research. Key Words: AHA Scientific Statements • cardiac arrest • cardiopulmonary arrest • cardiopulmonary resuscitation • children • ILCOR • pediatrics • resuscitation.

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• Intubation Trends and Survival in Pediatric In-Hospital Cardiac Arrest

  JAMA Network Open · 2025-11-20 · 3 citations

  articleOpen access

  Importance: The optimal airway management during pediatric in-hospital cardiac arrest (IHCA) is unknown. Objective: To evaluate intubation trends during pediatric IHCA between 2000 and 2022, and determine the association of intra-arrest intubation with survival in a recent cohort of patients (2017-2022). Design, Setting, and Participants: This retrospective cohort study (analysis performed between June 2023 and October 2024) used data from the multicenter American Heart Association Get With The Guidelines-Resuscitation registry. Pediatric patients (<18 years) with IHCA from 2000 through 2022 were included. Exposure: Intra-arrest endotracheal intubation. Main Outcomes and Measures: The primary outcome was survival to hospital discharge. Intra-arrest intubation trends were assessed using nonparametric test for trend. A time-dependent propensity matched analysis assessed the association between intra-arrest intubation and hospital survival from 2017 through 2022. Each minute, patients intubated were matched with patients at risk of intubation using a propensity score, with forced matching on stratification variables and replacement of controls. Mixed-effects logistic regression assessed the association with survival outcomes, with subgroup analysis by age and illness category. Results: The cohort included 3262 pediatric patients with IHCA (median age, 12.0 [IQR, 3.0-83.8] months; 1775 [54.4%] male) with no advanced airway at CPR onset. Return of spontaneous circulation was attained in 2413 patients (74.0%), and 1748 (53.6%) survived to hospital discharge. The intubation rate decreased over time (33 of 39 [84.6%] in 2000 to 112 of 168 [66.7%] in 2022; P < .001). In the 2017-2022 cohort, intubation vs nonintubation in each minute of CPR was associated with decreased discharge survival odds in unadjusted analysis (odds ratio [OR], 0.18; 95% CI, 0.14-0.24; P < .001) but not after matching (adjusted OR, 1.18; 95% CI, 0.90-1.53; P = .23). In children aged 8 years or older, after matching, intubation compared with nonintubation in each minute was associated with increased odds of discharge survival (adjusted OR, 1.91; 95% CI, 1.09-3.33; P = .02). Conclusions and Relevance: In this cohort study of pediatric patients with IHCA between 2017 and 2022 without an advanced airway at the start of CPR, no association was identified between intra-arrest tracheal intubation and hospital survival after time-dependent propensity score matching. In subgroup analysis, intra-arrest intubation in children 8 years or older was associated with higher survival odds. These findings may have important clinical implications for clinicians caring for children with IHCA and warrant further investigation into the physiologic and practical mechanisms of this association.

  PublisherOA PDFDOI

• Pediatric Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations

  Resuscitation · 2025-10-01 · 1 citations

  article
  PublisherDOI

• Author response: NIRS illuminates, but MAPopt should guide post-cardiac arrest care

  Resuscitation · 2025-09-30

  letter
  PublisherDOI

• New sepsis-associated morbidity and mortality in pediatric oncology patients

  Frontiers in Oncology · 2025-08-27 · 1 citations

  articleOpen access

  Sepsis is a leading cause of morbidity and mortality in children worldwide, yet the development of new morbidity after sepsis has not been clearly defined in high-risk subgroups such as children with cancer. Using the TOPICC (Trichotomous Outcome Prediction in Critical Care) multicenter cohort study dataset, we evaluated whether children with cancer have a higher risk of the composite outcome of death or new morbidity at hospital discharge compared to children without cancer. Among 854 children with sepsis, 88 patients (10.3%) had an underlying cancer diagnosis. Children with cancer were older (median 8.1 vs 3.7 years) and more frequently developed sepsis while in the hospital. The pattern of organ failure differed between groups, with less frequent invasive mechanical ventilation (26.1% vs 49.9%, p &amp;lt;0.001) but more frequent vasoactive infusions (47.7% vs 35.8%, p =0.03) in children with cancer compared to non-oncology patients. Children with cancer had an increased rate of death or new morbidity (22.7% vs 12.1%, p= 0.006) compared to non-oncology patients. New morbidity (defined by ΔFSS score &amp;gt;2 points) occurred in 13.9% of cancer vs 6.9% of non-cancer survivors ( p =0.03), and PICU mortality was similar between groups (10.2% vs 5.6%, p =0.09). Cancer diagnosis was independently associated with higher odds of death or new disability at discharge (adjusted odds ratio 3.71, p &amp;lt;0.001) in multivariable logistic regression, after adjusting for baseline FSS, baseline developmental delay, clinical concern for neurologic injury on PICU admission, and PICU supportive measures. These results suggest that children with cancer who develop sepsis are more likely to experience adverse outcomes at hospital discharge, even after accounting for baseline health and critical illness severity.

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Recent grants

• NIH Grant K23NS075363

  NIH · $874k · 2018

Frequent coauthors

• Vinay Nadkarni

  Children's Hospital of Philadelphia

  476 shared

• Robert A. Berg

  University of Pennsylvania

  471 shared

• Iván Sánchez Fernández

  Boston University

  424 shared

• Nicholas S. Abend

  Children's Hospital of Philadelphia

  423 shared

• Matthew P. Kirschen

  226 shared

• Ryan W. Morgan

  University of Pennsylvania

  174 shared

• Robert M. Sutton

  Children's Hospital of Philadelphia

  170 shared

• Katrina Peariso

  Children's Hospital of Philadelphia

  169 shared

Education

• B.A., Biology

  Harvard College

  1996

• M.D.

  Columbia College of Physicians & Surgeons

  2001

• Other

  University of Pennsylvania School of Medicine

  2011