About

Ryan W. Morgan, MD, MTR, is an Associate 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. Dr. Morgan is also the Associate Director of the Resuscitation Science Center at the Research Institute of the Children's Hospital of Philadelphia and the Chair of the Hospital Resuscitation Committee, having previously served as Vice Chair. His role includes overseeing critical care and resuscitation efforts, with a focus on pediatric cardiac arrest and resuscitation science. His educational background includes a BS in Cell and Molecular Biology from Binghamton University, an MD from New York University School of Medicine, and a Master’s in Translational Research from the University of Pennsylvania Perelman School of Medicine. His research contributions involve pediatric advanced life support, outcomes of in-hospital cardiac arrest in children with sepsis, and the physiologic responses during pediatric cardiopulmonary resuscitation, among other areas related to pediatric critical care and resuscitation.

Research topics

• Medicine
• Internal medicine
• Humanities
• Cardiology
• Computer Science
• Biology
• Political Science
• Anesthesia
• Computational biology
• Gerontology
• Art
• Microbiology
• Emergency medicine
• Medical emergency
• Law
• Intensive care medicine
• Genetics

Selected publications

• Diastolic Blood Pressure During Pediatric In-Hospital Cardiac Arrest: Trends and Associations With Outcomes

  Critical Care Medicine · 2026-03-31

  articleOpen accessSenior author

  OBJECTIVES: Pediatric resuscitation guidelines support using diastolic blood pressure (DBP) as a marker of cardiopulmonary resuscitation (CPR) quality. Thresholds of greater than or equal to 25 mm Hg in infants and greater than or equal to 30 mm Hg in children were derived from data limited to the first 10 minutes of CPR, regardless of event duration. We aimed to describe DBP trajectories throughout in-hospital cardiac arrest and evaluate associations between DBP thresholds and return of spontaneous circulation (ROSC) in prolonged CPR (≥ 10 min). DESIGN: Single-center retrospective cohort study (2017-2023). SETTING: PICU and CICU. PATIENTS: Pediatric IHCA with invasive arterial BP monitoring. SETTING AND PATIENTS: Pediatric IHCAs with invasive arterial BP monitoring. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Events with greater than or equal to 1 minute of evaluable DBP data were included in trend analyses; those with greater than or equal to 1 minute of evaluable DBP data after 10 minutes of CPR were included in prolonged CPR analyses. Linear and mixed-effects regression assessed DBP trends; univariate logistic regression evaluated associations between DBP thresholds and ROSC. Among 118 events (median age 0.4 yr; 69% with congenital heart disease), DBP rose early and plateaued above guideline thresholds. Early ROSC was associated with higher average DBP (p = 0.02) and steeper early DBP rise (p < 0.001). In 46 prolonged events, 80% had mean DBP above guideline thresholds. In prolonged CPR, an upward DBP trend was associated with ROSC (p < 0.001). In prolonged CPR, meeting current DBP thresholds was not significantly associated with ROSC, but achieving higher thresholds (≥ 30 mm Hg in infants and ≥ 35 mm Hg in children) later in CPR was associated with ROSC (odds ratio 7.14; 95% CI, 1.58-51.35; p = 0.009). CONCLUSIONS: DBP can be sustained above current thresholds during prolonged CPR. Larger cohort studies are needed to determine if higher, patient-specific, and time-dependent DBP targets are required to achieve ROSC in prolonged CPR.

  PublisherOA PDFDOI

• Latest in Resuscitation Research: Highlights from the 2025 American Heart Association's Resuscitation Science Symposium

  Journal of the American Heart Association · 2026-05-06

  articleOpen access
  PublisherDOI

• 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

• Extracorporeal cardiopulmonary resuscitation for pediatric cardiac arrest: lifesaving rescue, but not for everyone

  Current Opinion in Pediatrics · 2026-02-23

  articleSenior author

  PURPOSE OF REVIEW: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used as a rescue therapy for pediatric cardiac arrest. Its use has expanded beyond its original application in select cardiac populations at highly specialized centers despite limited evidence regarding patient selection, intra-arrest management, and long-term outcomes. Current pediatric ECPR data are derived predominantly from observational studies and registries that are vulnerable to selection bias and incomplete reporting. Estimates of benefit may be overstated, and generalizability across heterogeneous cardiac arrest populations remains uncertain. RECENT FINDINGS: We examine five key vulnerabilities in pediatric ECPR: limitations of supporting data; challenges in patient selection; compromise of other resuscitative priorities during deployment; impact on patients and families; and strain on healthcare systems and personnel. While ECPR can be lifesaving for carefully selected patients, its indiscriminate application risks unintended harm by undermining patient-centered outcomes and program sustainability. SUMMARY: Responsible expansion of ECPR requires acknowledgement of existing knowledge gaps, investment in thorough collection of prospective data including neurologic and quality-of-life outcomes, and development of clearer institutional frameworks for candidacy. Aligning eagerness for this rescue modality with scientific objectivity is critical to ensure ECPR aligns with the best interests of children, families, and healthcare systems.

  PublisherDOI

• Machine Learning-Based Prediction of Critical Deterioration in the PICU

  Critical Care Explorations · 2026-04-01

  articleOpen access

  BACKGROUND: Existing PICU early warning systems lack sufficient accuracy and timeliness for effective preparation. Machine learning approaches may improve prediction of critical deterioration events (CDEs), but their operational utility relative to existing tools remains unclear. OBJECTIVES: To develop a machine learning model for early detection of CDEs and evaluate operational utility against existing tools using a novel alert burden analysis. DERIVATION COHORT: PICU admissions (ages 0-24 yr, stay ≥ 24 hr) at a quaternary children's hospital from 2014 to 2020 (n = 12,771 patients; 21,141 admissions). CDEs (6% of patients) included cardiopulmonary resuscitation, extracorporeal membrane oxygenation initiation, dilute epinephrine administration, or unplanned intubation. VALIDATION COHORT: Temporally distinct PICU admissions from 2021 to 2022 (n = 5144 patients; 6929 admissions; 6% CDE rate). PREDICTION MODEL: An ensemble of extreme gradient-boosted models (PICU Warning INdex [P-WIN]) trained to predict CDEs at 1-12-hour horizons using 550 features derived from demographics, medications, laboratory results, and vital signs. RESULTS: P-WIN demonstrated excellent discrimination at 2-hour (area under the receiver operating characteristic curve [AUROC], 0.95 [95% CI, 0.94-0.96] and area under the precision-recall curve [AUPRC], 0.76 [95% CI, 0.72-0.80]) and 12-hour horizons (AUROC, 0.93 [95% CI, 0.92-0.94] and AUPRC, 0.68 [95% CI, 0.64-0.72]). To alert before 80% of events, P-WIN generated 0.20 alerts per patient-day at a median 10.17 hours before CDE. Compared with the existing rule-based PICU Warning Tool (alerting before 38% of events), P-WIN generated one-third the alert burden at equivalent sensitivity (0.03 vs. 0.10 alerts per patient-day). CONCLUSIONS: P-WIN accurately predicted PICU CDEs up to 12 hours in advance with low alert burden, providing a viable opportunity for shifting care from reactive rescue to proactive, resource-intensive preparation and prevention.

  PublisherDOI

• Severe intracranial hemorrhage or ischemia associated with unfavorable outcomes after pediatric in-hospital cardiac arrest

  Resuscitation · 2025-11-08 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• Abstract 4367514: Association of Cardiopulmonary Resuscitation Strategies with Diffuse Optical Measurements of Cerebral Hemodynamics

  Circulation · 2025-11-03

  article

  Introduction: Hemodynamic-directed cardiopulmonary resuscitation (HD-CPR) targets blood pressure (BP) goals during resuscitation and has shown improved outcomes compared to conventional algorithmic CPR. However, the relationship between specific BP targets and cerebral health remains poorly understood. Objective: Evaluate the association of intra- and post-arrest cerebral hemodynamics, assessed using non-invasive optical neuromonitoring, with CPR strategies that include higher and lower target HD-CPR and algorithmic CPR. Hypothesis: Higher target HD-CPR will result in increased crerebral oxygenation (StO 2 ) and relative blood flow (rCBF) and blood volume (rCBV) compared to lower target HD-CPR or algorithmic CPR. Methods: Invasive BP monitoring and non-invasive optical neuromonitoring were performed in a pediatric swine model of asphyxia-associated cardiac arrest. After baseline (5 min) and asphyxia (7 min), ventricular fibrillation was induced. Animals were randomized to 1) high target HD-CPR with a goal systolic BP of 110 and diastolic BP of 45 mmHg (n=15), 2) low target HD-CPR with a goal systolic BP of 80 and diastolic BP of 30 mmHg (n=15), or 3) algorithmic depth-directed CPR (n=15). During HD-CPR, vasopressor administration was titrated to BP goals versus protocolized administration every 4 min in algorithmic CPR. After 15 min of CPR, animals were eligible for defibrillation. Animals achieving return of spontaneous circulation (ROSC) were monitored for 4 hours post-ROSC. A Kruskal Wallis test compared cerebral hemodynamics between groups during baseline, asphyxia (7th min), CPR (15th min), and post-ROSC (10, 60, and 240th min). Since not all subjects achieved HD-CPR goals intra-arrest, a secondary analysis compared subjects where mean BP in the 10-15th min of CPR was at goal. Results: No intra- or post-arrest group differences were observed in StO 2 , rCBV, rCBF, and MAP (p&gt;0.05; Fig. 1). In the secondary analysis of HD-CPR animals that achieved goal BP, StO 2 was higher in the high (n=8) vs. low (n=10) target BP groups (median [IQR]: 36.5 [32.9, 38.9] vs. 27.8 [20.1, 35.2], p=0.03). Discussion: In our primary intention-to-treat analysis, no differences were observed between CPR strategies. However, high BP target HD-CPR that achieved BP goals increased cerebral oxygenation. This reinforces the established association between BP and cerebral oxygenation. Future work is needed to optimize HD-CPR strategies to consistently achieve higher blood pressures.

  PublisherDOI

• Abstract Sat206: Differences in Cerebral and Somatic Hemodynamics during Asphyxia and Cardiac Arrest and Associations with Return of Spontaneous Circulation

  Circulation · 2025-11-03 · 1 citations

  articleSenior author

  Introduction: We have developed non-invasive optical devices for concurrent monitoring of cerebral and somatic hemodynamics using frequency-domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS). Objectives: In a pediatric swine model of asphyxia-associated cardiac arrest, compare cerebral and somatic hemodynamics during asphyxia and CPR and assess their association with return of spontaneous circulation (ROSC) in early (&lt;15 min) and late CPR (15-25 min). Hypothesis: Cerebral hemodynamics will exceed somatic hemodynamics. Greater hemodynamics, and their temporal increase, during CPR will be associated with return of spontaneous circulation (ROSC). Methods: Optical cerebral and somatic monitoring was performed on the left forehead and left biceps femoris, respectively, in pediatric swine during asphyxia followed by ventricular fibrillation induction and CPR for a minimum of 15 min, up to 25 min. Animals were eligible for defibrillation at 15 min, and every 2 min thereafter. FD-DOS tissue oxygenation (StO2), total hemoglobin concentration (HbT), and DCS blood flow index (BFI) quantified oxygenation, blood volume (BV), and blood flow (BF), respectively. Wilcoxon signed-rank tests with Bonferroni correction compared cerebral versus somatic hemodynamics in 1-min intervals during asphyxia and CPR. Rank-based mixed-effects models assessed the associations of hemodynamics with ROSC in early and late CPR. For late CPR, only data from animals without ROSC at each respective timepoint were included. Results: Of 22 animals monitored, 10 achieved ROSC (5 after first defibrillation). Cerebral and somatic hemodynamics differed throughout, but cerebral was not consistently greater. Compared to somatic, cerebral StO2 was lower during asphyxia and the 1st min of CPR but did not differ after. Cerebral BV and BF were greater during asphyxia. Cerebral BV remained greater to the 10th min of CPR but did not differ after; unexpectedly, cerebral BF was lower throughout CPR (Fig. 1). Examining ROSC associations, increasing somatic BV (p&lt;0.001), absolute cerebral StO2 (p&lt;0.003), and increasing cerebral-somatic BF difference (p&lt;0.05) were associated in both early and late CPR. Notably, increasing cerebral BV (p=0.002) was also strongly associated in late CPR. Conclusion: Advanced optical monitoring during asphyxia and CPR provided novel quantification of cerebral and somatic hemodynamics, their differences, and their associations with ROSC in early and late CPR.

  PublisherDOI

• Abstract Or116: Association of Ventilation Rate with Outcomes of Pediatric Cardiac Arrest

  Circulation · 2025-11-03 · 1 citations

  article

  Background: The optimal ventilation rate during pediatric in-hospital cardiac arrest is not known. Research Question/Hypothesis: Is guideline-compliant ventilation during cardiopulmonary resuscitation (CPR) associated with improved survival? We hypothesized that CPR events with guideline-compliant average ventilation rates would have increased rates of survival to hospital discharge. Aims: The overall objective of this study was to assess the association between pediatric CPR ventilation rates and survival outcomes. Methods/Approach: Multicenter prospective observational cohort ancillary study of the ICU-RESUS trial (NCT02837497). Hospitalized children (≤18 years) with cardiac arrest and an endotracheal tube at the onset of CPR and evaluable intra-arrest end tidal carbon dioxide (ETCO2) data to calculate ventilation rate were included. The association between the existing AHA CPR ventilation rate target (20-30 breaths per minute [bpm]) and survival to hospital discharge was evaluated with Poisson regression using generalized estimating equations, controlling for a priori covariates (initial rhythm, immediate cause of arrest). In an exploratory analysis, natural cubic splines, controlling for the same a priori covariates, stratified by age (&lt;8 and ≥8 years), were used to identify novel target intra-arrest ventilation rates for subsequent evaluation in multivariable models. Results: Among 234 included events, 36.8% (n=86) had guideline-compliant average ventilation rates (20-30 bpm). After adjusting for confounders, there was no association between guideline-complaint ventilation rates and survival to hospital discharge (aRR 0.95, 95% CI: 0.75, 1.21, p=0.68). Our exploratory analysis identified novel age-based potential thresholds (&lt;8 years: ≥26 bpm; ≥8 years: &lt;26 bpm) (Figure 1). In children &lt;8 years, an event-level average CPR ventilation rate of ≥26 bpm, compared to &lt;26 bpm, was associated with increased survival to hospital discharge (aRR 1.32, 95% CI: 1.00, 1.73, p=0.048). Conclusions: In our multicenter study of intra-arrest ventilation in children with IHCA with an invasive airway in place at the start of CPR, we did not find an association between guideline-compliant average ventilation rate and survival. In children &lt;8 years old we identified a target ventilation threshold of ≥26 breaths per minute, which was associated with improved survival to hospital discharge.

  PublisherDOI

Recent grants

• Pulmonary Hypertension-Associated Pediatric Cardiac Arrest

  NIH · $791k · 2020–2026

Frequent coauthors

• Vinay Nadkarni

  Children's Hospital of Philadelphia

  457 shared

• Robert M. Sutton

  Children's Hospital of Philadelphia

  445 shared

• Robert A. Berg

  University of Pennsylvania

  440 shared

• Heather Wolfe

  Children's Hospital of Philadelphia

  273 shared

• Todd J. Kilbaugh

  Children's Hospital of Philadelphia

  204 shared

• Kathryn Graham

  Children's Hospital of Philadelphia

  203 shared

• Maryam Y. Naim

  201 shared

• Alexis A. Topjian

  174 shared

Education

• Master of Science of Translational Research (MTR)

  Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania

  2017

• MD

  New York University School of Medicine

  2010