Multicenter cohort study of in-hospital pediatric cardiac arrest*
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- 1 September 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Pediatric Critical Care Medicine
- Vol. 10 (5), 544-553
- https://doi.org/10.1097/pcc.0b013e3181a7045c
Abstract
Objectives: 1) To describe clinical characteristics, hospital courses, and outcomes of a cohort of children cared for within the Pediatric Emergency Care Applied Research Network who experienced in-hospital cardiac arrest with sustained return of circulation between July 1, 2003 and December 31, 2004, and 2) to identify factors associated with hospital mortality in this population. These data are required to prepare a randomized trial of therapeutic hypothermia on neurobehavioral outcomes in children after in-hospital cardiac arrest. Design: Retrospective cohort study. Setting: Fifteen children’s hospitals associated with Pediatric Emergency Care Applied Research Network. Patients: Patients between 1 day and 18 years of age who had cardiopulmonary resuscitation and received chest compressions for >1 min, and had a return of circulation for >20 mins. Interventions: None. Measurements and Main Results: A total of 353 patients met entry criteria; 172 (48.7%) survived to hospital discharge. Among survivors, 132 (76.7%) had good neurologic outcome documented by Pediatric Cerebral Performance Category scores. After adjustment for age, gender, and first documented cardiac arrest rhythm, variables available before and during the arrest that were independently associated with increased mortality included pre-existing hematologic, oncologic, or immunologic disorders, genetic or metabolic disorders, presence of an endotracheal tube before the arrest, and use of sodium bicarbonate during the arrest. Variables associated with decreased mortality included postoperative cardiopulmonary resuscitation. Extending the time frame to include variables available before, during, and within 12 hours following arrest, variables independently associated with increased mortality included the use of calcium during the arrest. Variables associated with decreased mortality included higher minimum blood pH and pupillary responsiveness. Conclusions: Many factors are associated with hospital mortality among children after in-hospital cardiac arrest and return of circulation. Such factors must be considered when designing a trial of therapeutic hypothermia after cardiac arrest in pediatric patients.Keywords
This publication has 41 references indexed in Scilit:
- Survival From In-Hospital Cardiac Arrest During Nights and WeekendsJama-Journal Of The American Medical Association, 2008
- A prospective study of outcome of in-patient paediatric cardiopulmonary arrestResuscitation, 2006
- Out-of-Hospital Pediatric Cardiac Arrest: An Epidemiologic Review and Assessment of Current KnowledgeAnnals of Emergency Medicine, 2005
- Basic Cardiac Life Support Providers Checking the Carotid Pulse: Performance, Degree of Conviction, and Influencing FactorsAcademic Emergency Medicine, 2004
- Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac ArrestThe New England Journal of Medicine, 2002
- Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced HypothermiaThe New England Journal of Medicine, 2002
- Recommended Guidelines for Uniform Reporting of Pediatric Advanced Life Support: The Pediatric Utstein StyleAnnals of Emergency Medicine, 1995
- CPR in childrenAnnals of Emergency Medicine, 1987
- Regression modelling strategies for improved prognostic predictionStatistics in Medicine, 1984
- Pediatric cardiac resuscitation team: A 6 year studyThe Journal of Pediatrics, 1974