1165: RISK FACTOR AND OUTCOMES FOR RECURRENT PEDIATRIC IN-HOSPITAL CARDIAC ARREST

Abstract

Introduction: Recurrent in-hospital cardiac arrest (IHCA) is associated with increased morbidity and mortality in adult and pediatric patients. Event and patient-specific factors are associated with the risk for recurrent IHCA. We aimed to describe the risk factors and outcomes of recurrent IHCA in a large pediatric cohort. We hypothesized that patients who suffered recurrent IHCA would have worse survival outcomes. Methods: Retrospective cohort study of patients ≤18 years from the American Heart Association’s Get With The Guidelines®-Resuscitation Registry with single or recurrent IHCA who achieved ROSC and were not placed on ECMO with their initial IHCA. Recurrent IHCA was defined as ≥ 2 IHCAs within the same hospitalization. Categorical variables were expressed as percentages and compared via Chi square test. Continuous variables were expressed as medians with interquartile ranges and compared via rank sum test. Outcomes were assessed in a match cohort based on age, disease category, duration of first arrest, and acuity. Acuity was defined as low if no invasive airway or arterial line was present, defined as medium if one was present, and defined as high if both were present at the time of the IHCA. Results: From January 2010 to January 2022, 2225/10019 (22.2%) pediatric patients experienced a recurrent IHCA. Recurrent IHCA patients compared to single IHCA were more likely to be medical cardiac (21.3% vs. 19%; p=0.01) or trauma patients (7.5% vs. 5.3%; P< 0.001) and have higher acuity (27.8% vs. 22.7%; p< 0.001). Recurrent IHCAs were more likely to occur in the PICU (44.2% vs. 39.6%; p< 0.001) or CICU (11.5% vs. 9.5%; p=0.006) versus other inpatient locations and there was no difference in the duration of arrest. After matching, pediatric patients with a recurrent IHCA had worse survival to hospital discharge (44.1% vs 61.5%; p< 0.001). Conclusions: Higher acuity and ICU location during the initial IHCA event was associated with increased risk for recurrent IHCA in pediatric patients. Additionally, recurrent IHCA is associated with worse survival outcomes in the total cohort and following exact matching.