Abstract 13952: Incidence of In-Hospital Cardiac Arrest and Associated In-Hospital Mortality in Pediatric Critically Ill Patients With Cardiac Disease Significantly Decreased Over Time: Results From a Systematic Review and Meta-Analysis

Abstract

Introduction: Studies evaluating trends in the incidence and mortality for in-hospital cardiac arrest (IHCA) in children with cardiac disease admitted to the intensive care unit (ICU) are rare. Additionally, there is limited information on factors associated with IHCA and mortality. Hypothesis: We hypothesized that the incidence of IHCA and the mortality rate in cardiac children admitted to the ICU has significantly decreased over time. Methods: We conducted a systematic review of PubMed, Web of Science, EMBASE, and CINAHL from inception to Sept 2021. Random effects meta-analysis was used to compute pooled-proportions and pooled-ORs. Meta-regression adjusted for type of study (registry vs cohort) and diagnostic category (surgical vs general cardiac) was used to evaluate trends in incidence and mortality. Results: Of the 2,574 studies identified, 25 were included in the systematic review (126,087 patients), 18 in the meta-analysis. Five percent (95% CI: 4-7%) of ICU children experienced IHCA and 35% (95% CI: 27-44%) did not achieve ROSC. In centers with ECMO, 21% (95% CI: 15-28%) underwent ECPR. The pooled in-hospital mortality was 54% (95% CI: 47-62%). Both incidence of IHCA and in-hospital mortality decreased significantly in the last 20 y (p<0.001, Figure 1, and p=0.020, respectively), while the proportion of patients achieving ROSC did not change (p=0.572). Neonatal age, prematurity, comorbidities, univentricular physiology, arrhythmias, pre-arrest mechanical ventilation, ECMO, and higher surgical complexity increased IHCA and mortality odds. Conclusions: A significant proportion (5%) of cardiac children in the ICU experience IHCA. Decreasing trends in IHCA and in-hospital mortality suggests that education on preventive measures and post-arrest care have been effective. However, unchanged proportion of patients not achieving ROSC illustrates the crucial need for developing resuscitation strategies specific to children with cardiac disease.