Pediatric cardiopulmonary resuscitation: comparison between emergency department and inpatients setting at a tertiary academic hospital in Oman

Abstract

Objective: The aim of this study was to compare cardiopulmonary resuscitation (CPR) between emergency department (ED) and inpatients setting at Sultan Qaboos University Hospital (SQUH). Methods: The study was a retrospective cohort chart review of pediatric CPR at Sultan Qaboos University Hospital (SQUH) from January 2012 till August 2017. The CPR sheets were reviewed for four main variables: patient related, event related, treatment and outcomes. Results: A total of 83 cases were included, 48 males (58%) and 35 females (42%). Two Thirds of the patients (n=56) were in-patient; whereas one third of cases were from ED (n=27). Overall, most common cause for arrest that accounted 73.5% (n=61) was due to respiratory arrest. Events were more common in younger age group with 50% in less than 1 year (n=41). Bradycardia with hypo-perfusion represented most of arrest type 65% (n=54) followed by asystole 31% (n=26). Only 10% of patient survived to discharge (n=8). In comparison, 89% of ED arrest were unwitnessed. On the other hand, PICU and ward arrests predominantly were monitored 98% (n=55). ED patients’ survival appeared better at 19.2% (n=5) within 24hrs post arrest and 11.5% (n=3) within 1-year in comparison to PICU/Ward of 8.9% (n=5) survival within 24hrs and 1-year post event yet it was not statistically significant. Conclusion: The survival outcome in resuscitation was almost similar between ED & In-patient setting (PICU/wards) cardiopulmonary arrests despite having few significant differences based on variables. Overall, 10% of patients survived to discharge and higher survival rates are associated with duration of CPR less than 20 minutes . Intraosseous route is underutilized and should be applied earlier especially in ED to prevent delay in administration of resuscitation medications.