Abstract
IntroductionMost studies have analyzed pre-arrest and resuscitation factors associated with mortality after cardiac arrest (CA) in children, but many patients that reach return of spontaneous circulation die within the next days or weeks. The objective of our study was to analyze post-return of spontaneous circulation factors associated with in-hospital mortality after cardiac arrest in children.MethodsA prospective multicenter, multinational, observational study in 48 hospitals from 12 countries was performed. A total of 502 children aged between 1 month and 18 years with in-hospital cardiac arrest were analyzed. The primary endpoint was survival to hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each post-return of spontaneous circulation factor on mortality.ResultsReturn of spontaneous circulation was achieved in 69.5% of patients; 39.2% survived to hospital discharge and 88.9% of survivors had good neurological outcome. In the univariate analysis, post- return of spontaneous circulation factors related with mortality were pH, base deficit, lactic acid, bicarbonate, FiO2, need for inotropic support, inotropic index, dose of dopamine and dobutamine at 1 hour and at 24 hours after return of spontaneous circulation as well as Pediatric Intensive Care Unit and total hospital length of stay. In the multivariate analysis factors associated with mortality at 1 hour after return of spontaneous circulation were PaCO2 < 30 mmHg and >50 mmHg, inotropic index >14 and lactic acid >5 mmol/L. Factors associated with mortality at 24 hours after return of spontaneous circulation were PaCO2 > 50 mmHg, inotropic index >14 and FiO2 ≥ 0.80.ConclusionsSecondary in-hospital mortality among the initial survivors of CA is high. Hypoventilation, hyperventilation, FiO2 ≥ 0.80, the need for high doses of inotropic support, and high levels of lactic acid were the most important post-return of spontaneous circulation factors associated with in-hospital mortality in children in our population.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0607-9) contains supplementary material, which is available to authorized users.
Highlights
Most studies have analyzed pre-arrest and resuscitation factors associated with mortality after cardiac arrest (CA) in children, but many patients that reach return of spontaneous circulation die within the days or weeks
Five patients were rescued with extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR) and four of them survived to hospital discharge
The characteristics of the 502 patients, pre-arrest factors, and cardiac arrest and resuscitation factors associated with mortality have been previously published [11]
Summary
Most studies have analyzed pre-arrest and resuscitation factors associated with mortality after cardiac arrest (CA) in children, but many patients that reach return of spontaneous circulation die within the days or weeks. The objective of our study was to analyze post-return of spontaneous circulation factors associated with in-hospital mortality after cardiac arrest in children. Most studies have analyzed pre-arrest and resuscitation factors associated with mortality after cardiac arrest (CA) in children [1,2,3,4,5,6,7,8,9,10,11,12,13]. In previous studies performed on the same prospective register we have analyzed the pre-arrest and resuscitation factors [11] and the ventilation and oxygenation factors associated with mortality [14]. The hypothesis was that respiratory status and hemodynamic status are the most important prognosis factors after ROSC in children
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