In-hospital Cardiac Arrest In Children Research Articles

Impact of Quality Improvement Bundle on Compliance with Resuscitation Guidelines during In-Hospital Cardiac Arrest in Children.

Various quality improvement (QI) interventions have been individually assessed for the quality of cardiopulmonary resuscitation (CPR). We aimed to assess the QI bundle (hands-on training and debriefing) for the quality of CPR in our children's hospital. We hypothesized that the QI bundle improves the quality of CPR in hospitalized children. We initiated a QI bundle (hands-on training and debriefing) in August 2017. We conducted a before-after analysis comparing the CPR quality during July 2013-May 2017 (before) and January 2018-December 2020 (after). We collected data from the critical events logbook on CPR duration, chest compressions (CC) rate, ventilation rate (VR), the timing of first dose of epinephrine, blood pressure (BP), end-tidal CO2 (EtCO2), and vital signs monitoring during CPR. We performed univariate analysis and presented data as the median interquartile range (IQR) and in percentage as appropriate. We compared data from 58 CPR events versus 41 CPR events before and after QI bundle implementation, respectively. The median (IQR) CPR duration for the pre- and post-QI bundle was 5 (1-13) minutes and 3 minutes (1.25-10), and the timing of the first dose of epinephrine was 2 (1-2) minutes and 2 minutes (1-5), respectively. We observed an improvement in compliance with the CC rate (100-120 per minute) from 72% events before versus 100% events after QI bundle implementation (p=0.0009). Similarly, there was a decrease in CC interruptions and hyperventilation rates from 100% to 50% (p=0.016) and 100% vs. 63% (p=<0.0001) events before vs. after QI bundle implementation, respectively. We also observed improvement in BP monitoring from 36% before versus 60% after QI bundle (p=0.014). Our QI bundle (hands-on training and debriefing) was associated with improved compliance with high-quality CPR in children.

Factors associated with survival and neurologic outcome after in-hospital cardiac arrest in children: A cohort study

AimIn-hospital paediatric cardiopulmonary resuscitation (CPR) survival has been improving in high-income countries. This study aimed to analyse factors associated with survival and neurological outcome after paediatric CPR in a middle-income country. MethodsThis observational study of in-hospital cardiac arrest using Utstein-style registry included patients <18 years old submitted to CPR between 2015 and 2020, at a high-complexity hospital. Outcomes were survival and neurological status assessed using Paediatric Cerebral Performance Categories score at prearrest, discharge, and after 180 days. ResultsOf 323 patients who underwent CPR, 108 (33.4%) survived to discharge and 93 (28.8%) after 180 days. In multivariable analysis, lower survival at discharge was associated with liver disease (OR 0.060, CI 0.007–0.510, p = 0.010); vasoactive drug infusion before cardiac arrest (OR 0.145, CI 0.065–0.325, p < 0.001); shock as the immediate cause (OR 0.183, CI 0.069–0.486, p = 0.001); resuscitation > 30 min (OR 0.070, CI 0.014–0.344, p = 0.001); and bicarbonate administration during CPR (OR 0.318, CI 0.130–0.780, p = 0.01). The same factors remained associated with lower survival after 180 days. Neurological outcome was analysed in the 93 survivors after 180 days following CPR. Prearrest neurological dysfunction was observed in 31.4%, and neurological prognosis was favourable in 79.7% at discharge and similar after 180 days. ConclusionIn-hospital paediatric cardiac arrest patients with complex chronic conditions had lower survival associated with liver disease, shock as cause of cardiac arrest, vasoactive drug infusion before cardiac arrest, bicarbonate administration during CPR, and prolonged resuscitation. Most survivors had favourable neurological outcome.

Abstract 15047: Survival With Favorable Neurological Outcome and Quality of CPR Following In-Hospital Cardiac Arrest in Children With Cardiac Disease Compared to Non-Cardiac Disease

Introduction: Children with cardiac disease have higher rates of in hospital cardiac arrest (IHCA) compared to non-cardiac disease. We aimed to determine differences in survival in children with medical and surgical cardiac compared to non-cardiac disease following IHCA and to assess whether CPR quality was different between groups. Hypothesis: We hypothesized: 1) medical cardiac have worse and surgical cardiac have improved outcomes compared to non-cardiac patients, and 2) CPR quality is similar between groups. Methods: A secondary analysis of the ICU-RESUS citation project ( ICU-RESUS ; NCT02837497) was conducted. The primary outcome was survival to hospital discharge with favorable neurological outcome defined as a Pediatric Cerebral Performance Category score of 1 - 3 or no change from baseline. Secondary outcomes included physiologic measures of intra-arrest quality. Results: Of 1100 children with IHCA, 273 (25%) were medical cardiac, 383 (35%) were surgical cardiac, and 444 (40%) were non-cardiac. The medical cardiac group was less likely to survive with favorable outcome compared to the non-cardiac group (48% vs. 55%, aOR 0.59, CI 95 0.40, 0.88). There was no difference in outcome between the surgical cardiac (58%) and non-cardiac group. There were no differences in chest compression (CC) rate, CC fraction, ventilation rate, intra-arrest average target diastolic blood pressure or average target systolic blood pressure between medical cardiac vs. non-cardiac and surgical cardiac vs. non-cardiac groups. The surgical cardiac group was less likely to achieve target CC depth compared to non-cardiac group (OR 0.15, CI 95 0.02, 0.52). There was no difference in CC depth in medical cardiac vs. non-cardiac groups. Conclusions: In this large study of pediatric IHCA, medical cardiac patients had lower survival with favorable neurologic outcome compared to non-cardiac patients. Surgical cardiac patients had similar outcome to non-cardiac patients. CPR quality was similar in medical-cardiac and non-cardiac patients, however delivered CC depths were lower in surgical cardiac compared to non-cardiac patients.

Abstract 273: Epinephrine Dose Distribution And Impact On Survival After Extracorporeal Cardiopulmonary Resuscitation In Children

Background: Although AHA guidelines recommend a fixed epinephrine (epi) dosing frequency during cardiac arrest, it is unknown if a fixed dosing practice is both utilized and effective for EPCR events in children. We hypothesized that 1) epi dosing would not be uniformly distributed during ECPR events and 2) a strategy of limiting epi doses during ECPR would be associated with better survival to hospital discharge (SHD). Methods: This was a multicenter retrospective cohort study of ECPR after in-hospital cardiac arrest in children (&lt; 18 years) between 2012 - 2019. Patient and arrest event details as well as epi dose and time-stamps were recorded. In patients with a CPR duration of ≥ 30 minutes, dosing strategies were categorized as either “frequent epi” (FE; average epi dosing interval of ≤ 5 mins/dose during the first 30 mins of CPR) or “limited epi” (LE; average dosing interval of ≤ 5 mins/dose for the first 10 mins followed by &gt; 5 mins/dose through 30 mins). The primary outcome was SHD. Results: A total of 191 patients from 5 centers were included; overall SHD was 43% (82/191). Epi doses were not evenly distributed, with 66% (919/1385) of doses being given during the first half of CPR. Mean number of epi doses was similar between survivors and non-survivors in the first 10 mins (2.7 doses). After 10 mins, survivors received fewer doses than non-survivors per each 10 min interval (Figure). In the subset of patients that received ≥ 30 mins of CPR (n=147) the LE group had higher SHD [48% (14/52) vs. 27% (46/95), p=0.01] and improved odds of SHD after adjusting for age, sex, illness category, time of day, first pulseless rhythm and CPR duration [OR (95% CI) 4.2 (1.5-11.7); p =0.008]. Conclusion: In contrast to AHA guidelines, epi dosing was not evenly distributed during events in this multicenter study of pediatric in-hospital ECPR. For children with CPR duration ≥ 30 minutes a strategy of limiting epi doses was associated with improved SHD.

Abstract 02: Intravenous Oxygen Microparticles as Resuscitative Fluid Improves Outcomes in a Swine Model of Asphyxial Cardiac Arrest

Introduction: Asphyxia-induced cardiac arrest (ACA) can lead to organ damage and death within minutes, with a reported survival rate of 25-38%. It is the leading cause of in-hospital cardiac arrest in children and elderly and the second in adults. The direct injection of oxygen as a rescue therapy for ACA is not yet possible. Methods: We manufactured immediate-release intravenous oxygen (IVO 2 ) microparticles with a shell composed of biocompatible dextran polymers formed by nanoprecipitation. Following intravenous injection, the hydrophobic shell transitions from a crystalline state to a rapidly dissolving, fluid shell based on pH (A). IVO 2 was manufactured following Good Manufacturing Practice control over particle size, chemical purity, and sterility. Following instrumentation, Yorkshire swine (n=10 control, n=6 IVO 2 ) underwent complete asphyxia by endotracheal tube occlusion for 12 minutes (B). ACLS was performed whenever SBP&lt;40 mmHg. At minute 6, 8 and 10 of asphyxia, IVO 2 or placebo (20 mL/kg fluid phase) was administered. Animals were then survived for 4 days in an ICU environment, followed by brain MRI and neurohistology. Results: Animals receiving IVO 2 exhibited increased arterial oxygen saturation during asphyxia (p&lt;0.05, C), with less CPR time (p&lt;0.001, D) and higher ROSC (p=0.011, E). Three out of 6 IVO 2 animals vs 0/3 surviving controls were successfully extubated (p=0.035). IVO 2 treatment was associated with increased survival (p=0.037, F) with improved swine neurologic deficit scores (p&lt;0.05, G). MRI (H) and pathology (I) demonstrated devastating hypoxic-ischemic injury in all surviving controls, endpoints that were significantly improved with IVO 2 . No significant adverse effects were noted in hematologic, coagulation, hepatic, or renal function due to IVO 2 . Conclusion: Treatment of ACA with IVO 2 may diminish critical oxygen deficit, resulting in improved survival and neurological outcomes.

Abstract 370: Delivery of CPR in Patients With Single and Biventricular Cardiac Disease

Introduction: Diminished survival after cardiopulmonary resuscitation (CPR) has been shown in patients with congenital heart disease (CHD) and single ventricle (SV) anatomy compared to biventricular anatomy (BV). The role guideline-compliant CPR plays in SV outcomes is unknown. Hypothesis: During pediatric in-hospital cardiac arrest (IHCA), there will be a difference in CPR delivery and outcomes of patients with SV compared to BV anatomy. Methods: Prospective observational cohort from 12 pediRES-Q sites of IHCA in children ≤ 18 years with CPR quality metric data (chest compression (CC) rate, depth, and fraction (CCF)) (Zoll R-Series, Chelmsford, MA). We compared 60-sec CC epoch compliance with 2015 American Heart Association guideline targets defined as: CC rate 100-120/min; depth ≥4.0 cm in &lt;1 yo, ≥5 to ≤6 cm in 1-&lt;18 yo; and CCF ≥0.80. Total guideline compliance was defined as a CC event with ≥ 60% epochs meeting all targets. Metric summaries were reported as median [IQR] and compliance as frequency (%). Differences were assessed using Wilcoxon rank-sum and Fishers exact tests, respectively. Logistic regression assessed for associations with outcomes, including anatomy and proportion of guideline-compliant CPR. Results: From 10/2015 to 3/2019, we analyzed 82 events (&gt; 5 epochs) in patients with CHD. Thirty-seven percent had SV anatomy and more SV patients were post-operative (70% vs 2%). There were no differences in time to first epinephrine dose (1 vs 2 min), shockable rhythm (7% vs 6%), or need for ECMO (27% vs 23%). Total guideline compliance across all ages was not different (SV 10.0% vs BV 5.8%, P=0.67) and not associated with ROSC or survival to hospital discharge (SHD). There was a 75% lower adjusted odds of SHD in 1-&lt;8 yo vs &lt;1 yo. Conclusion: There were no meaningful differences in resuscitative practice or delivery of guideline-compliant CPR in those with SV versus BV anatomy. Guideline-compliant CPR was not associated with outcomes regardless of cardiac anatomy.

Changing Risk of In-Hospital Cardiac Arrest in Children Following Cardiac Surgery in Victoria, Australia, 2007–2016

Reported incidence of in hospital cardiac arrest (IHCA) after paediatric cardiac surgery varies between 3-4% in high income countries and this risk may have changed over time. We sought to examine this trend in detail. A retrospective observational study of 3,781 children who underwent 4,938 cardiac surgeries between 1 January 2007 and 31 December 2016 in a tertiary children's hospital. IHCA was defined as cessation of cardiac mechanical activity requiring cardiac massage for ≥1minute. Surgical complexity was categorised using risk adjusted congenital heart surgery (RACHS-1) category. Poisson regression was used to analyse trends for every two-year period. There were a total of 211 (4.3%) IHCA events after surgery. These patients were younger, more likely to have had a premature birth, have a chromosomal or genetic syndrome association and have a high surgical complexity. Overall, there was a 52% reduction in IHCA rate over 10 years: reducing from 5.4 /100 surgeries in 2007-08 to 2.6/100 surgeries in 2015-16 (p-trend=<0.001). The reduction was mainly seen in low-to-moderate risk categories (RACHS-1 categories 1-4) and not in high risk categories (RACHS-1 category 5-6). Children in high risk categories were 13.6 times more likely to experience an IHCA (compared to low risk categories). Overall hospital mortality for children suffering IHCA decreased from 42.5/100 patients in 2007-08 to 11.1/100 patients in 2015-16 (p-trend=0.037). The IHCA rate following cardiac surgery has more than halved over the last decade; children who experience IHCA also have lower mortality than in previous years. High risk procedures still have a substantial rate of IHCA and efforts are needed to minimise the burden further in this population.

Serum S100B protein as a prognostic biomarker for neurological outcome after in-hospital cardiac arrest in children

Background Survivors of cardiac arrest often require lengthy intensive care admission, rehabilitation, and ongoing treatment of chronic complications as a result of poor function outcomes. S100B protein has emerged as a candidate peripheral biomarker of blood–brain barrier permeability and central nervous system injury. Aim This study aimed to evaluate the serum levels of S100B protein as a prognostic biomarker for predicting neurological outcome after in-hospital cardiac arrest and cardiopulmonary resuscitation (CPR) in children.Patients and methods Thirty infants and children underwent CPR after in-hospital cardiac arrest; blood samples for the evaluation of S100B were drawn after 1 and 24 h after initiation of CPR. Neurological assessment for survivors was done 6 months after cardiac arrest using the cerebral performance category (CPC) score, which was used also immediately following CPR for all patients (including those who died 24 h after CPR). Fifteen healthy children were enrolled as a control group.Results There was highly significant increase of serum S100B protein in postarrest patients at 1 and 24 h as compared with the control group (P<0.001); significant increase in patients at 1 h as compared with patients at 24 h (P<0.05); and highly significant increase of serum S100B protein in dead patients (n=25) as compared with survivors (n=5) (P<0.001). There was highly significant positive correlation between the duration of CPR and the CPC score and S100B protein level (P<0.001).The cutoff value of S100B protein at 1 h (as a prognostic biomarker) was 1430 ng/l with 76% sensitivity and 94% specificity, whereas the cutoff value of S100B protein at 24 h was 227 ng/l with 75% sensitivity and 91% specificity.Conclusion S100B protein was potentially useful as a prognostic biomarker (with high sensitivity and specificity) for neurological outcome after cardiac arrest, as its levels significantly correlated with CPC score of the survivors 6 months after cardiac arrest and with the duration of CPR.

Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children

BackgroundTargeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited.MethodsIn a trial conducted at 37 children’s hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest.ResultsThe trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse events, as well as 28-day mortality, did not differ significantly between groups.ConclusionsAmong comatose children who survived in-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute; THAPCA-IH ClinicalTrials.gov number, NCT00880087.)

Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study

ObjectiveThe main objective was to study survival and neurologic evolution of children who suffered in-hospital pediatric cardiac arrest (CA). The secondary objective was to analyze the influence of risk factors on the long term outcome after CA. Methodsprospective, international, observational, multicentric study in 48 hospitals of 12 countries. CA in children between 1 month and 18 years were analyzed using the Utstein template. Survival and neurological state measured by Pediatric Cerebral Performance Category (PCPC) scale one year after hospital discharge was evaluated. Results502 patients with in-hospital CA were evaluated. 197 of them (39.2%) survived to hospital discharge. PCPC at hospital discharge was available in 156 of survivors (79.2%). 76.9% had good neurologic state (PCPC 1–2) and 23.1% poor PCPC values (3–6). One year after cardiac arrest we could obtain data from 144 patients (28.6%). PCPC was available in 116 patients. 88 (75.9%) had a good neurologic evaluation and 28 (24.1%) a poor one. A neurological deterioration evaluated by PCPC scale was observed in 40 patients (7.9%). One year after cardiac arrest PCPC scores compared to hospital discharge had worsen in 7 patients (6%), remained constant in 103 patients (88.8%) and had improved in 6 patients (5.2%). ConclusionSurvival one year after cardiac arrest in children after in-hospital cardiac arrest is high. Neurologic outcome of these children a year after cardiac arrest is mostly the same as after hospital discharge. The factors associated with a worst long-term neurological outcome are the etiology of arrest being a traumatic or neurologic illness, and the persistency of higher lactic acid values 24h after ROSC. A standardised basic protocol even practicable for lower developed countries would be a first step for the new multicenter studies.

In-hospital pediatric cardiac arrest in Honduras.

The objective of this study was to analyze the characteristic and the prognostic factors of in-hospital pediatric cardiac arrest (CA) in a public hospital Honduras. A prospective observational study was performed on pediatric in-hospital CA as a part of a multicenter international study. One hundred forty-six children were studied. The primary end point was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality. Cardiac arrest occurred in the emergency department in 66.9%. Respiratory diseases and sepsis were predominant causes of CA. Return of spontaneous circulation was achieved in 60% of patients, and 22.6% survived to hospital discharge. The factors related with mortality were nonrespiratory cause of CA (odds ratio [OR], 2.55; P = 0.045), adrenaline administration (OR, 4.96; P = 0.008), and a duration of cardiopulmonary resuscitation more than 10 minutes (OR, 3.40; P = 0.012). In-hospital CA in children in a developing country has low survival. Patients with nonrespiratory causes and those who need adrenaline administration and prolonged resuscitation had worse prognosis.

Hospital Variation in Survival After Pediatric In-Hospital Cardiac Arrest

Although survival after in-hospital cardiac arrest is likely to vary among hospitals caring for children,validated methods to risk-standardize pediatric survival rates across sites do not currently exist. From 2006 to 2010, within the American Heart Association's Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest, we identified 1551 cardiac arrests in children (<18 years). Using multivariable hierarchical logistic regression, we developed and validated a model to predict survival to hospital discharge and calculated risk-standardized rates of cardiac arrest survival for hospitals with a minimum of 10 pediatric cardiac arrest cases. A total of 13 patient-level predictors were identified: age, sex, cardiac arrest rhythm, location of arrest, mechanical ventilation, acute nonstroke neurological event, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency, sepsis, illness category, and need for intravenous vasoactive agents prior to the arrest. The model had good discrimination (C-statistic of 0.71), confirmed by bootstrap validation (validation C-statistic of 0.69). Among 30 hospitals with ≥10 cardiac arrests, unadjusted hospital survival rates varied considerably (median, 37%; interquartile range, 24-42%; range, 0-61%). After risk-standardization, the range of hospital survival rates narrowed (median, 37%; interquartile range, 33-38%; range, 29-48%), but variation in survival persisted. Using a national registry, we developed and validated a model to predict survival after in-hospital cardiac arrest in children. After risk-standardization, significant variation in survival rates across hospitals remained. Leveraging these models, future studies can identify best practices at high-performing hospitals to improve survival outcomes for pediatric cardiac arrest. (

Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study

Objective: To study survival and neurologic evolution of children who suffered in-hospital pediatric cardiac arrest (CA).

Parada cardiaca pediátrica intrahospitalaria en España

Introduction and objectivesThe objective was to analyze the characteristics and prognostic factors of in-hospital pediatric cardiac arrest in Spain. MethodsA prospective observational study was performed to examine in-hospital pediatric cardiac arrest. Two hundred children were studied, aged between 1 month and 18 years, with in-hospital cardiac arrest. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on survival to hospital discharge. ResultsReturn of spontaneous circulation was achieved in 74% of the patients and 41% survived to hospital discharge. The survival rate was significantly higher than that reported in a previous Spanish study 10 years earlier (25.9%). In the univariate analysis, the factors related to mortality were body weight higher than 10 kg; continuous infusion of vasoactive drugs prior to cardiac arrest; sepsis and neurological disorders as causes of cardiac arrest, the need for treatment with adrenaline, bicarbonate, and volume expansion, and prolonged cardiopulmonary resuscitation. In the multivariate analysis, the factors related to mortality were hematologic/oncologic diseases, continuous infusion of vasoactive drugs prior to cardiac arrest, cardiopulmonary resuscitation for more than 20 min, and treatment with bicarbonate and volume expansion. ConclusionsSurvival after in-hospital cardiac arrest in children has significantly improved in recent years. The factors related to in-hospital mortality were hematologic/oncologic diseases, continuous infusion of vasoactive drugs prior to cardiac arrest, the duration of cardiopulmonary resuscitation, and treatment with bicarbonate and volume expansion.Full English text available from:www.revespcardiol.org/en

In-hospital Pediatric Cardiac Arrest in Spain

Introduction and objectivesThe objective was to analyze the characteristics and prognostic factors of in-hospital pediatric cardiac arrest in Spain. MethodsA prospective observational study was performed to examine in-hospital pediatric cardiac arrest. Two hundred children were studied, aged between 1 month and 18 years, with in-hospital cardiac arrest. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on survival to hospital discharge. ResultsReturn of spontaneous circulation was achieved in 74% of the patients and 41% survived to hospital discharge. The survival rate was significantly higher than that reported in a previous Spanish study 10 years earlier (25.9%). In the univariate analysis, the factors related to mortality were body weight higher than 10 kg; continuous infusion of vasoactive drugs prior to cardiac arrest; sepsis and neurological disorders as causes of cardiac arrest, the need for treatment with adrenaline, bicarbonate, and volume expansion, and prolonged cardiopulmonary resuscitation. In the multivariate analysis, the factors related to mortality were hematologic/oncologic diseases, continuous infusion of vasoactive drugs prior to cardiac arrest, cardiopulmonary resuscitation for more than 20 min, and treatment with bicarbonate and volume expansion. ConclusionsSurvival after in-hospital cardiac arrest in children has significantly improved in recent years. The factors related to in-hospital mortality were hematologic/oncologic diseases, continuous infusion of vasoactive drugs prior to cardiac arrest, the duration of cardiopulmonary resuscitation, and treatment with bicarbonate and volume expansion.

Relación entre el estado de gravedad previo y el pronóstico de la parada cardiaca intrahospitalaria

ObjectivesTo analyze the relationship between previous severity of illness, lactic acid, creatinine and inotropic index with mortality of in-hospital cardiac arrest (CA) in children, and the value of a prognostic index designed for adults. MethodsThe study included total of 44 children aged from 1 month to 18 years old who suffered a cardiac arrest while in hospital. The relationship between previous severity of illness scores (PRIMS and PELOD), lactic acid, creatinine, treatment with vasoactive drugs, inotropic index with return of spontaneous circulation and survival at hospital discharge was analyzed. ResultsThe large majority (90.3%) of patients had a return of spontaneous circulation, and 59% survived at hospital discharge. More than two-thirds (68.2%) were treated with inotropic drugs at the time of the CA. The patients who died had a higher lactic acid before the CA (3.4 mmol/L) than survivors (1.4 mmol/L), P=.04. There were no significant differences in PRIMS, PELOD, creatinine, inotropic drugs, and inotropic index before CA between patients who died and survivors. ConclusionA high lactic acid previous to cardiac arrest could be a prognostic factor of in-hospital cardiac arrest in children.

Relationship between pre-arrest severity of illness and outcome after in-hospital cardiac arrest in children

Relationship between pre-arrest severity of illness and outcome after in-hospital cardiac arrest in children

Abstract 350: Hospital Variation in Survival for Pediatric In-Hospital Cardiac Arrest: A Report From Get With the Guidelines -Resuscitation

Background: Although survival after in-hospital cardiac arrest is likely to vary among hospitals caring for children, validated methods to risk-standardize pediatric survival rates across sites do not currently exist. Methods: Within the American Heart Association’s Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest, we identified 1,640 cardiac arrests in children from 168 hospitals from 2006 to 2010. Using multivariable hierarchical logistic regression, we developed and validated a model to predict survival to hospital discharge. We then applied the coefficients and random hospital intercepts from the model to examine risk-standardized rates of cardiac arrest survival for those hospitals with a minimum of 10 pediatric cardiac arrest cases. Results: A total of 15 patient-level predictors were identified: age, sex, race, cardiac arrest rhythm, location and day of arrest, mechanical ventilation, baseline depression in neurological function, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency, sepsis, and use of intravenous antiarrhythmics or vasopressors at the time of arrest. The model had good discrimination (C-statistic of 0.71), confirmed by bootstrap validation (validation C-statistic of 0.69). Among 31 hospitals with at least 10 cardiac arrests, unadjusted hospital survival rates varied considerably (median, 37%; inter-quartile range [IQR]: 21% to 44%; range: 0% to 59%). After risk-standardization, variation in hospital survival rates persisted (median, 37%; IQR: 33% to 41%; range: 31% to 49%), although the range of outcomes narrowed considerably. Conclusion: In a large national registry, we developed and validated a model to predict survival after in-hospital cardiac arrest in children. Even with risk-standardization, there is significant variation in survival rates across hospitals. Leveraging these models, best practices can be assessed at high-performing hospitals and shared with others to improve care in the setting of pediatric cardiac arrest.

Factors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study

To analyze prognostic factors associated with in-hospital cardiac arrest (CA) in children. A prospective, multicenter, multinational, observational study was performed on pediatric in-hospital CA in 12 countries and included 502 children between 1 month and 18 years. The primary endpoint was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality. Return 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. The pre-arrest factors related to mortality were lower Human Development Index [odds ratio (OR) 2.32, 95 % confidence interval (CI) 1.28-4.21], oncohematologic disease (OR 3.33, 95 % CI 1.60-6.98), and treatment with inotropic drugs at the time of CA (OR 2.35, 95 % CI 1.55-3.56). CA and resuscitation factors related to mortality were CA due to neurological disease (OR 5.19, 95 % CI 1.49-18.73) and duration of cardiopulmonary resuscitation greater than 10 min (OR 4.00, 95 % CI 1.49-18.73). Factors related to survival were CA occurring in the pediatric intensive care unit (PICU) (OR 0.38, 95 % CI 0.16-0.86) and shockable rhythm (OR 0.26, 95 % CI 0.09-0.73). In-hospital CA in children has a low survival but most of the survivors have a good neurological outcome. Some prognostic risk factors cannot be modified, making it important to focus efforts on improving hospital organization to care for children at risk of CA in the PICU and, in particular, in other hospital areas.

Outcomes After In-Hospital Cardiac Arrest in Children With Cardiac Disease

Background— Small studies suggest that children experiencing a cardiac arrest after undergoing cardiac surgery have better outcomes than other groups of patients, but the survival outcomes and periarrest variables of cardiac and noncardiac pediatric patients have not been compared. Methods and Results— All cardiac arrests in patients &lt;18 years of age were identified from Get With the Guidelines–Resuscitation from 2000 to 2008. Cardiac arrests occurring in the neonatal intensive care unit were excluded. Of 3323 index cardiac arrests, 19% occurred in surgical-cardiac, 17% in medical-cardiac, and 64% in noncardiac (trauma, surgical-noncardiac, and medical-noncardiac) patients. Survival to hospital discharge was significantly higher in the surgical-cardiac group (37%) compared with the medical-cardiac group (28%; adjusted odds ratio, 1.8; 95% confidence interval, 1.3–2.5) and the noncardiac group (23%; adjusted odds ratio, 1.8; 95% confidence interval, 1.4–2.4). Those in the cardiac groups were younger and less likely to have preexisting noncardiac organ dysfunction, but were more likely to have ventricular arrhythmias as their first pulseless rhythm, to be monitored and hospitalized in the intensive care unit at the time of cardiac arrest, and to have extracorporeal cardiopulmonary resuscitation compared with those in the noncardiac group. There was no survival advantage for patients in the medical-cardiac group compared with those in the noncardiac group when adjusted for periarrest variables. Conclusion— Children with surgical-cardiac disease have significantly better survival to hospital discharge after an in-hospital cardiac arrest compared with children with medical-cardiac disease and noncardiac disease.