Multicenter cohort study of in-hospital pediatric cardiac arrest*

Abstract

Objectives (1) Describe the clinical characteristics, hospital courses and outcomes of a cohort of children cared for within the Pediatric Emergency Care Applied Research Network (PECARN) who experienced in-hospital cardiac arrest with sustained return of circulation between July 1, 2003 and December 31, 2004, and (2) identify factors associated with hospital mortality in this population. These data are required to prepare a randomized trial of therapeutic hypothermia on neurobehavioral outcomes in children after in-hospital cardiac arrest. Design Retrospective cohort study. Setting Fifteen children’s hospitals associated with PECARN. Patients Patients between one day and 18 years of age who had cardiopulmonary resuscitation (CPR) and received chest compressions for >1 minute, and had a return of circulation for >20 minutes. Interventions None. Measurements and Main Results A total of 353 patients met entry criteria; 172 (48.7%) survived to hospital discharge. Among survivors, 132 (76.7%) had good neurological outcome documented by Pediatric Cerebral Performance Category scores. After adjustment for age, gender and first documented cardiac arrest rhythm, variables available prior to and during the arrest that were independently associated with increased mortality included pre-existing hematologic, oncologic, or immunologic disorders, genetic or metabolic disorders, presence of an endotracheal tube prior to the arrest, and the use of sodium bicarbonate during the arrest. Variables associated with decreased mortality included post-operative CPR. Extending the time frame to include variables available prior to, during, and within 12 hours following arrest, variables independently associated with increased mortality included the use of calcium during the arrest. Variables associated with decreased mortality included higher minimum blood pH and pupillary responsiveness. Conclusions Many factors are associated with hospital mortality among children after in-hospital cardiac arrest and return of circulation. Such factors must be considered when designing a trial of therapeutic hypothermia after cardiac arrest in pediatric patients.

What brings the 2015 updates about the pediatric basic life support that published by American Heart Association?

“…8,14 Hastane içi çocukluk dönemi arrestlerin sonuçlarının son 10 yılda belirgin olarak iyiye doğru gittiği, bu olguların 2001 yılından 2009 yılına dek hastaneden taburcu olma oranlarının %24'den %39'a yükseldiği gösterilmiştir.…”

Pediatric Neurocritical Care

“…The groundwork for this study has been well built. Three large, retrospective cohort studies that included patients from 15 hospitals affiliated with the Pediatric Emergency Care Applied Research Network have examined the outcome and identified risk factors associated with poor outcome for both in-hospital and out-of-hospital pediatric cardiac arrest [161][162][163][164][165][166][167][168][169][170][171]. Surveys from the United Kingdom and the United States have demonstrated both variability in the practice of cooling, and a widespread willingness and interest in a randomized controlled trial to study its use [172,173].…”

What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort study

“…However, mortality (52%) and morbidity remain high despite advances in resuscitation training, technology and treatment (Tibballs et al, 2005). The devastating physical consequences of deterioration leading to cardiopulmonary arrest are well documented (Meert et al, 2009), as are the psychological effects that emergency admission to the Paediatric Intensive Care Unit (PICU) has on the family (Balluffi et al, 2004). There are significant additional financial costs to the National Health Service of 'failing to rescue' deteriorating children in hospital (Duncan and Frew, 2009).…”