Survival of pediatric patients after cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Abstract

Background In-hospital cardiac arrest is a major public health issue. It is a serious condition; most probably end up with death within a few minutes even with corrective measures. However, cardiopulmonary resuscitation is expected to increase the probability of survival and prevent neurological disabilities in patients with cardiac arrest. Having a pooled prevalence of survival to hospital discharge after cardiopulmonary resuscitation is vital to develop strategies targeted to increase probability of survival among patients with cardiac arrest. Therefore, this systematic review and meta-analysis was aimed to assess the pooled prevalence of survival to hospital discharge among pediatric patients who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest. Methods PubMed, Google Scholar, and Cochrane review databases were searched. To have current (five-year) evidence, only studies published in 2016 to 2020 were included. The weighted inverse variance random-effects model at 95%CI was used to estimate the pooled prevalence of survival. Heterogeneity assessment, test of publication bias, and subgroup analyses were also employed accordingly. Results Twenty-five articles with a total sample size of 28,479 children were included in the final analysis. The pooled prevalence of survival to hospital discharge was found to be 46% (95% CI = 43.0–50.0%; I2 = 96.7%; p < 0.001). Based on subgroup analysis by “continent” and “income level”, lowest prevalence of pooled survival was observed in Asia (six studies; pooled survival =36.0% with 95% CI = 19.01–52.15%; I2 = 97.4%; p < 0.001) and in low and middle income countries (six studies, pooled survival = 34.0% with 95% CI = 17.0–51.0%, I2 = 97.67%, p < 0.001) respectively. Conclusion Although there was an extremely high heterogeneity among reported results (I2 = 96.7%), in this meta-analysis more than half of pediatric patients (54%) who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest did not survived to hospital discharge. Therefore, developing further strategies and encouraging researches might be crucial.

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“…Despite the provision of cardiopulmonary resuscitation (CPR) by medical personnel with full access to equipment, more than half of pediatric IHCA patients do not survive [1,2]. High-quality chest compression (CC) and effective airway management are the keys to pediatric resuscitation [3].…”

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“…In-hospital pediatric cardiopulmonary arrest (IHCA) occurring outside of acute care settings is an uncommon but potentially devastating event [ 1–4 ]. While survival following the IHCA has improved, more than 50% of children do not survive to discharge[ 2 ]. In children, cardiopulmonary arrest rarely occurs without signs of preceding decompensation[ 5 ].…”

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“…There is a long-standing debate on the survival following discharge from hospital in pediatric patients who performed cardiopulmonary resuscitation for in-hospital cardiac arrest with cardiac activity cessation [ 19 ]. Bimerew et al [ 20 ] undertook a systematic review and meta-analysis on this uncommon event [ 21 ]. They included 25 studies with 28,479 patients.…”