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Objectives The main objectives of this study were to describe in-hospital acute respiratory compromise among children (age < 18 years), and its association with cardiac arrest and in-hospital mortality. Design Observational study using prospectively collected data. Setting United States hospitals reporting data to the Get With The Guidelines® – Resuscitation registry. Patients Pediatric patients (age < 18 years) with acute respiratory compromise. Acute respiratory compromise was defined as absent, agonal, or inadequate respiration that required emergency assisted ventilation and elicited a hospital-wide or unit-based emergency response. Interventions None. Measurements and Main Results The primary outcome was in-hospital mortality. Cardiac arrest during the event was a secondary outcome. To assess the association between patient, event, and hospital characteristics and the outcomes, we created multivariable logistic regressions models accounting for within-hospital clustering. One thousand nine hundred and fifty two patients from 151 hospitals were included. Forty percent of the events occurred on the wards, 19% in the emergency department, 25% in the intensive care unit, and 16% in other locations. Two hundred eighty patients (14.6%) died before hospital discharge. Pre-existing hypotension (odds ratio: 3.26 [95%CI: 1.89, 5.62], p < 0.001) and septicemia (odds ratio: 2.46 [95%CI: 1.52, 3.97], p < 0.001) were associated with increased mortality. The acute respiratory compromise event was temporally associated with a cardiac arrest in 182 patients (9.3%), among whom 46.2% died. One thousand two hundred and eight patients (62%) required tracheal intubation during the event. In-hospital mortality among patients requiring tracheal intubation during the event was 18.6%. Conclusion In this large, multicenter study of acute respiratory compromise, 40% occurred in ward settings, 9.3% had an associated cardiac arrest, and overall in-hospital mortality was 14.6%. Pre-event hypotension and septicemia were associated with increased mortality rate.

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