In this multicenter registry of in-hospital cardiac arrest, the first documented pulseless arrest rhythm was typically asystole or PEA in both children and adults. Because of better survival after asystole and PEA, children had better outcomes than adults despite fewer cardiac arrests due to VF or pulseless VT.

HE INSTITUTE OF MEDICINE RE-ports that as many as 98 000 preventable in-hospital deaths occur annually. 1 Diagnostic, treatment, preventive, and other system errors have been identified as focus areas to prevent medical injury. 2 The detection and treatment of arrests and their antecedents may be less effective at night because of patient, event, hospital, staffing, and response factors. If in-hospital cardiac arrests are more common or survival is worse on nights and weekends, this information could have important implications for hospital staffing, training, care delivery processes, and equipment decisions.We evaluated survival rates for adults with in-hospital cardiac arrest by time of day and day of week. We hypothesized that outcome after cardiac arrest would be worse during nights and weekends, even when adjusted for potentially confounding patient, event, and hospital factors.

In pediatric patients with in-hospital cardiac arrests, survival outcomes were highest among patients in whom ventricular fibrillation or tachycardia was present initially than among those in whom it developed subsequently. The outcomes for patients with subsequent ventricular fibrillation or tachycardia were substantially worse than those for patients with asystole or pulseless electrical activity.

OBJECTIVE: We hypothesized that childhood obesity would be associated with decreased likelihood of survival to hospital discharge after in-hospital, pediatric cardiopulmonary resuscitation (CPR). METHODS: We reviewed 1477 consecutive, pediatric, CPR index events (defined as the first CPR event during a hospitalization in that facility for a patient <18 years of age) reported to the American Heart Association National Registry of Cardiopulmonary Resuscitation between January 2000 and July 2004. The primary outcome was survival to hospital discharge. A total of 1268 index subjects (86%) with complete registry data were included for analysis. Children were classified as obese (≥95th weight-for-length percentile if <2 years of age or ≥95th BMI-for-age percentile if ≥2 years of age) or underweight (<5th weight-for-length percentile if <2 years of age or <5th BMI-for-age percentile if ≥2 years of age), with adjustment for gender. RESULTS: Obesity was noted for 213 (17%) of 1268 subjects and underweight for 571 (45%) of 1268 subjects. Obesity was more likely to be associated with male gender, noncardiac medical illness, and cancer and inversely associated with heart failure. Underweight was more likely to be associated with male gender, cardiac surgery, and prematurity and inversely associated with age and cancer. Self-reported, process-of-care, CPR quality was generally worse for obese children. With adjustment for important potential confounding factors, obesity was independently associated with worse odds of event survival (adjusted odds ratio: 0.58 [95% confidence interval: 0.35–0.76]) and survival to hospital discharge (adjusted odds ratio: 0.62 [95% confidence interval: 0.38–0.93]) after in-hospital, pediatric CPR. Underweight was not associated with worse outcomes. CONCLUSIONS: Childhood obesity is associated with a lower rate of survival to hospital discharge after in-hospital, pediatric CPR.

Background-Clinicians often place high priority on invasive airway placement during cardiopulmonary resuscitation. The benefit of early versus later invasive airway placement remains unknown. In this study we examined the association between time to invasive airway (TTIA) placement and patient outcomes after inhospital cardiopulmonary arrest (CPA).