A Prospective Investigation Into the Epidemiology of In-Hospital Pediatric Cardiopulmonary Resuscitation Using the International Utstein Reporting Style

Abstract

During this study, CPR was uncommon but not rare. Respiratory failure was the most common precipitating cause, followed by shock. Preexisting chronic diseases were prevalent among these children. Asystole was the most common initial cardiac rhythm, and bradycardia with pulses and poor perfusion was the second most common. Ventricular fibrillation was rare, but children with acute cardiac diseases, such as cardiac surgery and acute cardiomyopathies, were not admitted to this children's hospital. CPR was effective: nearly two thirds of these children were initially successfully resuscitated, and one third were alive at 24 hours compared with imminent death without CPR and advanced life support. Nevertheless, survival progressively decreased over time, generally as a result of the underlying disease process. One-year survival was 15%. Importantly, most of these survivors had no demonstrable change in gross neurologic function from their pre-CPR status.

Retrospective review of emergency response activations during a 13‐year period at a tertiary care children's hospital

“…1 Additionally, more than half of pediatric patients that experience a cardiopulmonary arrest have an underlying chronic illness. 1,2,4,5,6 These are similar to our findings that chronic pulmonary and cardiac diseases were among the most frequent admission diagnosis. Unlike Peberdy et al, 7 we did not find an increase in the number of emergency response team activations at night or on weekends.…”

Extracorporeal cardiopulmonary resuscitation

“…Immediate availability of ECLS equipment and skilled personnel in the catheterization laboratory may play a role in the improved survival rate observed in these patients. Survival has been reported to decrease by 5% with each elapsed minute of CPR (3). Clinical reports of ECPR for out-of-hospital cardiac arrest typically describe longer ECLS initiation time and extended periods of inadequate cerebral and myocardial oxygen delivery (21).…”

“…Even though cardiac arrest occurs less frequently in children than adults, approximately 16,000 American children experience out-of-hospital cardiac arrest annually (2) and 1-2% of pediatric hospital admissions result in cardiopulmonary resuscitation (CPR) (3,4). Overall survival for children who experience out-ofhospital cardiac arrest is less than 10%, whereas in-hospital cardiac arrest survival is >40% in this population (5).…”

Pediatric Neurocritical Care

“…Although the return of spontaneous circulation is seen in 30 to 65% of pediatric patients following a cardiac arrest (more commonly found in-hospital cardiac arrest) long-term survival with good neurological recovery that may be achieved in only a minority [158][159][160]. Common causes of death in nonsurvivors are brain death or neurological futility, particularly among patients who have an out-of-hospital arrest [161].…”