Pediatric Cardiac Arrest Outcomes in the United States: A Nationwide Database Cohort Study

Abstract

BackgroundKnowledge about the causes and outcomes of pediatric cardiac arrest in the emergency department is limited. The aim of our study was to evaluate the characteristics and outcomes of pediatric cardiac arrest in the emergency department (EDCA) and inpatient (IPCA) settings in the United States using a large database designed to provide nationwide estimates. MethodsWe performed a retrospective cohort study using the Nationwide Emergency Department Sample (NEDS), a database that includes both ED and inpatient encounters. The NEDS was analyzed for episodes of cardiac arrest between 2016-2018 in patients aged ≤18 years. Patients with cardiac arrest were identified using the International Classification of Diseases, 10th revision codes. ResultsA total of 15,348 pediatric cardiac arrest events with cardiopulmonary resuscitation were recorded, of which 13,239 had EDCA and 2,109 had IPCA. A lower survival rate of 19% was observed for EDCA compared to 40.4% for IPCA. While more than half of the EDCA events had no associated diagnoses, trauma (15.6%), respiratory failure (5%), asphyxiation (2.7%), acidosis (2.4%), and ventricular arrhythmia (1.4%) were associated with the remaining events. In comparison, the most frequently associated diagnoses for IPCA were respiratory failure (75.8%), acidosis (43.9%), acute kidney injury (27.2%), trauma (27.1%), and sepsis (22.5%). ConclusionsSurvival rates for EDCA were less than half of that for IPCA. The low survival rates along with the distinctive characteristics of EDCA events suggest the need for further research in this area to identify remediable factors and improve survival.

Reviving Hope: A Comprehensive Review of Post-resuscitation Care in Pediatric ICUs After Cardiac Arrest

“…The incidence rates, common causes, and demographic considerations of pediatric cardiac arrest are essential factors in understanding the epidemiology of this critical condition. The overall incidence rate for out-of-hospital cardiac arrest (OHCA) in the United States is 8.3 per 100,000 person-years, with a survival to hospital discharge rate of 11.3% [ 6 ]. Pediatric OHCA rates are reported to be 6-10 per 100,000 person-years, with only about 10% of patients surviving hospital discharge [ 7 ].…”

The Effect of the Time of In-hospital Cardiopulmonary Resuscitation on the Immediate Outcome in Pediatric Patients

“…The mortality rate of pediatric In Hospital Cardiac Arrest (IHCA) is high and the survival rates were reported as 41.1% compared to 11.4% for Out-Hospital Cardiac Arrest (OHCA). Also, the survival rates of IHCA differs among departments and cardiac arrest in the emergency department has higher mortality than Inpatient Cardiac Arrest (IPCA) (1). Mckenzie et al found that a high proportion of pediatric OHCA had ROSC (Return of spontaneous circulation), but the rate of survival to discharge was low (2).…”