Post return of spontaneous circulation factors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study

Abstract

IntroductionMost studies have analyzed pre-arrest and resuscitation factors associated with mortality after cardiac arrest (CA) in children, but many patients that reach return of spontaneous circulation die within the next days or weeks. The objective of our study was to analyze post-return of spontaneous circulation factors associated with in-hospital mortality after cardiac arrest in children.MethodsA prospective multicenter, multinational, observational study in 48 hospitals from 12 countries was performed. A total of 502 children aged between 1 month and 18 years with in-hospital cardiac arrest were analyzed. The primary endpoint was survival to hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each post-return of spontaneous circulation factor on mortality.ResultsReturn of spontaneous circulation was achieved in 69.5% of patients; 39.2% survived to hospital discharge and 88.9% of survivors had good neurological outcome. In the univariate analysis, post- return of spontaneous circulation factors related with mortality were pH, base deficit, lactic acid, bicarbonate, FiO2, need for inotropic support, inotropic index, dose of dopamine and dobutamine at 1 hour and at 24 hours after return of spontaneous circulation as well as Pediatric Intensive Care Unit and total hospital length of stay. In the multivariate analysis factors associated with mortality at 1 hour after return of spontaneous circulation were PaCO2 < 30 mmHg and >50 mmHg, inotropic index >14 and lactic acid >5 mmol/L. Factors associated with mortality at 24 hours after return of spontaneous circulation were PaCO2 > 50 mmHg, inotropic index >14 and FiO2 ≥ 0.80.ConclusionsSecondary in-hospital mortality among the initial survivors of CA is high. Hypoventilation, hyperventilation, FiO2 ≥ 0.80, the need for high doses of inotropic support, and high levels of lactic acid were the most important post-return of spontaneous circulation factors associated with in-hospital mortality in children in our population.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0607-9) contains supplementary material, which is available to authorized users.

Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study

“…13,20 Hospital course and clinical and neurological status at pediatric intensive care unit (PICU) discharge, hospital discharge and one year after CA, according to the pediatric cerebral performance category (PCPC) were registered. 26 Variable definitions were based on Utstein-style guidelines.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] High mortality has mainly been attributed to the post-resuscitation syndrome, which involves hypoxia-ischemia and reperfusion, and its potential damage to the brain. [13][14][15][16][17][18][19][20][21] Neurological injury has been related to an important decrease in survival rates after IHCA in both children and adults. However, there are no multicenter, multinational prospective studies on CA in children that have analyzed long-term neurological follow-up.…”

“…In previous studies performed on the same prospective register we have analyzed the pre-arrest and resuscitation factors, 11 the ventilation and oxygenation factors 13 and post-resuscitation factors associated with mortality. 20 The main objective of the present study was to analyze survival and neurologic evolution of children who suffered in-hospital pediatric cardiac arrest (CA). The secondary objective was to analyze the factors affecting long-term neurological outcome of in-hospital CA in children.…”

The role of the gray-to-white matter ratio to predict the prognosis of cardiac arrest treated with ECMO

“…A significant percentage of patients who attain ROSC, die within days or weeks, most of them from brain death or multiorgan failure, and a significant percentage of survivors are left with important neurological sequelae (4).…”

Incidence and Prognosis of Acute Kidney Injury After Cardiac Arrest in Children

“…A significant percentage of adult and children who achieve return of spontaneous circulation (ROSC) after cardiac arrest (CA) die later, mostly of brain death or multiorgan failure [1][2][3][4][5].…”