Survival Rates Following Pediatric In-Hospital Cardiac Arrests During Nights and Weekends

Abstract

IMPORTANCE Nearly 6000 hospitalized children in the United States receive cardiopulmonary resuscitation (CPR) annually. Little is known about whether the survival of these children is influenced by the time of the event (eg, nighttime or weekends). Differences in survival could have important implications for hospital staffing, training, and resource allocation.OBJECTIVE To determine whether outcomes after pediatric in-hospital cardiac arrests differ during nights and weekends compared with days/evenings and weekdays. DESIGN, SETTING, AND PARTICIPANTSThis study included a total of 354 hospitals participating in the American Heart Association's Get With the Guidelines-Resuscitation registry from January 1, 2000, to December 12, 2012. Index cases (12 404 children) from all children younger than 18 years of age receiving CPR for at least 2 minutes were included. Data analysis was performed in December 2014 and June 2016. We aggregated hourly blocks of time, using previously defined time intervals of day/evening and night, as well as weekend. Multivariable logistic regression models were used to examine the effect of independent variables on survival to hospital discharge. We used a combination of a priori variables based on previous literature (including age, first documented rhythm, location of event in hospital, extracorporeal CPR, and hypotension as the cause of arrest), as well as variables that were identified in bivariate generalized estimating equation models, and maintained significance of P Յ .15 in the final multivariable models. MAIN OUTCOMES AND MEASURESThe primary outcome measure was survival to hospital discharge, and secondary outcomes included return of circulation lasting more than 20 minutes and 24-hour survival.RESULTS Of 12 404 children (56.0% were male), 8731 (70.4%) experienced a return of circulation lasting more than 20 minutes, 7248 (58.4%) survived for 24 hours, and 4488 (36.2%) survived to hospital discharge. After adjusting for potential confounders, we found that the rate of survival to hospital discharge was lower during nights than during days/evenings (adjusted odds ratio, 0.88 [95% CI, 0.80-0.97]; P = .007) but was not different between weekends and weekdays (adjusted odds ratio, 0.92 [95% CI, 0.84-1.01]; P = .09). CONCLUSIONS AND RELEVANCEThe rate of survival to hospital discharge was lower for pediatric CPR events occurring at night than for CPR events occurring during daytime and evening hours, even after adjusting for many potentially confounding patient-, event-, and hospital-related factors.

Glucocorticoid receptor and serum‐ and glucocorticoid‐induced kinase‐1 in esophageal adenocarcinoma and adjacent Barrett's esophagus

“…The Cox proportional hazard model was used for conducting univariate and multivariate analyses. The multivariate analysis performed in this study included clinicopathological features with a P ‐value of <0.01 in the antecedent univariate analysis 23 . P < 0.05 denoted statistical significance in this study.…”

Changes in the depth of chest compressions during cardiopulmonary resuscitation in a pediatric simulator

“…Cardiorespiratory arrest (CRA) is an infrequent event in pediatric patients; it occurs in 8 to 20 out of 100 000 children per year in the United States of America (USA) and in 1.9-6 % of patients admitted to the pediatric intensive care unit. [1][2][3][4] T h e r e s u l t s o f i n -h o s p i t a l resuscitations have improved over the years and, at present, survival is about 36 % at the time of hospital discharge. 2,[5][6][7] However, results vary among the different sites, the time of the event, and the place where it occurred; in some cases, a survival rate of approximately 12 % is achieved.…”

Modificación de la profundidad de las compresiones cardíacas durante la reanimación cardiopulmonar en un simulador pediátrico

“…y entre un 1,9 % y un 6 % de los pacientes ingresados en terapias intensivas pediátricas. [1][2][3][4] L o s r e s u l t a d o s d e l a s reanimaciones realizadas en el ámbito hospitalario han mejorado en los últimos años y muestran una supervivencia actual del orden del 36 % al momento del egreso hospitalario. 2,[5][6][7] Sin embargo, los resultados varían entre los diferentes c e n t r o s , e l h o r a r i o e n q u e s e produce el episodio y el lugar en el que se presenta el paro cardíaco, y llegan, en algunos casos, a tasas de supervivencia del orden del 12 %.…”

“…[1][2][3][4] L o s r e s u l t a d o s d e l a s reanimaciones realizadas en el ámbito hospitalario han mejorado en los últimos años y muestran una supervivencia actual del orden del 36 % al momento del egreso hospitalario. 2,[5][6][7] Sin embargo, los resultados varían entre los diferentes c e n t r o s , e l h o r a r i o e n q u e s e produce el episodio y el lugar en el que se presenta el paro cardíaco, y llegan, en algunos casos, a tasas de supervivencia del orden del 12 %. 2,3,8 Esto ilustra la necesidad de obtener un acceso rápido a personal debidamente capacitado, y, dado lo infrecuente de estos eventos, el uso de simuladores cobra trascendencia.…”