Variability of Characteristics and Outcomes Following Cardiopulmonary Resuscitation Events in Diverse ICU Settings in a Single, Tertiary Care Children’s Hospital*

Gupta, Punkaj; Yan, Karen; Chow, Vinca; Dao, Duy T.; Gossett, Jeffrey M.; Leong, Kit; Franzon, Deborah; Reddy, Sushma; Berg, Robert A.; Roth, Stephen J.

doi:10.1097/pcc.0000000000000067

Cited by 17 publications

(5 citation statements)

References 33 publications

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“…The possible explanatory factors associated with greater odds of survival in cardiac surgical patients, all of which were present in this study, include increased presence of vascular access, use of mechanical ventilation, and increased use of ECPR. These explanatory factors plus younger age, improved recognition and presence of invasive monitoring have previously been described as being associated with better outcomes in CICU versus PICU populations (11). In the current study, we did not identify differences in survival to hospital discharge for any illness category.…”

Section: Discussionmentioning

confidence: 90%

“…In pediatric cohorts from 2002 to 2016, cardiac disease-versus not-was associated with higher rates of in-hospital cardiac arrest (IHCA) (9,10), but there are conflicting results about higher or lower survival (10)(11)(12). Other historical cohorts, 2000-2010, suggest that amongst children with cardiac disease, cardiac surgical patients have higher rates of postresuscitation ROSC and survival to hospital discharge compared to cardiac medical patients after IHCA (13)(14)(15).…”

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confidence: 99%

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Survival With Favorable Neurologic Outcome and Quality of Cardiopulmonary Resuscitation Following In-Hospital Cardiac Arrest in Children With Cardiac Disease Compared With Noncardiac Disease*

Federman,

Sutton,

Reeder

et al. 2023

Pediatric Critical Care Medicine

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Objectives: To assess associations between outcome and cardiopulmonary resuscitation (CPR) quality for in-hospital cardiac arrest (IHCA) in children with medical cardiac, surgical cardiac, or noncardiac disease. Design: Secondary analysis of a multicenter cluster randomized trial, the ICU-RESUScitation Project (NCT02837497, 2016–2021). Setting: Eighteen PICUs. Patients: Children less than or equal to 18 years old and greater than or equal to 37 weeks postconceptual age receiving chest compressions (CC) of any duration during the study. Interventions: None Measurements and Main Results: Of 1,100 children with IHCA, there were 273 medical cardiac (25%), 383 surgical cardiac (35%), and 444 noncardiac (40%) cases. Favorable neurologic outcome was defined as no more than moderate disability or no worsening from baseline Pediatric Cerebral Performance Category at discharge. The medical cardiac group had lower odds of survival with favorable neurologic outcomes compared with the noncardiac group (48% vs 55%; adjusted odds ratio [aOR] [95% CI], aOR 0.59 [95% CI, 0.39–0.87], p = 0.008) and surgical cardiac group (48% vs 58%; aOR 0.64 [95% CI, 0.45–0.9], p = 0.01). We failed to identify a difference in favorable outcomes between surgical cardiac and noncardiac groups. We also failed to identify differences in CC rate, CC fraction, ventilation rate, intra-arrest average target diastolic or systolic blood pressure between medical cardiac versus noncardiac, and surgical cardiac versus noncardiac groups. The surgical cardiac group had lower odds of achieving target CC depth compared to the noncardiac group (OR 0.15 [95% CI, 0.02–0.52], p = 0.001). We failed to identify a difference in the percentage of patients achieving target CC depth when comparing medical cardiac versus noncardiac groups. Conclusions: In pediatric IHCA, medical cardiac patients had lower odds of survival with favorable neurologic outcomes compared with noncardiac and surgical cardiac patients. We failed to find differences in CPR quality between medical cardiac and noncardiac patients, but there were lower odds of achieving target CC depth in surgical cardiac compared to noncardiac patients.

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Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 99%

Survival With Favorable Neurologic Outcome and Quality of Cardiopulmonary Resuscitation Following In-Hospital Cardiac Arrest in Children With Cardiac Disease Compared With Noncardiac Disease*

Federman,

Sutton,

Reeder

et al. 2023

Pediatric Critical Care Medicine

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“…Following removal of duplicates (n = 496), 2078 studies were screened on titles and abstracts. Of the remaining 344 full-text articles, 25 observational studies were included for the qualitative review, for a total of 131 724 children and 5213 IHCAs (4%) 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ( Figure 1 , Table ). Of the 25 studies included, 23 were cohort studies and 2 were case-control studies.…”

Section: Resultsmentioning

confidence: 99%

Trends in In-Hospital Cardiac Arrest and Mortality Among Children With Cardiac Disease in the Intensive Care Unit

et al. 2023

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ImportanceData on trends in incidence and mortality for in-hospital cardiac arrest (IHCA) in children with cardiac disease in the intensive care unit (ICU) are lacking. Additionally, there is limited information on factors associated with IHCA and mortality in this population.ObjectiveTo investigate incidence, trends, and factors associated with IHCA and mortality in children with cardiac disease in the ICU.Data SourcesA systematic review was conducted using PubMed, Web of Science, EMBASE, and CINAHL, from inception to September 2021.Study SelectionObservational studies on IHCA in pediatric ICU patients with cardiac disease were selected (age cutoffs in studies varied from age ≤18 y to age ≤21 y).Data Extraction and SynthesisQuality of studies was assessed using the National Institutes of Health Quality Assessment Tools. Data on incidence, mortality, and factors associated with IHCA or mortality were extracted by 2 independent observers. Random-effects meta-analysis was used to compute pooled proportions and pooled ORs. Metaregression, adjusted for type of study and diagnostic category, was used to evaluate trends in incidence and mortality.Main Outcomes and MeasuresPrimary outcomes were incidence of IHCA and in-hospital mortality. Secondary outcomes were proportions of patients who underwent extracorporeal membrane oxygenation (ECMO) cardiopulmonary resuscitation (ECPR) and those who did not achieve return of spontaneous circulation (ROSC).ResultsOf the 2574 studies identified, 25 were included in the systematic review (131 724 patients) and 18 in the meta-analysis. Five percent (95% CI, 4%-6%) of children with cardiac disease in the ICU experienced IHCA. The pooled in-hospital mortality among children who experienced IHCA was 51% (95% CI, 42%-59%). Thirty-nine percent (95% CI, 29%-51%) did not achieve ROSC; in centers with ECMO, 22% (95% CI, 14%-33%) underwent ECPR, whereas 22% (95% CI, 12%-38%) were unable to be resuscitated. Both incidence of IHCA and associated in-hospital mortality decreased significantly in the last 20 years (both P for trend &lt; .001), whereas the proportion of patients not achieving ROSC did not significantly change (P for trend = .90). Neonatal age, prematurity, comorbidities, univentricular physiology, arrhythmias, prearrest mechanical ventilation or ECMO, and higher surgical complexity were associated with increased incidence of IHCA and mortality odds.Conclusions and RelevanceThis systematic review and meta-analysis found that 5% of children with cardiac disease in the ICU experienced IHCA. Decreasing trends in IHCA incidence and mortality suggest that education on preventive interventions, use of ECMO, and post-arrest care may have been effective; however, there remains a crucial need for developing resuscitation strategies specific to children with cardiac disease.

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“…1). 7,8 Patients were excluded if they were on ECLS at the time of the arrest or if they received extracorporeal CPR (ECPR) or ECLS post-arrest. We excluded patients receiving ECLS during or after the initial CPR event as it would be expected to change the risk of subsequent RA.…”

Section: Methodsmentioning

confidence: 99%

Factors Associated with Pediatric In-Hospital Recurrent Cardiac Arrest

Brown

Roberts

Killien

et al. 2022

J Pediatr Intensive Care

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The objective of this article was to identify demographic and clinical factors associated with early recurrent arrest (RA) (<48 hours) and late RA (≥48 hours) among pediatric inpatients following an initial in-hospital cardiac arrest. A retrospective cohort study of inpatients was performed in a free-standing academic quaternary care children's hospital. All inpatients were <18 years old with a cardiac arrest event requiring ≥1 minute of cardiopulmonary resuscitation with the return of spontaneous circulation sustained for ≥20 minutes at Seattle Children's Hospital from February 1, 2012 to September 18, 2019. Of the 237 included patients, 20 (8%) patients had an early RA and 30 (13%) had a late RA. Older age and severe pre-arrest acidosis were associated with a higher risk of early RA, odds ratios (OR) 1.2 (95% confidence interval [CI] 1.1–1.3) per additional year and 4.6 (95% CI 1.2–18.1), respectively. Pre-arrest organ dysfunction was also associated with a higher risk of early RA with an OR of 3.3 (95% CI 1.1–9.4) for respiratory dysfunction, OR 1.4 (95% CI 1.1–1.9) for each additional dysfunctional organ system, and OR 1.1 (95% CI 1–1.2) for every one-point increase in PELOD2 score. The neonatal illness category was associated with a lower risk of late RA, OR 0.3 (95% CI 0.1–0.97), and severe post-arrest acidosis was associated with a higher risk of late RA, OR 4.2 (95% CI 1.1–15). Several demographic and clinical factors offer some ability to identify children who sustain a recurrent cardiac arrest, offering a potential opportunity for intervention to prevent early recurrent arrest.

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Variability of Characteristics and Outcomes Following Cardiopulmonary Resuscitation Events in Diverse ICU Settings in a Single, Tertiary Care Children’s Hospital*

Cited by 17 publications

References 33 publications

Survival With Favorable Neurologic Outcome and Quality of Cardiopulmonary Resuscitation Following In-Hospital Cardiac Arrest in Children With Cardiac Disease Compared With Noncardiac Disease*

Survival With Favorable Neurologic Outcome and Quality of Cardiopulmonary Resuscitation Following In-Hospital Cardiac Arrest in Children With Cardiac Disease Compared With Noncardiac Disease*

Trends in In-Hospital Cardiac Arrest and Mortality Among Children With Cardiac Disease in the Intensive Care Unit

Factors Associated with Pediatric In-Hospital Recurrent Cardiac Arrest

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