Log in | Register

Factors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study

Jesús López-Herce| Jimena del Castillo| Martha Matamoros| Sonia Cañadas| Ana Rodriguez-Calvo| Corrado Cecchetti| Antonio Rodriguez-Núñez| Angel Carrillo Álvarez
Original
Volume 39, Issue 2 / February , 2013

Pages 309 - 318

Abstract

Purpose

To analyze prognostic factors associated with in-hospital cardiac arrest (CA) in children.

Methods

A prospective, multicenter, multinational, observational study was performed on pediatric in-hospital CA in 12 countries and included 502 children between 1 month and 18 years. The primary endpoint was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality.

Results

Return 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. The pre-arrest factors related to mortality were lower Human Development Index [odds ratio (OR) 2.32, 95 % confidence interval (CI) 1.28–4.21], oncohematologic disease (OR 3.33, 95 % CI 1.60–6.98), and treatment with inotropic drugs at the time of CA (OR 2.35, 95 % CI 1.55–3.56). CA and resuscitation factors related to mortality were CA due to neurological disease (OR 5.19, 95 % CI 1.49–18.73) and duration of cardiopulmonary resuscitation greater than 10 min (OR 4.00, 95 % CI 1.49–18.73). Factors related to survival were CA occurring in the pediatric intensive care unit (PICU) (OR 0.38, 95 % CI 0.16–0.86) and shockable rhythm (OR 0.26, 95 % CI 0.09–0.73).

Conclusions

In-hospital CA in children has a low survival but most of the survivors have a good neurological outcome. Some prognostic risk factors cannot be modified, making it important to focus efforts on improving hospital organization to care for children at risk of CA in the PICU and, in particular, in other hospital areas.

Keywords

References

  1. Slonim AD, Patel KM, Ruttimann UE, Pollack MM (1997) Cardiopulmonary resuscitation in pediatric intensive care units. Crit Care Med 25:1951–1955
    • View reference on PubMed
    • View reference on publisher's website
  2. Suominen P, Olkkola KT, Voipio V, Korpela R, Palo R, Räsänan J (2000) Utstein style reporting of-in hospital paediatric cardiopulmonary resuscitation. Resuscitation 45:17–25
    • View reference on PubMed
    • View reference on publisher's website
  3. Reis AG, Nadkarni V, Perondi MB, Grisi S, Berg RA (2002) A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style. Pediatrics 109:200–209
    • View reference on PubMed
    • View reference on publisher's website
  4. López-Herce J, García C, Domínguez P, Carrillo A, Rodríguez-Núñez A, Calvo C, Delgado MA, The Spanish Study Group of Cardiopulmonary Arrest in Children (2004) Characteristics and outcome of cardiorespiratory arrest in children. Resuscitation 63:311–313
    • View reference on PubMed
    • View reference on publisher's website
  5. Guay J, Lortie L (2004) An evaluation of pediatric in-hospital advanced life support interventions using the pediatric Utstein guidelines: a review of 203 cardiorespiratory arrests. Can J Anaesth 51:373–378
    • View reference on PubMed
    • View reference on publisher's website
  6. Rodriguez-Núñez A, López-Herce J, García C, Carrillo A, Dominguez P, Calvo C, Delgado MA, The Spanish Study Group of Cardiopulmonary Arrest in Children (2006) Effectiveness and long-term outcome of cardiopulmonary resuscitation in paediatric intensive care units in Spain. Resuscitation 71:301–309
    • View reference on PubMed
    • View reference on publisher's website
  7. Tibballs J, Kinney S (2006) A prospective study of outcome of in-patient paediatric cardiopulmonary arrest. Resuscitation 71:310–318
    • View reference on PubMed
    • View reference on publisher's website
  8. Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME, Nichol G, Lane-Truitt T, Potts J, Ornato JP, Berg RA, National Registry of Cardiopulmonary Resuscitation Investigators (2006) First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 295:96–98
    • View reference on publisher's website
  9. De Mos N, van Litsenburg RR, McCrindle B, Bohn DJ, Parshuram CS (2006) Pediatric in-intensive-care-unit cardiac arrest: incidence, survival, and predictive factors. Crit Care Med 34:1209–1215
    • View reference on PubMed
    • View reference on publisher's website
  10. Meaney PA, Nadkarni VM, Cook EF, Testa M, Helfaer M, Kaye W, Larkin GL, Berg RA, National Registry of Cardiopulmonary Resuscitation Investigators (2006) Higher survival rates among younger patients after pediatric intensive care unit cardiac arrest. Pediatrics 118:2424–2433
    • View reference on PubMed
    • View reference on publisher's website
  11. Wu ET, Li MJ, Huang SC, Wang CC, Liu YP, Lu FL, Ko WJ, Wang MJ, Wang JK, Wu MH (2009) Survey of outcome of CPR in pediatric in-hospital cardiac arrest in a medical center in Taiwan. Resuscitation 80:443–448
    • View reference on PubMed
    • View reference on publisher's website
  12. Meert KL, Donaldson A, Nadkarni V, Tieves KS, Schleien CL, Brilli RJ, Clark RS, Shaffner DH, Levy F, Statler K, Dalton HJ, van der Jagt EW, Hackbarth R, Pretzlaff R, Hernan L, Dean JM, Moler FW (2009) Pediatric Emergency Care Applied Research Network. Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 10:544–553
    • View reference on PubMed
    • View reference on publisher's website
  13. Olotu A, Ndiritu M, Ismael M, Mohammed S, Mithwani S, Maitland K, Newton CR (2009) Characteristics and outcome of cardiopulmonary resuscitation in hospitalised African children. Resuscitation 80:69–72
    • View reference on PubMed
    • View reference on publisher's website
  14. Berens RJ, Cassidy LD, Matchey J, Campbell D, Colpaert KD, Welch T, Lawson M, Peterson C, O’Flynn J, Dearth M, Tieves KS (2011) Probability of survival based on etiology of cardiopulmonary arrest in pediatric patients. Paediatr Anaesth 21:834–840
    • View reference on PubMed
    • View reference on publisher's website
  15. Cummins R, Chamberlain D, Hazinski MF, Nadkarni V, Kloek W, Kramer E (1997) Recommended guidelines for reviewing, reporting, and conducting research on in hospital resuscitation: the in-hospital “Utstein style”. Resuscitation 34:151–183
    • View reference on PubMed
    • View reference on publisher's website
  16. Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D’Este K, Finn J, Halperin H, Handley A, Herlitz J, Hickey R, Idris A, Kloeck W, Larkin GL, Mancini ME, Mason P, Mears G, Monsieurs K, Montgomery W, Morley P, Nichol G, Nolan J, Okada K, Perlman J, Shuster M, Steen PA, Sterz F, Tibballs J, Timerman S, Truitt T, Zideman D; International Liaison Committee on Resuscitation; American Heart Association; European Resuscitation Council; Australian Resuscitation Council; New Zealand Resuscitation Council; Heart and Stroke Foundation of Canada; InterAmerican Heart Foundation; Resuscitation Councils of Southern Africa; ILCOR Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes (2004) Cardiac arrest and cardiopulmonary resuscitation outcomes reports: update and simplification of the Utstein templates for resuscitation registries: A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation 110:3385–3397
  17. Fiser DH, Long N, Roberson PK, Heffley G, Zolten K, Brodie-Fowler M (2000) Relationship of pediatric overall performance category and pediatric cerebral performance category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments. Crit Care Med 28:2616–2620
    • View reference on PubMed
    • View reference on publisher's website
  18. The World Bank (2012). http://data.worldbank.org/about/country-classifications/country-and-lending-groups. Accessed date 10 Apr 2012
  19. World Health Organization (2012) http://www.who.int/en/ Accessed date 10 Apr 2012
  20. Human Development Reports (2012) http://hdr.undp.org/en/ Accessed date 10 Apr 2012
  21. Moler FW, Meert K, Donaldson AE, Nadkarni V, Brilli RJ, Dalton HJ, Clark RS, Shaffner DH, Schleien CL, Statler K, Tieves KS, Hackbarth R, Pretzlaff R, van der Jagt EW, Levy F, Hernan L, Silverstein FS, Dean JM, Pediatric Emergency Care Applied Research Network (2009) In-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study. Crit Care Med 37:2259–2267
    • View reference on PubMed
    • View reference on publisher's website
  22. Smith GB (2010) In-hospital cardiac arrest: is it time for an in-hospital ‘chain of prevention’? Resuscitation 81:1209–1211
    • View reference on PubMed
    • View reference on publisher's website
  23. Sharek PJ, Parast LM, Leong K, Coombs J, Earnest K, Sullivan J, Frankel LR, Roth SJ (2007) Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a children’s hospital. JAMA 298:2267–2274
    • View reference on PubMed
    • View reference on publisher's website
  24. Tibballs J, Kinney S (2009) Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatr Crit Care Med 10:306–312
    • View reference on PubMed
    • View reference on publisher's website
  25. Suraseranivongse S, Chawaruechai T, Saengsung P, Komoltri C (2006) Outcome of cardiopulmonary resuscitation in a 2300-bed hospital in a developing country. Resuscitation 71:188–193
    • View reference on PubMed
    • View reference on publisher's website
  26. Tian J, Kaufman DA, Zarich S, Chan PS, Ong P, Amoateng-Adjepong Y, Manthous CA, American Heart Association National Registry for Cardiopulmonary Resuscitation Investigators (2010) Outcomes of critically ill patients who received cardiopulmonary resuscitation. Am J Respir Crit Care Med 182:501–506
    • View reference on PubMed
    • View reference on publisher's website
  27. Kissoon N, Carcillo JA, Espinosa V, Argent A, Devictor D, Madden M, Singhi S, van der Voort E, Latour J, Global Sepsis Initiative Vanguard Center Contributors. World Federation of Pediatric Intensive Care and Critical Care Societies (2011) Global Sepsis Initiative. Pediatr Crit Care Med 12:494–503
    • View reference on PubMed
    • View reference on publisher's website
  28. Donoghue AJ, Nadkarni VM, Elliott M, Durbin D, American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators (2006) Effect of hospital characteristics on outcomes from pediatric cardiopulmonary resuscitation: a report from the national registry of cardiopulmonary resuscitation. Pediatrics 118:995–1001
    • View reference on PubMed
    • View reference on publisher's website
  29. Sasson C, Rogers MA, Dahl J, Kellermann AL (2010) Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 3:63–81
    • View reference on PubMed
    • View reference on publisher's website
  30. Wolff H, Chong HG, Auffhammer M (2011) Classification, detection and consequences of data error: evidence from the Human Development Index. Econ J 121:843–870
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement