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Long-term outcomes of burned children after in-hospital cardiac arrest
M G Jeschke1, D N Herndon, R E Barrow
1Shriners Hospital for Children, Galveston Burns Hospital, and the Department of Surgery, University of Texas Medical Branch, Galveston, USA.
Insights
Cardiopulmonary resuscitation (CPR) for burned children experiencing cardiac arrest (CA) yields a 50% long-term survival rate. Key factors influencing survival include timely fluid resuscitation and absence of sepsis, suggesting CPR should be universally offered.
Area of Science:
- Pediatric critical care medicine
- Burn trauma management
- Emergency medicine
Background:
- Cardiopulmonary resuscitation (CPR) in severely burned pediatric patients with cardiac arrest (CA) is often considered futile.
- Limited data exists on predisposing factors and outcomes for this specific patient population.
Purpose of the Study:
- To investigate the predisposing factors and outcomes of in-hospital cardiac arrest (CA) in severely burned children.
- To evaluate the efficacy of cardiopulmonary resuscitation (CPR) in this patient group.
Main Methods:
- Retrospective review of 595 pediatric burn patients admitted between 1985 and 1998 with >35% total body surface area burns.
- Detailed analysis of 34 children who received CPR following in-hospital CA, focusing on predisposing factors and long-term outcomes.
Main Results:
- The incidence of CA in severely burned children was 5.7%.
- CPR was initially successful in 65% of cases, with 77% of these achieving long-term survival (2-14 years).
- Sepsis and delayed fluid resuscitation (>2 hours) were significant predictors of mortality in non-survivors.
Conclusions:
- Fifty percent of burned children experiencing cardiac arrest achieved long-term survival in this study.
- The findings support the recommendation that all burned children experiencing cardiac arrest should be offered cardiopulmonary resuscitation.
- Early fluid resuscitation and management of sepsis are critical for improving outcomes.
Objective:
Cardiopulmonary resuscitation (CPR) in severely burned patients experiencing cardiac arrest (CA) has been considered by some as futile. The objective of this article is to report predisposing factors and the outcomes of burned children experiencing in-hospital CA at our institution.
Design:
The records of 595 children admitted from 1985 to 1998 with burns covering >35% of their total body surface area were reviewed. Thirty-four children receiving CPR after in-hospital CA were studied for predisposing factors and long-term outcomes.
Setting And Patients:
Shriners Burns Hospital. Burned children of both genders, 0.5-19 yrs of age, who experienced in-hospital CA and received CPR.
Intervention:
Standard burn care and CPR.
Measurements And Main Results:
Predisposing factors of CA, mortality, and long-term outcomes were measured. The incidence of CA in burned children with burns on >35% total body surface area was 5.7%. No significant difference in age or burn size could be shown between long-term CA survivors (n = 17) and nonsurvivors (n = 17). CPR was successful (defined as survival for at least 1 day after CA) in 22 of 34 children (65%), with 17 of the 22 survivors (77%) experiencing long-term survival, currently from 2-14 yrs. Significant predisposing factors of CA were sepsis, identified in 53% of the nonsurvivors vs. 12% of the survivors (p<.05), and delayed fluid resuscitation (>2 hrs after burn injury), identified in 82% of the nonsurvivors vs. 6% of the survivors (p<.001). There was only one morbid long-term survivor. This survivor was diagnosed as having anoxic brain injury with persistent neurologic deficiencies.
Conclusion:
In this study, 50% of the burned children experiencing CA are long-term survivors. We suggest that all burned children with CA should be afforded cardiopulmonary resuscitation.