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Published on: January 30, 2020
One-year survival and neurological outcome after pediatric cardiopulmonary resuscitation
T Horisberger1, E Fischer, S Fanconi
1Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
Insights
Predictors of survival after pediatric cardiopulmonary resuscitation (CPR) include arrest location, cause, and duration. Most survivors maintained their neurological status, indicating good long-term outcomes after pediatric CPR.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Neurology
Background:
- Survival rates after pediatric cardiopulmonary resuscitation (CPR) show significant variability.
- Assessing long-term neurological outcomes post-resuscitation is crucial for pediatric patients.
Purpose of the Study:
- To identify predictors of 1-year survival following in- and outpatient pediatric CPR.
- To evaluate the long-term neurological status of children who survive CPR.
Main Methods:
- Retrospective review of medical records and prospective follow-up of CPR survivors.
- Multivariable logistic regression analysis was used to identify survival predictors.
- Neurological outcome was assessed using the Pediatric Cerebral Performance Category (PCPC) scale.
Main Results:
- Of 89 patients receiving CPR, 71 were successfully resuscitated, with 48 (54%) alive at 1 year.
- Survival predictors included resuscitation location, CPR during peri- or postoperative care, and duration of resuscitation.
- 77% of 1-year survivors had no change in their neurological status (PCPC score) compared to pre-CPR baseline.
Conclusions:
- Location of arrest, underlying cause, and duration of CPR are independent determinants of long-term survival in pediatric resuscitation.
- Pediatric CPR survivors generally experience little to no decline in neurological function.
Objective:
Reported survival after cardiopulmonary resuscitation (CPR) in children varies considerably. We aimed to identify predictors of 1-year survival and to assess long-term neurological status after in- or outpatient CPR.
Design:
Retrospective review of the medical records and prospective follow-up of CPR survivors.
Setting:
Tertiary care pediatric university hospital.
Patients And Methods:
During a 30-month period, 89 in- and outpatients received advanced CPR. Survivors of CPR were prospectively followed-up for 1 year. Neurological outcome was assessed by the Pediatric Cerebral Performance Category scale (PCPC). Variables predicting 1-year survival were identified by multivariable logistic regression analysis.
Interventions:
None.
Results:
Seventy-one of the 89 patients were successfully resuscitated. During subsequent hospitalization do-not-resuscitate orders were issued in 25 patients. At 1 year, 48 (54%) were alive, including two of the 25 patients with out-of-hospital CPR. All patients died, who required CPR after trauma or near drowning, when CPR began >10 min after arrest or with CPR duration >60 min. Prolonged CPR (21-60 min) was compatible with survival (five of 19). At 1 year, 77% of the survivors had the same PCPC score as prior to CPR. Predictors of survival were location of resuscitation, CPR during peri- or postoperative care, and duration of resuscitation. A clinical score (0-15 points) based on these three items yielded an area under the ROC of 0.93.
Conclusions:
Independent determinants of long-term survival of pediatric resuscitation are location of arrest, underlying cause, and duration of CPR. Long-term survivors have little or no change in neurological status.
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