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Factors influencing outcome of inpatient pediatric resuscitation
Ahmet Akçay1, Serpil Ugur Baysal, Taner Yavuz
1Department of Pediatrics, Pamukkale University Faculty of Medicine, Denizli, Turkey.
Insights
Pediatric cardiopulmonary resuscitation (CPR) survival rates are low, with only 16.4% achieving long-term survival. Shorter CPR duration and reactive pupils predict better outcomes in children experiencing cardiopulmonary arrest (CPA).
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Cardiology
Background:
- Pediatric cardiopulmonary arrest (CPA) is a critical event with significant mortality.
- Understanding survival rates and predictors is crucial for improving outcomes in pediatric resuscitation.
Purpose of the Study:
- To determine the rate of long-term survivors (LTS) after pediatric cardiopulmonary resuscitation (CPR).
- To identify predictors of survival in pediatric resuscitation.
- To evaluate outcomes six months post-discharge for pediatric survivors.
Main Methods:
- Retrospective analysis of 67 pediatric patients undergoing CPR.
- Categorization into three groups: Long-term Survivors (LTS), Short-term Survivors (STS), and Nonsurvivors (NS).
- Analysis of factors including CPR duration and pupillary response at the onset of CPA.
Main Results:
- Only 16.4% (11/67) of patients were LTS, with 6 surviving six months post-discharge.
- A significant majority (68.7%) were Nonsurvivors (NS), and 14.9% were Short-term Survivors (STS).
- Less than 5 minutes of CPR duration and reactive pupils at CPA onset were key predictors of LTS.
Conclusions:
- Long-term survival after pediatric CPR is challenging, highlighting the need for early intervention.
- Pupillary light reflex and CPR duration are critical, readily assessable predictors of survival in pediatric CPA.
- These predictors can guide clinical decision-making and prognostication in pediatric resuscitation.
Abstract:
The aims of this study were: 1) To define the rate of long-term survivors (LTS) after cardiopulmonary resuscitation (CPR) in children; 2) To identify the predictors of survival in pediatric resuscitation; and 3) To assess the outcome six months after discharge. Three groups of patients were identified based on outcome: 1. Long-term survivors (LTS), who were discharged, 2. Short-term survivors (STS), who survived longer than 24 hours after CPR but not until discharge, and 3. Nonsurvivors (NS), who died within 24 hours after their arrest. Of the 67 patients, 10 (14.9%) children were STS, while 46 (68.7%) were NS. Only eleven (16.4%) were LTS who were eventually discharged from the hospital and six were alive six months after discharge. Four patients had neurological sequelae. Less than 5 minutes' duration of CPR and reactive pupils at the onset of cardiopulmonary arrest (CPA) were the most important factors that predicted long term survival. We suggest that a positive pupillary light reflex at the onset of CPA and the duration of CPR should be considered as important predictors of survival in children with CPA.
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