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Updated: Jun 23, 2026
Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Multicenter cohort study of in-hospital pediatric cardiac arrest
Kathleen L Meert1, Amy Donaldson, Vinay Nadkarni
1Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA. kmeert@med.wayne.edu
Insights
In a study of pediatric in-hospital cardiac arrest, nearly half of children survived to discharge, but many factors influenced survival. These findings are crucial for designing future therapeutic hypothermia trials in children.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Critical Care
Background:
- In-hospital cardiac arrest (IHCA) in children is a critical event with significant mortality.
- Understanding factors influencing outcomes is essential for improving care and designing interventions like therapeutic hypothermia.
Purpose of the Study:
- To describe the clinical characteristics, hospital courses, and outcomes of children experiencing IHCA with sustained return of circulation.
- To identify factors associated with hospital mortality in this pediatric population.
Main Methods:
- Retrospective cohort study involving 353 pediatric patients (1 day to 18 years) from 15 children's hospitals.
- Data collected on clinical characteristics, interventions, and outcomes, including survival and neurological status (Pediatric Cerebral Performance Category scores).
Main Results:
- Overall survival to hospital discharge was 48.7% (172/353).
- Good neurological outcome was achieved in 76.7% of survivors.
- Factors associated with increased mortality included pre-existing hematologic, oncologic, immunologic, genetic, or metabolic disorders, endotracheal intubation before arrest, and sodium bicarbonate or calcium use during arrest.
- Postoperative CPR, higher minimum blood pH, and pupillary responsiveness were associated with decreased mortality.
Conclusions:
- Numerous factors influence hospital mortality in children following IHCA with return of circulation.
- These identified factors are critical considerations for the design of randomized trials investigating therapeutic hypothermia for neurobehavioral outcomes in pediatric post-cardiac arrest care.
Objectives:
1) To describe clinical characteristics, hospital courses, and outcomes of a cohort of children cared for within the Pediatric Emergency Care Applied Research Network who experienced in-hospital cardiac arrest with sustained return of circulation between July 1, 2003 and December 31, 2004, and 2) to identify factors associated with hospital mortality in this population. These data are required to prepare a randomized trial of therapeutic hypothermia on neurobehavioral outcomes in children after in-hospital cardiac arrest.
Design:
Retrospective cohort study.
Setting:
Fifteen children's hospitals associated with Pediatric Emergency Care Applied Research Network.
Patients:
Patients between 1 day and 18 years of age who had cardiopulmonary resuscitation and received chest compressions for >1 min, and had a return of circulation for >20 mins.
Interventions:
None.
Measurements And Main Results:
A total of 353 patients met entry criteria; 172 (48.7%) survived to hospital discharge. Among survivors, 132 (76.7%) had good neurologic outcome documented by Pediatric Cerebral Performance Category scores. After adjustment for age, gender, and first documented cardiac arrest rhythm, variables available before and during the arrest that were independently associated with increased mortality included pre-existing hematologic, oncologic, or immunologic disorders, genetic or metabolic disorders, presence of an endotracheal tube before the arrest, and use of sodium bicarbonate during the arrest. Variables associated with decreased mortality included postoperative cardiopulmonary resuscitation. Extending the time frame to include variables available before, during, and within 12 hours following arrest, variables independently associated with increased mortality included the use of calcium during the arrest. Variables associated with decreased mortality included higher minimum blood pH and pupillary responsiveness.
Conclusions:
Many factors are associated with hospital mortality among children after in-hospital cardiac arrest and return of circulation. Such factors must be considered when designing a trial of therapeutic hypothermia after cardiac arrest in pediatric patients.
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