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Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing
Robert A Berg1, Robert M Sutton, Richard Holubkov
11Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, University of Utah, Salt Lake City, UT. 3Division of Critical Care Medicine, Department of Pediatrics, National Institute of Child Health and Human Development, Bethesda, MD. 4Division of Critical Care Medicine, Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA. 5Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 6Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital Los Angeles, Los Angeles, CA. 7Division of Critical Care Medicine, Department of Pediatrics, University of Michigan and Mott Children's Hospital, Ann Arbor, MI. 8Division of Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ. 9Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO. 10Division of Critical Care Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC. 11Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
Insights
Pediatric cardiopulmonary resuscitation (CPR) events in hospitals are increasingly occurring in intensive care units (ICUs) rather than general wards. This shift over a decade is linked to improved survival rates, specifically increased return of spontaneous circulation.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary resuscitation research
- Hospital quality improvement
Background:
- In-hospital pediatric cardiopulmonary resuscitation (CPR) events require careful analysis of location and outcomes.
- Previous data on the shift of CPR events from general wards to intensive care units (ICUs) is limited.
- Understanding trends in CPR location is crucial for optimizing pediatric resuscitation protocols.
Purpose of the Study:
- To evaluate the changing frequency of pediatric in-hospital cardiopulmonary resuscitation (CPR) events in ICUs versus general wards.
- To test the hypothesis that CPR events have increasingly occurred in ICUs over the past decade.
- To determine if this shift in CPR location is associated with improved resuscitation outcomes.
Main Methods:
- A prospective, observational study utilizing data from 315 hospitals in the American Heart Association's Get With The Guidelines-Resuscitation database.
- Analysis of 5,870 pediatric cardiopulmonary resuscitation (CPR) events between January 1, 2000, and September 14, 2010.
- Statistical evaluation using chi-square test for trend and multivariable modeling to assess changes in CPR location and outcomes over time.
Main Results:
- The vast majority of pediatric cardiopulmonary resuscitation (CPR) events (93.3%) occurred in ICUs, with only 6.7% on general wards.
- A statistically significant increase in the proportion of CPR events occurring in ICUs was observed over the study period (p<0.01).
- Return of spontaneous circulation following CPR events increased in the later period (2004-2010) compared to the earlier period (2000-2003).
Conclusions:
- In-hospital pediatric cardiopulmonary resuscitation (CPR) is predominantly provided in ICUs, a trend that has significantly increased over the last decade.
- The observed shift of CPR events to ICUs is associated with a concomitant improvement in return of spontaneous circulation.
- These findings highlight the evolving landscape of pediatric resuscitation and the critical role of ICUs.
Objectives:
The aim of this study was to evaluate the relative frequency of pediatric in-hospital cardiopulmonary resuscitation events occurring in ICUs compared to general wards. We hypothesized that the proportion of pediatric cardiopulmonary resuscitation provided in ICUs versus general wards has increased over the past decade, and this shift is associated with improved resuscitation outcomes.
Design:
Prospective and observational study.
Setting:
Total of 315 hospitals in the American Heart Association's Get With The Guidelines-Resuscitation database.
Patients:
Total of 5,870 pediatric cardiopulmonary resuscitation events between January 1, 2000 and September 14, 2010. Cardiopulmonary resuscitation events were defined as external chest compressions longer than 1 minute.
Interventions:
None.
Measurements And Main Results:
The primary outcome was proportion of total ICU versus general ward cardiopulmonary resuscitation events over time evaluated by chi-square test for trend. Secondary outcome included return of spontaneous circulation following the cardiopulmonary resuscitation event. Among 5,870 pediatric cardiopulmonary resuscitation events, 5,477 (93.3%) occurred in ICUs compared to 393 (6.7%) in inpatient wards. Over time, significantly more of these cardiopulmonary resuscitation events occurred in the ICU compared to the wards (test for trend: p<0.01), with a prominent shift noted between 2003 and 2004 (2000-2003: 87-91% vs 2004-2010: 94-96%). In a multivariable model controlling for within center variability and other potential confounders, return of spontaneous circulation increased in 2004-2010 compared with 2000-2003 (relative risk, 1.08; 95% CI, 1.03-1.13).
Conclusions:
In-hospital pediatric cardiopulmonary resuscitation is much more commonly provided in ICUs than in wards, and the proportion has increased significantly over the past decade, with concomitant increases in return of spontaneous circulation.
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