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Post return of spontaneous circulation factors associated with mortality in pediatric in-hospital cardiac arrest: a
Insights
Secondary in-hospital mortality after pediatric cardiac arrest (CA) is high. Key factors influencing survival include ventilation status, oxygen levels, inotropic support, and lactic acid levels post-return of spontaneous circulation (ROSC).
Area of Science:
- Pediatric Critical Care Medicine
- Cardiology
- Resuscitation Science
Background:
- While pre-arrest and resuscitation factors for pediatric cardiac arrest (CA) are studied, post-arrest survival remains a critical concern.
- Many children achieving return of spontaneous circulation (ROSC) succumb to secondary complications during hospitalization.
Purpose of the Study:
- To identify factors influencing in-hospital mortality in children after achieving ROSC.
- To analyze the impact of post-ROSC physiological parameters on survival outcomes.
Main Methods:
- A prospective, multinational, observational study involving 502 children (1 month–18 years) across 48 hospitals.
- Analysis of post-ROSC factors using univariate and multivariate logistic regression to determine their association with mortality.
- Primary endpoint was survival to hospital discharge.
Main Results:
- Return of spontaneous circulation (ROSC) was achieved in 69.5% of patients; 39.2% survived to discharge with good neurological outcomes in 88.9% of survivors.
- Univariate analysis identified pH, base deficit, lactic acid, bicarbonate, FiO2, inotropic support, and length of stay as mortality predictors.
- Multivariate analysis revealed that at 1 hour post-ROSC, mortality was associated with PaCO2 levels, inotropic index, and lactic acid; at 24 hours, factors included PaCO2, inotropic index, and FiO2.
Conclusions:
- Secondary in-hospital mortality following pediatric CA is substantial.
- Hypoventilation, hyperventilation, high fraction of inspired oxygen (FiO2 ≥ 0.80), significant inotropic support, and elevated lactic acid levels are critical post-ROSC factors associated with mortality.
Introduction:
Most studies have analyzed pre-arrest and resuscitation factors associated with mortality after cardiac arrest (CA) in children, but many patients that reach return of spontaneous circulation die within the next days or weeks. The objective of our study was to analyze post-return of spontaneous circulation factors associated with in-hospital mortality after cardiac arrest in children.
Methods:
A prospective multicenter, multinational, observational study in 48 hospitals from 12 countries was performed. A total of 502 children aged between 1 month and 18 years with in-hospital cardiac arrest were analyzed. The primary endpoint was survival to hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each post-return of spontaneous circulation factor on mortality.
Results:
Return of spontaneous circulation was achieved in 69.5% of patients; 39.2% survived to hospital discharge and 88.9% of survivors had good neurological outcome. In the univariate analysis, post- return of spontaneous circulation factors related with mortality were pH, base deficit, lactic acid, bicarbonate, FiO2, need for inotropic support, inotropic index, dose of dopamine and dobutamine at 1 hour and at 24 hours after return of spontaneous circulation as well as Pediatric Intensive Care Unit and total hospital length of stay. In the multivariate analysis factors associated with mortality at 1 hour after return of spontaneous circulation were PaCO2 < 30 mmHg and >50 mmHg, inotropic index >14 and lactic acid >5 mmol/L. Factors associated with mortality at 24 hours after return of spontaneous circulation were PaCO2 > 50 mmHg, inotropic index >14 and FiO2 ≥ 0.80.
Conclusions:
Secondary in-hospital mortality among the initial survivors of CA is high. Hypoventilation, hyperventilation, FiO2 ≥ 0.80, the need for high doses of inotropic support, and high levels of lactic acid were the most important post-return of spontaneous circulation factors associated with in-hospital mortality in children in our population.
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