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Cardiopulmonary Resuscitation in Children With In-Hospital and Out-of-Hospital Cardiopulmonary Arrest: Multicenter
Tanl Kendirli1, Nilgün Erkek, Tolga Köroğlu
1From the Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey.
Insights
Pediatric cardiopulmonary arrest (CPA) in Turkey is most often caused by respiratory failure. Outcomes for pediatric CPR are poor, with significantly lower survival rates for out-of-hospital events compared to in-hospital events.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Resuscitation Science
Background:
- Pediatric cardiopulmonary arrest (CPA) and cardiopulmonary resuscitation (CPR) outcomes vary significantly based on location and cause.
- Understanding the epidemiology of pediatric CPA is crucial for improving resuscitation efforts and patient outcomes.
Purpose of the Study:
- To determine the causes, locations, and demographics of pediatric CPA in Turkey.
- To evaluate survival rates and morbidities associated with in-hospital and out-of-hospital pediatric CPA.
- To analyze the effectiveness of CPR in Turkish pediatric emergency departments and pediatric intensive care units (PICUs).
Main Methods:
- A multicenter, prospective, descriptive study conducted over six months in 2011.
- Data collected from 18 centers across Turkey, including 15 PICUs and 3 pediatric emergency departments.
- Inclusion of 239 pediatric patients who received CPR during the study period.
Main Results:
- Respiratory failure was the leading cause of CPA (49.8%).
- The majority of CPA events occurred in the PICU (68.6%), followed by hospital wards (18%) and out-of-hospital settings (10%).
- Overall survival rate was 24.2%, with significantly higher survival for in-hospital (26%) versus out-of-hospital (8%) CPA (P = 0.001). Neurologic disability was observed in 32.1% of survivors.
Conclusions:
- Pediatric CPA, whether in-hospital or out-of-hospital, is associated with a poor prognosis.
- Improving survival rates for pediatric CPA requires targeted interventions, particularly for out-of-hospital events and respiratory failure as a primary cause.
Objectives:
The objectives of this study were to determine the causes, location of cardiopulmonary arrest (CPA) in children, and demographics of cardiopulmonary resuscitation (CPR) in Turkish pediatric emergency departments and pediatric intensive care units (PICUs) and to determine survival rates and morbidities for both in-hospital and out-of-hospital CPA.
Methods:
This multicenter descriptive study was conducted prospectively between January 15 and July 15, 2011, at 18 centers (15 PICUs, 3 pediatric emergency departments) in Turkey.
Results:
During the study period, 239 children had received CPR. Patients' average age was 42.4 (SD, 58.1) months. The most common cause of CPA was respiratory failure (119 patients [49.8%]). The location of CPA was the PICU in 168 (68.6%), hospital wards in 43 (18%), out-of-hospital in 24 (10%), and pediatric emergency department in 8 patients (3.3%). The CPR duration was 30.7 (SD, 23.6) minutes (range, 1-175 minutes) and return of spontaneous circulation was achieved in 107 patients (44.8%) after the first CPR. Finally, 58 patients (24.2%) were discharged from hospital; survival rates were 26% and 8% for in-hospital and out-of-hospital CPA, respectively (P = 0.001). Surviving patients' average length of hospital stay was 27.4 (SD, 39.2) days. In surviving patients, 19 (32.1%) had neurologic disability.
Conclusion:
Pediatric CPA in both the in-hospital and out-of-hospital setting has a poor outcome.