Incidence and Outcomes of Cardiopulmonary Resuscitation in PICUs
Robert A Berg1, Vinay M Nadkarni, Amy E Clark
11Department of Anesthesiology and Critical Care, the Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 3Department of Pediatrics, University of Michigan, Ann Arbor, MI. 4Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 5Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA. 6Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 7Department of Pediatrics, Children's National Medical Center, Washington DC. 8Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 9Department of Child Health, Phoenix Children's Hospital and University of Arizona College of Medicine-Phoenix, Phoenix, AZ. 10Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 11Branch of Trauma and Critical Illness of the Eunice Kennedy Shriver National Institutes of Child Health and Human Development, the National Institutes of Health, Bethesda, MD. 12Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington DC.
Insights
Pediatric cardiopulmonary resuscitation (CPR) in intensive care units has a 45% survival rate to hospital discharge, with 89% of survivors experiencing favorable neurologic outcomes. Shorter CPR durations significantly improve survival chances for critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiology
- Neurology
Background:
- Cardiopulmonary resuscitation (CPR) is a critical intervention in pediatric intensive care units (PICUs).
- Outcomes following CPR in critically ill children are variable and require further investigation.
- Understanding CPR incidence and associated outcomes is essential for improving pediatric critical care.
Purpose of the Study:
- To determine the incidence of CPR in PICUs.
- To evaluate the subsequent outcomes of CPR in pediatric patients.
- To analyze factors influencing CPR success, including patient population and CPR duration.
Main Methods:
- Multicenter prospective observational study.
- Involved children younger than 18 years old admitted to PICUs.
- Data collected from December 2011 to April 2013 within the Collaborative Pediatric Critical Care Research Network.
Main Results:
- 1.4% of 10,078 children received CPR (≥1 minute) or defibrillation.
- 78% achieved return of circulation; 45% survived to hospital discharge with 89% having favorable neurologic outcomes.
- Shorter CPR duration (1-3 minutes) was associated with higher survival rates (66%) compared to longer durations (>30 minutes, 28%).
Conclusions:
- Contemporary PICU CPR demonstrates high survival-to-discharge (45%) and favorable neurologic outcomes (89%) among survivors.
- Survival with favorable neurologic outcomes was similar for cardiac and non-cardiac patients.
- The study design minimized data limitations and selection biases, providing reliable insights into PICU CPR outcomes.
Objectives:
To determine the incidence of cardiopulmonary resuscitation in PICUs and subsequent outcomes.
Design, Setting, And Patients:
Multicenter prospective observational study of children younger than 18 years old randomly selected and intensively followed from PICU admission to hospital discharge in the Collaborative Pediatric Critical Care Research Network December 2011 to April 2013.
Results:
Among 10,078 children enrolled, 139 (1.4%) received cardiopulmonary resuscitation for more than or equal to 1 minute and/or defibrillation. Of these children, 78% attained return of circulation, 45% survived to hospital discharge, and 89% of survivors had favorable neurologic outcomes. The relative incidence of cardiopulmonary resuscitation events was higher for cardiac patients compared with non-cardiac patients (3.4% vs 0.8%, p <0.001), but survival rate to hospital discharge with favorable neurologic outcome was not statistically different (41% vs 39%, respectively). Shorter duration of cardiopulmonary resuscitation was associated with higher survival rates: 66% (29/44) survived to hospital discharge after 1-3 minutes of cardiopulmonary resuscitation versus 28% (9/32) after more than 30 minutes (p < 0.001). Among survivors, 90% (26/29) had a favorable neurologic outcome after 1-3 minutes versus 89% (8/9) after more than 30 minutes of cardiopulmonary resuscitation.
Conclusions:
These data establish that contemporary PICU cardiopulmonary resuscitation, including long durations of cardiopulmonary resuscitation, results in high rates of survival-to-hospital discharge (45%) and favorable neurologic outcomes among survivors (89%). Rates of survival with favorable neurologic outcomes were similar among cardiac and noncardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data.
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