Related Experiment Video
Updated: Feb 26, 2026
Technical Refinement of a Bilateral Renal Ischemia-Reperfusion Mouse Model for Acute Kidney Injury Research
Published on: November 3, 2023
Epidemiology and Outcomes of Cardiac Arrest in Pediatric Cardiac ICUs
Jeffrey A Alten1, Darren Klugman, Tia T Raymond
11Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL. 2Departments of Pediatric Critical Care Medicine and Pediatric Cardiology, Children's National Health System, Washington, D.C. 3Department of Pediatric Cardiology, Medical City Children's Hospital, Dallas, TX. 4Department of Pediatric Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5Department of Pediatrics and Communicable Diseases, Division of Cardiology, C. S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, MI.
Insights
Cardiac arrest in pediatric cardiac intensive care units (ICUs) affects 3.1% of patients, with higher rates in medical versus surgical cases. Identifying high-risk patients and timing is crucial for prevention efforts.
Area of Science:
- Pediatric critical care medicine
- Cardiology
- Intensive care
Background:
- In-hospital cardiac arrest (IHCA) in children with cardiac disease carries high morbidity and mortality.
- Epidemiology of cardiac arrest within pediatric cardiac ICUs remains incompletely understood.
Purpose of the Study:
- To describe the contemporary epidemiology and outcomes of cardiac arrest in a multicenter pediatric cardiac ICU cohort.
- Identify high-risk patient populations and temporal patterns associated with cardiac arrest.
Main Methods:
- Retrospective analysis of the Pediatric Cardiac Critical Care Consortium clinical registry.
- Inclusion of 15,908 cardiac ICU encounters from 23 North American hospitals (August 2014 - July 2016).
- Multivariable analysis to identify risk factors for cardiac arrest in medical and surgical encounters.
Main Results:
- Cardiac arrest occurred in 3.1% of encounters (4.8 per 1,000 ICU days), with higher rates in medical vs. surgical patients.
- Key risk factors included prematurity, neonatal age, STS/EACTS risk scores (surgical), and acute heart failure, acidosis, ventilation (medical).
- Survival after cardiac arrest was 53.2% overall, with significant variations by patient type (medical vs. surgical, Norwood procedure) and center.
Conclusions:
- Contemporary data on pediatric cardiac ICU cardiac arrest epidemiology and outcomes are presented.
- Findings highlight specific high-risk patient cohorts and timeframes for targeted research and quality improvement.
- Emphasis on prevention strategies for cardiac arrest in this vulnerable population is warranted.
Objectives:
In-hospital cardiac arrest occurs in 2.6-6% of children with cardiac disease and is associated with significant morbidity and mortality. Much remains unknown about cardiac arrest in pediatric cardiac ICUs; therefore, we aimed to describe cardiac arrest epidemiology in a contemporary multicenter cardiac ICU cohort.
Design:
Retrospective analysis within the Pediatric Cardiac Critical Care Consortium clinical registry.
Setting:
Cardiac ICUs within 23 North American hospitals.
Patients:
All cardiac medical and surgical patients admitted from August 2014 to July 2016.
Interventions:
None.
Measurements And Main Results:
There were 15,908 cardiac ICU encounters (6,498 medical, 9,410 surgical). 3.1% had cardiac arrest; rate was 4.8 cardiac arrest per 1,000 cardiac ICU days. Medical encounters had 50% higher rate of cardiac arrest compared with surgical encounters. Observed (unadjusted) cardiac ICU cardiac arrest prevalence varied from 1% to 5.5% among the 23 centers; cardiac arrest per 1,000 cardiac ICU days varied from 1.1 to 10.4. Over half cardiac arrest occur within 48 hours of admission. On multivariable analysis, prematurity, neonatal age, any Society of Thoracic Surgeons preoperative risk factor, and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 4, 5 had strongest association with surgical encounter cardiac arrest. In medical encounters, independent cardiac arrest risk factors were acute heart failure, prematurity, lactic acidosis greater than 3 mmol/dL, and invasive ventilation 1 hour after admission. Median cardiopulmonary resuscitation duration was 10 minutes, return of spontaneous circulation occurred in 64.5%, extracorporeal cardiopulmonary resuscitation in 27.2%. Unadjusted survival was 53.2% in encounters with cardiac arrest versus 98.2% without. Medical encounters had lower survival after cardiac arrest (37.7%) versus surgical encounters (62.5%); Norwood patients had less than half the survival after cardiac arrest (35.6%) compared with all others. Unadjusted survival after cardiac arrest varied greatly among 23 centers.
Conclusions:
We provide contemporary epidemiologic and outcome data for cardiac arrest occurring in the cardiac ICU from a multicenter clinical registry. As detailed above, we highlight high-risk patient cohorts and periods of time that may serve as targets for research and quality improvement initiatives aimed at cardiac arrest prevention.
Related Concept Videos
01:21Cardiopulmonary Resuscitation I: Adult
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:23Cardiopulmonary Resuscitation III: AED Use
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:30Introduction Cardiac Emergencies
01:28Cardiac Catheterization I: Pre-Procedure Overview