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Outcomes After In-Hospital Pediatric Recurrent Cardiac Arrests
Stephanie R Brown1,2, Thomas V Brogan1,2, D Michael McMullan1,3
1University of Washington, Seattle, WA.
Insights
Survival after pediatric recurrent cardiac arrest is better than expected. Factors like initial rhythm and duration of cardiopulmonary resuscitation impact outcomes in children.
Area of Science:
- Pediatric critical care medicine
- Cardiology
- Resuscitation science
Background:
- Recurrent cardiac arrest in pediatric inpatients is a critical event.
- Understanding outcomes is vital for improving patient care.
Purpose of the Study:
- To determine the outcomes of recurrent cardiac arrest events in pediatric inpatients.
- To identify factors associated with survival and neurologic function.
Main Methods:
- Retrospective cohort study at a single tertiary care children's hospital.
- Inclusion of patients under 18 with recurrent cardiac arrest from 2010-2018.
Main Results:
- Overall survival to discharge was 50%, with all survivors achieving good neurologic outcomes.
- Survival rates varied with interventions: extracorporeal life support (43%) and extracorporeal cardiopulmonary resuscitation (33%).
- Favorable factors included initial rhythm of ventricular tachycardia/fibrillation, shorter CPR duration, and absence of multiple organ dysfunction. Severe metabolic acidosis was linked to poor outcomes.
Conclusions:
- Survival after pediatric in-hospital recurrent cardiac arrest is higher than previously reported.
- Initial rhythm, CPR duration, multiple organ dysfunction, and lactic acidosis are key prognostic indicators.
Objectives:
The objective of this study is to determine outcomes of recurrent cardiac arrest events in the general pediatric inpatient population.
Design:
Retrospective cohort study of inpatients in a single institution.
Setting:
A tertiary care free-standing children's hospital.
Patients:
All patients less than 18 years old at Seattle Children's Hospital with recurrent cardiac arrest events occurring from January 1, 2010, to March 1, 2018, were included.
Interventions:
None.
Measurements And Main Results:
Overall survival to hospital discharge was 50% and all survivors had a good neurologic outcome, defined as Pediatric Cerebral Performance Category of 3 or less, or unchanged from baseline. Survival among patients who received extracorporeal life support was 43% and among those who received extracorporeal cardiopulmonary resuscitation, 33%. Initial arrest factors associated with survival included initial rhythm of ventricular tachycardia or ventricular fibrillation, shorter duration of cardiopulmonary resuscitation, and absence of multiple organ dysfunction. Additionally, nonsurvivors had more severe metabolic acidosis in the prearrest and postarrest period.
Conclusions:
Survival after pediatric in-hospital recurrent cardiac arrest is higher than previously reported. There is also evidence that initial rhythm other than ventricular tachycardia/ventricular fibrillation and longer duration of cardiopulmonary resuscitation as well as multiple organ dysfunction and more severe lactic acidosis in the peri-arrest period are associated with poor outcomes.
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